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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Taxonomia de Stenochironomus Kieffer, 1919 (Diptera: Chironomidae ) nos estados do Amazonas e Roraima, Brasil

Chironomidae (Diptera: Nematocera), compõe um importante grupo ecológico de insetos aquáticos e frequentemente representam o grupo mais abundante e diverso de invertebrados bentônicos. Apesar de possuir uma ampla distribuição mundial, o seu conhecimento no Brasil ainda é incipiente, com cerca 141 gêneros e 392 espécies descritas. Na região Norte são registradas 164 espécies. O objetivo deste trabalho foi estudar as espécies do gênero Stenochironomus Kieffer, 1919, que possui larvas e pupas minadoras de folhas e troncos submersos em ambientes lênticos e lóticos. Este gênero possui cerca de 95 espécies descritas com representantes em quase todas as regiões zoogeográficas com exceção da Antártica. Na Região Neotropical estão registradas 34 espécies (28 publicadas e seis não publicadas), sendo 24 (18 publicadas e seis não publicadas) assinaladas para o Brasil, três para a região sul e 15 para região Amazônica. As coletas foram realizadas em diversos igarapés, distribuidos nos Estados do Amazonas e Roraima, nos municípios de Presidente Figueiredo, São Gabriel da Cachoeira, Manaus, Alto Alegre, Amajari e Boa Vista. Em cada igarapé foi feita uma busca manual de troncos e folhas submersas minadas por larvas de Stenochironomus. Para a obtenção dos adultos, o material coletado foi individualizado e mantido em recipientes e aquários no laboratório. Os espécimes foram montados entre lâmina e lamínula, utilizando Euparal® como meio de imersão, identificados sob microscópio estereoscópico e óptico. O material examinado está depositado na coleção de invertebrados do Instituto Nacional de Pesquisas da Amazônia (AM). Neste trabalho ampliamos o número de espécies para o Brasil de 24 para 31, com a descrição de cinco espécies novas, novos registros de duas espécies para o Brasil: S. nudipupa Borkent, 1984 e S. gladius Borkent, 1984, ampliamos a distribuição de S. jubatus Borkent, 1984 e S. triannulatus Borkent, 1984 para Roraima, S. bacrionis Borkent, 1984 para o Amazonas e complementamos as descrições dos imaturos (larva e pupa) de S. triannulatus Borkent, 1984 e S. reissi Borkent, 1984

