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

Non-destructive investigation on the effect of precipitation hardening on impact toughness of 7020 Al-Zn-Mg alloy

The aim of the study is to investigate the effect of precipitation hardening on the impact toughness of Al-Zn-Mg alloys, and to search for the relationship between sound velocity, electrical conductivity, and impact toughness in order to provide a rapid and non-destructive measurement of toughness. The specimens of 7020 alloy were solution treated at 723 K for 1 h and quenched, then, following a 96 h natural ageing at room temperature, artificially aged at 413 K for various times. For each specimen group, Charpy impact and hardness tests were performed, sound velocity and electrical conductivity was measured at room temperature. The results show that impact toughness decreases with increasing ageing time for the conditions from under-aged to peak aged, and the lowest toughness was obtained for the sample having highest hardness. The reason of the toughness reduction is thought to be the formation of metastable eta' precipitate during ageing. Improvement in hardness and yield strength by precipitation result in a reduction in the impact energy since less plastic work is done before the strain in the plastic zone is sufficient to fracture the test specimen. A correlation between impact toughness, hardness, sound velocity, and electrical conductivity of the aged specimens has been established

Utilization of Non-destructive Methods for Determining the Effect of Age-Hardening on Impact Toughness of 2024 Al-Cu-Mg Alloy

The aim of the study is to investigate the correlation between non-destructive measurements and impact toughness of 2024 Al-alloy. Following the solutionizing at 493 degrees C/1 h and water quench, the samples were aged at 190 degrees C for various periods between 0.5 h and 18 h. Hardness, impact toughness, sound velocity, and electrical conductivity were measured for each specimen group, and fracture surfaces were investigated by SEM. To focus on only the effect of precipitation, the process variables were minimized by preparing the samples from the same batch, and applying the identical procedure for solution heat treatment and quenching. Any cold deformation prior to aging of the samples was not applied. It has been concluded that sound velocity and electrical conductivity measurements are promising for the determination of variations in the impact toughness of the precipitation hardened 2024 Al-alloy

The Synthesis of Novel Mono(alkoxy)-, Tris(thio)- and Tetrakis(thio)-Substituted Quinones from the Reactions of p-Chloranil with Various S-Nucleophiles

The tetrakis(thio)-substituted-1,4-benzoquinone products 4a-e, 6, 7 and the mono(alkoxy)-tris(thio)-substituted-1,4- products 5a-e zinc 8a-e were synthesized from the reactions of p-chloranil with some thiols and mixture of two different thiol compounds in alchol in the presence of Na(2)CO(3) at room temperature. The structures of the novel S,S,S,S- and S,S,S,O-substituted products, which were obtained by the reactions of p-chloranil as a starting compound with n-propanethiol, n-pentanethiol, n-decanethiol, n-dodecanethiol, 2-methyl-2-propanethiol, and mixture of n-decanethiol and n-cyclohexanethiol as S-nucleophiles, were characterized by spectroscopic methods

Hyperosmolar hyperglycaemic nonketotic coma associated with acute myocardial infarction: report of three cases

Diabetes mellitus is one of the most commonly associated diseases of patients suffering an acute myocardial infarction. Although the coexistence of acute myocardial infarction with other clinical manifestations of diabetes have been well described, extremely few data exists about the concomitant occurrence of hyperosmolar hyperglycaemic nonketotic coma and myocardial infarctions. This article presents three patients with this association and aimed to discuss the clinical course and treatment strategies of this rare condition

Management of a patient with active rheumatoid arthritis and suspected tuberculosis causing effusive-constrictive pericarditis

In the following case report we present a patient who has been admitted for pericardial effusion causing cardiac compression with active rheumatoid arthritis and suspected tuberculosis. The patient was successfully treated with intravenous pulse steroid for active rheumatoid arthritis, with prophylactic anti-tuberculosis agents for suspected tuberculosis and with surgical pericardiectomy for the thickened pericardium as well as recurrent pericardial effusion. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved

Biomonitoring of heavy metals by Pseudevernia furfuracea (L.) Zopf in Ankara (Turkey)

The objective of this study was to determine the air pollution level of Ankara and to generate the air pollution map of this city by using Pseudevernia furfuracea (L.) Zopf as a biomonitor. Lichen samples were collected from unpolluted area at Yaprakli Mountains, Cankiri in November 2002 and transplanted to 27 localities in Ankara. Lichen samples were retrieved following an exposure of 3 and 6 months. Heavy metal, Cu, Mn, Ni, Pb and Zn, contents were determined by using inductively coupled plasma spectrometry (ICP). The chlorophyll a and b contents were determined by using DMSO method. The increase in Ni, Pb, Zn and chlorophyll a content of the specimens were statistically important. All the increases and decreases in the variables could be explained by the environmental stress like pollution, but it is hard to say that this is the only reason of these changes, also climatic conditions, seasons, strength of the light and the physiological status of the plant itself effective on these changes. According to the results of heavy metal analysis Pseudevernia furfuracea continued to accumulate heavy metals and worked well as a biomonitor. The air pollution level of Ankara shows great variations because of the great area of the city