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

Menstrual Disorders Among Nursing Students at Al Neelain University, Khartoum State

Background: Menstrual disorders can severely affect the daily life of young females, particularly the student population, which generates a massive tension that extends to families, but they seldom affect the quality and standard of life. Objectives: The aim of this study was to determine the morbidity nature of menstrual disorders among nursing students and their effect on students' life activities. Methods: This study was a descriptive cross-sectional institutional-based study conducted at the Al Neelain University, Faculty of Nursing. Of the 200 students recruited, 149 completed the questionnaire with the responding rate of (74.5%). Data were collected using a self-administered structured questionnaire. Results: Of the 149 participants, most were young and in the age range of 18–24 years with a mean age of 21 years. Most students (74%) started their menarche at a normal age range of 12–15 years. A relatively high dysmenorrhea (94.0 %)  was observed  among the participants. More than half of the respondents (55.0%) had irregular menstruation. Conclusion: The authors concluded that the prevalence and morbidity of dysmenorrhea and menstrual irregularity were high but broadly comparable to those observed in similar developing countries. Therefore, national health policies need to consider the health and educational impact of menstrual disorders on nursing students and develop the plan through a change in students' lifestyle; moreover, school authorities and teachers need to be aware of the problems to provide psychological and academic support. Keywords: morbidities, dysmenorrhea prevalence, menstrual disorders, nursing students, irregular menstruatio

Effectiveness of Gum Arabic in Diabetes and Its Complications: A Narrative Review

Gum Arabic (GA) is a gummy exudation from Acacia species, rich in soluble fibers. It is a dietary fiber used traditionally by the natives of many countries of the Arabian Peninsula, Pakistan, and India as therapeutic natural product for treating various diseases including kidney diseases, impotence, obesity, and epilepsy. Diabetes represent a global health problem causing many complications and health risk to people of different ages. The current study aimed at identifying the role of Gum Arabic in treating diseases especially diabetes. Many studies have been conducted on the role of Gum Arabic in experimentally induced diabetes as well as randomized clinical studies. This narrative review was written based on a database search in common libraries such as PubMed, Cochrane, Web of Science, and Scopus. The libraries were searched for English articles published between 1995 and 2020 focusing on the role of Gum Arabic in different preclinical and clinical trials of early and advanced level of diabetes. Keywords: Gum Arabic, diabetes, animals, human, nanoparticle

Nurses’ Knowledge and Attitudes Regarding Pain Assessment and Management in Saudi Arabia

Inadequate pain management affects the patient outcome. Pain assessment and management are fundamental in nursing care, and nurses must be equipped with adequate knowledge and a positive attitude toward pain assessment and management. This study aims to evaluate nurses’ knowledge and attitudes regarding pain assessment and management at King Fahad Hospital, Al-Madinah, Kingdom of Saudi Arabia. A quantitative, cross-sectional survey, using a self-administered questionnaire, was conducted from January to February 2020 with 660 registered nurses working in the Emergency Department, critical care units, inpatient and outpatient departments at King Fahad Hospital in Al-Medinah, Kingdom of Saudi Arabia. The data were analyzed with descriptive and inferential statistics. Of the 660 nurses, 291 responded, resulting in a response rate of 44.09%. The participants’ scores ranged from 17.7% to 100%, with a mean score 45.29%. The majority of the participants (70.1%) had a poor level of knowledge and attitudes (score < 50%). Nurses working in the outpatient department scored significantly higher than the group working in the Emergency Department and inpatient wards. Deficient knowledge and negative attitudes were found and nurses continue to underassess and undertreat pain. Nursing school curricula and in-service continuous education must equip nurses with the required knowledge and attitudes to enable them to manage pain effectively

Efficacy of Massage on Pain Intensity in Post-Cesarean Women: a Systematic Review and Meta-Analysis

Background: Cesarean section is a common surgical procedure that may be considered a safe alternative to natural birth and helps to resolve numerous obstetric conditions. Still, the Cesarean section is painful; relieving pain after a Cesarean section is crucial, therefore analgesia is necessary for the postoperative period. However, analgesia is not free of complications and contraindications, so massage may be a cost-effective method for decreasing pain post-Cesarean. Our study aims to determine the massage role in pain intensity after Cesarean sections. Methods: We searched five electronic databases for relevant studies. Data were extracted from the included studies after screening procedures. We calculated the pooled mean difference (MD) and standardized mean difference (SMD) for our continuous outcomes, using random or fixed-effect meta-analysis according to heterogenicity status. Interventional studies were assessed for methodological quality using the Cochrane risk-of-bias assessment tool, while observational studies were assessed using the National Institutes of Health’s tools. Results: Our study included 10 RCTs and five observational studies conducted with over 1,595 post-Cesarean women. The pooled MDs for pain intensity considering baseline values either immediately or post 60-90 minutes were favoring the massage group over the control group as follows:(stand. MD = -2.64, 95% CI [-3.80, -1.48], p > .00001; MD = -2.64, 95% CI [-3.80, -1.48], p > .00001, respectively). While pooled MDs regarding post-intervention only either immediately or post 60-90 minutes were:(stand. MD = -2.04, 95% CI [-3.26, -0.82], p = .001; stand. MD = -2.62, 95% CI [-3.52, -1.72], p > .00001, respectively). Conclusion: Our study found that using massage was superior to the control groups in decreasing pain intensity either when the pain was assessed immediately after or 60-90 minutes post-massage application

Correction: Epidemiology and outcomes of early-onset AKI in COVID-19-related ARDS in comparison with non-COVID-19-related ARDS: insights from two prospective global cohort studies (Critical Care, (2023), 27, 1, (3), 10.1186/s13054-022-04294-5)

Following publication of the original article [1], the authors identified that the collaborating authors part of the collaborating author group CCCC Consortium was missing. The collaborating author group is available and included as Additional file 1 in this article