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

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Assessment of lower urinary tract symptoms among calcium channel blocker-users and its impact on quality of life

Objective: to investigate the prevalence and severity of lower urinary tract symptoms (LUTS) among calcium channel blocker (CCB) users and its impact on patients’ quality of life (QOL) Methods: This cross-sectional study was conducted among CCB-users, recruited using convenience sampling, at one hospital and 2 community pharmacies at Lahore, Pakistan during November 2017-July 2018. Urdu version of the International Prostate Symptom Score (IPSS) and EQ-5D-3L were used to assess LUTS and QOL, respectively. All data were entered and analyzed using SPSS version 22. Results: The median age of the study participants (N = 410) was 50.84, with majority of males. Around 26% of study participants were on CCB monotherapy whereas 73.7% were on CCB combinations with other antihypertensive agents. Overall prevalence of LUTS was 74.9%, with storage symptoms more common than voiding. The most common troublesome symptom was nocturia (89.5%) followed by increased daytime urinary frequency (87.1%). Median IPSS-QOL index, EQ-5D index and EQVAS score in our participants were 3, 0.621 and 60, respectively. Moreover, LUTS were significantly associated with reduced QOL (mean rank IPSS QOL-index: none-mild = 156.76 and moderate-severe = 221.85, p < 0.001; median EQ 5D index; none-mild = 0.796 and moderate-severe = 0.416; mean rank EQ-VAS: none-mild = 228.51, moderate-severe = 197.78, p = 0.022). Conclusion: Around 75% of CCB-users suffer from clinically significant LUTS which is associated with significant reduction in patient’s QOL. An earlier detection and management of LUTS by healthcare provider among CCB-users may and improve the overall QOL. Continuous..

Quantitative and Qualitative Counterion Exchange in Cationic Metallocene Polyelectrolytes

Metallocene-containing polyelectrolytes show many unique properties in a variety of electrochemical, optoelectronic, medicinal, and magnetic applications. The utilization of counterions plays crucial roles in many aspects of these polyelectrolytes. This paper reports the first quantitative analysis of counterion exchange in metallocene-containing polyelectrolytes. Particularly counterion exchange of cationic cobaltocenium-containing polyelectrolytes was analyzed by diffusion NMR, which determined molar fractions of dissociated and associated ions as well as ion-exchange constant. Qualitative impact of counterion exchange on macromolecular conformation was directly observed from cobaltocenium-containing molecular brushes. This study may provide valuable guidance on applications such as layer-by-layer assembly and ion-triggered drug delivery that are involved with ion exchange of polyelectrolytes

Biomass approach toward robust, sustainable, multiple-shape-memory materials

We report biomass-derived, shape-memory materials prepared via simple reactions, including "grafting from" ATRP and TAD click chemistry. Although the biomass, including plant oils and cellulose nanocrystals, has heterogeneous chemical structures in nature, these materials exhibit excellent multiple shape-memory properties toward temperature, water, and organic solvents, which are comparable to petroleum counterparts. The work presented herein provides burgeoning opportunities to design the next-generation, low-cost, biomass-prevalent, green materials for niche applications