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

Beş yıldızlı otel işletmelerinde tutundurma çabalarına yönelik Bodrum yöresinde bir araştırma

Tutundurma çabalan reklâm, halkla ilişkiler, kişisel satış ve satış geliştirme faaliyetleri arasındaki bağın kuvvetlendirilmesiyle ve arttırılmasıyla etkili bir hale gelmektedir. Tutundurma çabalarından sadece birini kullanan ya da birine ağırlık veren turizm işletmeleri, tutundurma faaliyetlerini bir bütün olarak gören ve uygulayan ya da hepsini bir arada yürüten turizm işletmelerine nazaran daha az başarılı olurlar. Tutundurma çabalarının birlikte yürütülmesi ve turistik tüketici üzerinde beklenilen etkiyi göstermesi turizm işletmelerinin hedef¬leri arasında yer alır. Bu çalışmada da Bodrum ilçesinde turistik işletmelerinde tutundurma çabalannın değerlendirilmesi yapılmıştır.Promotional activities are strengthened as the relationships between advertising, public relations, personal selling and selling development activities are strengthened and increased and these promotional activities become efficient. Tourism organization which are carrying out a single promotional activity or a weighted promotional activity achieve less with respect to the tourism organizations that are carrying out integrative or a variety of promotional activities. Keeping the promotional activities abreast and getting the expected effects on the consumers are among the objectives of tourism organizations. In this study the promotional efforts of touristic organizations in bodrum touristic region are evaluated

THE EFFECT OF IMPROVISED MEDIA AND SUGAR CONCENTRATION ON IN VITRO SHOOT MULTIPLICATION OF RICCIA FLUITANS L.: AN AMPHIBIOUS LIVERWORT

In the present study, effect of different regeneration media (R) and combination (R1 = MS medium, R2 = MS Salts + B5 vitamins, R3 = MS salts + SH vitamins, R4 = SH medium, R5 = SH salts + MS vitamins, R6 = SH salts + B5 vitamins) and various carbon sources (glucose, sucrose and fructose) was investigated on efficient in vitro shoot multiplication of Riccia fluitans. The media composition significantly affected (P <= 0.05) length, width, area, fresh and dry weight of clumps on multiplied plants. The R5 medium produced highest length (2.58 cm), width (2.16 cm), area (5.57 cm(2)), fresh weight (402.6 g) and dry weight (37.6 g) on regenerated clumps that showed healthier and green plant on culture medium. However, the regenerated clumps diameter was also significantly influenced (P <= 0.05) by the type and concentration of sugar (carbon sources) used. The highest clump diameter (7.27 cm) was obtained on R5 medium supplemented with 1.5% sucrose. Whereas, the higher concentration fructose (4.5 and 6.0%) showed abnormalities and phenotypic growth inhibition on cultured explants. The present paper reports direct production of multiple shoots of riccia plant make it a potential system for developing true-to-type plant that maintain genetic stability for future commercial production of this ornamental aquatic plant.Universityto Ankara; Kahramanmaras Sti tctiImam UniversityThe authors are thankful Universityto Ankara and Kahramanmaras Sti tctiImam University for providing facility and supporting the present research work

Şayli Ailesi tarihi

Ankara : İhsan Doğramacı Bilkent Üniversitesi İktisadi, İdari ve Sosyal Bilimler Fakültesi, Tarih Bölümü, 2018.This work is a student project of the Department of History, Faculty of Economics, Administrative and Social Sciences, İhsan Doğramacı Bilkent University.The History of Turkey course (HIST200) is a requirement for all Bilkent undergraduates. It is designed to encourage students to work in groups on projects concerning any topic of their choice that relates to the history of Turkey. It is designed as an interactive course with an emphasis on research and the objective of investigating events, chronologically short historical periods, as well as historic representations. Students from all departments prepare and present final projects for examination by a committee, with 10 projects chosen to receive awards.Includes bibliographical references (page 26).by Yasemin Başaran Doğan

SPECTROPHOTOMETRIC MEASUREMENTS OF RHODAMINE B AS A DYE TRACER FOR BRINE OUTFALL LABORATORY EXPERIMENTS

Rhodamine B (RhB) as a dye tracer is widely used both in laboratory scale and in-situ studies about determination of wastewater plumes' movement and their dilution characteristics in marine environments. RhB added salt (mainly NaCl) water solutions are used on brine outfall laboratory physical model experiments. Some of the experiments in laboratory tanks can be conducted via taking samples inside the discharged brine jets. Taken samples can be measured by optical methods such as ultraviolet visible spectrophotometry for determination of dye tracer concentrations and dilution levels. However, absorbance specifications of a dye tracer, like RhB, might be affected by high concentrations of NaCI in discharge solutions

