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

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Determınatıon Of Thermophysıcal Propertıes Of Dolomıte And Bauxıte Based Nanofluıds And Effect On Performance Of Thermal Systems

Isı transferi için temel akışkan olarak en çok kullanılan su, etilen glikol, mineral yağlar gibi geleneksel akışkanlar zayıf ısı aktarım karakteristikleri nedeniyle ısıl sistemlerde istenilen performansı sağlayamamaktadırlar. Bu dezavantaj nanopartiküllerin temel akışkan ile süspansiyon oluşturulmasıyla giderilmeye çalışılmaktadır. Bu çalışmada temel akışkan olarak su, etilen glikol, etilen glikol-su (50:50) kullanılarak iki adım metoduyla farklı konsantrasyonlarda (%1, %2, %4) dolomit ve boksit nanoakışkanları hazırlanmış, hazırlanan nanoakışkaların termofiziksel özellikleri belirlenmiş ve ısıl sistemlerdeki performansa etkileri incelenmiştir. Spex tipi bilyeli öğütücüde optimum şartlarda sırasıyla 24,5 nm ve 38,9 nm boyutunda dolomit ve boksit nanopartikülleri elde edilmiştir. Nanoakışkanların kararlılıklarının belirlenmesinde zeta potansiyeli ölçüm yöntemi kullanılmıştır. Hazırlanan nanoakışkanların termal iletkenlik, özgül ısı, vizkozite ve yüzey gerilimi gibi termofiziksel özellikleri deneysel olarak ölçülmüştür. Dolomit nanoakışkanının, boksit nanoakışkanına göre daha üstün termofiziksel özelliklere sahip olduğu belirlenmiştir. Isı borusu deneylerinde kullanılan sistem, 1 m uzunluğunda, iç ve dış çapı sırasıyla 13 mm ve 15 mm olan çift fazlı kapalı bakır borudur. Deneylerde evaporatör bölümüne 200 W, 300 W ve 400 W ısıtma gücü uygulanmış ve kondenser bölümünde farklı debilerdeki (5 g/s, 7,5 g/s, 10 g/s) su ile soğutma gerçekleştirilmiştir. Isı borusu duvar sıcaklığı, termal direnci ve verimi temel akışkanların ve nanoakışkanların ısı borusunda çalışma akışkanı olarak kullanımıyla ayrı ayrı incelenmiş ve elde edilen sonuçlar karşılaştırılmıştır. Nanoakışkanlar, üstün termal özelliklerinden dolayı ısı borusunda çalışma akışkanı olarak kullanıldıklarında, temel akışkanlara göre evaporatör bölgesinin ortalama sıcaklığını daha fazla düşürmüşlerdir. 200 W ısıtma gücü ve 10 g/s soğutma suyu debisinde dolomit-EG nanoakışkanı çalışma akışkanı olarak kullanıldığında evaporatör bölgesindeki ortalama duvar sıcaklığı etilen glikol kullanıldığı duruma göre 26,25 °C düşmüştür. 200 W ısıtma gücü, 5 g/s debide, %2 konsantrasyondaki dolomit-su nanoakışkanı kullanıldığında ısı borusu termal direncinde saf suya göre %36,84 iyileşme görülmüştür. 400 W, 10 g/s debide dolomit-etilen glikol nanoakışkanı çalışma akışkanı olarak kullanıldığında etilen glikole kıyasla ısı borusu veriminde %47 artış sağlamıştırConventional fluids such as water, ethylene glycol, mineral oils, which are most commonly used as base fluids for heat transfer, cannot provide the desired performance in thermal systems due to their poor heat transfer characteristics. This disadvantage is tried to be overcome by suspending the nanoparticles with the base fluid. In this study, dolomite and bauxite nanofluids were prepared by using two-step method in different concentrations (1%, 2%, 4%) using water, ethylene glycol, ethylene glycol-water (50:50) as the base fluid, and the thermophysical properties of the prepared nanofluids were determined and effects on performance of thermal systems were investigated. Dolomite and bauxite nanoparticles of 24.5 nm and 38.9 nm were obtained in the Spex type ball mill under optimum conditions, respectively. Zeta potential measurement method was used to determine the stability of nanofluids. Thermal conductivity, specific heat, viscosity and surface tension of the prepared nanofluids were measured experimentally. Dolomite nanofluid has superior thermophysical properties compared to bauxite nanofluid. The system used in the heat pipe tests is a two phase closed copper pipe with a length of 1 m, inner and outer diameter of 13 mm and 15 mm, respectively. In the experiments, 200 W, 300 W and 400 W heating power were applied to the evaporator section and cooling was performed with different flow rates (5 g/s, 7.5 g/s, 10 g/s) in the condenser section. Heat pipe wall temperature, thermal resistance and efficiency were investigated separately by using the base fluids and nanofluids as working fluids in the heat pipe and the obtained results were compared. Because of their superior thermal properties, nanofluids have reduced the average temperature of the evaporator section more than base fluids when used as working fluid in the heat pipe. When the dolomite-EG nanofluid was used as the working fluid at 200 W heating power and 10 g/s cooling water flow rate, the average wall temperature in the evaporator section decreased by 26.25 °C compared to ethylene glycol. At a heating power of 200 W and a flow rate of 5 g/s, thermal resistance of the heat pipe improved by 36.84% when 2% concentration of dolomite-water nanofluid was used. At the conditions of 400 W and 10 g/s, the dolomite-ethylene glycol nanofluid used as working fluid provided a 47% increase in heat pipe efficiency compared to ethylene glyco

