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

Rethinking Data Privacy: Examining Innovative Policy Solutions and Private Sector Mechanisms for Consumer Data Privacy in the United States

This thesis focuses on rethinking the approach to addressing data privacy in America. It examines and proposes the use of innovative policy solutions and private sector mechanisms to address the consumer data privacy concerns of citizens that are at the heart of the issue. It proposes a new framework for analyzing the issue at hand and argues that a hybrid of improved private and public sector mechanisms must be in place in order to safeguard privacy in America. The analysis and arguments in this paper stem from a non-technical perspective on the issue of data privacy, and therefore it is important to acknowledge the limitations in the consideration of the technical implications of some of the policy recommendations presented in this paper. Before diving into policy recommendations and potential solutions, Chapter 1 first defines data privacy as a concept and emphasizes the importance of the topic as an area for research and analysis given recent developments. Using data from the Pew Research Center and other sources, Chapter 1 substantiates the three largest concerns that need to be addressed as being: lack of transparency, lack of control, and lack of choice. In order to ensure data privacy, this paper argues that users must be empowered with end-to-end transparency on their data, along with the autonomy to control its collection and use. In Chapter 2, this paper presents a case study of Facebook in order to highlight many of these issues and concerns in practice at one of the largest and ubiquitous technology companies in the world. Later, Chapter 3 examines the existing data privacy regulatory approaches of the European Union and the United States by focusing on the two preeminent legislations with the General Data Protection Regulation and the California Consumer Privacy Act. After understanding and analyzing the issues and concerns at hand along with the current regulatory approach in Europe and the United States, the key research takeaways and ensuing recommendations are presented in Chapter 4 and a reimagined American federal regulatory framework for data privacy is proposed. While government policies such as the GDPR and CCPA are on the path towards an adequate regulatory framework, there is much room for improvement and growth. The larger themes captured within these recommendations include creating a new data protection and privacy authority, increasing private and public sector collaboration, exploring ways to implement the notice and choice model, and incorporating digital literacy into policy. However, Chapter 5 highlight that while policy-making plays an important role in addressing the data privacy concerns consumers have, it is not the complete solution and only works to a certain extent, as many gaps remain. Therefore, in Chapter 6, this paper present how private sector mechanisms can fill the remaining gaps in addressing lack of transparency, lack of control, and lack of choice through a variety of technologies and solutions. Afterwards, Chapter 7 highlights remaining considerations that should be included in the conversation of data privacy, from the concept of privacy for the privileged to the privacy implications of Covid-19. Lastly, this thesis concludes with a synthesis of the analysis and an outlook on the path forward

Rethinking Data Privacy: Examining Innovative Policy Solutions and Private Sector Mechanisms for Consumer Data Privacy in the United States

This thesis focuses on rethinking the approach to addressing data privacy in America. It examines and proposes the use of innovative policy solutions and private sector mechanisms to address the consumer data privacy concerns of citizens that are at the heart of the issue. It proposes a new framework for analyzing the issue at hand and argues that a hybrid of improved private and public sector mechanisms must be in place in order to safeguard privacy in America. The analysis and arguments in this paper stem from a non-technical perspective on the issue of data privacy, and therefore it is important to acknowledge the limitations in the consideration of the technical implications of some of the policy recommendations presented in this paper. Before diving into policy recommendations and potential solutions, Chapter 1 first defines data privacy as a concept and emphasizes the importance of the topic as an area for research and analysis given recent developments. Using data from the Pew Research Center and other sources, Chapter 1 substantiates the three largest concerns that need to be addressed as being: lack of transparency, lack of control, and lack of choice. In order to ensure data privacy, this paper argues that users must be empowered with end-to-end transparency on their data, along with the autonomy to control its collection and use. In Chapter 2, this paper presents a case study of Facebook in order to highlight many of these issues and concerns in practice at one of the largest and ubiquitous technology companies in the world. Later, Chapter 3 examines the existing data privacy regulatory approaches of the European Union and the United States by focusing on the two preeminent legislations with the General Data Protection Regulation and the California Consumer Privacy Act. After understanding and analyzing the issues and concerns at hand along with the current regulatory approach in Europe and the United States, the key research takeaways and ensuing recommendations are presented in Chapter 4 and a reimagined American federal regulatory framework for data privacy is proposed. While government policies such as the GDPR and CCPA are on the path towards an adequate regulatory framework, there is much room for improvement and growth. The larger themes captured within these recommendations include creating a new data protection and privacy authority, increasing private and public sector collaboration, exploring ways to implement the notice and choice model, and incorporating digital literacy into policy. However, Chapter 5 highlight that while policy-making plays an important role in addressing the data privacy concerns consumers have, it is not the complete solution and only works to a certain extent, as many gaps remain. Therefore, in Chapter 6, this paper present how private sector mechanisms can fill the remaining gaps in addressing lack of transparency, lack of control, and lack of choice through a variety of technologies and solutions. Afterwards, Chapter 7 highlights remaining considerations that should be included in the conversation of data privacy, from the concept of privacy for the privileged to the privacy implications of Covid-19. Lastly, this thesis concludes with a synthesis of the analysis and an outlook on the path forward

