The Sustainable Architectural Values of Eclectic Style Shophouses Case Study: Sun Yat Sen Museum Penang, Malaysia

The Sun Yat Sen shophouse in Penang is a small private Museum, which was converted from a shophouse or townhouse situated in theArmenian Street heritage area of George Town. The building is an example of embraces of the architectural heritage of George Town which is an extraordinarily beautiful example of Straits Settlements merchant's shophouse.Historically, it is associated with the global historical personality of Dr. Sun Yat Sen and hisrevolutionary. This city was added to the UNESCO's world heritage list in 2008 to acknowledge its rich cultural heritage that constitutes of unique architectural and cultural townscape along the Straits of Melaka. This paper investigates the architectural plan of a shophouse and the valuesof cultural heritage buildingswhich eventually was converted into a Museum in George Town, Penang. Classified as an eclectic style shophouse, it is rich in design and art components featured in its architecture that are still sustaining until today. This building has an interesting mixture of architectural and cultural inspirations adapted from the Chinese origin, with the local Malay ethnicity and the European influencesthat colonised the region. The introduction of new non related architectural components into the southern Chinese (eclectic style) style in shophouses in George Town has resulted in the disappearance of this unique style of architecture. This investigation employs a qualitative research approach by documenting evidence and understanding the architectural as well as cultural influences of the southern Chineseeclectic style by studying the Sun Yat Sen Museum as a case study. The findings of the research point towards an understanding of the architectural and cultural influences that govern the design of the shophouse and its architectural character

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