Synthesis Of Zinc Fluoroborate And Usability As Flame Retardant

Türkiye bor rezervi bakımından en zengin ülke olma özelliğine sahiptir. Bor rezervlerinin değerlendirmesi bakımından ise daha alt sıralarda yer almaktadır. Bunun nedeni Türkiye'nin ham ve rafine ürünlere yönelmesi ve genellikle yüksek teknoloji gerektiren metotlar ile rafine bor ürünleri kullanılarak üretilen, pek çok değişik kullanım alanları olan özel bor ürünlerinin üretiminde yeterli olamamasıdır. Floroboratlar geniş kullanım alanına sahip olan özel bor ürünlerindendir. Bu çalışmada floroboratlardan biri olan çinko floroboratın, iki farklı yöntemle sentezi gerçekleştirilmiştir. Bu iki yöntemden biri olan mekanokimyasal yöntemle çinko floroborat sentezinde; çinko florür ve elementel bor reaktant olarak kullanılmıştır. Farklı mol oranlarında hazırlanan numuneler belirli sabit sürede bilyalı değirmende mekanik öğütülerek optimum mol oranı seçilmiştir. Farklı sürelerde sentezlere devam edilmiştir ve süre optimizasyonu yapılmıştır. Elde edilen madde aşırı reaktif ve yan üründen saflaştırılmıştır. Yapılan deneyler sonucunda çinko floroborat sentezi için reaktant mol oranı (nB/nZnF2) 1,6:1 ve bilyalı değirmende 3000 dakika süresince gerçekleştirilen mekanokimyasal reaksiyon ile en verimli sonuç elde edilmiştir. Çinko floroboratın suda çözünürlük farkından yararlanılarak %82 saflıkta çinko floroborat sentezlenmiştir. Sentez yöntemlerinden bir diğeri olan yaş yöntemle çinko floroborat sentezinde çinko oksit ve floroborik asit reaktant olarak kullanılmıştır. Reaktant mol oranı, sıcaklık ve süre parametrelerinin etkileri ayrı ayrı belirlenmiş, optimum şartlar tespit edilmiştir. Reaktant mol oranı (nHBF4/nZnO) 1,5:1 ve 90° C sıcaklıkta %98 saflıkta çinko floroborat sentezlenmiştir. Karakterizasyon çalışmalarında FTIR ve BF4- iyon seçici elektrot kullanılmıştır. TGA-DTA analizi ile üretilen maddenin termal özellikleri incelenmiştir. Sentezlenen çinko floroboratın farklı derişimlerde çözeltileri hazırlanmış, kumaşlara emdirilmiş ve LOI testleri yapılmıştır. LOI test metodu ile çinko floroboratın alev geciktirici özelliği incelendiğinde, çinko floroboratın çok iyi alev geciktirici etki gösterdiği görülmüştür.Turkey has the distinction of being the richest country in terms of boron reserves. It locates in terms of evaluation of the boron reserves in the lower row. The reason is that Turkey runs to crude and refined products and often produced using refined boron products and methods that require high technology, can not be sufficient in production of special boron products which have many different application areas. Fluoroborates are the special boron products having wide range of applications. In this study, one of the fluoroborates, zinc fluoroborate is carried out synthesis by two different methods. In the synthesis of zinc fluoroborate by mechanochemical process one of these two methods; zinc fluoride and elemental boron are used as reactants. Optimum molar ratio is selected by samples are prepared at different molar ratio of mechanical grinding in a ball mill in a certain fixed period. The synthesis is continued in different time and duration is optimized. The acquired material is purified from excess reagent and side product. As a result of experiments most efficient results are obtained with reactant molar ratio (nB/nZnF2) 1,6:1 and mechanochemical reaction carried out during 3000 minutes by making a uniform ball mill. Utilizing the difference in water solubility of zinc fluoroborate is synthesized in 82% purity zinc fluoroborate. One of the synthesis methods, in the wet method for the synthesis of zinc fluoroborate, zinc oxide and fluoroboric acid are used as reactants. The effects of molar ratio of reactants, temperature and time parameters are determined separately, optimum conditions are fixed. %98 purity zinc fluoroborate is synthesized at molar ratio of reactant (nHBF4/nZnO) 1,5:1 and 90 °C . In the characterization studies, FTIR and BF4- ion selective electrode are used. The thermal properties of the produced substances are investigated by TGA-DTA analysis. Synthesized zinc fluoroborate are prepared at different concentrations, impregnated fabrics and LOI tests are conducted. When examined flame retandancy properties of zinc fluoroborate with LOI test method, it has been shown that zinc floroborate has very good flame retandancy effect

