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

Discharge coefficient and jet deflection studies for combustor liner air-entry holes

In the simple tubular combustor system for turbojets and ramjets, figure 1, at the primary zone it is required to achieve a high heat release and stable flame. At the dilution cone to have a good air flow distribution (Ref. I ), and adequate penetration. In both zones these requirements needs to be with the minimum total pressure loss for high overall efficiency, short liner length, and light simple construction (Ref. 2 ). The air flow distribution between these two zones is still the main problem of the design engineer. But the flow of annular air to these zones is governed by the geometry of the eyetem, hole coonetry and dicehargo coefficient of these holes. For light construction and adequate penetration, the main governing factor is the deflection angle of the liner jots. Cont/d

The Nucleation of Co Bubbles in Molten Ironcarbon Drops Reacting with Oxidizing Gases

A theoretical representation has been developed for the supersaturation of molten iron drops with respect to carbon monoxide caused by the counter diffusion of carbon and oxygen. These theoretical predictions were compared with experimental measurements obtained using droplets, 4 to 6 mm in diameter at temperatures ranging from 1600 °C to 2000 °C under levitated conditions and with free fall. The agreement between the theoretically predicted and the experimentally measured limits for the onset of the carbon boil was very good, assuming that the effective diffusivity in levitated drops was about three times the molecular diffusivity. This observation is consistent with calculations of flow and mixing in electromagnetically levitated metal droplets

Variability in the resistance of sodium chloride salinity within rice (Oryza sativa l.) varieties

Varieties of rice differ in their resistance to sodium chloride salinity. Within varieties, which are not homozygous lines, there is very high variability in sodium uptake and in survival under saline conditions by the individual plants. This is in contrast with the relative uniformity in (for example) potassium uptake, dry wt and transpiration rate. There is a negative correlation between sodium (and chloride) accumulation by individual plants and their survival in saline conditions, demonstrating that variability amongst individuals fits the same pattern as has become generalized for varietal differences in glycophyte species. Possible reasons for this variability in sodium and chloride uptake within varieties, and its relevance to selecting salt-resistant varieties of rice, are discussed

Potentiometric & Spectrophotometric Determinations of Dissociation Constants of B-Diketoarylazo Compounds

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Type 2 diabetes raises serum sclerostin levels and disturbs the relation between sclerostin and bone mineral density: a call for caution with antisclerostin therapy in osteoporosis

Background Sclerostin is an osteocyte-secreted protein that negatively regulates osteoblasts. Wnt signaling may be crucial in the pathogenesis of impaired bone quality in type 2 diabetes mellitus (T2DM). The possibility that currently studied antisclerostin bone-forming agents could be useful to T2DM patients with osteoporosis needs further investigations. Aim The aim of this study was to investigate the relationship between serum sclerostin and bone mineral density in T2DM patients, in comparison with nondiabetic individuals. Patients and methods This study was conducted on 21 T2DM patients and 22 nondiabetic individuals. All participants were 60 years or older. They underwent history taking, clinical examination, routine lab investigations, and glycated hemoglobin assessment. Serum sclerostin was measured by ELISA. Bone mineral density (BMD) was measured at the left femoral neck and lumbar spine. Results Serum sclerostin level was significantly higher in T2DM patients compared with nondiabetic individuals. Male participants showed significantly higher sclerostin levels among the nondiabetic individuals, whereas this difference was not significant among T2DM patients. The Bone mineral density (BMD) and t-values of T2DM patients and the nondiabetic group were not significantly different. We found a significant positive correlation between sclerostin level and lumbar spine BMD among nondiabetic individuals, whereas among T2DM patients, this correlation was not significant. Sclerostin levels did not show a significant difference between diabetic osteoporotic and diabetic nonosteoporotic patients. Conclusion Patients with T2DM have raised sclerostin levels that, unlike those in nondiabetic individuals, are not correlated with BMD. This pathological condition that is specific to diabetes necessitates further study, careful assessment of the role of antisclerostin therapy, and probable dose adjustment for osteoporosis in T2DM patients

Асоціація ЕКГ-феноменів ранньої реполяризації і «Т-infantile» з вегетативною регуляцією серцевого ритму в юних спортсменів

