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

PEMIKIRAN IBNU KHALDUN TERHADAP FILSAFAT HUKUM ISLAM

Abstract: the greatest contribution of Ibn Khaldun to the Philosophy of Islamic Law is his sociology theory. This theory was based on three fundamental laws: first, his stand on the law of cause and effect in social reality, second, the similarity law of social phenomena that are applied in general but not absolute, third, the law of the difference and speciality of social phenomena that are constantly changing and varied in different space and time. These three basic laws became the basic epistemological assumptions in highlighting legal differences due to the difference in space and time. On the other hand, Ibn Khaldun's theory became the basis of the legal application of social engineering, later popularized as social engineering by Roscoe Pound.&#x0D; Abstrak: Konstribusi terbesar Ibn Khaldūn terhadap Filsafat Hukum Islam adalah teorinya tentang sosiologi yang dilandaskan pada tiga hukum dasar. Pertama, pendirian Ibn Khaldūn tentang adanya hukum sebab akibat dalam realitas sosial. Kedua, hukum keserupaan fenomena sosial yang berlaku umum akan tetapi tidak mutlak. Ketiga, hukum perbedaan dan kekhususan fenomena sosial yang terus berubah dan berbeda oleh perbedaan ruang dan waktu. Ketiga hukum dasar di atas menjadi asumsi dasar epistemologis dalam menyorot perbedaan hukum akibat perbedaan ruang dan waktu. Di sisi lain, teori Ibn Khaldūn menjadi dasar keberlakuan hukum sebagai alat rekayasa sosial, yang kemudian dipopulerkan dengan social engineering oleh Roscoe Pound.&#x0D; Kata kunci: Filsafat Hukum Islam, Social Engineering</jats:p

Sejarah Pemikiran Kebangsaan Jakob Oetama Pada Surat Kabar Kompas 1970-2001

Nationality is needed by every Indonesian as one of the efforts to continue maintaining the unity and integrity of the nation. One of the national press figures who seriously think about the issue of nationality is Jakob Oetama. One of the ways Jakob Oetama channeled national ideology was through the press media named the Kompas. The purpose of this study was to find out how Jakob Oetama ideology about nationality in Kompas newspaper. The period is from 1970 to 2001. The research method uses historical research methods consisting of four stages; heuristics, verification, interpretation and historiography. The results showed that Jakob Oetama's national ideology in the first Kompas daily newspaper was Bhinneka Tunggal Ika and national ideology, national integration and disintegration, religious issues, knowing the homeland, and the principle of transcendental humanism. Pemahaman kebangsaan sangat diperlukan oleh setiap rakyat Indonesia sebagai salah satu upaya untuk terus mempertahankan persatuan dan kesatuan bangsa. Salah satu tokoh pers nasional yang serius memikirkan persoalan tentang kebangsaan adalah Jakob Oetama. Cara Jakob Oetama menyalurkan pemikiran kebangsaan salah satunya yaitu lewat media pers yang diberi nama surat kabar Kompas. Tujuan penelitian ini adalah untuk mengetahui bagaimana pemikiran Jakob Oetama tentang kebangsaan pada surat kabar Kompas periode tahun 1970 sampai dengan tahun 2001. Penelitian ini menggunakan metode penelitian sejarah yang terdiri dari empat tahap yaitu, heuristik, verifikasi, interpretasi dan historiografi. Hasil penelitian menunjukan bahwa pemikiran kebangsaan Jakob Oetama pada surat kabar harian Kompas adalah Bhinneka Tunggal Ika dan ideologi kebangsaan, integrasi dan disintegrasi nasional, persoalan agama, mengenal tanah air, dan prinsip humanisme transendental.</jats:p

KREATIFITAS PEMBELAJARAN : PERSPEKTIF GURU SEJARAH PROVINSI DKI JAKARTA

The purpose of this study was to obtain empirical data on learning creativity in the perspective of history teachers in DKI province. This study is a cross-sectional survey study. Data was obtained through a semi-closed questionnaire. Data analysis and interpretation are carried out with the criteria of numbers 0-25% very weak (very less, 26-50% weak (less), 51-75% sufficient (low) and 76-100% strong (high).The results of the study are four indicators in the low category, namely interaction with peers, sharing experiences, a mental block of creative thinking and practicing creativity. Four indicators in the high category are knowledgeable, a collector of ideas for teaching, experimenting and self-reflection, and creativity is a daily goal.</p

