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 q-Weibull Counting Process through a Fractional Differential Operator

We use the q-Weibull distribution and define a new counting process using the fractional order. As a consequence, we introduce a q-process with q-Weibull interarrival times. Some interesting special cases are also discussed which leads to a Mittag-Leffler form

Does fasting or postprandial state affect thyroid function testing?

Background: Thyroid stimulating hormone (TSH) levels vary with the time of the day and probably in relation to food. In this study, we addressed the question of whether a fasting or non-fasting sample would make a clinically significant difference in the interpretation of thyroid function tests. Materials and Methods: Fifty seven adult ambulatory patients were selected from our laboratory database and were divided into Group A [Normal free thyroxine (T4) and TSH], Group B (subclinical hypothyroid with increased TSH and normal free T4) and Group C (overt hypothyroid with low free T4 and high TSH). Thyroid functions (free T4 and TSH) were done in fasting state and 2 hours postprandially. Results: TSH was suppressed in all subjects after food irrespective of the fasting levels. Free T4 values did not change significantly. This resulted in reclassification of 15 out of 20 (75%) subjects as subclinical hypothyroidism (SCH) based on fasting values whose TSH values were otherwise within range in the postprandial sample. This may have an impact on the diagnosis and management of hypothyroidism especially where even marginal changes in TSH may be clinically relevant as in SCH and in pregnancy. Conclusion: TSH levels showed a statistically significant decline postprandially in comparison to fasting values. This may have clinical implications in the diagnosis and management of hypothyroidism, especially SCH

Online Corrosion and Force Monitoring for Inner Containment Concrete Structures

Corrosion of steel in concrete reduces the service life and durability of concrete structures. It is a worldwide problem, which causes heavy losses to the economy of the country. The durability of concrete structures primarily depends on the condition of the embedded steel in concrete, apart from any deterioration that concrete may undergo. In general potential surveys are carried out on concrete structures to know about the condition of steel. Most of these measurements in the field are carried out manually and the data obtained are analyzed. This offline measurements leads to an error in the data collected, time consuming and involvement of huge man power. Online corrosion monitoring eliminates such errors in the measurements and improves the accuracy of the data collected from humanly inaccessible regions of a structure. To mitigate corrosion prior to significant degradation and optimize the performance of such concrete structures, various sensors have been used to detect the corrosion and to provide early warning. To assess the condition of the embedded steel, the sensors of the probe are connected to a computer through specialized data acquisition hardware. The computer controls the data acquisition using suitable user friendly software that calculates the corrosion rate at prescribed intervals for continuous monitoring. New types of corrosion sensors and its mechanism in real time measurements are described. Online analysis of data for corrosion and force monitoring is described in this paper

Diurnal variations of the low-level jet over peninsular India during the onset of Asian summer monsoon

The evidence for diurnal variation of monsoon low-level jet (MLLJ) over the southern tip of India is illustrated from observations, a mesoscale model results, and long-term reanalysis products. This illustration showed that MLLJ has a diurnal variation in its strength and location of maxima. Diurnal signature of MLLJ is not found to be location-specific. Stronger jets are formed at a lower elevation during the nighttime, and the jets are weaker during the day but are higher elevated. During the daytime, a secondary jet is also observed along with the MLLJ. Both the jets were numerically simulated during the onset phase of southwest monsoon over the southwest coast of India. Thirty-year climatological analysis from Modern Era Retrospective analysis for Research and Applications (MERRA) showed that the secondary jet is shallow and weak during the pre-onset phase of monsoon. With the progress of monsoon, the MLLJ gets stronger with increased wind speed and elevated location of its core. In occasions where the jet is strong before the onset, the strongest jets proceed after the onset. Daytime MLLJ is higher elevated compared to the nocturnal MLLJ due to the frictional decoupling