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 impact of the lack of certain vitamins and minerals intake rate of hair loss in pregnant and breastfeeding women

The research aims to identify the rates of hair loss during pregnancy and lactation and its relation to the rates get some elements motivator urged through the results of the continued failure to meet the need of daily assessments of these elements, which led to the continuation of Hair Los

Risk factors of anterior ischemic optic neuropathy among a sample of patients in Erbil City

Background and objectives: Although a lot of studies suggested the predisposition of many risk factors, non-arteritic anterior ischemic optic neuropathy was considered for a long time to be idiopathic. This study aimed to assess the relationship between different factors and anterior ischemic optic neuropathy among a sample of patients in Erbil city. Methods: A case-control study was conducted in Erbil city, Iraq from 2008 to 2011. A total of 36 cases of non-arteritic anterior ischemic optic neuropathy and 36 controls with other visual problems were included. Results: Eight percent of patients in this study had one or more risk factors (P = 0.001), in particular hypertension and diabetes were shown to have a significant relationship (P = 0.046 and 0.001, respectively). The absence of physiological cup over the optic disc has crucial importance both independently (P = 0.001) and in association with diabetes (P = 0.001). Old age and male gender were significant factors in relation to co-morbidities (P = 0.001 and 0.038, respectively). Conclusion: The study had concluded that hypertension, diabetes, age, male gender and absent physiological cup over the optic disc were important risk factors for anterior ischemic optic neuropathy