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

The Invasive American Weed Parthenium hysterophorus Can Negatively Impact Malaria Control in Africa.

The direct negative effects of invasive plant species on agriculture and biodiversity are well known, but their indirect effects on human health, and particularly their interactions with disease-transmitting vectors, remains poorly explored. This study sought to investigate the impact of the invasive Neotropical weed Parthenium hysterophorus and its toxins on the survival and energy reserves of the malaria vector Anopheles gambiae. In this study, we compared the fitness of An. gambiae fed on three differentially attractive mosquito host plants and their major toxins; the highly aggressive invasive Neotropical weed Parthenium hysterophorus (Asteraceae) in East Africa and two other adapted weeds, Ricinus communis (Euphorbiaceae) and Bidens pilosa (Asteraceae). Our results showed that female An. gambiae fitness varied with host plants as females survived better and accumulated substantial energy reserves when fed on P. hysterophorus and R. communis compared to B. pilosa. Females tolerated parthenin and 1-phenylhepta-1, 3, 5-triyne, the toxins produced by P. hysterophorus and B. pilosa, respectively, but not ricinine produced by R. communis. Given that invasive plants like P. hysterophorus can suppress or even replace less competitive species that might be less suitable host-plants for arthropod disease vectors, the spread of invasive plants could lead to higher disease transmission. Parthenium hysterophorus represents a possible indirect effect of invasive plants on human health, which underpins the need to include an additional health dimension in risk-analysis modelling for invasive plants

Interactive effect of plant and animal/human lures on anopheline trap captures using MM-X traps.

<p>IRR  =  incidence rate ratio, CI  =  confidence interval, N  =  number of replicates, n  =  total number of mosquitoes caught, LO  =  (<i>E</i>)-linalool oxide and OC  =  β-ocimene. Worn socks were used as reference.</p

Development and Assessment of Plant-Based Synthetic Odor Baits for Surveillance and Control of Malaria Vectors

<div><p>Background</p><p>Recent malaria vector control measures have considerably reduced indoor biting mosquito populations. However, reducing the outdoor biting populations remains a challenge because of the unavailability of appropriate lures to achieve this. This study sought to test the efficacy of plant-based synthetic odor baits in trapping outdoor populations of malaria vectors.</p><p>Methodology and Principal Finding</p><p>Three plant-based lures ((<i>E</i>)-linalool oxide [LO], (<i>E</i>)-linalool oxide and (<i>E</i>)-β-ocimene [LO + OC], and a six-component blend comprising (<i>E</i>)-linalool oxide, (<i>E</i>)-β-ocimene, hexanal, β-pinene, limonene, and (<i>E</i>)-β-farnesene [Blend C]), were tested alongside an animal/human-based synthetic lure (comprising heptanal, octanal, nonanal, and decanal [Blend F]) and worn socks in a malaria endemic zone in the western part of Kenya. Mosquito Magnet-X (MM-X) and lightless Centre for Disease Control (CDC) light traps were used. Odor-baited traps were compared with traps baited with either solvent alone or solvent + carbon dioxide (controls) for 18 days in a series of randomized incomplete-block designs of days × sites × treatments. The interactive effect of plant and animal/human odor was also tested by combining LO with either Blend F or worn socks. Our results show that irrespective of trap type, traps baited with synthetic plant odors compared favorably to the same traps baited with synthetic animal odors and worn socks in trapping malaria vectors, relative to the controls. Combining LO and worn socks enhanced trap captures of <i>Anopheles</i> species while LO + Blend F recorded reduced trap capture. Carbon dioxide enhanced total trap capture of both plant- and animal/human-derived odors. However, significantly higher proportions of male and engorged female <i>Anopheles gambiae s.l.</i> were caught when the odor treatments did not include carbon dioxide.</p><p>Conclusion and Significance</p><p>The results highlight the potential of plant-based odors and specifically linalool oxide, with or without carbon dioxide, for surveillance and mass trapping of malaria vectors.</p></div

Proportions of male and engorged female <i>An. gambiae s.l.</i> caught by different odor treatments.

<p>The bars show the proportions of male and engorged (blood-fed + semi-gravid/gravid) female <i>An. gambiae s.l.</i>; numbers embedded in the bars are the total of mosquitoes caught by each of the odor treatment; LO  =  (<i>E</i>)-linalool oxide; OC  =  β-ocimene; the different treatments were compared to socks (control); bars capped with asterisks are significantly different from their respective controls as determined by chi square test of proportions in R 2.15.1 software *  = <i>P</i><0.05, **  = <i>P</i><0.01, ***  = <i>P</i><0.001.</p

Energy reserves (sugar, glycogen and lipid content) of female <i>An</i>. <i>gambiae</i> exposed to different nutritional regimes after 7 days.

<p>Bars capped with different letters are significantly different.</p

Total number of each mosquito species/genusof both sexes caught by each type of trap.

<p>Total number of each mosquito species/genusof both sexes caught by each type of trap.</p

Proportions of male and engorged female <i>An. funestus s.l.</i> caught by different odor treatments.

<p>The bars show the proportions of male and engorged (blood-fed + semi-gravid/gravid) female <i>An. funestus s.l.</i>; numbers embedded in the bars are the total of mosquitoes caught by each of the odor treatment; LO  =  (<i>E</i>)-linalool oxide; OC  =  -β-ocimene; the different treatments were compared to socks (control); bars capped with asterisks are significantly different from their respective controls as determined by chi square test of proportions using R 2.15.1 software *  = <i>P</i><0.05, **  = <i>P</i><0.01, ***  = <i>P</i><0.001.</p