Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

The moderating effect of organizational size on the relationship between internal & external factors of organizations and medical waste management practices in southern Libyan hospitals

The global debate on medical waste management practices is ongoing and well documented in the literature. While some scholars opine that medical waste management is generally lagging behind other industries in terms of practices, others contend that this claim does not reflect the actual condition of the industry which is reasonably done to a certain extent. With respect to identifying the current medical waste management practices in Libya which is experiencing similar problems, this research aims at examining the internal and external factors that have been found to significantly influence medical waste management practices. The objective of this research is to identify the organizational internal and external factors that influence their waste management practices. A proportionate stratified simple random sampling was used to select two hundred and ten respondents from the targeted hospitals in five states in Libya. A total of one-hundred and seventy-one duly completed and valid questionnaires were returned, yielding approximately eighty-one percent response rate. Statistical Package for the Social Sciences (SPSS) analysis were utilised to achieve the research objectives. This research has found that organizational structure, culture, external factors have strong and positive relationships with medical waste management practices. The correlation analysis carried out between the medical waste management practices and, centralization, formalization, individualism vs collectivism and power distance do not establish any significant relationships with segregation respectively. The findings of this research indicate that the moderating effect of organizational size only establishes the relationship between government policy and medical waste management practices. This research therefore, recommends for future studies to look for additional independent variables so that the moderating effects appears to be more significant

Wpływ samooceny przedsiębiorczości na przetrwanie : czy literacyjność finansowa i pasja przedsiębiorczości mają zastosowanie?

The primary purpose of the current study is to investigate the entrepreneurial self-efficacy as an antecedent to persistency among entrepreneurs. In addition to that, the study examines the mediating role of entrepreneurial passion between entrepreneurial self-efficacy and entrepreneurial persistence. Lastly, the study explored the relationship between financial literacy and persistence and its moderating role between entrepreneurial passion and persistence. Structural equation modeling through of partial least square bootstrapping resampling was used for hypotheses testing to analyze the data collected from a sample of 273 Malaysian entrepreneurs. The results of the study supported all arguments broached in the current research for the subjective norm, entrepreneurial self-efficacy, which showed a significant impact on entrepreneurial passion and entrepreneurial persistence. The moderating effect of financial literacy on entrepreneurial passion and entrepreneurial persistency was also highly significant. The current work is among the pioneering studies that examine entrepreneurial self-efficacy, entrepreneurial passion, financial literacy and entrepreneurial persistence among entrepreneurs.Głównym celem niniejszego badania jest zbadanie własnej skuteczności przedsiębiorczej jako czynnika poprzedzającego wytrwałość wśród przedsiębiorców. Ponadto badanie bada mediacyjną rolę pasji przedsiębiorczej między samowystarczalnością przedsiębiorczą a wytrwałością przedsiębiorczą. Wreszcie w badaniu zbadano związek między znajomością finansów a wytrwałością oraz jej moderującą rolą między pasją przedsiębiorczości a wytrwałością. Do testowania hipotez wykorzystano modelowanie równań strukturalnych za pomocą częściowego ponownego próbkowania ładowania metodą najmniejszych kwadratów, aby przeanalizować dane zebrane z próby 273 malezyjskich przedsiębiorców. Wyniki badania potwierdziły wszystkie argumenty poruszone w bieżących badaniach na rzecz subiektywnej normy, własnej skuteczności przedsiębiorczej, która wykazała znaczący wpływ na pasję przedsiębiorczą i trwałość przedsiębiorczą. Bardzo istotny był również moderujący wpływ wiedzy finansowej na pasję przedsiębiorczości i trwałość przedsiębiorcy. Obecna praca należy do pionierskich badań, w których analizuje się skuteczność przedsiębiorczą, pasję przedsiębiorczą, znajomość finansów i wytrwałość przedsiębiorczą wśród przedsiębiorców

Pediatric systemic lupus erythematosus in a single nephrology unit

Clinical manifestations of systemic lupus erythematosus (SLE) are widely variable, and its course is unpredictable. SLE that begins in childhood has been considered more severe than SLE with onset during adulthood. Our aim was to determine the presentation and the outcome of SLE of 26 children (20 females and 6 males, with a female to male ratio of 3.8:1) with SLE in our center, their ages ranging from 5 - 18 years and followed from 2005 till October 2011. They were diagnosed according to the American Rheumatism Association′s revised criteria. Complete blood count, erythrocyte sedimentation rate, C3, urine analysis, 24-h urinary protein, antinuclear antibodies, anti-ds DNA and renal biopsy were obtained for the patients. We found that the most extra-renal manifestation of SLE was fever (57.7%), while lupus nephritis (LN) was the most commonly affected organ (50%). Hemolytic anemia was the most common hematological abnormality (80.8%), while immunological characteristics were positive in all the patients. Remission in patients without LN was more than 5.3-times the remission in LN patients. The outcome of the patients without LN was better than the patients with LN

Fresh Insight through a Keynesian Theory Approach to Investigate the Economic Impact of the COVID-19 Pandemic in Pakistan

