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

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Rate of subscription and after-market volatility in Hong Kong IPOs

The majority of the empirical literature on initial public offerings (IPOs) concentrates on the impact of newly listed companies' characteristics on the initial return. It is implicitly assumed that investors act only in accordance with the information they have collected before the application deadline and that the market reaction towards the public listing of a new offering will only be known on the first day of trading. Using data from a large sample of IPOs in Hong Kong, the study shows that an offering's rate of subscription contains important information of its own. Namely, it is demonstrated that the well-known relationship between initial returns and the ex-post volatility of returns actually is spurious, volatility being associated with the unpredicted component of the subscription rate.

The short-run price performance of initial public offerings in Hong Kong: new evidence

The study examines the first day returns of over 480 initial public offerings (IPO) in Hong Kong during a 12-year period (1994–2005). Based on this set of observations the study builds a comprehensive model of the short-term price performance of new offerings, in the light of the existing theoretical hypotheses about IPO underpricing. Results show clear evidence of the signaling effect of underwriters' reputation. For a set of different conditions and time periods examined, the most sought after underwriters are consistently associated with less underpriced offerings. In addition, the study shows that offerings underwritten by two or more underwriters tend to be less underpriced and that underpricing may be a signal in its own right. The study also shows that the informed demand hypothesis of Rock (1986) is supported only where some specific circumstances are verified. Finally, results confirm the recent trend (in Hong Kong) towards a less aggressive underpricing

An empirical extension of Rock's IPO underpricing model to three distinct groups of investors

This article examines earned returns and allocation details of more than 200 new offerings (Initial Public Offering, IPO) from companies that went public in Hong Kong during the period 1988 to 1995. Three distinct groups of investors are identified, each exhibiting a particular type of return's pattern. Each pattern seems to correspond to a specific level of information. This finding is of particular interest as it shows the level of return that an investor can expect from IPO investments, also being an extension of previous studies where, following Rock (1986), two, not three, groups of investors are identified. This article also finds that expected returns from IPOs remain positive and highly significant after adjusting for the allocation bias. With the exception of the smallest application sizes, results are invariant to adjustments such as transaction costs and the risk-free rate of return.

An examination of IPO underpricing in the growth enterprise market of Hong Kong

This study examines the first-day returns of initial public offerings listed on the Growth Enterprise Market (GEM) of Hong Kong from its inception until the year of 2005. Results show that GEM, operating under a relaxed set of listing requirements, exhibits a higher underpricing level than that of the Main Board. Such a higher level can be explained by the ex-post volatility of after-market returns, the timing effects and the geographic location (i.e. 'H' SHARES). Both the reputation of underwriters and the signalling role of underpricing show no effect on initial excess returns.

Varför undviker konsumenter vissa varumärken? : En studie om varumärkesundvikning inom den svenska kosmetikindustrin

Background - As of today, the positive forms of consumer-brand relationships have been intensively researched, whereas its counterpart has attained far less attention. Whilst current literature is focused on increasing positive brand equity, the knowledge of negative brand equity is sparse. When the brand-consumer relationship is negatively affected and the brand equity is unfavourable, rejection of a specific brand, namely brand avoidance might occur. This may affect companies negatively if not managed properly. Therefore, brand avoidance is a phenomenon demanding further research. Purpose - The purpose of this study is to investigate, and gain a deeper understanding of the underlying reasons of why consumers engage in brand avoidance within the Swedish cosmetics industry for women.  Method – In this cross-sectional study with an underlying qualitative and abductive research approach, semi-structured interviews were conducted utilising a convenience sampling approach that also incorporated characteristics of snowball sampling. The participants, 18 Swedish female cosmetics consumers, were interviewed face-to-face or over Skype. Findings - This study has validated the main drivers of brand avoidance: Experience-, Identity-, Moral-, Deficit-Value- and Advertising. Furthermore, it confirmed that the reasons for engaging in brand avoidance could be intertwined and are highly individual, making it nearly impossible to generalise. Moreover, four new factors behind brand avoidance were found: Product Attributes, Employee-Brand Relationship, Ethical Concerns and Negative WoM. Lastly, the motive Food Favoritism was found to apply not only to food products, but also to cosmetic products. Finally, the findings resulted in a modified framework of factors behind brand avoidance

The short-run price performance of initial public offerings in Hong Kong: New evidence

The study examines the first day returns of over 480 initial public offerings (IPO) in Hong Kong during a 12-year period (1994-2005). Based on this set of observations the study builds a comprehensive model of the short-term price performance of new offerings, in the light of the existing theoretical hypotheses about IPO underpricing. Results show clear evidence of the signaling effect of underwriters' reputation. For a set of different conditions and time periods examined, the most sought after underwriters are consistently associated with less underpriced offerings. In addition, the study shows that offerings underwritten by two or more underwriters tend to be less underpriced and that underpricing may be a signal in its own right. The study also shows that the informed demand hypothesis of Rock (1986) is supported only where some specific circumstances are verified. Finally, results confirm the recent trend (in Hong Kong) towards a less aggressive underpricing.Ex-ante uncertainty Initial public offerings Subscription rate Underpricing Underwriters' reputation

Venture capitalist participation and the performance of Chinese IPOs

We examine the effects of venture capitalist participation in IPOs in China and find that VC-backed firms are more underpriced than non-VC firms. Both VC-backed and non-VC-backed IPOs experience long-run underperformance; however, VC-backed IPOs perform significantly better. The higher level of underpricing and cost of going public for the VC-backed firms are consistent with the monitoring role of the VC. Finally, the fact that VC reputation is associated with lower underpricing is consistent with the reputational capital theory, which asserts that reput

RelB-deficient autoinflammatory pathology presents as interferonopathy, but in mice is interferon-independent.

BACKGROUND: Autoimmune diseases are leading causes of ill health and morbidity and have diverse etiology. Two signaling pathways are key drivers of autoimmune pathology, interferon and nuclear factor-κB (NF-κB)/RelA, defining the 2 broad labels of interferonopathies and relopathies. Prior work has established that genetic loss of function of the NF-κB subunit RelB leads to autoimmune and inflammatory pathology in mice and humans. OBJECTIVE: We sought to characterize RelB-deficient autoimmunity by unbiased profiling of the responses of immune sentinel cells to stimulus and to determine the functional role of dysregulated gene programs in the RelB-deficient pathology. METHODS: Transcriptomic profiling was performed on fibroblasts and dendritic cells derived from patients with RelB deficiency and knockout mice, and transcriptomic responses and pathology were assessed in mice deficient in both RelB and the type I interferon receptor. RESULTS: We found that loss of RelB in patient-derived fibroblasts and mouse myeloid cells results in elevated induction of hundreds of interferon-stimulated genes. Removing hyperexpression of the interferon-stimulated gene program did not ameliorate the autoimmune pathology of RelB knockout mice. Instead, we found that RelB suppresses a different set of inflammatory response genes in a manner that is independent of interferon signaling but associated with NF-κB binding motifs. CONCLUSION: Although transcriptomic profiling would describe RelB-deficient autoimmune disease as an interferonopathy, the genetic evidence indicates that the pathology in mice is interferon-independent