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

Görme Yetersizliği Olan Kadınların Üreme Sağlığı Sorunları ve Çözüm Yolları

Görme yetersizliği olan kadınlar, üreme sağlığına yönelik, menstrual siklus, cinsel sağlık, gebelik, doğum şekli, emzirme ve çocuk sahibi olma, aile planlaması, jinekolojik muayene ve yıllık düzenli kontrole gitme sorunlarının yanı sıra sağlık hizmetine erişim, eğitim alma ve bakıma yönelik sorunlar yaşamaktadır. Bu sorunlar ve çözüm yollarına yönelik eğitim ve danışmanlık verilirken optimal düzeyde yarar sağlayabilmek için dokunsal, işitsel materyallerden yararlanılması gerekmektedir. Görme eylemi, bilgi edinmeden sorumludur ve bu organdaki herhangi bir değişiklik, bireyin kapasitesinin azalmasına neden olmaktadır. Sağlık profesyonellerinin görme yetersizliğinin nedenlerini, bireylerin öğrenmelerine olan etkisini bilmeleri, üreme sağlığına yönelik düzenlenecek eğitim planlarının oluşturulmasında yarar sağlayacaktır. Kadınları bilgilendirmek için hazırlanan üreme sağlığına yönelik broşür ve kitapçıkların Braille alfabesi ile yazılması ya da seslendirilmesi görme yetersizliği olan kadınların bilgiye ulaşmalarını kolaylaştırmaktadır. Hemşirelerin görme yetersizliği olan bireylere yaklaşım, eğitim ve danışmanlık verme konularında eğitim alması sağlanmalıdır. Bu derlemenin amacı, bireylerin eğitim/danışmanlık alma şeklini etkileyen görme yetersizliğinin tanımlarına ve nedenlerine dikkat çekerek, kadınların üreme sağlığına yönelik yaşadıkları sorunlar ve çözüm yollarına ilişkin hemşirelerin farkındalığını artırmaktır

Atypical Herpetic Corneal Endothelitis:: A Case Report

Corneal endotheliitis; frequently caused by viruses, is a disorder in which corneal endothelium is the primary site of the inflammation. We discuss a case of atypical herpetic endotheliitis presented with unilateral diffuse corneal edema with no signs of anterior chamber reaction

Patients' and Parents' Perception of Functional Appliances: A Survey Study

WOS: 000414431100001PubMed ID: 30112490Objective: To evaluate patients' and parents' perception of removable, fixed rigid, and fixed hybrid functional appliances and to compare their impacts on anxiety and discomfort during treatment in different age groups and genders. Methods: Data were gathered by means of a questionnaire that included items presumed to be associated with orthodontic compliance. A self-administered questionnaire was used to quantify patients' and parents' perceptions. Three groups were formed regarding the type of functional appliance used: fixed rigid (Functional Mandibular Advancer, FMA), fixed hybrid (Forsus Fatigue Resistant Device, FRD), and removable (Twin Block, TB). Two separate questionnaires were used for the patients and their parents comprising the necessary context. Chi-square, Mann-Whitney U, and Kruskal-Wallis tests were used for data analysis. Results: Patients needed less time to adapt to the FRD appliance. Eating difficulties were encountered by patients in the FMA group. Adolescents who had completed functional orthodontic treatment with a removable appliance had difficulties in controlling their saliva. Patients' and parents' perceptions were found to be in accordance with each other. Conclusion: Adolescents who had completed functional orthodontic treatment with fixed appliances had more difficulty in their daily life. Orthodontists should be aware of this impact caused by functional orthodontic treatment and should regularly encourage patients by reminding them of the improvements to be had by fixing the malocclusion