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 Experience of Class Tutors in a Peer Tutoring Programme: A Novel Theoretical Framework

The following paper presents the first known examination of the experiences of class tutors within a peer-assisted learning program. Three female first-year class tutors, aged 25-28 years, provided insight into how they experienced a novel peer tutoring programme embedded in their tutorials. Using grounded theory techniques, it was found that the following five themes underlie their experiences: role exploration, sharing responsibility, regulation of the peer tutored groups, harnessing the peer tutors’ role, and community. Literature from the domain was examined post-hoc and was found to complement these themes. Additionally, it was found that class tutors were beneficiaries of the programme. It was suggested that future research address the limitations of the present study and test a number of hypotheses within a novel theoretical framework. The hypotheses were constructed to include the key roles within embedded peer tutoring, and learning climate typologies and dimensions (Little, 1975)

Irritability and internalizing symptoms : modeling the mediating role of emotion regulation

Background: Irritability and emotion regulation are both important transdiagnostic factors that contribute to the development of internalizing symptoms during adolescence. The current study examined whether emotion regulation mediates the relationship between irritability and internalizing symptoms. Methods: To examine this relationship we analysed the indirect effect of irritability (measured using a single item from the Goldberg Mania Questionnaire) on internalizing symptoms (anxiety and depression) via the mediator, emotion regulation (Difficulties in Emotion Regulation Scale) in 112 adolescent females. Results: Mediation analysis, using bootstrapping, showed a significant indirect effect and suggests that the relationship between irritability and internalizing symptoms is mediated by emotion dysregulation. Limitations: These include measuring irritability using a single item and employing a cross sectional design. Conclusions: These novel findings add to our understanding of the processes and mechanisms by which irritability contributes to the development of internalizing symptoms.6 page(s

"The food matches the mood" : experiences of eating disorders in bipolar disorder

Approximately 33% of those with bipolar disorder (BD) have a comorbid eating disorder (ED). However, the trajectory of these conditions has received little research attention. Nine participants who met criteria for BD and an ED participated in qualitative interviews exploring experiences of illness onset, the interaction of these conditions, and service provision. Almost all participants in the sample reported minimal to no screening of ED problems, despite their health professionals’ frequent discussion of obesity. Findings suggested that ED features were diverse and evolved over time. Mania and depression were connected to ED features such as overeating and restricting, but this differed between and within participants. Most participants disclosed historic trauma which they considered central to their mental health concerns. This clinical group appears to be underserviced. Clinicians and researchers should routinely screen for ED features when treating and diagnosing BD to inform their physical and mental health interventions

The impact of oxytocin administration on brain activity: a systematic review and meta-analysis protocol

Background Converging evidence demonstrates the important role of the neuropeptide hormone oxytocin (OT) in human behaviour and cognition. Intranasal OT administration has been shown to improve several aspects of social communication, such as the theory of mind performance and gaze to the eye region, and reduce anxiety and related negative cognitive appraisals. While this early research has demonstrated the potential for intranasal OT to treat psychiatric illnesses characterized by social impairments, the neurobiological mechanisms are not well known. Researchers have used functional magnetic resonance imaging (fMRI) to examine the neural correlates of OT response; however, results have been variable and moderating factors are poorly understood. The aim of this meta-analysis is to synthesize data examining the impact of intranasal OT administration on neural activity. Methods/design Studies that report fMRI data after intranasal OT administration will be identified. PubMed, Embase, PsycINFO, and Google Scholar databases will be searched as well as the citation lists of retrieved articles. Eligible articles written in English from 2005 onwards will be included in the meta-analysis, and corresponding authors of these papers will be invited to contribute t-maps. Data will be collected from eligible studies for synthesis using Seed-based d Mapping (SDM) or Multi-Level Kernel Density Analysis (MKDA), depending on the number of usable t-maps received. Additionally, publication bias and risk of bias will be assessed. Discussion This systematic review and meta-analysis will be the first pre-registered synthesis of data to identify the neural correlates of OT nasal spray response. The identification of brain regions underlying OT’s observed effects will help guide future research and better identify treatment targets. Systematic review registration PROSPERO CRD4201603878

