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

Onüçüncü yüzyıl Anadolu toplumunun yüz iskelet normlarının günümüz normlarının günümüz toplumu ile sefalometrik yöntemle karşılaştırılması

TEZ4559Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2003.Kaynakça (s. 43-47) var.ıx, 47 s. ; 30 cm.

Comparison of the clinical effects of two different canine retraction springs

Bu çalışmada, iki farklı kanin retraksiyon zembereğinin üst kaninler ve birinci büyük azılar üzerindeki etkileri incelenmiştir. Küçük azı çekimi gereken yirmibeş hasta çalışmaya dahil edilmiştir. Grubun yaş ortalaması 14.08+1.88 yıldır. Sağ üst kaninler 'Ladanyi' zembereğiyle ve sol üst kaninler 'LasVegas' zembereğiyle retrakte edilmiştir. Başlangıçta 100 gr şiddetinde kuvvet uygulanmıştır ve her dört haftada bir (ayda bir) zembereklerin aktivasyonları yenilenmiştir. 'Ladanyi' tarafının retraksiyon süresi ortalama 4.77±1.08 ay ve 'LasVegas' tarafının retraksiyon süresi ortalama 5.0±0.83 aydır. Ölçümler yan kafa filmleri, çalışma modellerinin fotokopileri ve panoramik filmler üzerinde yapılmıştır. 'Ladanyi' tarafının retraksiyon hızı ortalama 1.39±0.88 mm / ay ve 'LasVegas' tarafının retraksiyon hızı ortalama 1.04±0.96mm / ay'dır. Her iki taraf karşılaştırıldığında kanin hareketlerinin şeklinde anlamlı farklılık bulunmamıştır. Kaninler belirgin miktarda distale devrilerek hareket etmişlerdir. Her iki tarafta da önemsiz miktarda ankraj kaybı ölçülmüştür. Ortodontistlerin bu iki zemberek arasındaki tercihleri manipulasyonlarınmın kolaylığı ve hasta rahatlığı gibi faktörlere dayanmalıdır.In this study, effects of two different canine retraction springs on maxillary canines and maxillary molars were evaluated. Twenty-five patients, requiring premolar extractions, were included to the study. The mean age of the group was 14.08±1.88 years. Upper right canines were retracted by 'Ladanyi' springs and upper left canines by 'LasVegas' springs. The forces initially applied were 100 grams and the springs were reactivated every four weeks (every month). The mean retraction duration of the 'Ladanyi' side was 4.77±1.08 months and the mean retraction duration of the 'Las-Vegas' side was 5.0+0.83 months. Measurements were done on the lateral cephalograms, photocopies of the study casts and panoramic radiographs. The mean retraction rate of the 'Ladanyi' side was 1.39±0.88 mm / month and the mean retraction rate of the 'LasVegas' side was 1.04±0.96 mm / month. A comparison among the two sides revealed insignificant difference in the type of upper canine movements. The canines moved distally with a considerable amount of tipping. Insignificant amount of anchorage loss was measured for both sides. Decision by the orthodontist to se-lect one of these two springs should be based on the factors, such as ease of manipulation and patient comfort

Farklı yüzey pürüzlendirme işlemlerinin yapıştırıcı simanların seramiğe olan bağ dayanımı üzerine etkisi

