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

An ordinal game theory approach to the analysis and selection of partners in public:Private partnership projects

Nowadays, public–private partnership projects have become a standard for delivering public services in both developed and developing countries. In this paper, we are concerned with the analysis of private sector proposals and the selection of the private sector partner to whom to award the contract. To the best of our knowledge, this problem has not been addressed within a game theory framework. To fill this gap, we model this decision problem as a static non-cooperative game of complete information and propose a new ordinal game theory algorithm for finding an optimal generalized Nash equilibrium. The proposed algorithm determines a single ranking of proposals or bidders that takes account of multiple performance criteria and reflects both the public sector and the private sector perspectives, and can handle any number of private sector players and any number of contractual terms. An illustrative scenario is provided to guide the reader through the workings of the proposed ordinal game theory algorithm. The proposed ordinal game theory-based analysis framework can be used by the private sector to analyse any set of potential proposals most likely to be submitted by bidders and to assist with the choice of bidding strategies, and by the public sector player to analyse any set of potential proposals most likely to be submitted under any set of contractual terms and to assist with the choice of a realistic set of contractual terms and their performance measures

Thermomechanical process modelling of 40NICRMO8-4 alloy by artificial neural networks

Artificial neural networks (ANNs) as simplified model of mankind’s neural system, are capable of simulating and predicting real world complex problems which are challenging and expensive to model physically. In this study the correlation between the flow stresses and strain rate, temperature, strain in thermomechanical process of 40NICRMO8-4 alloy has been modelled. The results revealed that flow stress for every strain value is less at high temperatures compared to those at low temperatures and material resistance against deformation will also decrease as temperature goes down. Moreover, increasing in strain rate when temperature is constant results in recrystallization to happen in higher strain values at times shorter. The employed neural network for this study was a feed forward multilayer perceptron trained with common back propagation algorithm. Similar to any other ANNs, the employed network receives some parameters as inputs and delivers some as outputs. The inputs given to this model were temperature, strain and strain rate while flow stress parameter was collected as requested output. Outputs, with high precision of approximately 99% accuracy, were predicted and produced during training phase. Likewise, the predicted output of the ANN model achieved an R-value of about 0.99871 compared with of those experimental values. Best results were obtained with an ANN model consist of two hidden layers trained with Levenberg–Marquardt training algorithm

An Ordinal Game Theory Approach to the Analysis and Selection of Partners in Public–Private Partnership Projects

Nowadays, public–private partnership projects have become a standard for delivering public services in both developed and developing countries. In this paper, we are concerned with the analysis of private sector proposals and the selection of the private sector partner to whom to award the contract. To the best of our knowledge, this problem has not been addressed within a game theory framework. To fill this gap, we model this decision problem as a static non-cooperative game of complete information and propose a new ordinal game theory algorithm for finding an optimal generalized Nash equilibrium. The proposed algorithm determines a single ranking of proposals or bidders that takes account of multiple performance criteria and reflects both the public sector and the private sector perspectives, and can handle any number of private sector players and any number of contractual terms. An illustrative scenario is provided to guide the reader through the workings of the proposed ordinal game theory algorithm. The proposed ordinal game theory-based analysis framework can be used by the private sector to analyse any set of potential proposals most likely to be submitted by bidders and to assist with the choice of bidding strategies, and by the public sector player to analyse any set of potential proposals most likely to be submitted under any set of contractual terms and to assist with the choice of a realistic set of contractual terms and their performance measures

