Randomised double-blind comparison of morphine vs a morphine-alfentanil combination for patient-controlled analgesia

Kaedah penggunaan analgesi/ubat penahan sakit kawalan pesakit (AKP) telah dilaksanakan semenjak 30 tahun dahulu lagi sebagai satu kaedah altematif untuk mengawal selia penggunaan analgesi/ubat penahan sakit selepas pembedahan. Ianya membolehkan pesakit mengawal sendiri sejumlah kecil opiod yang diperlukan dengan lebih baik dan berkesan. Jumlah ubat yang diberikan kepada pesakit telah dihadkan berdasarkan beberapa faktor antaranya; jumlah permintaan terhadap dos, had masa kekunci dan jeda masa kekunci misalnya setiap jam atau setiap 4 jam. Kajian ini dijalankan secara rawak untuk mengkaji kesan penggunaan diantara campuran morfin dan alfentanil dengan hanya penggunaan morfin, keatas pesakit yang menjalani pembedahan 'Caesarean'. Patient-controlled analgesia (PCA) has been used for the past 30 years as an alternative method to administer postoperative analgesia. Patient-Controlled Analgesia allows patients to self-administer small boluses of opioids, providing better dose titration and regulation. The quantity of analgesic available to the patient is limited by the prescribed patient-controlled analgesia variables; demand dose size, lockout period and hourly or 4-hourly limits. In a randomized, double-blind study, I compared a combination of morphine and alfentanil with morphine alone for patient-controlled analgesia after Caesarean section under spinal anesthesia

Technical efficiency of pepper farms in Sarawak, Malaysia: an application of data envelopment analysis

This study is carried out to analyze the performance of pepper farms in Sarawak by estimating the level of technical efficiency and to identify the determinants of technical efficiency of pepper farms. Data Development Analysis (DEA) method were applied to estimate technical efficiency levels and Tobit analysis were used to investigate the determinants of technical efficiency of pepper farms. A sample of 678 pepper farmers was chosen for this study through field survey that was conducted from August to December 2009. The results show that the mean of technical efficiency under constant returns to scale (CRS) and variable returns to scale (VRS) were 0.567 and 0.661, respectively. Meanwhile, efficiency in farm management is positively and significantly influenced by education level, the frequency of contacts with extension agents per year, being member of farmer’s association, being full-time pepper farmers, and joining farming courses and study visits

Technology adoption in pepper farming: a case study in Sarawak, Malaysia

Farm maintenance requires before and after harvest season to minimize the damages of pepper vines and to maintain quality and quantity of pepper berries. Farm maintenance is includes mounding, liming before planting, pruning, weeds control, fertilizing, and pest and disease control. Pepper farmers had inherited about pepper farming practices from parents, based on their experience and they also learned about technology in pepper farming from extension agents. However, pepper farming practices are different among farmers because they come from different socioeconomic background. This study is carried out to examine the factors influence the adoption of technology in pepper farming among pepper farmers in Sarawak. The results show that the total pepper vines, farming experience, and education level, are significant factors influencing technology adoption in pepper farming

Determinants of cost efficiency of smallholders pepper in Sarawak, Malaysia

Pepper crop (Piper Nigrum L) is one of an important source of income for 67,000 rural families in the interior areas of Sarawak. This study is carried out to estimate technical, allocate, and cost efficiency among smallholders pepper in Sarawak. Then, the determinants of cost efficiency among smallholders pepper also investigated. It will identify the sources where improvements can be made to help the pepper farmers to minimize production cost. This study used 678 of smallholders pepper and the data is obtained from the field survey that was conducted in the month of August to December 2009. This study used a constant return to scale (CRS) input-oriented model to estimate technical efficiency and a Cost-DEA model is used to estimate cost efficiency. Mean of technical, allocative, and cost efficiency are 0.567, 0.585, and 0.438, respectively. Farmers are not efficient in input utilization and are not producing pepper yield at minimum input and minimize cost. The inefficiencies are due to misallocation of resources used. The contacts with extension agents per year, joining farmer’s organization, full-time pepper farming, and participating in farming courses and study visit and education level is positively and statistically significant with cost efficiency among smallholders pepper

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Technical Efficiency of Pepper Farms in Sarawak, Malaysia: An Application of Data Envelopment Analysis

Abstract This study is carried out to analyze the performance of pepper farms i

Technical Efficiency Among Pepper Farmers in Sarawak, Malaysia: A Stochastic Frontier Analysis

This study aimed to estimate the technical efficiency among pepper (Piper nigrum. L) farmers in Sarawak, Malaysia, using Stochastic Frontier Analysis (SFA). SFA involves a one-step process that can estimate technical inefficacy factors simultaneously with the production frontier. 678 pepper farmers were involved in this study, and the data were collected from 2012 to 2013. The mean score for technical efficiency was 0.518, indicating that pepper farmers were not efficient. However, the inefficiency model showed that education level, membership in farmers’ association, full-time as a pepper farmer, attending courses and visiting sample farms were factors that significantly improved inefficiency. The major problem of pepper farming in Sarawak is poor agricultural practices where farmers do not fully utilize the available agricultural inputs to produce maximum output. Based on the findings, farmers must improve their knowledge and skills in pepper farming through agronomic education