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

T wave peak-to-end interval in COPD

Introduction: The interval from the peak to the end of the electrocardiographic (ECG) T wave (Tp-Te) can estimate cardiovascular mortality and ventricular tachyarrhythmias

Classification of Neuromuscular Junction and Tendon Recordings of Neuromuscular Diseases by Their Spectrogram

In this study, the effect of spectrograms from neuromuscular junction and tendon records for normal, neurogenic and myopathic motor units being constructed via EMG Simulator v3.6 on the differential diagnosis were investigated. Multi-layer perceptron is chosen as classifier. If only the neuromuscular junction records are applied to the network, the performance is 73.33%. If only tendon records are applied to the input of network, the performance is 94.67%. When neuromuscular junction and tendon records are applied together to the network, the performance is 100%

Nöromüsküler Hastalıkların Kavşak ve Tendon Kayıtlarında Spektrogramlarına Göre Sınıflandırılması

Artuğ, Tuğrul (Arel Author), Göker, İmran (Arel Author), Osman, Onur (Arel Author)In this study, the effect of spectrograms from neuromuscular junction and tendon records for normal, neurogenic and myopathic motor units being constructed via EMG Simulator v3.6 on the differential diagnosis were investigated. Multi-layer perceptron is chosen as classifier. If only the neuromuscular junction records are applied to the network, the performance is 73.33%. If only tendon records are applied to the input of network, the performance is 94.67%. When neuromuscular junction and tendon records are applied together to the network, the performance is 100%. ÖZET- Bu çalışmada EMG Simulator v3.6 ile oluşturulan normal, nörojenik ve miyopatik motor üniteler için nöromüsküler kavşak ve tendon kayıtlarında spektrogramlarının ayırıcı tanıya etkisi araştırılmıştır. Çok katmanlı algılayıcı sınıflayıcı olarak seçilmiştir. Sadece kavşaktan alınan veriler ağa uygulandığında başarı %73.33’tür. Sadece tendon verileri girişten uygulandığında ise başarı %94.67’dir. Kavşak ve tendon verileri beraber ağa uygulandığında %100 başarı elde edilmiştir

Classification of Neuromuscular Diseases in Neuromuscular Junction and Tendon Recordings with Needle EMG by Using Welch's Method

In this study, the power spectral density of simulated data which contain neuromuscular diseases and normal motor unit (i.e. control group) scenarios was calculated using Welch's method. Furthermore, the effect of Welch's method on differential diagnosis was investigated. Data were recorded both near innervation zone which is the area that motor unit action potential occurs and near tendon. Multi-layer perceptron was preferred as artificial neural network to investigate the effect of method on classification. When the data from innervation zone and from tendon were applied separately to the ANN, 68.67% performance was obtained. The accuracy of the network was increased up to 76% when data were applied together

İğne EMG’si ile Nöromüsküler Kavşak ve Tendon Kayıtlamalarında Nöromüsküler Hastalıkların Welch Yöntemi ile Sınıflandırılması

Artuğ, Tuğrul (Arel Author), Osman, Onur (Arel Author), Göker, İmran (Arel Author)In this study, the power spectral density of simulated data which contain neuromuscular diseases and normal motor unit (i.e. control group) scenarios was calculated using Welch's method. Furthermore, the effect of Welch's method on differential diagnosis was investigated. Data were recorded both near innervation zone which is the area that motor unit action potential occurs and near tendon. Multi-layer perceptron was preferred as artificial neural network to investigate the effect of method on classification. When the data from innervation zone and from tendon were applied separately to the ANN, 68.67% performance was obtained. The accuracy of the network was increased up to 76% when data were applied together

Estimation of the muscle fiber density from the motor unit action potential

A space $X$ has a $mathbb{Q}$-diagonal if $X^2 setminus Delta$ has a $mathcal{K}( mathbb{Q})$-directed compact cover. We show that any compact space with a $mathbb{Q}$-diagonal is metrizable, hence any Tychonorff space with a $mathbb{Q}$-diagonal is cosmic. These give a positive answer to Problem 4.2 and Problem 4.8 in cite{COT11} raised by Cascales, Orihuela and Tkachuk

Determining Phase Duration of Scanning EMG Signals

There are more than one motor unit activities recorded simultaneously during scanning EMG recordings. It is not possible to determine the phase duration correctly by inspecting only one sweep. The other motor unit activities, which are out of interest, should be filtered for this purpose. In this study, a new method is developed by revealing the activity corridor of scanning EMG recordings, wavelet transform based noise reduction, autocorrelation function based signal cutting location detection, and alpha trim filtering are applied to the recorded signals for determining phase duration correctly. Data are recorded from normal people and neuromuscular diseased people. Dataset contains 20 scanning EMG recordings

Effect of Cigarette Smoking on Platelet Aggregation

Background: Cigarette smoking may increase platelet aggregation and cause atherothrombotic cardiovascular events. We aimed to investigate the impact of cigarette smoking on platelet function in patients with ischemic coronary heart disease (CHD). Methods: Twenty patients with ischemic stable CHD under aspirin therapy (300 mg/d), who continue to smoking despite all warnings, and 20 nonsmokers with CHD are enrolled in the study. Platelet function is studied at the morning, before and 15 minutes after the first cigarette, by the Platelet Function Analyzer (PFA)-100, with collagen and epinephrine and collagen and adenosine diphosphate cartridges. Post aspirin platelet hyperactivity is defined as having a closure time (CT) shorter than 186 seconds despite regular aspirin intake. Serial CT measurements are analyzed by paired samples t test. Results: Persistent platelet activity was present in 4 smoker (20%) and 3 nonsmoker (15%) patients at the beginning. Platelet activity measured by the PFA-100 is been increased significantly after cigarette smoking (P = .004). Shorter CTs were determined after smoking in all patients with and without baseline persistent platelet activity, and 4 more participants became aspirin nonresponder (P = .004). No significant differences in demographic, hematological, and biochemical parameters were determined between aspirin responders and nonresponders. Conclusions: We determined that cigarette smoking may increase platelet aggregation in patients with ischemic CHD in an aspirin nonresponsive manner. Our results emphasize the importance of quitting cigarette smoking in patients with CHD