Eating disorder features in bipolar disorder : clinical implications

Background: Bipolar disorder (BD) is associated with elevated rates of eating disorders (EDs), but the nature and impact of specific ED features are unclear. Aims: This study sought to identify which ED features are common in BD, and whether these relate to quality of life (QoL) impairment and body mass index (BMI). Method: A clinical sample of 73 adults with BD completed self-report measures of health, ED features, emotion regulation ability, impulsivity, and QoL. Results: Binge eating (45%), excessive dietary restriction (39%), overvaluation of weight/shape (51%), purging (16%) and driven exercise (27%) were common, and associated with a poorer clinical picture, including poorer QoL and poorer emotion regulation. Furthermore, regular binge eating episodes explained a significant proportion of variance in QoL impairment after controlling for other significant predictors. The best predictors of BMI were number of medical conditions, impulsivity and positive beliefs about binge eating. Conclusions: ED features that may not meet criteria for a fully diagnosable ED–particularly overvaluation of weight/shape and binge eating–warrant greater attention, as they may still significantly worsen QoL. Future research should focus on modifying existing psychological interventions to better target ED features among individuals with BD and thereby improve clinical outcomes

Matter Over Mind: A Randomised-Controlled Trial of Single-Session Biofeedback Training on Performance Anxiety and Heart Rate Variability in Musicians

Musical performance is a skilled activity performed under intense pressure, thus is often a profound source of anxiety. In other contexts, anxiety and its concomitant symptoms of sympathetic nervous system arousal have been successfully ameliorated with HRV biofeedback (HRV BF), a technique involving slow breathing which augments autonomic and emotional regulatory capacity.This randomised-controlled study explored the impact of a single 30-minute session of HRV BF on anxiety in response to a highly stressful music performance.A total of 46 trained musicians participated in this study and were randomly allocated to a slow breathing with or without biofeedback or no-treatment control group. A 3 Group×2 Time mixed experimental design was employed to compare the effect of group before and after intervention on performance anxiety (STAI-S) and frequency domain measures of HRV.Slow breathing groups (n=30) showed significantly greater improvements in high frequency (HF) and LF/HF ratio measures of HRV relative to control (n=15) during 5 minute recordings of performance anticipation following the intervention (effect size: η(2) =0.122 and η(2) =0.116, respectively). The addition of biofeedback to a slow breathing protocol did not produce differential results. While intervention groups did not exhibit an overall reduction in self-reported anxiety, participants with high baseline anxiety who received the intervention (n=15) displayed greater reductions in self-reported state anxiety relative to those in the control condition (n=7) (r=0.379).These findings indicate that a single session of slow breathing, regardless of biofeedback, is sufficient for controlling physiological arousal in anticipation of psychosocial stress associated with music performance and that slow breathing is particularly helpful for musicians with high levels of anxiety. Future research is needed to further examine the effects of HRV BF as a low-cost, non-pharmacological treatment for music performance anxiety

Additional file 1: of The impact of oxytocin administration on brain activity: a systematic review and meta-analysis protocol

PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) 2015 checklist. Recommended items to address in a systematic review protocol. (PDF 160 kb

High Frequency (Natural log) Means and Standard Error.

<p>High Frequency (Natural log) Means and Standard Error.</p

Individual Data: Interbeat intervals (IBI) and frequency analysis during Rest period and Slow breathing.

<p>a) IBI during two minutes of resting state. Changes in HR due to respiration, 12–14 breaths per minute, are small and irregular. b) IBI during two minutes of slow breathing. Changes in HR due to respiration, 6 breathes per minute, are large and regular. High amplitude indicates large differences between the slowest beats during exhalation and fastest beats during inhalation. c) Frequency analysis during 5 minutes resting state indicates low amplitude LF and HF (recording is too short to accurately characterise VLF (Malick, 1996)) d) Frequency analysis during 5 minutes slow breathing indicates very high amplitude LF oscillations at the frequency of breathing (10 times per minute or 0.1 Hz).</p