Broncholithiasis with Recurrent Lithoptysis: A Case Report

Objective: To report a case of broncholithiasis with different types of calculi in the tracheobronchial tree. Clinical Presentation and Intervention: A 50-year-old male who suffered from hemoptysis presented with recurrent broncholith expectoration due to past tuberculous middle lobe syndrome. Bronchoscopic examination revealed loose and embedded broncholiths located at two different bronchi. A surgical resection was suggested, but he refused. Conclusion: The diagnosis of broncholithiasis should be kept in mind in patients who had hemoptysis and calcified mediastinal lymph nodes on thorax computerized tomography, and diagnostic bronchoscopy should be done to prove the relationship of the tracheobronchial tree with a broncholith. (C) 2013 S. Karger AG, Base

Ancient (sclerosing) thymoma: Case report

A 43-year-old female who had dyspnea and had been diagnosed as myasthenia gravis was found to have a mass lesion of the anterior mediastinum that protruded to the left and contained calcified areas on radiological investigation. The patient was operated on with a preliminary diagnosis of thymoma. Macroscopically the tumoral lesion was 5x4.5 cm in size and was light tan, firm and solid without necrosis or hemorrhage. Histological investigation showed epithelial islands without atypical features scattered within large areas of hyalinized collagenous tissue and the presence of immature T lymphocytes some of which were TdT positive, which led to a preliminary diagnosis of sclerosing thymoma. Sclerosing thymoma is a rare type of thymoma and has first been reported in 1994. Since there are only a few reports in the literature detailed information on clinical features and pathogenesis is needed. The possibility of sclerosing thymoma should always be kept in mind in the differential diagnosis of mediastinal lesions with marked sclerosis that can lead diagnostic difficulties especially when evaluating small mediastinoscopic biopsies

Thermal Performance Improvement of the Heat Pipe by Employing Dolomite/Ethylene Glycol Nanofluid

In heat transfer applications, heat pipes are widely- preferred because of some characteristics such as low cost, being able to be produced in any size and low maintenance cost make them superior. Moreover, the working fluid to be employed substantially affects the heat transfer characteristics of a heat pipe. In this paper, effects of nanoparticle addition into the ethylene glycol on heat pipe’s thermal performance were analysed experimentally. Every test was done using two variant working fluids, ethylene glycol and dolomite nanoparticles-doped ethylene glycol, respectively. Dolomite nanoparticles (2% by weight) and Sodium Dodecyl Benzene Sulfonate (0.5% by weight) were doped into the ethylene glycol while preparing the dolomite/ethylene glycol nanofluid. After filling in the heat pipe, experiments were realized under changing working conditions. Using experimental data, efficiency and thermal resistance of the heat pipe were examined. Viscosity of the each working fluid was determined. The contact angle –wettability measurements were also performed to specify the effects of surface active agent addition. The obtained findings revealed that nanoparticle inclusion inside the base fluid, i.e. ethylene glycol, improved the thermal performance (efficiency) and decreased the heat pipe’s thermal resistance substantially. ©2020. CBIORE-IJRED. All rights reserve

Aspergillus colonization of an echinococcal cyst cavity: case report

Although lungs are common sites for the occurrence of saprophytic or invasive mycosis as well as hydatid cyst, aspergilloma within a hydatid cyst is a rare occurrence. A 36-year-old immunocompetent male presented with hemoptysis episodes of about 1 year duration. Chest X-ray revealed a smooth countered mass lesion located in the upper part of lower lobe of lef lung. Surgical enucleation of the cyst wall was performed. Microscopic examination showed that the laminated membranes of hydatid cyst were invaded by septated fungal hyphea oriented with acute angles consistent with aspergillus. Herein, we report such a unique coexistence of hydatid cyst and aspergilloma, and emphasize possible complications depending on the immunostatus of the patient, if the aspergillus colonization is unnoticed in resected cystectomy material