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

Hamburger ekmeği yapımında değişik düzeylerde bitkisel katı yağ ile birlikte mono ve digliseridlerin diasetil tartarik asit esterleri (Datem) kullanılmasının ekmek nitelikleri üzerindeki etkileri

TEZ3375Tez (Yüksek Lisans) -- Çukurova Üniversitesi, Adana, 1999.Kaynakça (s. 30-35) var.vii, 40 s. ; 30 cm.

Effect of different forms of buckwheat addition on the physicochemical and sensory properties of bread

This study aimed to obtain buckwheat bread by adding whole buckwheat to the white bread formulation in groat and flour form. The addition was made in different proportions (0, 10, 20, and 30%) according to the principle of substitution. Buckwheat addition, as groat, increased the bread's hardness to a great extent. Moisture analysis results indicated that the buckwheat additive can increase the water-holding capacity and may extend the shelf life, especially in flour form. The samples' antioxidant activities and phenolic content significantly increased when the addition was made as flour. All buckwheat-added samples had lower volume values than control samples. Buckwheat addition caused an increase in volatile components such as phenylethanol and benzylalcohol. As a result of sensory analysis, using buckwheat as flour and groat positively affected breadmaking. Considering the samples' nutritional and sensory properties, the combination in which 20% buckwheat flour is added to the white bread formulation is the most appropriate use

Efficacy of Modified Yeast Extract and HSCAS Containing Mycotoxin Adsorbent on Ruminal Binding Characteristics of Various Aflatoxins

The objective of this experiment was to determine the ruminal binding characteristics of modified S. cerevisiae extract and hydrated sodium calcium aluminosilicate (HSCAS) containing mycotoxin adsorbent (MA) against various aflatoxins in an in vitro study. A certified aflatoxin mixture (B1, G1, B2, G2) in a liquid form was mixed with ruminal in vitro medium providing the final concentrations of 6 ng/ml aflatoxin B1 (AFB1), 6 ng/ml aflatoxin G1 (AFG1), 1.5 ng/ml aflatoxin B2 (AFB2), and 1.5 ng/ml aflatoxin G2 (AFG2). Treatments were: 1) aflatoxin mixture + distilled water (Control); 2) aflatoxin mixture + rumen fluid (AR); and 3) aflatoxin mixture + MA (6 mg) + rumen fluid (AMAR). After various incubation time points (0, 3, 6, 12, 24 h) at 39 C, aflatoxin concentrations in ruminal medium were detected with HPLC. Although AFB1 concentration at 0 h was 6 ng/ml, it was reduced to 2.50 and 1.68 ng/ml in Control, 0.86 and 0.50 ng/ml in AR, and 0.34 and 0.20 ng/ml in AMAR treatments at 3 and 12 h, respectively (P<0.001). In addition, AFB1 concentration in AMAR treatment was in a steady-state condition after 3 h of incubation compared to Control and AR treatments where AFB1 concentration became stabilized after 12 h of incubation. A similar type of binding pattern was also observed for AMAR treatment in ruminal incubation of AFB2. In addition, the concentrations of both AFG1 and AFG2 were in a steady-state condition for AR (0.67 and 0.48 ng/ml) and AMAR (0.46 and 0.38 ng/ml) treatments after 12 h of ruminal incubation. The binding capability of the MA on AFG1 and AFG2 was always in favor of AMAR treatment at all time points. There was no treatment effect on ruminal in vitro gas production across all treatments, averaging 53.5 ml at 24 h. Results indicate that the MA can help binding the studied aflatoxins and reducing their concentrations in the rumen before they enter into the bloodstream

Efficacy of modified yeast extract and HSCAS containing mycotoxin adsorbent on ruminal binding characteristics of various aflatoxins Modifiye maya ekstraktı ve HSCAS i̇çeren mikotoksin baǧlayıcının rumende aflatoksinleri baǧlama etkinliǧi

