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

DESIGN OF ELECTROMAGNETIC ABSORBERS WITH RIGHT-HANDED AND LEFT-HANDED MATERIALS USING PARTICLE SWARM OPTIMIZATION

In this study, ‘Electromagnetic Absorbing Structures’ have been designed using right-handed ( ) and left-handed ( ) materials. The aim of designing these structures is to decrease target’s radar detectability within the range of 8 GHz and 12 GHz by minimizing its reflection coefficient. Various materials with thicknesses ranging between 0.01 mm and 2 mm are considered for the design of the absorbers whose layer number is varying between 1 and 15. Results obtained by optimizing the error function formed by taking into account of polarization (perpendicular and parallel) frequency and angle of incidence are presented and compared. Among evolutionary optimization techniques, ‘Particle Swarm Optimization (PSO)’ is used in order to obtain thin structures with low reflection coefficients. For this purpose, a computer program including a user interface has been developed using MATLAB software

The prognostic importance of double-expressor subgroup and AID, UNG and mismatch repair protein expressions in diffuse large B-cell lymphomas

Objective: The cases of diffuse large B-cell lymphoma, (DLBCL not otherwise specified (NOS)) which immunohistochemically exhibit MYC and BCL2 expressions arc defined as double-expressor lymphomas (DELs). This study aimed to assess the prognostic impact of DEL and the expressions of other proteins that may have role in tumorogenesis. Materials and Methods: In this study, 90 tumor samples from patients diagnosed with DLBCL NOS were evaluated retrospectively. Immunoexpressions of MYC, BCL2, activation-induced cytidine deaminase (AID), uracil-DNA glycosylase (UNG) and DNA mismatch repair proteins including MLH1, MSH2, MSH6 and PMS2 were analyzed. Result: Eleven cases (12.2%) which exhibited >= 40% MYC and >= 50% BCL2 immunexpressions were classified as DEL DLBCL. Patients with MYC positivity displayed lower overall survival rate than MYC negative cases. A trend of lower overall survival was observed in the double-expressor lymphoma group, however, this was not proven to be statistically significant. Significant relationship between AID, UNG and p53 immunexpressions with double-expressor lymphoma or overall survival was not detected. The correlation between immunexpressions of p53 and MYC was observed. 'I'he loss of expression of mismatch repair proteins was not observed in any cases. Conclusion: In this study, a relationship between low overall survival and MYC expression is detected. However, our result does not demonstrate that double-expressor lymphoma can be associated with poor outcomes

The prognostic importance of double-expressor subgroup and AID , UNG and mismatch repair protein expressions in diffuse large B-cell lymphomas

Objective: The cases of diffuse large B-cell lymphoma, (DLBCL not otherwise specified (NOS)) which immunohistochemically exhibit MYC and BCL2 expressions arc defined as double-expressor lymphomas (DELs). This study aimed to assess the prognostic impact of DEL and the expressions of other proteins that may have role in tumorogenesis

The prognostic importance of double-expressor subgroup and AID, UNG and mismatch repair protein expressions in diffuse large B-cell lymphomas

Objective: The cases of diffuse large B-cell lymphoma, (DLBCL not otherwise specified (NOS)) which immunohistochemically exhibit MYC and BCL2 expressions arc defined as double-expressor lymphomas (DELs). This study aimed to assess the prognostic impact of DEL and the expressions of other proteins that may have role in tumorogenesis