 The incidence of autonomic disorders in athletes varies widely from 6.2 % to 36.5 %. With the improving sport qualification, the frequency and severity of autonomic dysfunction increase. Various ECG phenomena, including SEVR and “T-infantile” are associated with a type of autonomic tone. Moreover, ANS dysfunction does not determine the genesis, but only contributes to the manifestation of these syndromes signs. The association between the ECG phenomena and autonomic dysfunction nature, age and gender of athletes remains an open question.The purpose of this work was to study the incidence of juvenile T-wave and SEVR, their association with the autonomic regulation of heart rate in young athletes in the age range between 6 and 17 years.Materials and methods. An electrocardiographic study and 5-minute recordings of the heart rate variability were carried out in 3720 children and adolescents aged between 6 and 17 years, of them 74.6 % were boys (n = 2774) and 25.4 % were girls (n = 946), engaged in various sports.The study results. The “T-infantile” phenomenon was detected in 1.5 % (56/3720) of athletes, among them 1.07 % (40) were boys and 0.43 % (16) were girls. In five (12.5 %) athletes, “T-infantile” was combined with incomplete right bundle branch block, in 3 (7.5 %) – with short PQ syndrome, and in one (2.5 %) – with SEVR. In addition to the ECG signs of “T-infantile”, three (18.75 %) athletes additionally had incomplete RBBB, and also short PQ syndrome was detected in one athlete (6.25 %).A comparative analysis of HRV indices in boys and girls with the “T-infantile” phenomenon showed that in boys, the D value was significantly higher, reflecting the vagal regulation activity of the heart rhythm (0.403 ± 0.028 s versus 0.311 ± 0.025 s, P = 0.019). When assessing the autonomic state according to R. M. Baevsky, it was found that 40 % (n = 16) of male athletes with T-infantile ECG phenomenon had an increased parasympathetic nervous system tone, 50 % (n = 20) had normal ANS tone, and 10 % (n = 4) had an increased sympathetic nervous system tone. In girls, there were 31.25 % (n = 5) with increased PNS tone, 50 % (n = 8) with normal ANS tone and 18.75 % (n = 3) with increased SNS tone, respectively.Conclusions. Early repolarization syndrome and “T-infantile” are more common in case of increased parasympathetic nervous system tone rather than in other variants of autonomic tone. A combination of parasympathetic overactivity with these ECG phenomena is observed mainly in males. The phenomenon of “T-infantile” can be combined with incomplete right bundle branch block in young athletes of both sexes. Частота встречаемости вегетативных расстройств у спортсменов колеблется в широком диапазоне – от 6,2 % до 36,5 %. С ростом спортивной квалификации частота и тяжесть вегетативной дисфункции увеличиваются. Различные ЭКГ-феномены, в том числе СРРЖ и «Т-infantile» имеют сопряженность с типом вегетативного тонуса. При этом дисфункция АНС не определяет генез, а только способствует проявлению признаков этих синдромов. Открытыми остаются вопросы связи ЭКГ-феноменов с характером вегетативной дисфункции, возрастом и полом спортсменов.Цель работы – изучить частоту встречаемости ювенильного зубца Т и СРРЖ, их ассоциации с вегетативной регуляцией сердечного ритма у юных спортсменов в возрастном диапазоне от 6 до 17 лет.Материалы и методы. Проведено электрокардиографическое исследование и запись 5-минутных интервалов вариабельности сердечного ритма у 3720 детей и подростков в возрасте от 6 до 17 лет, мальчиков – 74,6 % (n = 2774), девочек – 25,4 % (n = 946), занимающихся различными видами спорта.