Correlation between anxiety in labor and duration as well as outcome

AbstractBackground and aim:Delivery is a stressful event. It seems that the cervix of an anxious womandoes not dilate easily. The purpose of this study was determine the correlation between anxietyduring labor and duration as well as outcome of delivery in women referring to hospitals affiliatedto Shahid Behshti Medical University and Shahid Akbar Abadi Hospital .Materials and Methods:A descriptive correlational design was used.200 women were selected via a multistage quota sampling in each hospital. A demographic andobstetrical questionnaire, Spielberg's State Trait Anxiety Inventory, and a checklist regarding thecondition of the parturient women during hospitalization, duration of labor as well as delivery andApgar score of the neonate were used for data collection.Data were analysed using SPSS 16statistical software.Findings:Most women experienced moderate anxiety (%53/5).Mean of total time of delivery was250/87±150/34 minutes, %94/5 was normal delivery and the mean of apgar score in first minute was9 and in 5 minute was10.No significant correlation was found between anxiety in labor room and duration (first, second andthird stage) as well as outcome (type and Apgar score) of delivery.Conclusion:Since most women experienced moderate anxiety, midwives and other healthcareworkers should consider psychological aspects of mothers in labor rooms and make the atmosphereof these placed favorable addition, preparative educational courses during pregnancy is needed .Keywords:Anxiety, labor, deliveryREFERENCES-Anderson L Poromaa IS Wulff M Astrom M Bixo M (2004). Implications of antenatal depression and anxiety forobstetric outcome. Obstetrics and Gynecology. 104 (3) 467-476.-Carson VB (2000). Mental Health Nursing. 2nd edition, Philadelphia: W.B. Saunders Company.-Chang MY Wang SY Chen C H (2002). Effects of massage on pain and anxiety during labour: A randomizedcontrolled trial in Taiwan. Journal of Advanced Nursing. 38 (1) 68- 73.-Coad J Dunstal M (2001). Anatomy and Physiology for Midwives. Edinburgh, New York: Mosby.-Cunningham FG Williams JW (2010).Williams Obstetrics. 23rd edition New York: Mc Graw- Hill Company.-Decherney HA Nathan L (2003) Current Obstetric & Gynecologic, 9th edition, New York, Mc Graw- Hill.-Gagnon A Waghorn K (1999).One to one nurse labor support of nuliparous women stimulated with oxytocin. Journalof Obstetric. Gynecologic&Neonatal Nursing. 28 (4) 371- 376.-Johnson RC SLADE P (2003). Obstetric complications and anxiety during pregnancy: is there a relationship? Journalof Psychosomatic Obstetrics and Gynecologic. 24 (1) 1-14-Johnson C R Slade P (2002).Does fear of childbirth during pregnancy predicts emergency caesarean section. AnInternational Journal of Obstetrics' and Gynecology. 109 (11) 1213- 1221.-Kaviany H Ahmady Abhary A etal (2002). Prevalance of anxiety disorder in Tehran city. Thinking and BehaviorJournal.8 (31) 4-11-Keogh E Hughes S Ellery D Daniel C Psy C Holdcroft A (2006). Psychosocial influences on women's experience ofplanned elective cesarean section. Psychomatic Medicine. 68 (1) 167-174.-Lang AJ Sorrell JT Rodgers CS Lebeck M (2006). Anxiety sensitivity as a predictor of labor pain. European Journal ofPain, 10 (3) 263-270.-Langer A Campero L Garcia C Reynoso S (1998). Effects of psychosocial support during labour and childbirth onbreastfeeding, medical interventions, and mother's wellbing in a Mexican public hospital: a randomized clinical trial.British Journal of Obstetries and Gynaecology. 105 (10) 1056 – 1063-Littleton HL Breikopf CR Berenson AB (2007). Correlates of anxiety symptoms during pregnancy and association withperinatal outcomes: A meta – analysis. American Journal of Obstetrics & Gynecology. 196 (5) 424- 432.-Motevally E Feizy Z Gangy T Haganny H (2003). [Does viewing of videotape effect on childbirth anxiety level ofprimigravida mothers?].Iran Journal of Nursing.16 (33) 100-104 (Persian).-Moslemabadi Farahani A Malekzadegan R Mohammadi F Hosseini (2005). [Effect of the one to one midwifery careduring labor on modes of delivery Iran journal of nursing].18 (43) 71-82 (Persian).-Mallekpour Afshary F Salary P etal (2005). [Effect of childbiirth preparation of training on anxiety during pregnancyand parturition in primiparous women reffered to health centers in Mashhad city 2000] . Journal of Shaheed SadoghyUniversity of Medical Sciences. 13 (2) 39-44(Persian).-Nasiri Amiri F. Salmalian H, Hajiahmadi M (2009). [Association between Prenatal Anxiety and Spontaneous PretermBirth]. Journal of Babol University of Medical Sciences.11 (4) 42-48. (Persian)-Nasiry,M.(2000).[Psychcological Health During Pregnancy and Parturition]. Tehran Boshra Publication.(Persian).-Mirzaei F,Keshtgar S Kaviani M etal (2009).The Effect of Lavender essence smelling during labor on cortisol andserotonin plasma levels and anxiety reduction in nulliparous woman. Journal of Kerman University of MedicalSciences.16 (3) 245-254 (Persian).-Masoomi R Lamiyan M Ghaedi S (2008). [Role of oxytocin in anxiety in the normal Parturition].Journal of Zahedanuniversity of Medcial sciences. 10 (1) 53-58(Persian)-Pirdel M Pirdel L (2009). Perceived Environmental Stressors and Pain Perception During Labor Among Primiparousand Multiparous Women. Journal of Reproduction and Infertility. 10 (3) 224-217.-Sadock J Sadock VA Kaplan HI (2000).Comprehensive Textbook of Psychiatry. 7th edition, Philadelphia: LippincottWilliams & Wilkins.-Shamaeian Razavi N Bahri Binabaj N Hoseiny Shahidy L PourHeidar M (2006). [The effect of maternal position onlabor pain]. Journal of Ofogh-E-Danesh.12 (2) 16-21 (Persian)-Sadok B Sadok V (2005). [Abstract of Psychiatry] translated by .Pourafkary NVol (1,2).2nd Edition .Tehran. Shahrabpub. (Persian)-Sedaghat S (1999). [Factors causing anxiety before and after delivery in primiparous women reffered to health centersand hospitals of Tehran and Shaheed Beheshty University of Medical Sciences in 1999]. Tesis for MS degree inShaheed Beheshty University of Medical Sciences. (Persian)-Shamloo S (1994). [Mental Health].Tehran .Chehr pub. (Persian)-Wijma k (2003). Why focus" on fear of childbirth".Journal of Psychoso Obstetrics and Gyneocology. 24 (3)141-143.-World Health organization (2001). htt://www.emro.int/mnh/PublicInformation Part 6. htm. 

