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

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Prevalence and patterns of psychiatric disorders in referred adolescents with Internet addiction

Aim: To investigate prevalence and patterns of psychiatric disorders in young subjects with Internet addiction (IA)

Change in serum concentrations of interleukin-2 and interferon-gamma during treatment of tuberculosis

We aimed to investigate changes in serum concentrations of the cytokines interleukin (IL)-2 and interferon (IFN)-gamma during the clinical course of active tuberculosis, to establish the presence of cellular immunity before and after treatment. Blood samples were taken from 18 patients with active tuberculosis before and 2 months after therapy; IL-2 and IFN-gamma concentrations were evaluated. The mean serum IL-2 concentration before therapy was 164.5 pg/ml (range 12 - 980 pg/ml) and the concentration 2 months after therapy was 92.11 pg/ml (range 1 - 490 pg/ml). The mean serum IFN-gamma concentrations were 10.83 pg/ml (range 1 - 22.2 pg/ml) and 4.64 pg/ml (range 1 - 28.5 pg/ml), respectively. The decrease in concentrations of both cytokines after therapy was statistically significant. Further studies investigating the benefits of adding cytokines to drug treatment for tuberculosis are needed

Change in Serum Concentrations of Interleukin-2 and Interferon-γ during Treatment of Tuberculosis

We aimed to investigate changes in serum concentrations of the cytokines interleukin (IL)-2 and interferon (IFN)-gamma during the clinical course of active tuberculosis, to establish the presence of cellular immunity before and after treatment. Blood samples were taken from 18 patients with active tuberculosis before and 2 months after therapy; IL-2 and IFN-gamma concentrations were evaluated. The mean serum IL-2 concentration before therapy was 164.5 pg/ml (range 12 - 980 pg/ml) and the concentration 2 months after therapy was 92.11 pg/ml (range 1 - 490 pg/ml). The mean serum IFN-gamma concentrations were 10.83 pg/ml (range 1 - 22.2 pg/ml) and 4.64 pg/ml (range 1 - 28.5 pg/ml), respectively. The decrease in concentrations of both cytokines after therapy was statistically significant. Further studies investigating the benefits of adding cytokines to drug treatment for tuberculosis are needed

Sağlık yüksekokulunda öğrenim gören bir grup öğrencinin organ nakli/bağışına yönelik görüşleri ve bilgi düzeylerine eğitimin etkisi

AMAÇ: Bu çalışma, sağlık yüksekokulunda öğrenim gören bir grup öğrencinin organ nakli /bağışına yönelik görüşleri ve bilgi düzeylerine eğitimin etkisini belirlemek amacıyla tanımlayıcı olarak yapılmıştır YÖNTEM: Çalışmanın evrenini, Denizli Sağlık Yüksekokulu Hemşirelik ve Sağlık Memurluğu bölümü ikinci sınıfta öğrenim gören 65 öğrenci oluşturmuştur. Örnekleme tüm evren alınmıştır. Öğrencilerin %81,5'i (n=53) anket formlarını yanıtlamıştır. Araştırmanın verileri, araştırmacılar tarafından hazırlanan anket formu aracılığıyla Mayıs 2007'de toplanmıştır. Verilerin değerlendirilmesinde, sayı, yüzdelik hesaplamalar, bağımlı gruplarda t-testi kullanılmıştır. BULGULAR: Araştırma kapsamına alman öğrencilerin eğitim öncesi ve sonrası ile organ bağışı/nakline yönelik görüşlerinin değerlendirilmesi arasında istatistiksel olarak anlamlı farklılık saptanmıştır (p0,05). Eğitim öncesi öğrencilerin %75,5'i organ bağışı hakkında bilgisinin olduğunu ve %64,2'si bağış yapabileceğini ifade ederken, eğitim sonrası %92,5'inin bilgisinin olduğu ve %71,7'sinin organ bağışı yaparım dediği saptanmıştır. Eğitim öncesi 30,69±5,43 olan bilgi düzeyi puan ortalaması, eğitim sonrası 34,03±4,99'a yükselmiştir. SONUÇ: Sonuç olarak öğrencilerinin organ bağışı ve nakline yönelik görüş ve bilgi durumlarında verilen eğitimin etkili olduğu görülmüştür. Bu nedenle topluma önderlik edecek olan sağlık çalışanlarının eğitim öğretim aşamasında organ bağışı ve nakline yönelik yeterli bilgiye sahip olabilmeleri için ders müfredatlarında bu konuların yer almasının faydalı olacağı düşünülmektedir