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

Investigation of helium isotope variations of alkaline volcanic rocks In Osmaniye Region Turkey

The noble gases, in particular helium isotopes, provide valuable information on the mantle source of recentbasaltic volcanism, especially when linked to trace elements and radiogenic isotopes. Although the alkalinevolcanics in the Kütahya region have been studied in detail by several works by means of trace element variations,radiogenic dating and isotope systematics, noble gas isotope compositions that could significantly contribute todynamics of volcanism have not been investigated yet. In this study which aims to fill the deficiency of such data,helium isotope compositions of olivine-basalts in Kütahya region are measured.In this study we report helium isotope compositions of olivine from basalts. In olivine-basalts in alkalinevolcanic rocks from the Kütahya region, western Turkey, are investigated. 3He/4He range from 3.0 to 5.19 Ra.These low helium isotope values are most probably indicative of a lithospheric mantle source. Kütahya alkalinevolcanics are enriched in incompatible elements and show prominent negative Ti, Nd and Ta anomaly. Primitivemantle normalized trace element concentration patterns clearly display continental crustal contamination.Chemical compositions and helium isotope systematics imply contribution of a lithospheric mantle source andcontamination of continental crust in the genesis of the Kütahya alkaline lava

Study of Effect of Ebru Training on the Developmental Areas of Children Aged Under Five

AbstractThe study aims at determining the development areas and the effect of ebru art training on the development areas of children aged under five attending kindergartens of elementary schools. The study domain consisted of children aged under five with normal development, who attended kindergartens of elementary schools of Ministry of National Education in the central distinct of Ankara. Two kindergarten classes of elementary schools that were determined as not having any art training were included into the study from among the schools of Ministry of National Education in the central district of Ankara. Test and control groups were determined by random sampling from the kindergarten classes. Experimental pattern with pre-test and post-test control was used in the study. Information on children and families participating in the study was collected from the school records and with the used “Family Information Form” developed by the author. “Brigance Early Preschool Screen II”, which was adapted to Turkish by Aral et al. (2008), was used to determine the development level of children. Art of ebru training program was prepared specifically for the development characteristics of children aged under five in the study. Prior to application of the training program, Brigance Early Preschool Screen II was applied as pre-test on the test and control groups. Art of ebru training was given to children in the test group for a period of approximately one hour per day for ten weeks with education provided within the framework of the preschool education program of the Ministry of National Education during the remaining education time. Children in the control group continued the preschool education program of the Ministry of National Education. Brigance Early Preschool Screen II was applied as the post-test on the test and control groups after the education program. At the end of this research, it has been determined that group x common effect of scores which are gotten from Brigance Early Development Inventory II Receptive and Expressive Language Development Sub-dimension is significant (p<.05). However, group x common effect gotten from total score and scores obtained from other sub-dimensions of Brigance Early Development Inventory II is not significant (p>.05)

Integration of structural, hydrogeological and thermal remote sensing data for the determination of geothermal capacity A case study of the Edremit (Balıkesir) Basin

Basins formed on active strike-slip faults are important prospect areas for geothermal energy exploration since the crust gets thinner in these areas and tectonic structures provide favorable conditions for heat-fluid circulation and transport. The Edremit (Balıkesir) Basin holds a great promise for the discovery of new geothermal energy sources. The objective of the recent study is to evaluate the geothermal capacity of the Edremit Basin utilizing tectonic, geological, and hydrogeological studies, combining remote sensing (land surface temperature-LST, hydrothermal alteration, and multi-temporal InSAR (MT-InSAR) assessments). We present structural literature data and the results of field mapping, which revealed the geometry, kinematics, and dynamics of structural features, geological units as geothermal system components, thermal and cold water chemistry, and thermal infrared remote sensing analysis. For the purpose of assessing new targets and recent geothermal capacity, these data are combined and evaluated. According to the outcomes of the study, the fault pattern in the Edremit Basin is generated by N-S extension, which produced E-W dominant striking normal faults with a heritage of paleostructures oriented in various directions. According to remote sensing analyses, the primary LST regions in the basin are defined by the active faults. Therefore, a high sodium sulfate ratio recorded in the chemical analyses of the water samples indicates a deep circulation and high possibility for the presence of thermal water. Consequently, our findings are consistent with the work to include thorough field geology surveys, structural patterns, LST, and water chemistry to refined exploration process