Review of the effect cultural capital and subjective socioeconomic status on life satisfaction in Iran: the mediating role of health-promoting lifestyle and the moderating role of ethnicity

Abstract Introduction Health-promoting lifestyle can leads to improving the quality of life, life satisfaction, well-being and reducing the burden of health care in the society. This study was carried out to investigate the mediating role of health-promoting lifestyle and moderating role of ethnicity in the effect of cultural capital and subjective socioeconomic status on life satisfaction in Iran. Methods This cross-sectional study was conducted with 800 respondents in the cities of Kermanshah with Kurdish ethnicity and Tabriz with Azeri ethnicity. The data gathering tool was a questionnaire in five section including demographic checklist, cultural capital questionnaire (2015),Diener’s life satisfaction scale, and health-promoting lifestyle questionnaire (HPLP II), and socioeconomic status scale. Data were analyzed by SPSS and AMOS software. Results Life satisfaction had the highest correlation with the objective dimension of cultural capital (p  0.05). Conclusion The results of this study showed that paying attention to the concept of health-promoting lifestyle is a necessity to affect life satisfaction. It can play a role as a mediator for the path of cultural capital and socio-economic status on life satisfaction. This study also showed the role of ethnicity as a moderating variable in the relationship between socio-economic status and health-promoting lifestyle

Predicting perceived quality of life through social trust, physical activity, and sense of happiness in Iran: Moderating role of gender

Abstract Background and Aims In Iran, few studies have addressed the moderating effect of gender on determinants of quality of life. This study aimed to determine the effect of social trust, physical activity, and sense of happiness on the perceived quality of life, considering the moderating role of gender. Methods This was a population‐based cross‐sectional study. The statistical population were men and women aged 16 years and above in five western provinces of Iran. The final sample size was estimated to be 1268 people calculated through the correlation coefficient estimation formula, and finally 1185 questionnaires received. Data were analyzed using SPSS and AMOS software. Results The mean score of quality of life among women was significantly higher than that of men (p < 0.001). The direct standardized coefficient showed that the sense of happiness (β = 0.40), social trust (β = 0.20), and physical activity (β = 0.12) had a significant effect on the perceived quality of life (p < 0.001). Also, gender had a moderating role in the relationship between sense of happiness and perceived quality of life (z‐score = 3.246, p < 0.001). Totally, 21% of the changes in perceived quality of life were explained by three main variables. The main variables were stronger explanatory factors in men (R = 0.26) than in women (R = 0.17). Conclusions The final model showed that sense of happiness had the most direct effect on the perceived quality of life, moderated by gender. Considering that the quality of life among men was lower than that among women and the direct effect of happiness on quality of life was more among men than that among women, it is suggested that gender‐based health promotion interventions with an emphasis on men be carried out to strengthen the sources of happiness to improve quality of life

An Unusual Case of Recurrent Gastric Cancer Long after the First Gastrectomy Due to Adenocarcinoma

The postgastrectomy recurrence rate is as high as 30-65%, with 5-year overall survival rates of <20%. Local recurrence is very common which occurs in 38-45% of cases. The most common sites of locoregional recurrence are the gastric remnant at the anastomosis, the gastric bed, and the regional nodes. The recurrence may occur as early and late events after gastrectomy. Most recurrences are early, within three years of surgery. Numerous studies reported the late recurrences, but most of them having a survival time of less than ten years. This report elucidates a case of recurrent gastric cancer after 24 years postoperatively