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

Wireless 3-Axis Accelerometer System for Measurement of Structural Displacement

In this study, we present the design of a 3-axis acceleration measurement system that is capable of UTC (Coordinated Universal Time) time-stamping captured from a Global Positioning System (GPS) receiver module. With this achievement, the system is able to monitor and record the 3-axis vibrations with respect to an absolute time rather than the local sensor (and computer) time. Acquired 3-axis acceleration data and UTC are transferred via Bluetooth (R) protocol and developed software which enables monitoring and recording of UTC and acceleration data on a PC, respectively. For verification and synchronization quality test of acceleration data, shake-table tests were conducted for simulation of structural displacement and the calculated displacements were compared with a displacement sensor of a commercially available shake table system

High-rate real-time PPP for dynamic motion detection in vertical direction

[EN] Nowadays, with the developments in GNSS (Global Navigation Satellite System) technology, the data storage and data processing capacity of GPS (Global Positioning System) receivers has been gradually increased. This situation is widely used in the detection and monitoring of horizontal and vertical vibrations that occur in the structure when high temporal resolution geodetic GPS receivers are under the influence of dynamic loads such as earth crust motions, wind load, traffic load, which affect man-made engineering structures. In the study, RT DF-PPP (Real Time Dual Frequency-Precise Point Positioning) method was applied together with a GPS sensor with a sampling interval of 20 Hz, using a steel bar mounted on a steel tree model designed as a structure model, and a steel bar on which different sensors can be integrated and can provide simulation of vertical motions in detecting vertical motions occurring in structures. To evaluate the performance of the method used and to test the performance of capturing vertical displacements, the DF-RP (Dual Frequency-Relative Positioning) method was taken as reference and the results were compared with the PP-PPP (Post Process-PPP) method using the IGS-Final (International GNSS Service-Final) product. When the results are compared with the RP and PP-PPP solutions in the frequency domain of vertical motions as a result of harmonic oscillations of the high-rate RT-PPP method, it has been seen that the amplitudes and frequencies are compatible with each other. Therefore, dynamic motions that occur as a result of natural events such as earthquakes, tsunamis, landslides and volcanic eruptions can be instantly and reliably monitored and detected by the high-rate RT-PPP method. When the results were evaluated in the time domain, an improvement was observed in the RMSE (Root Mean Square Error) and maximum values of RT-PPP and PP-PPP methods according to RP after filtering. When the statistical results are examined, vertical harmonic motions of the solutions made by using both RT-PPP and PP-PPP methods can be detected with accuracy below centimeters. These results clearly show that it can detect vertical dynamic motions in engineering structures such as bridges, skyscrapers and viaducts with RT-PPP method to evaluate. Thus, by detecting the effects of dynamic motions occurring in the structure on the health of the structure, a safe environment will be provided by making a rapid hazard assessment for life safety.Karadeniz, B.; Bezcioglu, M.; Yigit, CO.; Dindar, AA.; Akpinar, B. (2023). High-rate real-time PPP for dynamic motion detection in vertical direction. Editorial Universitat Politècnica de València. 455-460. https://doi.org/10.4995/JISDM2022.2022.1390645546

High-Rate Real-Time Single-Frequency PPP for Structural Motion Detection in Horizontal Directions

[EN] Thanks to advances in receiver and software technology, the high-rate GPS (Global Positioning System) technique has become very important in monitoring the dynamic behavior of man-made structures in both real-time and post-missions. Real-time monitoring of the changes in the behavior of structures due to effects such as natural disasters, wind effect, traffic loading is critical in order to take precautions in time. In this study, the performance of the Real-Time Single Frequency Precision Point Positioning (RT SF-PPP) method based on IGS (International GNSS Service) RTS (real-time stream) products to capture the behavior of dynamic motions was evaluated. The performance of the SF RT-PPP method to detect dynamic behaviors was evaluated based on 20 Hz single frequency GPS observations obtained from shake table experiments, including 10 mm amplitude and different oscillation frequencies including 0.1, 0.6, 1.0, 2.0 and 3.0 Hz. RT SF-PPP results were compared with reference LVDT (Linear Variable Differential Transformer) and relative (or double difference) GPS positioning both frequency and time domain. Results show that the high-rate RT SF-PPP method can capture the frequencies and amplitudes of harmonic motions and it is comparable to LVDT and Relative GPS positioning solutions. These results show that the high-rate RT SF-PPP method can monitor earthquake-induced real-time vibration frequencies and amplitudes, which is especially important for early warning systems.Bezcioglu, M.; Karadeniz, B.; Yigit, CO.; Dindar, AA.; Akpinar, B. (2023). High-Rate Real-Time Single-Frequency PPP for Structural Motion Detection in Horizontal Directions. Editorial Universitat Politècnica de València. 461-465. https://doi.org/10.4995/JISDM2022.2022.1390746146

Non-Contact and Real-Time Displacement Measurement System for Structural Health Monitoring

In this paper, a multi-channel high-rate laser displacement sensor system accompanied with an open-source data acquisition software for structural health monitoring was explained. Hardware part of the system composed of three laser triangulation sensors with a resolution of 0.1 mm and a measurement acquisition rate at 70 Hz each. The software part is developed under Python open-source environment and handles initiation of data acquisition, data synchronization and data logging. The developed system was tested for reliability using a free vibration of a three-story model with a set of shaking-table tests and results are presented