4 research outputs found
Historicizing a moving target: Lawal’s peregrination on Lagos
No full textThe works of Prof. A. A. Lawal on various aspects of ‘Lagos’, are examined in this paper. At various periods in its history, Lagos was a British colony, acolonial and post-colonial capital of Nigeria, a commercial hub and a melting pot, all of which have excited writers of diverse genres. Currently,Lagos is the largest, fastest-developing megacity in Africa, it is generating even more literary attention because of the ‘Lagos @ 50’ anniversarycelebrations. This paper surveys the idiosyncrasy or motivation of the typical writer or researcher of Lagos that is similar or dissimilar with writers ofcontemporaneous conurbations around the world. The review of Prof. Lawal’s writings offers a unique chance to understand the personal constitution, experience and motivation of the typical writer of Lagos history or society and their empathy with the subject. Using a combination of primary and secondary sources and exclusive interviews with the author, the paper summarizes the works chronologically and assesses the major findingson a subject which can best be described as a moving target. I found the author enraptured with the pace of social change in the city and hishistoricism flowed from cultural affinity and academic specialization in economic history, of which the city is hugely symbolic in the country’sinternational trade. Specifically, Lawal’s insightful work on street trading was largely prophetic because, as he concluded, the problem has defiedpublic policy controls till the present day. In sum, the review justifies the thesis that writers focusing on cities often connect to perennial socialproblems as a canvas to express their disciplines
Enigma of urethral pain syndrome: why are there so many ascribed etiologies and therapeutic approaches?
No full textAuthor(s) Pre Print Version OnlyUrethral pain syndrome has had several sobriquets, which have led to much confusion over the existence of this pathological condition and the useful options in the care of the afflicted patient. Our aim was to explore the proposed etiologies of this syndrome, and to provide a critical analysis of each proposed etiology and present a balanced argument on the plausibility of the proposed etiology and therapeutic approaches. We carried out an English language electronic search in the following databases: Medline, Embase, Amed, Cinahl, Pubmed, Cochrane Library, Trip Database and SUMSearch using the following search terms: urethral syndrome, urethral diseases, urethra, urologic diseases etiology/etiology, presentation, treatment, outcome, therapeutics and treatment from 1951 to 2011. In excess of 200 articles were recovered. With the clearly defined objectives of analyzing the proposed etiologies and therapeutic regimes, two author(s) (HP and IO) perused the abstracts of all the recovered articles, selecting those that addressed the etiologies and therapeutic approaches to treating the urethral pain syndrome. The number of articles was reduced to 25. The full text of all 25 articles were retrieved and reviewed. Through the present article, we hope to elucidate the most probable etiology of this condition whilst simultaneously, advance a logical explanation for the apparent success in the treatment of this condition using a range of different therapeutic modalities. We have carried out a narrative review, which we hope will reduce some of the confusion around this clinical entity by combining the known facts about the disease
Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries
No full textBackground: 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 sideeffects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (β 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 lowand 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
Predicting opioid consumption after surgical discharge: a multinational derivation and validation study using a foundation model
No full textOpioids are frequently overprescribed after surgery. We applied a tabular foundation model to predict the risk of post-discharge opioid consumption. The model was trained and internally validated on an 80:20 training/test split of the ‘Opioid PrEscRiptions and usage After Surgery’ (ACTRN12621001451897p) study cohort, including adult patients undergoing general, orthopaedic, gynaecological and urological operations (n = 4267), with external validation in a distinct cohort of patients discharged after general surgical procedures (n = 826). The area under the receiver operator curve was 0.84 (95% confidence interval [CI] 0.81–0.88) at internal testing and 0.77 (95% CI 0.74–0.80) at external validation. Brier scores were 0.13 (95% CI 0.12–0.14) and 0.19 (95% CI 0.17–0.2). Patients with a <50% predicted risk of opioid consumption consumed a median of 0 oral morphine equivalents in the first week after surgery. Applying this model would reduce opioid prescriptions by 4.5% globally, and counterfactual modelling suggests without increasing time in severe pain (−4.3%, 95% CI −17.7 to 8.6)