Chironomidae (Diptera) to State of Tocantins, Brazil

Submitted by Sandra Infurna ([email protected]) on 2017-05-16T15:38:18Z No. of bitstreams: 1 veronica_silva_etal_IOC_2012.pdf: 997569 bytes, checksum: 228c8dccf4cd5377fdaac5aacda42459 (MD5)Approved for entry into archive by Sandra Infurna ([email protected]) on 2017-05-16T15:46:01Z (GMT) No. of bitstreams: 1 veronica_silva_etal_IOC_2012.pdf: 997569 bytes, checksum: 228c8dccf4cd5377fdaac5aacda42459 (MD5)Made available in DSpace on 2017-05-16T15:46:01Z (GMT). No. of bitstreams: 1 veronica_silva_etal_IOC_2012.pdf: 997569 bytes, checksum: 228c8dccf4cd5377fdaac5aacda42459 (MD5) Previous issue date: 2012Instituto Nacional de Pesquisas da Amazônia. Laboratório de Biologia e Ecologia de Insetos Aquáticos. AM, Brasil.Fundação Oswaldo Cruz. PIBS/Presidência. Programa Institucional de Biodiversidade e Saúde. Rio de Janeiro, RJ, Brasil / Universidade gama Filho. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Simulídeos e Oncocercose. Rio de Janeiro, RJ. Brasil.Inventariou-se a fauna de Chironomidae presente no sul do estado do Tocantins, Brasil. Foram realizadas seis coletas bimestrais em 45 locais de coleta com características lóticas no ano de 2006. O material foi coletado manualmente em diversos ambientes, onde verificou-se a abundância e a constância de Chironomidae. A partir do material coletado identificou-se 511 espécimes, montados em lâminas permanentes. Registramos a ocorrência de 30 gêneros distribuídos em três subfamílias (Chironominae, Orthocladiinae e Tanypodinae). Orthocladiinae foi a mais abundante constituindo 55% do total das larvas identificadas. Cricotopus foi o gênero mais abundante, representando 35,20% das larvas totais identificadas, seguido de Thienemanniella 14,85%, Rheotanytarsus 13,65% e Polypedilum 11,90%. A subfamília que apresentou o maior número de gêneros foi Chironominae com 18. O local de coleta mais abundante foi ENP1 com 70 espécimes, seguido de ENPN15 com 65. Os locais ENPN14 e ENP1 foram os que apresentaram o maior número de gêneros, com 11 em cada, ENP1 apresentou o maior número de gêneros acessórios com seis, seguido de EN147 com três gêneros acessórios. Neste estudo não observamos nenhum gênero constante. Todos os gêneros encontrados constituem novas ocorrências para o estado do Tocantins, sendo que 12, até o momento não possuem espécies descritas para o Brasil.Inventoried to Chironomidae fauna in the southern state of Tocantins, Brazil. Were carried out six collections bimonthly on 45 collection sites with lotic characteristics in 2006. The material was collected manually, at manual sampling in the various environments, where we verified abundance and constancy of Chironomidae. From the collected material was identified 511 specimens mounted on permanent slides. We recorded the occurrence of 30 genera distributed in three subfamilies (Chironominae, Orthocladiinae and Tanypodinae). Orthocladiinae was the most abundant constituting 55% of total identified larvae. Cricotopus was the most abundant, representing 35.20% of the total identified larvae, followed by Thienemanniella 14.85%, Rheotanytarsus 13.65% and Polypedilum 11.90%. The subfamily with the highest number of genera, was Chironominae with 18. The most abundant collection site, was ENP1 with 70 specimens, followed by ENPN15 with 65. The collection sites ENPN14 and ENP1 were those with the greatest number of genera, with 11 genera each, ENP1 had the largest number of accessories genera with six, followed by EN147 with three accessories genera. In this study we did not observed any constant genera. All genera found are new records for the state of Tocantins, and 12, have not yet described species for Brazil

Chironomidae (Diptera) do Estado do Tocantins, Brasil

Inventoried to Chironomidae fauna in the southern state of Tocantins, Brazil. Were carried out six collections bimonthly on 45 collection sites with lotic characteristics in 2006. The material was collected manually, at manual sampling in the various environments, where we verified abundance and constancy of Chironomidae. From the collected material was identified 511 specimens mounted on permanent slides. We recorded the occurrence of 30 genera distributed in three subfamilies (Chironominae, Orthocladiinae and Tanypodinae). Orthocladiinae was the most abundant constituting 55% of total identified larvae. Cricotopus was the most abundant, representing 35.20% of the total identified larvae, followed by Thienemanniella 14.85%, Rheotanytarsus 13.65% and Polypedilum 11.90%. The subfamily with the highest number of genera, was Chironominae with 18. The most abundant collection site, was ENP1 with 70 specimens, followed by ENPN15 with 65. The collection sites ENPN14 and ENP1 were those with the greatest number of genera, with 11 genera each, ENP1 had the largest number of accessories genera with six, followed by EN147 with three accessories genera. In this study we did not observed any constant genera. All genera found are new records for the state of Tocantins, and 12, have not yet described species for Brazil.Inventariou-se a fauna de Chironomidae presente no sul do estado do Tocantins, Brasil. Foram realizadas seis coletas bimestrais em 45 locais de coleta com características lóticas no ano de 2006. O material foi coletado manualmente em diversos ambientes, onde verificou-se a abundância e a constância de Chironomidae. A partir do material coletado identificou-se 511 espécimes, montados em lâminas permanentes. Registramos a ocorrência de 30 gêneros distribuídos em três subfamílias (Chironominae, Orthocladiinae e Tanypodinae). Orthocladiinae foi a mais abundante constituindo 55% do total das larvas identificadas. Cricotopus foi o gênero mais abundante, representando 35,20% das larvas totais identificadas, seguido de Thienemanniella 14,85%, Rheotanytarsus 13,65% e Polypedilum 11,90%. A subfamília que apresentou o maior número de gêneros foi Chironominae com 18. O local de coleta mais abundante foi ENP1 com 70 espécimes, seguido de ENPN15 com 65. Os locais ENPN14 e ENP1 foram os que apresentaram o maior número de gêneros, com 11 em cada, ENP1 apresentou o maior número de gêneros acessórios com seis, seguido de EN147 com três gêneros acessórios. Neste estudo não observamos nenhum gênero constante. Todos os gêneros encontrados constituem novas ocorrências para o estado do Tocantins, sendo que 12, até o momento não possuem espécies descritas para o Bras