Результаты. Феномен «T-infantile» обнаружен у 1,5 % (56/3720) спортсменов, из них 1,07 % (n = 40) мальчиков и 0,43 % (n = 16) девочек. У 5 (12,5 %) спортсменов «Т-infantile» сочетался с неполной блокадой правой ножки пучка Гиса, у 3 (7,5 %) – с синдромом укороченного PQ, у 1 (2,5 %) – с синдромом ранней реполяризации желудочков. Кроме ЭКГ признаков «Т-infantile» у 3 (18,75 %) спортсменок дополнительно зафиксирована неполная блокада ПНПГ, а у одной спортсменки (6,25 %) обнаружен синдром укороченного PQ. Сравнительный анализ показателей ВСР у мальчиков и девочек с феноменом «Т-infantile» показал, что у мальчиков достоверно больше величина Д, отражающая активность вагусной регуляции ритма сердца (0,403 ± 0,028 с против 0,311 ± 0,025 с, р = 0,019). При оценке вегетативного состояния по Р. М. Баевскому у спортсменов с ЭКГ-феноменом «Т-infantile» установлено, что у 40 % (n = 16) мальчиков имела место ваготония, у 50 % (n = 20) – эйтония, у 10 % (n = 4) – симпатикотония. Среди девочек было 31,25 % (n = 5) ваготоников, 50 % (n = 8) эйтоников, 18,75 % (n = 3) симпатикотоников.Выводы. Синдром ранней реполяризации желудочков и «Т-infantile» отмечают при ваготонии сравнительно чаще, чем при других вариантах вегетативного тонуса. Сопряжение избыточных парасимпатических влияний с этими ЭКГ-феноменами обнаруживают преимущественно у лиц мужского пола. Феномен «Т-infantile» может сочетаться у юных спортсменов с неполной блокадой правой ножки пучка Гиса. Частота вегетативних розладів у спортсменів коливається в широкому діапазоні – від 6,2 % до 36,5 %. З підвищенням спортивної кваліфікації частота й тяжкість вегетативної дисфункції збільшуються. Різні ЕКГ-феномени, зокрема СРРШ і «Т-infantile», мають зв’язок із типом вегетативного тонусу. Дисфункція АНС не визначає ґенез, а тільки зумовлює прояву ознак цих синдромів. Відкритими залишаються питання зв’язку ЕКГ-феноменів із характером вегетативної дисфункції, віком і статтю спортсменів.Мета роботи – вивчити частоту виявлення ювенільного зубця Т і СРРШ, їхньої асоціації з вегетативною регуляцією серцевого ритму в юних спортсменів у віковому діапазоні від 6 до 17 років.Матеріали та методи. Здійснили електрокардіографічне дослідження та запис 5-хвилинних інтервалів варіабельності серцевого ритму у 3720 дітей і підлітків віком від 6 до 17 років, хлопців – 74,6 % (n = 2774), дівчат – 25,4 % (n = 946), які займаються різними видами спорту.Результати. Феномен «T-infantile» виявили у 1,5 % (56/3720) спортсменів, з-поміж них 1,07 % (n = 40) хлопців і 0,43 % (n = 16) дівчат. У 5 (12,5 %) спортсменів «Т-infantile» поєднувався з неповною блокадою правої ніжки пучка Гіса, у 3 (7,5 %) – із синдромом укороченого PQ, у 1 (2,5 %) – з синдромом ранньої реполяризації шлуночків. Крім ЕКГ-ознак «Т-infantile» у 3 (18,75 %) спортсменок додатково зафіксована неповна блокада ПНПГ, в 1 (6,25 %) спортсменки зафіксували синдром укороченого PQ. Протягом порівняльного аналізу показників ВСР у хлопців і дівчат із феноменом «Т-infantile» з’ясували: у хлопців вірогідно більша величина Д, що показує активність вагусної регуляції ритму серця (0,403 ± 0,028 с проти 0,311 ± 0,025 с, р = 0,019). Оцінюючи вегетативний стан за Р. М. Баєвським у спортсменів з ЕКГ-феноменом «Т-infantile», встановили: у 40 % (n = 16) хлопців була ваготонія, у 50 % (n = 20) – ейтонія, в 10 % (n = 4) – симпатикотонія. З-поміж дівчат 31,25 % (n = 5) ваготоників, 50 % (n = 8) ейтоників і 18,75 % (n = 3) симпатикотоників.Висновки. Синдром ранньої реполяризації шлуночків і «Т-infantile» виявляють у випадку ваготонії порівняно частіше, ніж при інших варіантах вегетативного тонусу. Поєднання надлишкових парасимпатичних впливів із цими ЕКГ-феноменами спостерігають здебільшого в осіб чоловічої статі. Феномен «Т-infantile» може поєднуватися в юних спортсменів із неповною блокадою правої ніжки пучка Гіса.