Merkuri dan Keberadaannya

Merkuri yang dikenal dengan air raksa telah menyebabkan kematian lebih dari 1000 orang di Jepang pada tahun 1968 yang dikenal dengan Minamata disease. Masuknya merkuri ke dalam tubuh manusia melalui pencemaran merkuri pada kasus Minamata disease ini juga telah mengakibatkan belasan ribu orang Jepang menderita kerusakan fungsi saraf otak, kerusakan fungsi genetik yang akhirnya menyebabkan kelumpuhan dan cacat turunan. Kasus yang serupa terulang kembali di Iran pada tahun 1971 yang menyebabkan lebih dari 10.000 kehilangan nyawa dan kira-kira 100.000 orang menderita penyakit seperti yang terjadi di Jepang. Dua bencana tragis yang diakibatkan oleh pencemaran merkuri ini merupakan pelajaran berharga bagi kita untuk lebih mengenal merkuri dan mewaspadai akan keberadaan merkuri dalam kehidupan kita. Buku ini telah direvisi menjadi cetakan kedua dengan menambahkan materi tentang pencemaran perairan. Penambahan materi ini dibutuhkan karena pencemaran perairan oleh komponen pencemar termasuk merkuri merupakan mata rantai yang tidak dapat dipisahkan dari merkuri dan keberadaannya. Selain itu, penambahan materi tersebut juga diperuntukan untuk kebutuhan buku ajar yaitu materi pencemaran air seperti komponen-komponen pencemar air, indikator pencemaran air dan efek pencemaran perairan terhadap lingkungan dan manusia, termasuk di dalamnya tentang keberadaan merkuri sebagai pencemar perairan.</jats:p

A NOVEL IMAGE PROBING SYSTEM (SPIP) FOR THE ASSESSMENT AND QUANTIFICATION OF STRUCTURAL CHANGES IN CHORIOALLANTOIC MEMBRANE (CAM) CAUSED BY THE STRAWBERRY JUICE

The anticancer potential of berries has been related, at least in part, to a multitude of bioactive phytochemicals. Anticancer effects of berry bioactive are partially mediated through their abilities to counteract, reduce, and also repair damage resulting from oxidative stress and inflammation.</jats:p

ANALISIS KEKUATAN SAMBUNGAN BALOK DAN KOLOM DITINJAU DARI RASIO TULANGAN MENGGUNAKAN SOFTWARE ATENA 2D

Salah satu komponen struktur yang berpengaruh dalam keruntuhan suatu bangunan adalah balok yang berada padasambungan balok-kolom. Umumnya kehancuran sambungan balok kolom tersebut disebabkan oleh kurangnyakemampuan menahan geser dan rendahnya duktalitas yang diakibatkan oleh jumlah tulangan dipasang tidak mencukupiserta tidak kuat dalam menahan beban lentur dan aksial. Analisis ini dilakukan untuk mengetahui perilaku lentur balokpada sambungan balok kolom beton bertulang. Juga dilakukan dengan metode numerik menggunakan software Atena2D. Balok 40x60 cm dan Kolom 40x40 cm, penelitian ini menggunakan 2 kasus, masing-masing kasus terbagi menjadi3 tipe penulangan. Kasus dengan rasio tulangan kolom tetap rasio tulangan balok berubah, dan sebaliknya rasiotulangan balok tetap tetapi rasio tulangan kolom yang berubah. Tulangan kolom menggunankan D19 mm dan Balokmenggunakan tulangan D16 mm. Rasio tulangan kolom ρ = 0,0142 dengan rasio tulangan balok ρ1= 0,0042, ρ2=0,0050, ρ3= 0,0059. Dan Rasio tulangan Balok tetap = ρ = 0,0042 dengan rasio tulangan kolom ρ1= 0,0071, ρ2=0,0106, ρ3= 0,0142. Kekakuan struktur Joint balok kolom pada case I.a rasio penulangan kolom 0,0071 sebesar 8,015,pada case II.a dengan rasio penulangan kolom 0,0106 terjadi penurunan sebesar 0,87% dan case III.a dengan rasiopenulangan kolom 0,0142 terjadi peningkatan sebesar 0,27% dari case I.a.</jats:p

Prevalence of Non-Communicable Diseases in Schedule Caste dominated Rural Areas of Bhopal District, Madhya Pradesh

Introduction: Non-communicable diseases (NCDs) are the result of a combination of genetic, physiological, environmental and behavioral factors. Forty-one million people die each year due to NCDs, which is equivalent to 71% of all deaths globally. Objective: The study was done to estimate the prevalence of non-communicable diseases among five villages in the rural area of Bhopal, Madhya Pradesh, India. Methodology: The present study was an observational study carried out on 6516 patients visiting mobile healthcare OPD conducted under Schedule Caste Sub-Plan in schedule caste dominated villages (Kurana, Kalkheda, Bagoniya, Toomda and Dhamarra) of Bhopal, Madhya Pradesh. Results: It was found that 49.82% of the people from these villages were suffering from non-communicable diseases. Conclusion: Nearly half of the population of this rural area was suffering from NCDs, therefore, people of rural areas are equally vulnerable to have NCDs. Urbanisation of lifestyle in rural population, poor education level and low economic status were the contributing factors.</jats:p