Objectives: Promoting ceramic-cement integration by providing optimal adhesion between resin cements and glass ceramic surfaces is important from clinical point of view. To evaluate the effect of different surface roughening methods on the shear bond strength (SBS) of three luting resin cements to a lithium-disilicate- based glass ceramic. Materials and Methods: One hundred eighty cylindrical ceramic blocks (4x4 mm, IPS e.max, Ivoclar, Schaan, Liechtenstein) were prepared and divided into 3 main groups (n=60/group). Group 1 was treated with 9,5% hydrofloric acid (HF) for 45 sec. Group 2 was roughened by tribochemical silica coating (TSK). The specimens in Group 3 were subjected to 9,5% HF acid followed by TSK. Then each main group was divided into 3 luting cement subgroups named: (1) VariolinkII (Ivoclar, Liechtenstein), (2) RelyX ARC (3MEspe, Germany), (3) BifixQM (Voco, Germany). Ten of the specimens in each subgroup were luted to the other 10 by a luting cement specific for each subgroup. All specimens were thermocycled (x1000, 5-550C, 20 sec.) and SBS tests were performed (Autograph, Shimadzu, Japan, 0.5 mm/ min). The obtained data (mean;plusmn;SD) were statistically analyzed (ANOVA and Boferroni, alpha=.05). The interfaces of the specimens were observed under a SEM (Jeol JSM 5200, Japan). Results: While combined HF + TSK surface conditioning method resulted in significantly higher SBS values for all resin groups (Variolink II:48,1;plusmn;9,3; RelyX ARC:39,6;plusmn;8,4; Bifix QM:36,3;plusmn;5,1) (P;lt;.05), HF acid (Variolink II:33,8;plusmn;6,5; RelyX ARC:28,1;plusmn;4,4; Bifix QM:18,9;plusmn;4,8) and TSK alone (Variolink II:27,9;plusmn;8,5; RelyX ARC:22,5;plusmn;5,9; Bifix QM:16,4;plusmn;4,6) demonstrated insignificant differences (P;gt;.05). Conclusion: With HF acid etching followed by TSK, highest resin-ceramic bond strength values were obtained for all luting cement groups. Variolink II exhibited highest resin-ceramic bond strength regardless of different surface conditioning methods.Amaç: Rezin simanların cam seramik yüzeylere optimal tutunmalarını sağlayarak seramik-siman entegrasyonunun iyileştirilmesi klinik açıdan gereklidir. Farklı yüzey pürüzlendirme işlemlerinin, 3 farklı rezin siman ile lityum-disilikat esaslı cam seramik arasındaki makaslama bağ dayanımına etkisinin değerlendirilmesidir. Gereçler ve Yöntemler: Yüz seksen adet silindirik seramik örnek (IPS e.max, Ivoclar, Schaan, Liechtenstein, 4x4mm) hazırlandı ve 3 ana gruba ayrıldı (n=60/ grup). Grup 1’e, 45 sn süresince %9,5’luk hidroflorik asit (HF) uygulandı. Grup 2’de pürüzlendirme işlemi tribo-kimyasal silika kaplama (TSK) ile sağlandı. Grup 3’deki örneklere %9,5’luk HF asidin ardından TSK uygulandı. Üç ana grup, 3’er yapıştırıcı siman alt grubuna ayrıldı: (1) VariolinkII (Ivoclar, Liechtenstein), (2) RelyX ARC (3MEspe, Almanya), (3) BifixQM (Voco, Almanya). Her bir gruptaki 10 örnek gruba özgü yapıştırıcı siman ile diğer on örneğe yapıştırıldı. Tüm örnekler termal döngüden geçirildi (x1000, 5-550C, 20 s.) ve makaslama bağ dayanım testleri yapıldı (Autograph, Shimadzu, Japan, 0.5 mm/dk). Elde edilen veriler (ortalama±SS) istatistiksel olarak analiz edildi (ANOVA ve Bonferroni, alfa=.05). Örneklerin arayüzleri TEM ile incelendi (Jeol JSM 5200, Japan). Bulgular: Kombine HF+TSK yüzey pürüzlendirmesi tüm rezin grupları için en yüksek bağ dayanım değerlerini verirken (VariolinkII:48,1±9,3; RelyX ARC:39,6±8,4; Bifix QM:36,3±5,1) (P.05) sadece HF asit (VariolinkII:33,8±6,5; RelyX ARC:28,1±4,4; Bifix QM:18,9±4,8) ve sadece TSK (VariolinkII:27,9±8,5; RelyX ARC:22,5±5,9; Bifix QM:16,4±4,6) grupları arasında anlamlı farklar yoktu (P>.05). Sonuç: HF asit uygulaması sonrası silika kaplama işlemi ile, tüm siman gruplarında en yüksek rezinseramik bağ dayanımı değerleri elde edildi. Rezin simanlardan Variolink II yüzey hazırlama işleminden bağımsız olarak en yüksek rezin-seramik bağ dayanımını gösterdi

