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

A Comparative Study Between Type 1 & Type 2 Diabetes Mellitus and Its Effect on the Retina

     Diabetic retinopathy (DR) remains the leading cause of vision loss and blindness in people of working age, in spite of the fact that current treatments are effective. Vision loss occurs in DR due to the development of maculopathy, especially diabetic macular edema, and due to proliferative diabetic retinopathy. Vision loss due to DR is preventable with the appropriate monitoring and timely treatment. Improved patient and health professional, education to encourage tight control of blood glucose and other systemic factors, and the establishment of readily available and appropriately timed eye examinations are necessary steps to further reduce visual impairment of people with diabetes. Material & Method: In this work, the tests that we perform on diabetics will be described to see the effect of the disease on the retina. We also described the disease in a simplified manner. We conducted our tests on 40 patients suffering from retinal problems due to diabetes of all kinds. Results: There were patients with DM type I ,type II more occurring in age (>50years ) and in type II more in male than female. Also there was significant different between DM types and gender group (P< 0.05).&nbsp