Respiratory adverse effects of opioids for breathlessness: a systematic review and meta-analysis

Background: Previous studies have shown that opioids can reduce chronic breathlessness in advanced disease. However, physicians remain reluctant to prescribe opioids for these patients, commonly due to fear of respiratory adverse effects. Aim: To systematically review reported respiratory adverse effects of opioids in patients with advanced disease and chronic breathlessness. Methods: Pubmed, Embase, Cochrane central register of controlled trials, CINAHL, ClinicalTrials.gov and the reference lists of relevant systematic reviews were searched. Two independent researchers screened against predefined inclusion criteria and extracted data. Meta-analysis was conducted where possible. Results: We included 63 out of 1990 articles, describing 67 studies. Meta-analysis showed an increase in partial pressure of carbon dioxide (0.27 kPa; 95% CI 0.08 to 0.45) and no significant change in partial pressure of oxygen and oxygen saturation (both p>0.05). Non-serious respiratory depression (definition variable/not stated) was described in 4/1064 patients. One cancer patient pre-treated with morphine for pain needed temporary respiratory support following nebulized morphine for breathlessness (single case study). Conclusions: We found no evidence of significant or clinically relevant respiratory adverse effects of opioids for chronic breathlessness. Heterogeneity of design and study population, and low study quality are limitations. Larger studies designed to detect respiratory adverse effects are needed

Animated Edge Textures in Node-Link Diagrams: a Design Space and Initial Evaluation

International audienceNetwork edge data attributes are usually encoded using color, opacity, stroke thickness and stroke pattern, or some combination thereof. In addition to these static variables, it is also possible to animate dynamic particles flowing along the edges. This opens a larger design space of animated edge textures, featuring additional visual encodings that have potential not only in terms of visual mapping capacity but also playfulness and aesthetics. Such animated edge textures have been used in several commercial and design-oriented visualizations, but to our knowledge almost always in a relatively ad hoc manner. We introduce a design space and Web-based framework for generating animated edge textures, and report on an initial evaluation of particle properties – particle speed, pattern and frequency – in terms of visual perception

Development and measurement of guidelines-based quality indicators of caesarean section care in the Netherlands: A RAND-modified delphi procedure and retrospective medical chart review

Background There is an ongoing discussion on the rising CS rate worldwide. Suboptimal guideline adherence may be an important contributor to this rise. Before improvement of care can be established, optimal CS care in different settings has to be defined. This study aimed to develop and measure quality indicators to determine guideline adherence and identify target groups for improvement of care with direct effect on caesarean section (CS) rates. Method Eighteen obstetricians and midwives participated in an expert panel for systematic CS quality indicator development according to the RAND-modified Delphi method. A multi-center study was performed and medical charts of 1024 women with a CS and a stratified and weighted randomly selected group of 1036 women with a vaginal delivery were analysed. Quality indicator frequency and adherence were scored in 2060 women with a CS or vaginal delivery. Results The expert panel developed 16 indicators on planned CS and 11 indicators on unplanned CS. Indicator adherence was calculated, defined as the number of women in a specific obstetrical situation in which care was performed as recommended in both planned and unplanned CS settings. The most frequently occurring obstetrical situations with low indicator adherence were: 1) suspected fetal distress (frequency 17%, adh

Learning Three.js: the JavaScript 3D library for WebGL

If you know JavaScript and want to start creating 3D graphics that run in any browser, this book is a great choice for you. You don't need to know anything about math or WebGL; all that you need is general knowledge of JavaScript and HTML

A comparison between willingness to pay and willingness to give up time

Cost-benefit analysis, Willingness-to-pay, Utilities and preferences, Health economics, D61, I19,