The objective of this experiment was to determine the ruminal binding characteristics of modified S. cerevisiae extract and hydrated sodium calcium aluminosilicate (HSCAS) containing mycotoxin adsorbent (MA) against various aflatoxins in an in vitro study. A certified aflatoxin mixture (B1, G1, B2, G2) in a liquid form was mixed with ruminal in vitro medium providing the final concentrations of 6 ng/ml aflatoxin B1 (AFB1), 6 ng/ml aflatoxin G1 (AFG1), 1.5 ng/ml aflatoxin B2 (AFB2), and 1.5 ng/ml aflatoxin G2 (AFG2). Treatments were: 1) aflatoxin mixture + distilled water (Control); 2) aflatoxin mixture + rumen fluid (AR); and 3) aflatoxin mixture + MA (6 mg) + rumen fluid (AMAR). After various incubation time points (0, 3, 6, 12, 24 h) at 39°C, aflatoxin concentrations in ruminal medium were detected with HPLC. Although AFB1 concentration at 0 h was 6 ng/ml, it was reduced to 2.50 and 1.68 ng/ml in Control, 0.86 and 0.50 ng/ml in AR, and 0.34 and 0.20 ng/ml in AMAR treatments at 3 and 12 h, respectively (P<0.001). In addition, AFB1 concentration in AMAR treatment was in a steady-state condition after 3 h of incubation compared to Control and AR treatments where AFB1 concentration became stabilized after 12 h of incubation. A similar type of binding pattern was also observed for AMAR treatment in ruminal incubation of AFB2. In addition, the concentrations of both AFG1 and AFG2 were in a steady-state condition for AR (0.67 and 0.48 ng/ml) and AMAR (0.46 and 0.38 ng/ml) treatments after 12 h of ruminal incubation. The binding capability of the MA on AFG1 and AFG2 was always in favor of AMAR treatment at all time points. There was no treatment effect on ruminal in vitro gas production across all treatments, averaging 53.5 ml at 24 h. Results indicate that the MA can help binding the studied aflatoxins and reducing their concentrations in the rumen before they enter into the bloodstream

Comparison of Yield, Nutritive Value, and In Vitro Digestibility of Monocrop and Intercropped CornSoybean Silages Cut at Two Maturity Stages

Limited information on nutrient composition and in vitro digestibility of corn-soybean intercropped silage is available. The objective of this study was to compare corn (Zea mays L.) or soybean (Glycine max L. Yesilsoy) monocrop silage with corn-soybean intercropped silages in term of yield, nutritive value, and in vitro digestibility. Intercropping was as follows: 1 row corn to 1 row soybean (1M1S), 1 row corn to 2 rows soybean (1M2S) and 2 rows corn to 1 row soybean (2M1S). The crops were harvested when the corn reached 3/5 or 1/4 milk line. The silage samples were analysed for pH, dry matter (DM), crude protein (CP), ether extract (EE), neutral (NDF) and acid detergent fibre (ADF), calcium, potassium, magnesium and phosphorus. Also, in vitro true (IVTD) and in vitro NDF (IVNFD) digestibilities were determined in the silages samples. The DM, EE, calculated non structural carbohydrate values were higher in silage harvested at 1/4 than 3/5 milk line. All intercropped silages had higher CP values (1M1S, 8.3%; 1M2S, 10.1%; 2M1S, 8.0%) than the monocrop corn (SM, 6.8%) silage. The NDF and ADF levels were higher for 1M1S, 2M1S and SM compared with 1M2S and monocrop soybean (SS) silage. In vitro true DM digestibility of all silages increased with maturity stage; it was higher for the 1M2S than other silages. It is concluded that corn-soybean intercropped silage has better nutrient composition and digestibility than SM or SS silage

The Silage Characteristics of Legume, grasses and Mixtures of Siled with Lactobacillus Buchneri