Two new species and records of Stenochironomus Kieffer from Brazilian Amazon region, with description of immature stages (Diptera: Chironomidae)

Two new species of Stenochironomus Kieffer, 1919 are described in Brazil. New records of Stenochironomus nudipupa Borkent, 1984 and S. gladius Borkent, 1984 from Brazil, new data on geographical distribution of S. jubatus Borkent, 1984 and S. triannulatus Borkent, 1984 from the State of Roraima, and S. bacrionis Borkent, 1984 recorded from the State of Amazonas, as well as emended descriptions of immature stages of S. triannulatus Borkent, 1984 and S. reissi Borkent, 1984 are also presented. Copyright © 2013 Magnolia Press

Stenochironomus gladius Borkent 1984

Stenochironomus gladius Borkent, 1984 Stenochironomus gladius Borkent, 1984: 108; Spies & Reiss 1996: 73. Material examined. BRAZIL, Amazonas State, Manaus, São Gabriel da Cachoeira, saída da BR 307, Km 12, Igarapé das pilhas mark # 9, 00º 36 ’ 36,8 ”S, 67 º 01’ 37,7 ’’W, 23–30.VIII. 11, collected in a submerged leaf, 1 male with pupal and larval exuviae, leg. E.D. De-Angelis-Reis (INPA, slide-mounted in Euparal); Manaus, Sítio do Raul, Bairro Tarumã, 03º 01’22,0”S, 60 º 04’47,0’’W, 14.VII. 11, 1 male with pupal and larval exuviae, leg. E.D. De-Angelis-Reis; Presidente Figueiredo, AM 240, Km 20, Balneário Sossego da pantera, igarapé da onça, 02° 00' 52 "S, 60 ° 01' 43 "W, 25–30.IX. 10, 1 male with pupal exuviae, leg. E.D. De-Angelis-Reis; Presidente Figueiredo, AM 240, Igarapé do Chico, 02° 04' 30,1 "S, 59 ° 51 ' 20,6 "W, 25–30.IX. 10, 1 male with larval exuviae leg. E.D. De- Angelis-Reis. Remarks. The immatures of Stenochironomus gladius were obtained from submerged mined leaves on gravel or rocky bottom streams areas of permanent water flow. This species was only known to Costa Rica. Herein we record it for the first time in Brazil, in Amazonas and Roraima States. Stenochironomus nudipupa Borkent, 1984 Stenochironomus nudipupa Borkent, 1984: 117; Spies & Reiss 1996: 73 Material examined. BRAZIL, Roraima state, Amajari, Estação Ecológica de Maracá mark # 1, 03 º 22 ’ 11,6 ’’N, 61 º 26 ’ 30,1 ’’W, 13–20.IX. 11, collected in submerged leaves, 2 males with pupal and larval exuviae, leg. E.D. De- Angelis-Reis (INPA, slide-mounted in Euparal); BRAZIL, Amazonas state, Manaus, bairro Tarumã, Sítio do Raul, 03º 01’22,0”S, 60 º 04’47,0’’W, 14.VII. 11, 2 males with pupal and larval exuviae, leg. E.D. De-Angelis-Reis; Manaus, bairro Jorge Teixeira, Sítio três irmãos, 03º 00’ 22,5 ”S, 59 º 54 ’57,0’’W, 14.VII. 11, 2 males with pupal and larval exuviae, leg. E.D. De-Angelis-Reis. Remarks. The immatures of Stenochironomus nudipupa were obtained from submerged mined leaves in small streams with poor water flow. The adults were obtained through laboratory rearing. This species was, so far, only known from Costa Rica, Ecuador and Venezuela. In this paper we recorded this species for the first time in Brazil, in the Amazonas and Roraima States.Published as part of Reis, Emiliano De Angelis, Filho, Arlindo Serpa & Ferreira-Keppler, Ruth L., 2013, Two new species and records of Stenochironomus Kieffer from Brazilian Amazon region, with description of immature stages (Diptera: Chironomidae), pp. 449-466 in Zootaxa 3710 (5) on page 464, DOI: 10.11646/zootaxa.3710.5.4, http://zenodo.org/record/22321

