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

Neurological manifestations of COVID-19 in adults and children

Different neurological manifestations of coronavirus disease 2019 (COVID-19) in adults and children and their impact have not been well characterized. We aimed to determine the prevalence of neurological manifestations and in-hospital complications among hospitalized COVID-19 patients and ascertain differences between adults and children. We conducted a prospective multicentre observational study using the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) cohort across 1507 sites worldwide from 30 January 2020 to 25 May 2021. Analyses of neurological manifestations and neurological complications considered unadjusted prevalence estimates for predefined patient subgroups, and adjusted estimates as a function of patient age and time of hospitalization using generalized linear models. Overall, 161 239 patients (158 267 adults; 2972 children) hospitalized with COVID-19 and assessed for neurological manifestations and complications were included. In adults and children, the most frequent neurological manifestations at admission were fatigue (adults: 37.4%; children: 20.4%), altered consciousness (20.9%; 6.8%), myalgia (16.9%; 7.6%), dysgeusia (7.4%; 1.9%), anosmia (6.0%; 2.2%) and seizure (1.1%; 5.2%). In adults, the most frequent in-hospital neurological complications were stroke (1.5%), seizure (1%) and CNS infection (0.2%). Each occurred more frequently in intensive care unit (ICU) than in non-ICU patients. In children, seizure was the only neurological complication to occur more frequently in ICU versus non-ICU (7.1% versus 2.3%, P < 0.001). Stroke prevalence increased with increasing age, while CNS infection and seizure steadily decreased with age. There was a dramatic decrease in stroke over time during the pandemic. Hypertension, chronic neurological disease and the use of extracorporeal membrane oxygenation were associated with increased risk of stroke. Altered consciousness was associated with CNS infection, seizure and stroke. All in-hospital neurological complications were associated with increased odds of death. The likelihood of death rose with increasing age, especially after 25 years of age. In conclusion, adults and children have different neurological manifestations and in-hospital complications associated with COVID-19. Stroke risk increased with increasing age, while CNS infection and seizure risk decreased with age

Association of FTO protein with hyperandrogenism metabolic disturbances in women with polycystic ovary syndrome

Objective. Polycystic ovary syndrome (PCOS) is one of the commonest endocrinopathies in women characterized by hyperandrogenism, ovulatory dysfunction, and insulin resistance affecting 5–20% of reproductive-aged women worldwide. Recent studies have emphasized the role of the fat mass and obesity-associated (FTO) gene in the development of PCOS, specifically the rs9939609 A/T polymorphism, which is linked to an increased risk of PCOS. The study aimed to investigate the levels of FTO protein and its association with luteinizing hormone (LH), follicle-stimulating hormone (FSH) and anthropometric parameters in patients with PCOS compared to healthy controls

A Study on Management Discretion of Municipal Hospital Managers and its Hindering Factors

This paper aims to quantify the degree of managerial discretion held by business managers and hospital directors in municipal hospitals in India through the concept of managerial discretion and to clarify the factors that inhibit managerial discretion. We conducted a questionnaire survey of municipal hospital managers. First, we ascertained the amount of discretion that municipal hospital managers have concerning various areas of management efficiency. Managers have a great deal of discretion in measures to increase and secure revenues, secure and train doctors and other medical staff, and reduce and control recurring medical expenses. Second, it became clear to what extent the discretion of municipal hospital managers is limited and by which factors. Many managers opined that legal constraints and the medical fee system had a significant impact. Third, there was no significant difference in managerial discretion between the partial and full application of the Local Public Enterprises Law. The multiple regression analysis with other disincentive factors and the presence of total application as explanatory variables, together with the overall size of discretion as the dependent variable, indicated that total application did not affect the overall level of discretion and that negative impacts from heads of department and internal office staff may be significant.</jats:p