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

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Functional characterization of respiratory muscles and effects of rehabilitation in chronic heart failure patients

Ce projet se concentre sur la prise en charge non pharmacologique des patients atteints d'insuffisance cardiaque (HF), en mettant l'accent sur l'entraînement physique selon ses différentes modalités. Le but de cette étude est d'évaluer l'effet d'un programme combiné de deux ou trois modalités: entraînement aérobie en intervalles (AIT), entraînement musculaire inspiratoire (IMT) et entraînement contre résistance (RT) sur plusieurs paramètres tels que: la fonction des muscles cardiopulmonaire et squelettique, la dyspnée et la qualité de vie. En outre, cette thèse vise à chercher le meilleur type d'entraînement qui pourrait avoir des avantages supplémentaires sur les paramètres mesurés, fournissant ainsi une nouvelle application dans les programmes de réadaptation cardiaque. 60 patients atteints d'HF et de faiblesse musculaire inspiratoire (IMW) ont été répartis par randomisation dans l'un des groupes suivants: AIT (n = 10), IMT (n = 10), RT (n = 10), AIT + IMT (n = 10) et AIT + IMT + RT (n = 10). Les protocoles d'entraînements ont été effectués 3 fois par semaine pendant 12 semaines. Aucun changement n'a été détecté dans le groupe témoin. Tous les groupes ont montré des effets positifs significatifs sur presque tous les paramètres mesurés Cette thèse a permis de vérifier que la combinaison de l'AIT et de l'IMT a entraîné une amélioration supplémentaire des paramètres mesurés. Mais l'ajout de l'RT à l'AIT et à l'IMT a eu des avantages bénéfiques supplémentaires sur certains des paramètres mesurés par rapport au groupe combiné de deux modalités et à toutes les modalités d'entraînement, ce qui fait de la combinaison de deux modalités ou plus, le protocole le plus recommandé dans les programmes de réadaptation cardiaqueThe present study shed lights on the non-pharmacological management in patients with heart failure (HF), with special focus on exercise training by its different modalities. The aim of this study is to evaluate the effect of a combined program of two or three modalities: aerobic interval training (AIT), inspiratory muscle training (IMT), and resistance training (RT), on several outcomes such as: cardiopulmonary and skeletal muscle function, dyspnea and quality of life (QoL). Moreover, this study aims to find the best training exercise that could have additional benefits on measured parameters, thus providing a novel application in cardiac rehabilitation programs. 60 patients with HF (New York Heart Association, NYHA≤45) and inspiratory muscle weakness (IMW) were randomly assigned to one of the six following groups (n=10, for each group): Control, AIT, IMT, RT, AIT+IMT and AIT+IMT+RT. The training regimens were performed 3 times per week for 12 weeks. No changes were detected in the control group. All groups showed significant positive effects on almost all the measured parameters. However, the combination of IMT to AIT and the addition of RT to IMT and AIT were the most powerful modalities and resulted in additional benefits over all training modalities. This study verified that, in patients with CHF and IMW, any exercise training, whether it is AIT, IMT or RT, improves the inspiratory muscle function, QoL, exercise performance and dyspnea. Moreover, the combination of the AIT and the IMT resulted in an additional improvement in the measured parameters. However, the addition of RT to AIT and IMT resulted in additional benefits in some of the measured parameters over the double combined group and all training modalities, which make the combination of two or more exercise training the most recommended protocol in cardiac rehabilitation program

Caractérisation fonctionnelle des muscles respiratoires et effets de la réadaptation chez les sujets qui souffrent d'une insuffisance cardiaque chronique stable