Relation of the Fas and FasL gene polymorphisms with susceptibility to and severity of rheumatoid arthritis

Ankarali, Handan Camdeviren/0000-0002-3613-0523; barlas, ibrahim omer/0000-0002-2645-4487; Sahin, Gunsah/0000-0002-4215-6957; Erdal, Mehmet Emin/0000-0002-6191-2930WOS: 000324824500025PubMed: 23749041To investigate associations of the Fas and FasL genes polymorphisms with rheumatoid arthritis (RA). One hundred patients with RA and age-, sex- and ethnically matched 101 controls were included. Four polymorphisms of Fas (-670 A > G rs1800682, -1377 G > A rs2234767) and FasL (IVS2nt-124 A > G rs5030772, -844 T > C rs763110) genes were typed from genomic DNA. Genotype distributions and allelic frequencies were compared between patients and control subjects. After the history and clinical examination of patients with RA, in terms of pain, fatigue and general health status were evaluated by visual analogue scale. Thereafter, erythrocyte sedimentation rate, C-reactive protein, blood count and rheumatoid factor levels were measured. The Disease Activity Score-28, Health Assessment Questionnaire and modified Sharp score were used to evaluate the disease activity, functional disability and radiological damage, and their relationships with the Fas and FasL gene polymorphisms were investigated. In patients with RA, CT and TT genotypes of FasL-844, polymorphism were twofold and 4.8-fold higher, and AA genotype of FasL IVS2nt-124 polymorphism was 3.4-fold higher than the control group (respectively, p = 0.05, p = 0.002, p = 0.039). T allele of FasL-844 polymorphism was more frequent in patients than controls (respectively, 52.5 vs. 41.4 %, p = 0.027). Any association was not detected between Fas (-670 A > G, -1377 G > A) and FasL (-844 T > C, IVS2nt-124 A > G) gene polymorphisms with the disease activity scores, functional disability and radiological damage. However, the Fas-670 A > G polymorphism was associated with drug therapy (p = 0.049). The distribution of GG genotype was higher compared to GA or AA genotypes in patients using triple disease-modifying antirheumatic drug therapy (71.4, 14.3 and 14.3 %, respectively). These findings suggest that the -844 T > C and IVS2nt-124 A > G polymorphisms in the FasL gene related with apoptosis may increase genetic susceptibility to RA in a Turkish population. In addition, the Fas-670 A > G gene polymorphism may be associated with disease progression. There is a need for further studies to clarify the genetic role of apoptosis in RA

Apoptosis-related Fas and FasL gene polymorphisms' associations with knee osteoarthritis

barlas, ibrahim omer/0000-0002-2645-4487; Ankarali, Handan Camdeviren/0000-0002-3613-0523; Erdal, Mehmet Emin/0000-0002-6191-2930; Sahin, Gunsah/0000-0002-4215-6957WOS: 000322120400017PubMed: 23392773To investigate the associations between Fas and FasL gene polymorphisms and susceptibility to knee osteoarthritis. Genomic DNA was obtained from 146 patients with knee osteoarthritis and 102 healthy controls. Genotype distributions and allelic frequencies of four polymorphisms of Fas (-670 G > A rs1800682, -1377 G > A rs2234767) and FasL (IVS2nt-124 A > G rs5030772, -844 T > C rs763110) genes were compared between the groups. Thereafter, this association was investigated between patients and controls of the same sex. There were significant differences between patients with knee osteoarthritis and controls regarding the genotype distributions and allelic frequencies of Fas-1377 G > A polymorphism (P = 0.0001 and P = 0.005, respectively). The Fas-1377 GG genotype and G allele were significantly more frequent in patients with knee osteoarthritis than in controls. Genotype distributions and allelic frequencies of Fas-670 G > A, FasL-844 T > C, and FasL IVS2nt-124 A > G polymorphisms did not differ between the groups (P > 0.05). However, there were no significant differences between patients and controls of the same sex (P > 0.05). These findings suggest that the Fas-1377 G > A polymorphism in the Fas gene related with apoptosis may contribute to susceptibility to knee osteoarthritis in the Turkish population. There is a need for further studies to evaluate the role of apoptosis in large cohorts