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

Healthy Minds for Healthy Hearts: Tackling Stress-Induced Cardiac Events During the FIFA World Cup 2022

Muna Abed Alah,1 Sami Abdeen,1 Nagah Selim2,3 1Community Medicine Department, Hamad Medical Corporation (HMC), Doha, Qatar; 2Community Medicine Department, Primary Health Care Corporation, Doha, Qatar; 3Public health and Preventive medicine department, Cairo University, Cairo, EgyptCorrespondence: Muna Abed Alah, Email [email protected]: Millions of people are looking forward to the biggest event this year “FIFA World Cup 2022” taking place in the state of Qatar. This event is an opportunity for people around the world to socialize, connect, celebrate, and enjoy watching football matches. However, the emotional stress experienced by football players and fans during a such major sport event can sometimes result in unfavorable physiological responses that can adversely affect the heart leading to adverse cardiac consequences. In this mini-review, we summarized the evidence and pathophysiology of stress-induced cardiac events during football games, and the potential strategies to prevent stress-induced cardiac events during the FIFA World Cup 2022.Keywords: FIFA World Cup, soccer, football, stress, cardiac, menta

Age and Overweight Are Not Contraindications for a Breast Reconstruction with a TMG-Flap—A Risk and Complication Analysis of a Retrospective Double Center Study Including 300 Patients

Introduction: The transverse myocutaneous gracilis (TMG) flap has become a popular and reliable alternative for autologous breast reconstruction. Initially described as a valuable tissue source for women with low body-mass index, indications nowadays have widely expanded. The Western civilization demographic development with its aging population and the steady growing average BMI has led to increasing breast reconstructions with TMG flaps in overweight and aged individuals. Patients and Methods: A total of 300 TMG free flaps for unilateral autologous breast reconstruction were evaluated in the form of a retrospective double center cohort study. Data extraction, study group formation and statistical analysis (One-way analysis of variance (ANOVA), Pearson’s chi-squared statistical analysis and relative risk calculation) were done specifically to evaluate age and BMI as risk factors for postoperative complications and outcome. Results: No significant differences in patients’ age and BMI in the complication groups compared to the no-complication group could be found. No significant difference regarding the occurrence of complications could be found in any of the formed risk-groups. No significant increase of minor-, major- or overall complications, flap loss or revision surgeries were found in the elderly patient groups or for patients with overweight. Conclusion: Age and overweight do not significantly increase the risk for postoperative complications after breast reconstructions with free TMG flaps. The findings of this study support the fact that microsurgical breast reconstruction with a free TMG flap should not solely be reserved for younger patients and females with a lower BMI

Age and Overweight Are Not Contraindications for a Breast Reconstruction with a TMG-Flap—A Risk and Complication Analysis of a Retrospective Double Center Study Including 300 Patients

Introduction: The transverse myocutaneous gracilis (TMG) flap has become a popular and reliable alternative for autologous breast reconstruction. Initially described as a valuable tissue source for women with low body-mass index, indications nowadays have widely expanded. The Western civilization demographic development with its aging population and the steady growing average BMI has led to increasing breast reconstructions with TMG flaps in overweight and aged individuals. Patients and Methods: A total of 300 TMG free flaps for unilateral autologous breast reconstruction were evaluated in the form of a retrospective double center cohort study. Data extraction, study group formation and statistical analysis (One-way analysis of variance (ANOVA), Pearson’s chi-squared statistical analysis and relative risk calculation) were done specifically to evaluate age and BMI as risk factors for postoperative complications and outcome. Results: No significant differences in patients’ age and BMI in the complication groups compared to the no-complication group could be found. No significant difference regarding the occurrence of complications could be found in any of the formed risk-groups. No significant increase of minor-, major- or overall complications, flap loss or revision surgeries were found in the elderly patient groups or for patients with overweight. Conclusion: Age and overweight do not significantly increase the risk for postoperative complications after breast reconstructions with free TMG flaps. The findings of this study support the fact that microsurgical breast reconstruction with a free TMG flap should not solely be reserved for younger patients and females with a lower BMI

Optimal Allocation of a Hybrid Photovoltaic Biogas Energy System Using Multi-Objective Feasibility Enhanced Particle Swarm Algorithm

This paper aims to investigate a hybrid photovoltaic (PV) biogas on-grid energy system in Al-Ghabawi territory, Amman, Jordan. The system is accomplished by assessing the system’s reliability and economic viability. Realistic hourly measurements of solar irradiance, ambient temperature, municipal solid waste, and load demand in 2020 were obtained from Jordanian governmental entities. This helps in investigating the proposed system on a real megawatt-scale retrofitting power system. Three case scenarios were performed: loss of power supply probability (LPSP) with total net present cost (TNPC), LPSP with an annualized cost of the system (ACS), and TNPC with the index of reliability (IR). Pareto frontiers were obtained using multi-objective feasibility enhanced particle swarm optimization (MOFEPSO) algorithm. The system’s decision variables were the number of PV panels (Npv) and the number of biogas plant working hours per day (tbiogas). Moreover, three non-dominant Pareto frontier solutions are discussed, including reliable, affordable, and best solutions obtained by fuzzy logic. Double-diode (DD) solar PV model was implemented to obtain an accurate sizing of the proposed system. For instance, the best solution of the third case is held at TNPC of 64.504 million USD/yr and IR of 96.048%. These findings were revealed at 33,459 panels and 12.498 h/day. Further, system emissions for each scenario have been tested. Finally, decision makers are invited to adopt to the findings and energy management strategy of this paper to find reliable and cost-effective best solutions