The present study shed lights on the non-pharmacological management in patients with heart failure (HF), with special focus on exercise training by its different modalities. The aim of this study is to evaluate the effect of a combined program of two or three modalities: aerobic interval training (AIT), inspiratory muscle training (IMT), and resistance training (RT), on several outcomes such as: cardiopulmonary and skeletal muscle function, dyspnea and quality of life (QoL). Moreover, this study aims to find the best training exercise that could have additional benefits on measured parameters, thus providing a novel application in cardiac rehabilitation programs. 60 patients with HF (New York Heart Association, NYHA≤45) and inspiratory muscle weakness (IMW) were randomly assigned to one of the six following groups (n=10, for each group): Control, AIT, IMT, RT, AIT+IMT and AIT+IMT+RT. The training regimens were performed 3 times per week for 12 weeks. No changes were detected in the control group. All groups showed significant positive effects on almost all the measured parameters. However, the combination of IMT to AIT and the addition of RT to IMT and AIT were the most powerful modalities and resulted in additional benefits over all training modalities. This study verified that, in patients with CHF and IMW, any exercise training, whether it is AIT, IMT or RT, improves the inspiratory muscle function, QoL, exercise performance and dyspnea. Moreover, the combination of the AIT and the IMT resulted in an additional improvement in the measured parameters. However, the addition of RT to AIT and IMT resulted in additional benefits in some of the measured parameters over the double combined group and all training modalities, which make the combination of two or more exercise training the most recommended protocol in cardiac rehabilitation programsCe projet se concentre sur la prise en charge non pharmacologique des patients atteints d'insuffisance cardiaque (HF), en mettant l'accent sur l'entraînement physique selon ses différentes modalités. Le but de cette étude est d'évaluer l'effet d'un programme combiné de deux ou trois modalités: entraînement aérobie en intervalles (AIT), entraînement musculaire inspiratoire (IMT) et entraînement contre résistance (RT) sur plusieurs paramètres tels que: la fonction des muscles cardiopulmonaire et squelettique, la dyspnée et la qualité de vie. En outre, cette thèse vise à chercher le meilleur type d'entraînement qui pourrait avoir des avantages supplémentaires sur les paramètres mesurés, fournissant ainsi une nouvelle application dans les programmes de réadaptation cardiaque. 60 patients atteints d'HF et de faiblesse musculaire inspiratoire (IMW) ont été répartis par randomisation dans l'un des groupes suivants: AIT (n = 10), IMT (n = 10), RT (n = 10), AIT + IMT (n = 10) et AIT + IMT + RT (n = 10). Les protocoles d'entraînements ont été effectués 3 fois par semaine pendant 12 semaines. Aucun changement n'a été détecté dans le groupe témoin. Tous les groupes ont montré des effets positifs significatifs sur presque tous les paramètres mesurés Cette thèse a permis de vérifier que la combinaison de l'AIT et de l'IMT a entraîné une amélioration supplémentaire des paramètres mesurés. Mais l'ajout de l'RT à l'AIT et à l'IMT a eu des avantages bénéfiques supplémentaires sur certains des paramètres mesurés par rapport au groupe combiné de deux modalités et à toutes les modalités d'entraînement, ce qui fait de la combinaison de deux modalités ou plus, le protocole le plus recommandé dans les programmes de réadaptation cardiaqu

Epidemiological study of mental disorders in Gharb Region (North-West) of Morocco

Abstract Survey of Moroccan Health Ministry found that 48.9% of 5600 persons in the general population had a mental disorder and 26.5% were depressed. Objectives: The objective of this epidemiological study is to identify the socioeconomic and neuropsychiatrical profiles of patients examined at the Hospital Moulay El Hassan of Kenitra city (Northwest of Morocco) for psychiatric disorders. Subjects and Methods: This research is a retrospective study conducted between February 2010 and December 2013, among 5618 patients (between 1 and 90 years of age). The study is realized on the basis of social and clinical data existing in patients' records. Results: The most important obtained results show that in 5618 cases studied, about 50% of women and about 50% of men patients had suffered from psychiatric disorders. Moreover, mood disorders were the most common reasons for hospitalization (38.24%). The other psychiatric disorders were schizophrenia and psychotic disorders (17.55%), followed by anxiety disorders (13.65%). In addition, 71% of patients don't have parents alive and 51.62% of patients suffering from mood disorders are married and 51.61% are divorced. The proportion of illiterate patients is 42.98% and inactive or unemployed patients (85.87%). Conclusion: The prevalence of mental disorders in the Gharb region is important. It affects both men and women and are more developed in some socioeconomic categories. However, deeper investigations are needed in order to identify the factors that contribute to raising of these disorders in the society

From narrow-band to ultra-wide-band microwave sensors in direct skin contact for breast cancer detection

