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

Laparoscopic versus Open Retroperitoneal Bilateral Varix Ligation for Obese Patients Presenting with Primary Sub-Fertility: A Randomized Comparative Study

Objectives: To compare the outcome of laparoscopic versus open varicocelectomy in sub-fertile obese men presenting with bilateral testicular varicoceles. Materials and Methods Forty obese (body mass index > 30) primary sub-fertile males with bilateral varicoceles have been selected for this study and randomized to either laparoscopic varicocelectomy (Goup I, n=20) patients or high retroperitoneal open ligation (Group II, n=20) patients. Semen analysis was performed preoperatively and three months or more postoperatively. Scrotal duplex was done for each case preoperatively and 6 months post-operatively. Results The average operative time in Group I and Group II was ~77.3 minutes and ~58 minutes, respectively (P0.05). The mean percentage of improvement in sperm motility was ~ 16.5% in Group I and 14.1% in Group II (p< 0.05). The mean decrease in the percentage of abnormal forms was ~20% in Group I and ~5.5% in Group II (p< 0.05). Moreover, the quality of motility (grades) improved significantly after laparoscopic varix ligation, to a higher extent than after open surgery. Conclusion: The laparoscopic approach is an excellent option for varix ligation in obese patients. Morbidity is less and convalescence is shorter compared to open surgery. A particular advantage of laparoscopy over conventional surgery is the possibility of treatment of bilateral varicoceles through the usual three laparoscopic ports. In this study improvement in some semen parameters was significantly better following laparoscopic varix ligation. This may be explained by the better view and magnification offered by laparoscopy. Laparoscopie comparée à la chirurgie ouverte rétro péritonéale dans la ligature de varices chez des patients obèses présentant une hypofertilité primaire : Etude comparative randomisée. Objectifs: Comparer les résultats de la laparoscopie par rapport à la varicocèlectomie par chirurgie ouverte chez des patients obèses présentant une hypofertilité associée à une varicocèle bilatérale. Matériel et Méthodes: Quarante hommes obèses (index de masse corporelle > 30) présentant une hypofertilité primaire avec varicocèle bilatérale ont été sélectionnés pour cette étude randomisée. Ces patients ont bénéficié soit d'une varicocèlectomie laparoscopique (Groupe I n=20) soit d'une ligature haute par chirurgie haute rétro péritonéale (Groupe II n=20). Un spermogramme a été réalisé en préopératoire et 3 mois au moins en post-opératoire. Un écho doppler scrotal a été réalisé dans les 2 groupes en préopératoire et à 6 mois post-opératoire. Résultats: La durée moyenne de l'intervention était d'environ 77,3 minutes pour le Groupe I et de 58 minutes pour le Groupe II (P0.05). L'augmentation moyenne du nombre des spermatozoïdes était d'environ 96 millions de spermatozoïdes dans le Groupe I et de 92 million de spermatozoïdes dans le Groupe II (p>0.05). L'amélioration moyenne de la mobilité des spermatozoïdes était de 16.5% dans le Groupe I et de 14.1% dans le Group II (p< 0.05). La baisse moyenne du pourcentage de formes anormales de spermatozoïdes était d'environ 20% dans le Group I et de 5.5% dans le Group II (p< 0.05). La qualité de la mobilité était plus améliorée après ligature de varice par laparoscopie comparée à la chirurgie ouverte. Conclusion: La laparoscopie est une excellente option pour la varicocèlectomie chez les patients obèses. Comparée à la chirurgie ouverte la laparoscopie présente une moindre morbidité et une plus courte convalescence. Un avantage particulier de la laparoscopie par rapport à la chirurgie conventionnelle est la possibilité de faire la ligature bilatérale à travers les mêmes 3 orifices d'abord. Dans cette étude l'amélioration de certains paramètres du sperme était significativement plus marquée après ligature des varicocèles par laparoscopie. Cela pourrait s'expliquer par une meilleure visibilité des varices par laparoscopie. African Journal of Urology Vol.10(1) 2004: 50-5

Plasmonic nanostructures of SnO2:Sb thin film under gamma radiation response

This paper is a part of a natural dye solar cell project. Conductive transparent oxide (CTO) films have been deposited onto preheated glass substrates using a spray pyrolysis technique. The optical, electrical, structural properties as well as thermal annealing and gamma radiation response were studied. The average optical energy gap of doped films for direct allowed and direct forbidden transitions were found to be 3.92 and 3.68 eV, respectively. The plasmon frequency and plasmon energy after doping were found to be 3.48 × 1014 s −1 and 0.23 eV. The negative absorbance of the doped film was observed in UV-Vis range after applying both thermal annealing and γ-dose irradiation with 22 kGy. The negative refractive index of the doped film in UV range (220 – 300 nm) is promising for optical applications. The electron mobility μe reached a maximum of 27.4 cm2 V−1 s−1 for Sb concentration of 10 %. The corresponding resistivity ρ, and sheet resistance Rs reached their minimum values of 1.1 × 10−3 Ω cm and 35 Ω sq−1, respectively. The dopant concentration has been increased from 4.13 × 1019 to 2.1 × 1020cm−3. The doped film was found to exhibit three diffraction peaks associated with (2 2 2), (2 0 0), and (2 1 1) reflection planes, of which the peak of (2 2 2) of Sb2O3 and the peak of (2 0 0) were very close

Materials Research in the Group of Polymer Chemistry at ETH

The research activities of the group of Polymer Chemistry in the Department of Materials at ETH Zürich are briefly reviewed. The main research areas are concerned with (i) the behavior of polymeric solids, (ii) polymers and inorganic materials, and (iii) multi-functional polymeric materials. All three themes involve modeling, but the first one has a particularly strong simulation component. Two Zürich start-up companies have emerged from the group, Global Surface AG and MatSim GmbH