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

Decent work in nursing: Relationship between nursing work environment, job satisfaction, and physical and mental health

Aim To examine the relationship between nursing work environment, nurses' perception of decent work, job satisfaction, and physical and mental health. Background According to the psychology of working theory, work-related and overall well-being levels of employees with decent work increase as their basic needs are met. Methods This study was conducted as a cross-sectional, correlational study. The study sample consisted of 311 nurses working in two hospitals in a province of Turkey. The participants were selected using convenience sampling method. The model of the research was analyzed using structural equation modeling. This study was reported using the STROBE checklist for cross-sectional studies. Results The four dimensions of the nursing work environment were found to have a significant relationship with decent work. Decent work was found to have a direct relationship with physical and mental health. It had an indirect relationship between three subscales of work environment and physical and mental health, however, decent work had no significant relationship with job satisfaction. Conclusions The findings of this study indicated the role of decent work environment and its relationship with nurses' physical and mental health. Implications for nursing and health policy Nurse managers, policy makers, and decision-makers at all levels should improve nursing work environment and working conditions

Evaluation of Serum Lipid Parameters in Acromegaly Patients

Keskin, Havva/0000-0003-1794-4473WOS: 000475503600005Objective: In acromegaly, the incidence of cardiovascular disease is higher compared to healthy population because of the association of secondary cardiovascular disease risk factors such as hypertension, glucose intolerance, dyslipidemia, and insulin resistance. This study aimed to evaluate the relationship between Growth Hormone (GH), Insulin-like Growth Factor-1 (IGF-1), and lipid profiles in patients with newly diagnosed acromegaly. Methods: This study included 57 newly diagnosed acromegaly patients and 31 healthy control cases. Blood samples were taken after a 12-hour night fasting to analyze the levels of the hormones, the lipid profiles, and the fasting blood glucose. Results: The mean of LDL-C level in the acromegaly group and control group were respectively 140.2 +/- 61.3 mg/dL and 115.6 +/- 30.4 mg/dL, (p=0.029), triglyceride level 137.6 +/- 84.0 mg/dL and 102.9 +/- 43.0 mg/dL, (p=0.027) and HDL-C level 41.5 +/- 10.5 mg/dL and 50.5 +/- 10.6 mg/dL, (p=0.001). There was a significant positive correlation between GH levels of LDL (r=0.375, p=0.002), TG (r=0.302, p=0.01), IGF-1 (r=0.634, p=0.0001) and HOMA-IR (r=0.699, p=0.0001), IGF-1 and LDL levels (r=0.295, p=0.01) and TG (r=0.476, p=0.0001). There was a negative correlation between HDL and GH (r=-0.399, p=0.001) and HDL with IGF-1 (r=-0.310, p=0.01). Conclusions: Acromegaly is a disorder characterized by an excess of GH and GH appears to adversely affect the lipid profile. It can be considered that this risk factor may be eliminated by the control of the levels of GH and IGF-1 in acromegaly patients. Further studies seem necessary for more clarifica-tion