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

EVALUATION OF ACID HYDROLYSED STARCH DERIVED FROM DIGITARIA IBURUA AS BINDER

  Objective: This research work was aimed at investigating the binding properties of Digitaria iburua starch (DS) and acid hydrolyzed starch or microcrystalline starch (MCS) in the formulation of metronidazole (MET) tablet comparing it with gelatin (GLT) as a standard binder.Methods: DS was obtained from steeping the D. iburua grains in water. MCS was produced using 6 N HCl at 50°C for 24 hrs. The dilution potential test was conducted. MET granules of binder concentrations (2.5, 5.0, 7.5, 10.0 and 12.5% w/v) of DS and MCS was prepared by wet granulation method and compared with GLT. The granules flow properties were evaluated. The particle size distribution of the granules was determined. The quality of tablets was assessed by standard methods.Results: A yield of 62.88% w/w DS was obtained whereas MCS was found to be 85.14% w/w. The MCS was unable to bind MET at all ratios. The granules had good flow and compressible properties and are uniformly distributed. The crushing strength (CS) of the binder types is ranked: GLT>MCS>DS. The friability (FR) values decreased with increase in binder concentration for all binder types. Only FR at 12.5% w/v of MCS and GLT was <1%. The disintegration time (DT) increased with increase in binder concentration. The (CS/FR)/DT values of DS and MCS obtained >2.Conclusion: The Carr's index, Hausner's ratio and (CS/FR)/DT values suggests that DS and MCS are poor binders.Keywords: Acid hydrolyzed starch, Excipients, Digitaria iburua, Metronidazole.Â

Climate Change Vulnerability Assessment: an Evaluation of Social Dimension

Climate change vulnerability is the function of exposure, sensitivity, and adaptive capacity of its natural and socioeconomic systems. Following spatial “scale” of the assessment, administrative-territorial units were selected for this study. A field survey questionnaire was used to collect data for the study based on the sample size of 500 questionnaires that was administered to household heads in the study area. In the questionnaire, questions were designed to give respondents the opportunity to choose from several alternatives given in the instrument while descriptive statistics was for the analysis of data. Descriptive statistics analysis based on mean ranking was carried out to identify the level of peoples' vulnerability to climate change in the study area. The exposure assessment was based on the response analysis of baseline information. The sensitivity assessment for the study was analyzed by using physiographical and socioeconomic characteristics, described by a set of specific indicators and responses of the residents. The adaptive capacity was captured by general economic and agricultural indicators, taking into consideration the major occupation the predominant lifestyle of the residents. Through a ranking approach, the relative vulnerability of each ATU was calculated by summing its sensitivity and adaptive capacity ranks; the latter were obtained as combinations of their primary indicator ranks, arranged in an increasing and decreasing order, respectively. The major climate change exposure pathway in the study area were reduction in green environment, decrease in total annual rainfall, warmer weather, early cessation of rainfall, late on-set of rainfall and shrinkage of water bodies. The major sensitivity to climate change was decrease in crop yield, whereas increase in cost of food crops, drought incidents, famine, poverty, indiscriminate falling down of trees and disaster. It was also established that the major adaptive strategies to climate change in the study area were irrigation farming, use of organic manure, planting of drought tolerant varieties and early planting