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 Assessment of the Written Performance of the Sudanese EFL University Learners: A Communicative Approach to Writing

An Assessment of the Written Performance of the Sudanese EFL UniversityThe study investigates the written performance of the Sudanese EFL students. The study aims to assess the written texts produced by the students to find out how successful they are in their use of writing as a mechanism through which meaning is communicated. The subject of the study consists of 65 Sudanese EFL teachers drawn from some Sudanese universities and 240 fourth level students who are taking English as their major in five Sudanese universities. Three tools are used for data collection: writing test, two questionnaires (one for the teachers and the other for the students) and an interview with the students. By using the statistical program SPSS, the study reveals that Sudanese EFL students do not possess the ability to cope with the different modes of writing. This makes them unable to develop an understanding of how to employ the linguistic, cultural and social knowledge to develop an idea into a meaningful and comprehensive written text. The study also shows that students are not able to depend on the strategies of writing so that they could produce texts which stimulate readers and keep their attention. Furthermore, the study reveals that the students are not prepared to benefit from their teachers and peers while they are writing; they never ask for advice or any clarification but do their writing individually. Moreover, the study has reached the conclusion that the students’ inability to know what the readers know and what they want represents one of the factors that lead students to produce less informative written texts. The study concludes that the poorcommunicative competence the students possess stems from different factors: (1) the instruction the students receive in writing does not revolve around the issues that enable them to develop their abilities as writers, (2) the students are not motivated enough to exert efforts and seek opportunities to engage into deliberate writing and intensive reading so that they can promote their writing abilities, (3) the environment in which writing is done does not enhance and foster students' ability to create writing which is sophisticated and communicative in nature, (4) teachers also do not encourage these students to view writing as a mechanism through which meaning is negotiated, and (5) the sorts of feedback these students receive on their writing does not contribute to the development of students' writing proficiency. To help the students develop their writing skills, teachers should help the students be knowledgeable about the different modes of writing and be knowledgeable about the lexical and grammatical structures required b

Effects of feeding whole linseed on ruminal fatty acid composition and microbial population in goats

The objective of the present study was to evaluate the effect of feeding different levels of whole linseed, as a source of n-3 polyunsaturated fatty acids (PUFA), on ruminal fatty acid composition and microbial population in the goat. Twenty-four crossbred Boer goats were assigned to 3 dietary treatments: L0 (control), L10 and L20 containing 0, 10%, or 20% whole linseed, respectively. The ruminal pH and concentration of total volatile fatty acids (VFA) were not affected by dietary treatments. The feeding of L10 and L20 diets produced higher (P < 0.05) molar proportions of acetate and lower (P < 0.05) molar proportions of butyrate and valerate than the L0 diet. Molar proportions of myristic acid (C14:0) and palmitic acid (C16:0) were lower (P < 0.05) in the rumen of goats offered L10 and L20 diets than the control diet. However, stearic acid (C18:0), vaccenic acid (C18:1 trans-11), conjugated linoleic acid (CLA, C18:2 trans-10, cis-12) and α-lenolenic acid (C18:3 n-3) were higher (P < 0.05) in the rumen of goats fed L10 and L20 than L0. Both inclusion levels of linseed in the diet (L10 and L20) reduced the ruminal total bacteria, methanogens, and protozoa compared with L0 (P < 0.05). The effect of the dietary treatments on cellulolytic bacteria, varied between the individual species. Both inclusion levels of linseed resulted in a significant decrease (P < 0.05) in the population of Fibrobacter succinogenes, and Rumunococus flavefaciens compared with L0, with no significant difference between the groups fed linseed diets. The population of Rumunococus albus was not affected by the different dietary treatments. It was concluded that inclusion of whole linseed in the diet of goats could increase the concentration of PUFA in the rumen, and decrease the population of F. succinogenes, R. flavefaciens, methanogens and protozoa in rumen liquid of goats

Blood Culture Contaminants in a Paediatric Population : Retrospective study from a tertiary hospital in Oman

Objectives: Most children presenting with febrile illness require a blood culture to determine the causative organism as well as its sensitivity to antibiotics. However, false-positive results lead to unnecessary hospitalisations, prescriptions and tests. This study aimed to evaluate the impact of false-positive blood cultures among a paediatric population at a tertiary hospital in Oman. Methods: This retrospective study included all 225 children &lt;13 years old with positive blood cultures who presented to the Sultan Qaboos University Hospital, Muscat, Oman, between July 2011 and December 2013. Blood cultures were reviewed to determine whether they were true-positive or contaminated. Results: A total of 344 positive blood cultures were recorded during the study period, of which 185 (53.8%) were true-positive and 159 (46.2%) were contaminated. Most true-positive isolates (26.5%) were coagulase-negative Staphylococcus spp. (CONS) followed by Escherichia coli (9.7%), while the majority of contaminated isolates were CONS (67.9%) followed by Streptococcus spp. (6.9%). Children with contaminated cultures were significantly younger (P &lt;0.001) while those with true-positive cultures required significantly more frequent hospital admissions, longer hospital stays and more frequent antibiotic prescriptions (P &lt;0.001 each). Chronic illness and mortality was significantly more frequent among those with true-positive cultures (P &lt;0.001 and 0.04, respectively). While white blood cell and absolute neutrophil counts were significantly higher in truepositive cultures (P &lt;0.001 each), there was no significant difference in C-reactive protein (CRP) level (P = 0.791). Conclusion: In this population, CRP level was not an adequate marker to differentiate between true- and falsepositive cultures. A dedicated well-trained phlebotomy team for paediatric patients is essential

Mapping of infection prevention and control education and training in some countries of the World Health Organization’s Eastern Mediterranean Region: current situation and future needs

Abstract Background A strong understanding of infection prevention and control (IPC) procedures and comprehensive training among healthcare workers is essential for effective IPC programs. These elements play a crucial role in breaking the chain of nosocomial infections by preventing the transmission of resistant organisms to patients and staff members. This study mapped the components of IPC education and training across various member states of the World Health Organization (WHO) in the Eastern Mediterranean Region (EMR) at national, academic, and healthcare institutional levels. Methods A self-administered structured online questionnaire based on the WHO “Core Component 3” of IPC programs at the national and acute healthcare facility levels (IPC education and training) was given to national IPC focal persons in each of the WHO’s EMR countries between February and March 2023. Results From 14 of the 22 countries,15 IPC persons participated in the survey. Most countries have scattered nonhomogeneous IPC education programs in human health undergraduate majors without considering it a standalone module. Academic institutions are rarely involved, and elaborate and predefined undergraduate IPC education programs provided by universities are present in 21.4% of the countries. In 71.4% of these countries, postgraduate training targeting IPC professionals is provided by national IPC teams, primarily based on national IPC guidelines developed with the aid of the WHO. Generally, healthcare worker training relies heavily on healthcare facilities in 92.9% of the countries, rather than on a national training program. In 42.9% of the countries, practicing IPC physicians are not necessarily specialists of infectious disease or medical microbiologists and IPC nurses are not required to specialize in IPC. However, nonspecialized IPC professionals are expected to undergo training upon employment and before beginning practice. Nongovernmental organizations such as the WHO play a significant role in IPC education and in supporting national IPC authorities in establishing national IPC guidelines, as it is the case in 78.6% of these countries. Conclusion Clear disparities exist in IPC education and training across different countries in the WHO’s EMR. Establishing a regional scientific network specializing in IPC would help bridge the existing gaps and standardize this education within individual countries and across countries in the region. This region needs to establish IPC certification standards and standardized education curricula