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

SUSTAINABILITY REPORTING AND INTEGRATED REPORTING: EVIDENCE FROM TURKISH HIGH PERFORMANCE COMPANIES

Bu çalışma, finansal performans, entegre raporlama (IR) ve sürdürülebilirlik raporlaması (SR)arasındaki ilişkiyi inceleyen daha önceki araştırmaları genişletmektedir. IR ve SR yayınlamaya hazırolmaları bakımından, yüksek performanslı şirketler (HPC), yüksek performanslı olmayan şirketlerle(non-HPC) karşılaştırılmıştır. Örneklem Borsa İstanbul'da (BIST) faaliyet gösteren ve finans sektörüdışında yer alan şirketleri içermektedir. Çalışmanın hipotezi; IR ve SR yapmaya hazır olmalarıbakımından yüksek performanslı şirketlerin yüksek performanslı olmayan şirketlere göre daha öndeolduğu üzerine kuruludur. Örneklemi oluşturan şirketlerin açıklamaları Uluslararası EntegreRaporlama Komitesi (IIRC) ve Küresel Raporlama Girişimi (GRI) standartlarından geliştirilen IR ve SRmatrisi ile değerlendirilmektedir. Bulgular, yüksek performanslı şirketlerin IR ve SR açıklamalarınınyüksek performanslı olmayan şirketlere göre daha fazla olduğunu göstermektedir. Çalışmanınsonuçları önceki çalışmaların sonuçlarını destekler şekilde; HPC şirketler tarafından yapılanaçıklamaların non-HPC şirketler tarafından yapılan açıklamalardan daha iyi olduğunu göstermektedir.: auto; -webkit-text-stroke-width: 0p

Hypokalemic Rhabdomyolysis Induced Acute Renal Failure As a Presentation of Coeliac Disease

Adult coeliac disease commonly presents without classical symptoms as chronic diarrhea and weight loss. We describe the case of a 31-year-old woman with persistent life-threatening hypokalemia, acute renal failure, and acute quadriplegia due to diarrhea that had continued for one month. Although there are cases of coeliac disease diagnosed with hypokalemic rhabdomyolysis in the literature, none of the cases developed acute renal failure. This is the first case in the literature diagnosed with acute renal failure due to hypokalemic rhabdomyolysis as a presentation of coeliac disease. In acute renal failure cases that present with hypokalemic rhabdomyolysis due to severe diarrhea, coeliac disease should be considered as a differential diagnosis despite the negative antigliadin IgA antibody