Rethinking Data Privacy: Examining Innovative Policy Solutions and Private Sector Mechanisms for Consumer Data Privacy in the United States

This thesis focuses on rethinking the approach to addressing data privacy in America. It examines and proposes the use of innovative policy solutions and private sector mechanisms to address the consumer data privacy concerns of citizens that are at the heart of the issue. It proposes a new framework for analyzing the issue at hand and argues that a hybrid of improved private and public sector mechanisms must be in place in order to safeguard privacy in America. The analysis and arguments in this paper stem from a non-technical perspective on the issue of data privacy, and therefore it is important to acknowledge the limitations in the consideration of the technical implications of some of the policy recommendations presented in this paper. Before diving into policy recommendations and potential solutions, Chapter 1 first defines data privacy as a concept and emphasizes the importance of the topic as an area for research and analysis given recent developments. Using data from the Pew Research Center and other sources, Chapter 1 substantiates the three largest concerns that need to be addressed as being: lack of transparency, lack of control, and lack of choice. In order to ensure data privacy, this paper argues that users must be empowered with end-to-end transparency on their data, along with the autonomy to control its collection and use. In Chapter 2, this paper presents a case study of Facebook in order to highlight many of these issues and concerns in practice at one of the largest and ubiquitous technology companies in the world. Later, Chapter 3 examines the existing data privacy regulatory approaches of the European Union and the United States by focusing on the two preeminent legislations with the General Data Protection Regulation and the California Consumer Privacy Act. After understanding and analyzing the issues and concerns at hand along with the current regulatory approach in Europe and the United States, the key research takeaways and ensuing recommendations are presented in Chapter 4 and a reimagined American federal regulatory framework for data privacy is proposed. While government policies such as the GDPR and CCPA are on the path towards an adequate regulatory framework, there is much room for improvement and growth. The larger themes captured within these recommendations include creating a new data protection and privacy authority, increasing private and public sector collaboration, exploring ways to implement the notice and choice model, and incorporating digital literacy into policy. However, Chapter 5 highlight that while policy-making plays an important role in addressing the data privacy concerns consumers have, it is not the complete solution and only works to a certain extent, as many gaps remain. Therefore, in Chapter 6, this paper present how private sector mechanisms can fill the remaining gaps in addressing lack of transparency, lack of control, and lack of choice through a variety of technologies and solutions. Afterwards, Chapter 7 highlights remaining considerations that should be included in the conversation of data privacy, from the concept of privacy for the privileged to the privacy implications of Covid-19. Lastly, this thesis concludes with a synthesis of the analysis and an outlook on the path forward

Identifying areas of improvement in nursing knowledge regarding hepatic encephalopathy management

Hepatic encephalopathy (HE) is a reversible brain dysfunction caused by liver insufficiency and portosystemic shunting. Hepatic encephalopathy is a common complication of advanced liver disease and is on a rise with the increasing incidence of non-alcoholic steatohepatitis (NASH). Since partnership with nursing staff is a critical part of successful management of these complex patients, we conducted a survey assessing their knowledge regarding HE.169 nurses participated in the survey. We found that more than 30% of the nurses did not know that ammonia is one of the toxins responsible for causing hepatic encephalopathy. We also found that 20% of the nurses had difficulty answering questions regarding titration of lactulose to bowel movements. Dietary education is a significant area for improvement as 80% of the nurses wanted to restrict fat and carbohydrate intake in these patients. With this simple survey, we identified important knowledge gaps among experienced nurses at our institution. We believe that by improving knowledge through focused lectures, we can improve patient care and reduce the length of hospitalizations in patients with HE

Turmeric-Induced Hepatotoxicity: Report of 2 Cases

The use of herbal and dietary supplements is rising in the United States. Turmeric has been one of the most popular supplements recently, used widely for various conditions such as arthritis, digestive disorder, and liver conditions. Although rarely reported, hepatotoxicity can happen with turmeric use. Here, we present 2 cases of drug-induced liver injury due to turmeric use with the complete resolution after cessation