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

The current situation and development of textile industry and apparel industry in Turkey

Tekstil ve hazır giyim sanayi ülkemizin ekonomik kalkınma sürecinde önemli rol oynayan bir sanayi dalıdır.Dünya Ticaret Örgütü verilerine göre 2009 yılında yaklaşık 526 milyar dolar olan tekstil ve hazır giyim sektörü ihracatı 2010 yılında 602 milyar dolara yükselmiştir. İki sektörün 2010 yılında dünya ticaretindeki payı %4,1 olarak gerçekleşmiştir. Ülkemiz ise dünya tekstil ve hazırgiyim ihracatında %3,6’lık bir paya sahiptir.GSYH içindeki payı, dış ticaret potansiyeli, istihdam gibi parametrelerde ülkemizde ilk sıralarda olan sektörler ülkemizi küresel pazarda da ön sıralara taşımaktadır. Türkiye işgücü, hammadde ve pazarlama faktörleri dikkate alındığında Çin, Hindistan ve Güney Kore ile birlikte dünyanın en rekabetçi ülkeleri arasında yer almaktadır. Türkiye ekonomisi içinde çok güçlü bağlantıları olan bu sektördeki gelişmelerin tüm ekonomiyi etkilemesi kaçınılmazdır. Küresel rekabet koşulları altında ve rakip ülkelerin sektörlere tanıdığı pozitif katkılar göz önünde bulundurulduğunda bu sektör gücünün sürdürülmesi büyük önem taşımaktadır.Söz konusu sektörlerin tarihsel gelişimleri de dikkate alınarak yapılan bu çalışmada tekstil ve hazır giyim sektörlerinin değişik açılardan mevcut durumu güncel istatistiki bilgilerle ortaya çıkarılmıştır.The industry sector of textile and clothing has an important role in the economical development of Turkey.Export of textile and clothing increased to 602 billion dollar in 2010 from 526 billion dollar in 2009 as indicated by World Trade Organisation. The share of textiles and clothing in world trade of 2010 became 4,1% and Turkey has 3,6% share in world trade of textile and clothing.Textile and clothing industry is placed near the top in terms of parameters such as its share in GNP, foreign trade potential, employment in Turkey and has been increased to first rows in global trades. Turkey is between the best competitive countries of the World with China, India and South Korea considering labor force, raw material and marketing factors.The developments in textile and clothing industry sectors have unavoidable effect on all of Turkish economy because of their very strong connections within the country’s economic dynamics. The sustainability of the power of these sectors has high importance under such global competitive circumstances when positive contributions of competitor countries are considered.In this study, the current situation of textile sector and clothing sector in Turkey is demonstrated with updated statistical information considering also historical developments of these sectors