Beyond the immediate impositions of dealing with COVID-19, this disease represents a severe and significant challenge confronting Pakistan’s economy. The study’s objective was to evaluate the coronavirus epidemic’s effect on Pakistan’s economy and measures devised to mitigate the damage done by this disease. The study research design used the elementary concept of Keynesian theory comprising of the mapping of systematic behavior of the COVID-19 pandemic. Issues were formally underpinned, described, and visualized through the Keynesian theory concept. The eruption of COVID-19 has jolted the national and international economy. Pakistan is included, causing millions of people to stay at home, lose their jobs, and suspend or end business operations. Unemployment in Pakistan has reached nearly 25 million people, driving many towards conditions of hunger and poverty as the major economic damage in several sectors is anticipated at around PKR 1.3 trillion. The hardest-affected sectors comprise industries such as tourism and travel, financial markets, entertainment, manufacturing, etc., having a devastating effect on gross domestic product (GDP). It is mainly daily-wage earners and people running small businesses that have been seriously exploited and subjected to a curfew-like situation. However, the Keynesian theory suggests that supportive macroeconomic policies must restore trust, demand recovery, and provide interest-free loans to overcome Pakistan’s currently upcoming crisis

Fresh Insight through a Keynesian Theory Approach to Investigate the Economic Impact of the COVID-19 Pandemic in Pakistan

Beyond the immediate impositions of dealing with COVID-19, this disease represents a severe and significant challenge confronting Pakistan’s economy. The study’s objective was to evaluate the coronavirus epidemic’s effect on Pakistan’s economy and measures devised to mitigate the damage done by this disease. The study research design used the elementary concept of Keynesian theory comprising of the mapping of systematic behavior of the COVID-19 pandemic. Issues were formally underpinned, described, and visualized through the Keynesian theory concept. The eruption of COVID-19 has jolted the national and international economy. Pakistan is included, causing millions of people to stay at home, lose their jobs, and suspend or end business operations. Unemployment in Pakistan has reached nearly 25 million people, driving many towards conditions of hunger and poverty as the major economic damage in several sectors is anticipated at around PKR 1.3 trillion. The hardest-affected sectors comprise industries such as tourism and travel, financial markets, entertainment, manufacturing, etc., having a devastating effect on gross domestic product (GDP). It is mainly daily-wage earners and people running small businesses that have been seriously exploited and subjected to a curfew-like situation. However, the Keynesian theory suggests that supportive macroeconomic policies must restore trust, demand recovery, and provide interest-free loans to overcome Pakistan’s currently upcoming crisis

The key organizational factors in healthcare waste management practices of Libyan public hospitals

From MDPI via Jisc Publications RouterHistory: accepted 2021-11-10, pub-electronic 2021-11-19Publication status: PublishedThis study aims to investigate factors contributing to healthcare waste management practices among Libyan public hospitals. The organizational culture and structure are proposed to have their effect upon hospital organizational units in charge of healthcare waste production by a theoretical review to develop two main hypotheses. Hence, this study used the stratified random sampling technique to select respondents such as top management officials, heads of departments, and administrators who work in all the hospitals located in the south of Libya, from whom data was collected. The data for the study was gathered via a survey questionnaire from Libyan public hospitals in the country’s southern region. A total of 210 questionnaires were distributed and 171 usable responses were received, yielding a 70% response rate. Though the findings of the study show some inconsistency, the two dimensions of the culture examined in this study are found to have a positive relationship and significant influence on the management practices of health waste. Besides, it shows the positive relationship between organizational structure and healthcare waste management practices (HWMP). However, the findings of this study suggested that nurses and cleaners’ practices should critically consider structure dimensions such as formalization as well as moderating variables such as hospital location and type of services supplied on the interactions to improve the management of healthcare waste in Libya’s public hospitals.13pubpub2

Fundraising Appeals for the COVID-19 Epidemic Fight: A Cross-Country Study of Donor Responses

This research explores the intrinsic and extrinsic motivations driving donors to engage in fundraising appeals launched through social networking sites (SNSs) to mitigate COVID-19’s impact on vulnerable communities from a cross-national perspective. The research adopted a quantitative approach through a web-based survey; a total of 801 donors were obtained from Kuwait and Bahrain and were useable for the analysis. Smart PLS structural equation modelling was used to validate the research model and derive significant insights. In the Kuwaiti sample, we found that humanitarian projects, internet technology, SNSs and religiosity significantly drive donor attitudes towards online donation. All these relationships are indirectly related to the intention to give via SNS through the mediating role of attitudes. As for the Bahraini sample, humanitarian projects, non-profit organizations (NPOs), SNSs, and religiosity significantly influence donors’ attitudes. Attitudes, on the other hand, have a visible mediating role in the relationships between these predictors and behavioral intentions. The findings could be useful for the development of appropriate policies that boost online monetary donations to support emergency aid for communities crushed by the pandemic. This research differs from the existing literature in that its multi-national study scrutinizes the incorporation of both internal and external predictors of fundraising activities into a distinctive related context such as SNSs, particularly in a time of epidemiological crises such as COVID-19