Stenochironomus oliveirai Reis, Filho & Ferreira-Keppler, 2013, sp. n.

Stenochironomus oliveirai sp. n. Figs 1–3 Type material. Holotype, BRAZIL, Amazonas State, São Gabriel da Cachoeira, Road next BR 307, point # 3, 00º 10 ' 28,2 ''S, 67 º 00' 37,4 ''W, 23–30.VIII. 11, collected in submerged leaf, 1 male with pupal and larval exuviae, leg. E.D. De-Angelis-Reis & R.L. Ferreira-Keppler (INPA, slide-mounted in Euparal). Diagnostic characters. The adult male can be separated from all other Stenochironomus species by the following combination of characters: apex of tergite IX square-shaped, with two distinctly produced lateral broad protuberances covered with fine setae. The pupa is distinct by the presence of rounded frontal warts; dark brown margin of wing sheath; genital sac measuring more than 300 µm of length, extending beyond the apex of anal lobe. Etymology. This species is honourably named after Dr. Sebastião José de Oliveira, who was the major reference in Chironomidae research in Brazil. Description. Adult male (n = 1) Total length 5.43 mm. Wing length 2.25 mm. Wing length/length of profemur 1.49 mm. Colour. Eyes markedly metallic green, whether specimens were kept alive or in ethanol. Antenna with bristles and flagellomeres light brown. Postnotum dark brown in the ⅔ basal region, dark brown stripe at base of lateral vitae, dark brown median anepisternum, posterior anepisternum and mesepimeron, preepisternum with a dark brown stripe in the anterior region. Fore legs with a dark brown apex of femur; tibia with a dark brown spot in basal region, tarsomeres 1–5 with brown stripes on apices. Mid legs with apex and basal regions of femur with dark brown stripes; tibia with dark brown spot in basal region, tarsomeres 1–5 without markings. Hind legs with apex and posterior basal region of femur with dark brown stripes, tibia with a dark brown spot in apical region, tarsomeres 1–5 without markings. Light brown Wings with a large light brown spot in middle region. Abdomen with dark brown spots on tergite I, located in laterodorsal region extending medially from distal margin, forming a "U" shaped design (in dorsal view); tergites II–IV: brown band on posterior region; tergite IX: dark brown, inferior volsella and gonostylus varying from pale to brownish. Head (Fig. 1 A; 1 B). AR 2.15, ultimate flagellomere 1000 µm long. Temporal setae 36. Clypeus with 25 setae. Tentorium 204 µm long; 10 µm wide at sieve pore; 12 µm wide at posterior tentorial pit. Stipes 190 µm long; 10 µm wide. Palpomere lengths (in µm): 85; 43; 68; 199; 158. Thorax (Fig. 1 C). Ac 12; Dc 16; Pa 5, Scts 14 in two rows. Anterior edge of scutum slightly rounded in lateral aspect. Wing (Fig. 1 D). VR 1.07. Brachiolum: 4 setae. R: 42 setae; R 1: 54 setae; R 4 + 5: 65 setae; RM: 2 setae; remaining veins bare. Squama: 5 setae. Legs. Scale of fore tibia 27 µm long; spurs of mid tibia 70 µm; spurs of hind tibia 57 µm. Apex of fore tibia 69 µm wide, mid tibia 118 µm, hind tibia 57 