International audienceIn this paper, the design and test of different microwave antennas and sensors for breast cancer detection are presented. The sensors are designed and optimized to be used in direct skin contact, and for this purpose a specific breast phantom model is proposed. First, a miniaturized microstrip back-cavity Hilbert fractal antenna, operating in the ISM band (2.4–2.5 GHz), was designed. Then, this antenna was used to investigate the possibility of detecting the presence of breast tumors based on a narrowband frequency method that monitors the shift of the antenna frequency response. The antenna prototype was fabricated and tested in real in vivo measurement conditions on two different patients diagnosed with breast cancer. Measurement results have led after a comparison with the retro-simulation results of the structure to a more realistic breast model and to draw the limitations of this narrowband frequency method. As a time domain study seems to be more relevant, an UWB monopole antenna of dimensions 3 cm × 3 cm, to be used in direct contact with the breast model was designed. This antenna was optimized to both enhance the antenna/human body matching and to maximize the transfer of energy into the breast phantom by using a cavity, increasing by this way the detection potential. In order to improve the sensor’s directivity and enhance the electromagnetic field level inside the breast, a balanced antipodal Vivaldi antenna was also designed and optimized for a direct breast contact to operate in the 3.1–10.6 GHz band. A mono static and a bi static study in the time domain are finally proposed to investigate the presence of the tumor

Miniature Antenna for Breast Tumor Detection

International audienceMicrowave imaging is recognized as a potential candidate for biomedical applications, such as breast cancer detection. In this context a miniature antenna is used for quantitative imaging of inhomogeneous tissues. Microwave breast imaging (MBI) uses low power and longer wavelength signals to obtain information about breast tissues, and promises a safer and more accurate modality for regular breast scanning. This paper presents a miniature microstrip antenna that can be placed in contact with the breast model to investigate the presence of malignant tissues. A miniature antenna has been designed, and placed toward a breast phantom model with inhomogeneous tissues. Images are successfully obtained by using scattering electromagnetic waves (S11) from the designed model. The antenna was then manufactured and tested.In this paper the design of a miniature antenna for microwave imaging has been presented. This antenna aims to overcome the limitation of the conventional solutions by detecting breast tumors regardless its evolution stages. The simulation results show that the response of the antenna is affected in terms of frequency and return loss when it’s implanted on the heterogeneous model. Indeed, comparing to the normal breast model simulated response, the frequency was down shifted of around 100 MHz and the S11 parameter was improved. The antenna has been fabricated using plexyglass substrate and the measured results confirm the resonance frequency shift from 2.63 GHz to 2.54 GHz and the S11 improvement from -12 dB to -18 dB These results are respectively obtained when the antenna is implemented on two different mediums: clean serum representing a human body with absence of tumor and serum with steel balls representing human body with presence of tumor. After this first proof-of-concept, it’s intended to design the antenna using a flexible substrate and to perform real tests using samples representing tumors in human body which would be given by the research team of CHRU (Centre Hospitalier Régional et Universitaire de Brest) in Brest - France.

Best mode of inspiratory muscle training in heart failure patients: a systematic review and meta-analysis

International audienceObjectives The objective of this study was to evaluate the effects of inspiratory muscle training on inspiratory muscle strength, functional capacity and dyspnoea for patients with chronic heart failure, by summarising the published research on the effects of inspiratory muscle training. To identify the best mode of intervention in terms of: the load of maximal inspiratory pressure; the frequency of sessions; and the total duration of intervention. Methods A relevant literature research using the PubMed database, Cochrane and references of published studies, from 1998 to 2016, was conducted. Out of 65 randomised controlled trials, seven were considered as potentially relevant and were retrieved for detailed analysis. The methodological quality of each randomised controlled trial was rated using the physiotherapy evidence database scale. Results The included seven studies contained data on 203 patients. Typical training protocols involved training three, six or seven times per week with intensity ranging from 30% to 60% and for a duration ranging from 6 to 12 weeks. Maximal inspiratory pressure, walking distance and dyspnoea were improved in all studies and especially in those who set a load of 60% in their maximal inspiratory pressure, and have trained patients six times per week for 12 weeks. Conclusion In chronic heart failure patients, inspiratory muscle training results in a marked improvement in inspiratory muscle strength, walking distance and dyspnoea, notably when training patients at 60% of maximal inspiratory pressure, six times per week and for 12 weeks. A small number of studies and heterogeneity among studies may limit the findings of the present study

Bi-Static Time Domain Study for Microwave Breast Imaging

International audienceIn this paper a BAVA (Balanced Antipodal Vivaldi Antenna) antenna is designed and optimized to be used in direct breast contact to operate in the 3.1-10.6 GHz band. A bi-static study in the time domain is proposed to investigate the presence of the tumor. The tumor was first inserted in the fat tissues at 4 mm from the skin and then inserted deeper at 2 cm in the glandular tissues to validate the used approach. Finally a microwave breast image was constructed based on the recovered time domain signals for both cases