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

The effect of chronic khat chewing on liver enzyme levels ( a Yemenian study)

Background Khat is a natural stimulant from the Catha edulis plant, which grows mainly in Yemen. The liver has been suspected to be vulnerable to the harmful effects of khat use. AimThe aim of the study was to investigate the effect of khat chewing on the liver function in healthy Yemeni individuals. MethodsLiver function tests were performed on 30 chronic khat chewers (group I) and 20 individuals who did not chew khat (group II). Results Twenty percent of group I and only 5% of group II reported abnormally elevated alanine transaminase (ALT) levels, with no statistically significant difference between the mean ALT values (P=0.208); 13.3% of group I showed elevated aspartate aminotransferase levels (P=0.058). With regard to other liver function tests there was no statistically significant difference between the two groups. ALT levels increased with increasing duration of khat chewing. Conclusion Chronic khat chewing causes subclinical hepatocellular damage, whereas transient khat chewing has no effect on the liver function

Introducing the comprehensive unit-based safety program for mechanically ventilated patients in Saudi Arabian intensive care units

Over the past decade, there have been major improvements to the care of mechanically ventilated patients (MVPs). Earlier initiatives used the concept of ventilator care bundles (sets of interventions), with a primary focus on reducing ventilator-associated pneumonia. However, recent evidence has led to a more comprehensive approach: The ABCDE bundle (Awakening and Breathing trial Coordination, Delirium management and Early mobilization). The approach of the Comprehensive Unit-based Safety Program (CUSP) was developed by patient safety researchers at the Johns Hopkins Hospital and is supported by the Agency for Healthcare Research and Quality to improve local safety cultures and to learn from defects by utilizing a validated structured framework. In August 2015, 17 Intensive Care Units (ICUs) (a total of 271 beds) in eight hospitals in the Kingdom of Saudi Arabia joined the CUSP for MVPs (CUSP 4 MVP) that was conducted in 235 ICUs in 169 US hospitals and led by the Johns Hopkins Armstrong Institute for Patient Safety and Quality. The CUSP 4 MVP project will set the stage for cooperation between multiple hospitals and thus strives to create a countrywide plan for the management of all MVPs in Saudi Arabia

PdO@CoSe2 composites: efficient electrocatalysts for water oxidation in alkaline media

In this study, we have prepared cobalt selenide (CoSe2) due to its useful aspects from a catalysis point of view such as abundant active sites from Se edges, and significant stability in alkaline conditions. CoSe2, however, has yet to prove its functionality, so we doped palladium oxide (PdO) onto CoSe2 nanostructures using ultraviolet (UV) light, resulting in an efficient and stable water oxidation composite. The crystal arrays, morphology, and chemical composition of the surface were studied using a variety of characterization techniques, including X-ray diffraction (XRD), scanning electron microscopy (SEM), high resolution transmission electron microscopy (HRTEM), X-ray photoelectron spectroscopy (XPS), and Fourier transform infrared (FTIR) spectroscopy. It was also demonstrated that the composite systems were heterogeneous in their morphology, undergoing a shift in their diffraction patterns, suffering from a variety of metal oxidation states and surface defects. The water oxidation was verified by a low overpotential of 260 mV at a current density of 20 mA cm(-2) with a Tafel Slope value of 57 mV dec(-1). The presence of multi metal oxidation states, rich surface edges of Se and favorable charge transport played a leading role towards water oxidation with a low energy demand. Furthermore, 48 h of durability is associated with the composite system. With the use of PdO and CoSe2, new, low efficiency, simple electrocatalysts for water catalysis have been developed, enabling the development of practical energy conversion and storage systems. This is an excellent alternative approach for fostering growth in the field.Funding Agencies|Ajman University [2022-IRG-HBS-5]; National Natural Science Foundation of China [NSFC 51402065, 51603053]</p

Introducing the Comprehensive Unit-based Safety Program for mechanically ventilated patients in Saudi Arabian Intensive Care Units

Over the past decade, there have been major improvements to the care of mechanically ventilated patients (MVPs). Earlier initiatives used the concept of ventilator care bundles (sets of interventions), with a primary focus on reducing ventilator-associated pneumonia. However, recent evidence has led to a more comprehensive approach: The ABCDE bundle (Awakening and Breathing trial Coordination, Delirium management and Early mobilization). The approach of the Comprehensive Unit-based Safety Program (CUSP) was developed by patient safety researchers at the Johns Hopkins Hospital and is supported by the Agency for Healthcare Research and Quality to improve local safety cultures and to learn from defects by utilizing a validated structured framework. In August 2015, 17 Intensive Care Units (ICUs) (a total of 271 beds) in eight hospitals in the Kingdom of Saudi Arabia joined the CUSP for MVPs (CUSP 4 MVP) that was conducted in 235 ICUs in 169 US hospitals and led by the Johns Hopkins Armstrong Institute for Patient Safety and Quality. The CUSP 4 MVP project will set the stage for cooperation between multiple hospitals and thus strives to create a countrywide plan for the management of all MVPs in Saudi Arabia