µm. Lengths (in µm) and proportions of legs as in Table 1. Hypopygium (Figs. 1 E; 1 F). Anal point 169 µm long, 21 µm wide at base, 20 µm wide at apex; curved in lateral view. Tergite IX: 38 median setae, square-shaped, bearing 16 setae on each side of anal point, with two distinctly produced lateral broad protuberances covered with fine setae. Laterosternite IX: 7 setae. Phallapodeme 99 µm long; transverse sternapodeme 36 µm long. Gonocoxite 232 µm long; inferior volsella 94 µm long, with 5 long slender setae; superior volsella 94 µm long. Gonostylus with broadly rounded apex, 271 µm long. HR 0.85, HV 2.00. Pupa (n = 1, exuviae) Total length 6.30 mm. Colour: light brown cephalothorax and abdomen. Cephalothorax. Frontal apotome elongated with rounded frontal warts (Fig. 2 A), absent wing tubercle. Precorneal setae 2; 63–69 µm long. Dorsocentrals (Dc) 110 – 108 µm long. Distance between Dc 1 and Dc 2 2 µm; Dc 2 and Dc 3: 299 µm; Dc 3 and Dc 4: 1 µm; median suture granulose (Fig. 2 C). Abdomen (Fig. 2 B). TI: median, large field of shagreen; TII–V: median, large field of shagreen; TVI: field of shagreen restricted to two patches on anterior and posterior regions; TVII–VIII: bare; anal segment with an anterior pair of rounded shagreen patches. TII: posterior row of hooklets in median region, localized on a flap extending posteriorly on TIII and divided medially into two groups of 44 and 40 µm, by a distance of 23 µm. Abdominal setation: SI with no L setae; SII–IV: 3 L setae; SV–VII: 4 LS setae; SVIII: 5 LS setae. Spur on SVIII with 4–5 brownish teeth (Fig. 2 D). Genital sac 372 Μm long, overreaching apex of anal lobe by 76 Μm; apex of anal lobe rounded, with a fringe of 46 filaments. Fourth-instar larva (n = 1, exuviae) Head. Head capsule 0.60 mm long. Antenna (Fig. 3 A); lengths of antennal segments (in Μm): 77; 25; 13; 9; 2. Antennal blade 25 Μm long. Labrum damaged. Mandible (Fig. 3 B) 159 Μm long, containg 3 inner and 1 dorsal teeth. Mentum (Fig. 3 C) 133 Μm wide and convex, with 10 blackish teeth; micropore located posteriorly to setae submenti; paralabial plate with a light concavity near to mentum and no striae. Base of dorsolateral strip originating from the half of dorsomedian strip. Labiohypopharynx (Fig. 3 D) with ligular rounded lobes, with a narrow cleft between lobes, nearly parallel-sided to U-shaped structure. Female unknown. Distribution and habitat. This species is only known to north of Brazil, Amazonas State, municipality of São Gabriel da Cachoeira. The larva was collected in submerged leaves in a rocky bottom stream of permanent water flow with dense riparian vegetation.Published as part of Reis, Emiliano De Angelis, Filho, Arlindo Serpa & Ferreira-Keppler, Ruth L., 2013, Two new species and records of Stenochironomus Kieffer from Brazilian Amazon region, with description of immature stages (Diptera: Chironomidae), pp. 449-466 in Zootaxa 3710 (5) on pages 450-454, DOI: 10.11646/zootaxa.3710.5.4, http://zenodo.org/record/22321