Araştırma, Lactobacillus)buncheri bakteri inokulantın değişik yem bitkisi tür ve karışımlarından hazırlanan silajların kimyasal komposizyonları ile silaj kalitesi üzerine etkisini belirlemek amacıyla yürütülmüştür. Araştırmada yonca, ak üçgül, adi fiğ, soya fasulyesi, nohut, İngiliz çimi, buğday, tritikale, yulaf ve hardalın saf silajlarının yanı sıra; adi fiğin yulaf, tritikale, buğay karışımları, yoncaIbuğday ve İngiliz çimiIak üçgülün karışımlarında elde edilmiş 15 farklı karışım ile Lactobacillus)buncheri inokulantının 5x105 CFU/g/yaş materyal dozu, araştırmada materyal olarak kullanılmıştır. Silaj materyali üzerinde ham protein oranı (HPO), nötr detergant lif (NDF), asit deterjan lif (ADF), pH, sindirilebilir kuru madde oranı (SKMO), nispi yem değeri(NYD) gibi özellikler incelenmiştir. İncelenen tüm özelliklerde tür ve karışım ile inokulant uygulaması interaksiyonları istatistikî olarak önemli bulunmuştur. Ayrıca, inokulant uygulaması incelenen tüm özellikler üzerine istatistiksel olarak önemli etkide bulunmuştur. Asetik asit üreten L.) buchneriinokulant uygulaması, tür ve karışımların silaj ve yem kalite özelliklerinden HP oranı, SKM ve NYD ve ortalamalarını düşürdüğü; NDF, ADF ve pH ortalamalarını yükselttiği ve sonuç olarak silaj kalitesi üzerine olumlu etkide bulunmadığı saptanmıştır. Ayrıca, hardalın yüksek HP, SKM, NYD ve düşük NDF ve ADF değeri ile yem amaçlı olarak silajı yapılabilir ve rasyonlara belli oranlarda kullanılabileceği de saptanmıştır.The research was carried out to determine the effect of bacterial inoculant (Lactobacillus)buncheri) on the chemical composition and the quality of the silages prepared from different forage crops and their mixtures. Sole silage of alfalfa, white clover, common vetch, soybean, chickpea, perinnal rygrass, wheat, triticale, oat and wild mustard, furthermore 15 different silageItype obtained from different proportions mixture such as (vetch 50%Itritikale 50%, vetch 50%Iwheat 50%, vetch 50%Ioat 50%, perinnel rygrass 60%Iwhite clover 40%, alfalfa 50%Iwheat50%) and Lactobacillus)buncheri doses of 5x105 CFU/g/fresh material were used as matarials in the research. The following measurment were recorded on silage materials: Crude protein ratio (CPR), neutral detergen fiber (NDF), acid detergant fiber (ADF), pH, degistieble dry matter ratio (DDMR) and relative feed value (RFV). Interaction of the spices, their mixtures and application of the inoculant in all examined traits were found statistically significant. Furthermore, all examined traits were statistically significantly influenced by application of the inoculant. Application of L. buncheri inoculant producing acetic acid decreased (CP ratio, DDMR and RFV) the silage and forage quality features, but increased NDF, ADF and pH ratioIas a result, it was determined that these application had a positive effect on the quality of the silage. Also, It was determined that wild mustard (Sinapsis) arvensis) may be used as a forage crop to make silage or added certain amount in rations due to contein high CPR, DDMR, RFV and low ratio NDF and ADF

The influence of sowing dates on the oil content and fatty acid composition of standard, mid-oleic and high-oleic types of sunflower (Helianthus annuus L.)

Abstract This study aimed to determine the oil ratios and fatty acid compositions of sunflowers grown in the warm climate of the Çukurova region at different sowing dates. It was found that the crude fat ratios of standard, mid-oleic and high-oleic sunflower types were 42.57%, 39.35% and 39.07%, respectively. Crude oil ratios of high-oleic and mid-oleic sunflower types were significantly decreased (p<0.05) at SD4 (sowing date 4, May 30th). The oleic acid contents in standard, mid-oleic and high-oleic sunflower types were found to be 60.08%, 74.35% and 88.1%, respectively. The oleic acid ratios of standard sunflower types were determined to be significantly lower at SD1 (April 15th) (p<0.05). The results show that it is more appropriate to sow the sunflowers between SD1 and SD2 (15 April to 30 April) in terms of producing the required oil and oleic acid contents. Also, both oil ratios and fatty acid compositions can change according to the sowing dates