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 spatial correlation analysis and adaptive estimation techniques for MIMO-OFDM systems

In this study, the performance of multiple input multiple output (MIMO)-orthogonal frequency division multiplexing (OFDM) systems is analyzed with the existence of spatial correlation and the exploitation of adaptive techniques. For the spatial correlation analysis, the effect of a three-dimensional (3-D) scattering environment and the effect of mutual coupling are studied for different antenna types. A new channel model based on the 3-D scattering environment is developed for this purpose. By then using the MIMO capacity, the performance of the system is analyzed. It is observed that environment richness is the key factor for obtaining uncorrelated signals, and that the effect of mutual coupling decreases the capacity for most of the antenna distances. Then, based on the spatial correlation analysis, different adaptation techniques are investigated. Antenna selection algorithm aiming to pick antennas giving the maximum capacity, angle spread estimation for the determination of environment richness, and linear minimum mean-square error (LMMSE) channel estimation using the spatial correlation are investigated. It is observed that these adaptive techniques give accurate results that they can improve the system performance. The LMMSE channel estimation is then further investigated to make it adaptive and less complex so that it can be realized in practical systems. For this purpose, a low-rank LMMSE channel estimation is introduced by using comb type pilots. Moreover, the unification of LMMSE with other channel estimation methods such as transform domain and least squares (LS) estimates is also studied. The study concludes that for future high data rate oriented MIMO-OFDM systems, the effect of spatial correlation needs to be taken into account and the adaptive techniques proposed in this study can enable better performing systems

Central corneal thickness in tilted disc syndrome

WOS: 000255532300008PubMed: 18451731Purpose. Earlier literature reports that abnormal optic disc shape or size seem to be closely associated with the shape or size of the cornea. Here we search for an association between the presence of tilted disc syndrome and the central corneal thickness. Methods. Sixty-one eyes of 61 patients with tilted disc syndrome were included in the study. Sixty-one eyes of 61 subjects were chosen as controls. Corneal thickness was evaluated with ultrasound pachymetry from the central region after instillation of topical proparacaine hydrochloride and before the ophthalmologic examination. Results. The mean central corneal thickness in the tilted disc syndrome group was found to be 547.5 +/- 36.16 mu m (median 546, range 467 to 638). The mean central corneal thickness in the control group was measured as 541.09 +/- 29.52 mu m (median 540, range 500 to 627). There was no statistically significant difference in corneal thickness between the tilted disc syndrome group and control group (p = 0.218). Conclusion. There seems to be no correlation between the central corneal thickness and the presence of tilted disc syndrome

Burkholderia cepacia keratitis with endophthalmitis

WOS: 000271440200017PubMed: 19661206Keratitis with endophthalmitis of the right eye occurred in a 78-year-female following a complicated cataract surgery. Prompt intravitreal vancomycin and ceftazidime with topical fortified tobramycin and cefazolin treatments were started. The corneal, aqueous and vitreous cultures grew a Burkholderia cepacia complex (Bcc) strain on the fourth day. Restriction fragment length polymorphism analysis of the recA amplicon revealed B. cepacia genomovar I. The organism was found to be susceptible to ceftazidime, ciprofloxacin and ofloxacin. Topical ciprofloxacin was given immediately. At day 10, the pain relieved and the clinical condition of the patient improved with resolution of the purulent discharge, severe circumcorneal congestion and chemosis. The size of the corneal abscess and anterior chamber exudation decreased. The Bcc should be included among the bacterial species that may cause keratitis following intraocular surgeries

Cyber-WISE: A Cyber-Physical Deep Wireless Indoor Positioning System and Digital Twin Approach

In recent decades, there have been significant research efforts focusing on wireless indoor localization systems, with fingerprinting techniques based on received signal strength leading the way. The majority of the suggested approaches require challenging and laborious Wi-Fi site surveys to construct a radio map, which is then utilized to match radio signatures with particular locations. In this paper, a novel next-generation cyber-physical wireless indoor positioning system is presented that addresses the challenges of fingerprinting techniques associated with data collection. The proposed approach not only facilitates an interactive digital representation that fosters informed decision-making through a digital twin interface but also ensures adaptability to new scenarios, scalability, and suitability for large environments and evolving conditions during the process of constructing the radio map. Additionally, it reduces the labor cost and laborious data collection process while helping to increase the efficiency of fingerprint-based positioning methods through accurate ground-truth data collection. This is also convenient for working in remote environments to improve human safety in locations where human access is limited or hazardous and to address issues related to radio map obsolescence. The feasibility of the cyber-physical system design is successfully verified and evaluated with real-world experiments in which a ground robot is utilized to obtain a radio map autonomously in real-time in a challenging environment through an informed decision process. With the proposed setup, the results demonstrate the success of RSSI-based indoor positioning using deep learning models, including MLP, LSTM Model 1, and LSTM Model 2, achieving an average localization error of <= 2.16 m in individual areas. Specifically, LSTM Model 2 achieves an average localization error as low as 1.55 m and 1.97 m with 83.33% and 81.05% of the errors within 2 m for individual and combined areas, respectively. These outcomes demonstrate that the proposed cyber-physical wireless indoor positioning approach, which is based on the application of dynamic Wi-Fi RSS surveying through human feedback using autonomous mobile robots, effectively leverages the precision of deep learning models, resulting in localization performance comparable to the literature. Furthermore, they highlight its potential for suitability for deployment in real-world scenarios and practical applicability.European Union (EU) Marie Curie Action

Effects of coffee consumption on gut recovery after surgery of gynecological cancer patients: a randomized controlled trial

BACKGROUND: Paralytic ileus that develops after elective surgery is a common and uncomfortable complication and is considered inevitable after an intraperitoneal operation