A Rare Form of Guillan Barre Syndrome: A Child Diagnosed with Anti-GD1a and Anti-GD1b Positive Pharyngeal-Cervical-Brachial Variant

Background: Pharyngeal-cervical-brachial (PCB) variant is a rare form of Guillan-Barre Syndrome (GBS). Antibodies against other membrane proteins like GM1b and GD1a have been found only in a small number of patients with Guillan Barre syndrome variant. Case Report: Here, we report a 5.5 year-old boy diagnosed early with positive GD1a and GD1b gangliosides of Guillan-Barre syndrome pharyngeal cervical-Brachial variant, who improved and recovered fully in a short period. This is in contrast to those whose recovery period prolongs in spite of early diagnosis and appropriate treatment and/or those who experience incomplete recovery. Conclusion: In summary, diagnosis of PCB variant of GBS should be considered in infants with sudden onset bulbar symptoms and muscle weakness, and it should be kept in mind that early diagnosis and appropriate treatment can give successful outcomes

Deformation in SW Anatolia (Turkey) Documented by Anisotropy of Magnetic Susceptibility Data

© 2021. American Geophysical Union. All Rights Reserved.Convergence between the Eurasian and the African plates in the West Anatolian-Aegean region results in a trench retreat due to slab roll-back and tearing of the subducted African lithosphere. The upper plate response of this process gave way to back-arc extension in the region. We have conducted a very detailed anisotropy of magnetic susceptibility (AMS) study on the Neogene rocks in SW Anatolia to unravel the style and magnitudes of deformation. For this purpose, from 83 sites in 11 structurally homogeneous domains, 1,680 paleomagnetic samples were analyzed. The results show that AMS fabrics are related to the tectonic deformation and that the magnetic lineation (maximum susceptibility axis, k1) is parallel to inferred maximum extension, while minimum susceptibility (k3) is typically normal to the bedding plane, corresponding to a preserved compaction associated with deposition fabric. The intermediate axis (k2) is parallel to a second extension direction and indicates that the region has been under the control of multi-directional extension during the Neogene. Two main magnetic lineation directions are identified and represent Oligocene to middle Miocene E-W, and late Miocene to Pliocene NW-SE oriented extension. The magnetic lineation directions are dominantly parallel or perpendicular to the general strikes of the normal faults. The results show that the deformation in the region resembles two differentially stretched rubber sheets under the influence of SW oriented extension, exerted by the southward retreating Eastern Mediterranean subduction system

Deformation in SW Anatolia (Turkey) Documented by Anisotropy of Magnetic Susceptibility (AMS) Data

Convergence between the Eurasian and the African plates in the West Anatolian-Aegean region results in a trench retreat due to slab roll-back and tearing of the subducted African lithosphere. The upper plate response of this process gave way to back-arc extension in the region. We have conducted a very detailed anisotropy of magnetic susceptibility (AMS) study on the Neogene rocks in SW Anatolia to unravel the style and magnitudes of deformation. For this purpose, from 83 sites in 11 structurally homogeneous domains, 1,680 paleomagnetic samples were analyzed. The results show that AMS fabrics are related to the tectonic deformation and that the magnetic lineation (maximum susceptibility axis, k1) is parallel to inferred maximum extension, while minimum susceptibility (k3) is typically normal to the bedding plane, corresponding to a preserved compaction associated with deposition fabric. The intermediate axis (k2) is parallel to a second extension direction and indicates that the region has been under the control of multi-directional extension during the Neogene. Two main magnetic lineation directions are identified and represent Oligocene to middle Miocene E-W, and late Miocene to Pliocene NW-SE oriented extension. The magnetic lineation directions are dominantly parallel or perpendicular to the general strikes of the normal faults. The results show that the deformation in the region resembles two differentially stretched rubber sheets under the influence of SW oriented extension, exerted by the southward retreating Eastern Mediterranean subduction system