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

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Mejoramiento de la convivencia escolar a trav?s del cuento como estrategia pedag?gica, en ni?os y ni?as de cinco a siete a?os de la Instituci?n Educativa Carlos Mario Simmonds, de la ciudad de Popay?n (Cauca) 2016-2019

266 p. Recurso Electr?nicoDesde la temprana edad, los ni?os y ni?as adquieren conocimiento explorando el entorno, adem?s de la orientaci?n que en la familia y posteriormente en la escuela reciben. Las vivencias del infante en su entorno familiar y en el contexto donde ?l se desenvuelve pueden impactar negativamente sobre su comportamiento, situaciones que pueden ser repetidas en el contexto educativo, gener?ndose afectaciones en otros ni?os y ni?as y en su desempe?o acad?mico, lo que se traduce en la p?rdida de la armon?a en el aula de clase, afect?ndose por ende la convivencia escolar. Siendo el grado de transici?n un espacio educativo en donde gran parte del aprendizaje se fortalece desde lo l?dico, se observa que en el establecimiento educativo Carlos Mario Simmonds de la ciudad de Popay?n, el cuento no es utilizado como una estrategia pedag?gica para fortalecer los niveles de cohesi?n grupal y convivencia escolar. Surge entonces como prop?sito el desarrollar una estrategia de intervenci?n en donde el uso del cuento y actividades l?dicas contribuyan a moldear la conducta del infante y la resignificaci?n de valores de tal forma que la problem?tica evidenciada se reduzca, en favor de un mejor clima de aula. El cuento se convirti? en un insumo pedag?gico motivador y canalizador de informaci?n que busc? sensibilizar al ni?o y ni?a sobre su mejor comportamiento y desempe?o. Las actividades de intervenci?n realizadas, producto de la aplicaci?n de la Investigaci?n Acci?n surtieron un impacto positivo en la poblaci?n objeto de estudio. Palabras Claves: Cuento, estrategia pedag?gica, did?ctica de la ense?anza, convivencia escolar. Resignificaci?n de valores

Data Paper. Data Paper

<h2>File List</h2><blockquote> <p><a href="Species_Information.txt">Species_Information.txt</a> – Species data for all studies, including study details, limited life history characteristics, and species descriptions. ASCII text, tab delimited, 20 lines (not including header row), 5 KB.<br> (md5: 3aaff18b97d15ab45fe2bba8f721d20c)</p> <p><a href="Population_data.txt">Population_data.txt</a> – Details on population locations, habitats, and observed population status at study end and revisit. ASCII text, tab delimited, 82 lines (not including header row), 8 KB.<br> (md5: 73d9b38e52661829d3aea635498922a3)</p> <a href="Transition_Matrices.txt">Transition_Matrices.txt</a> – Annual transition matrices and observed stage structures for each population and year of study. ASCII text, tab delimited, 461 lines (not including header row), 249 KB.<br> (md5: f0a49ea65b58c92c5675f629f3589517)</blockquote><h2>Description</h2><blockquote> <p>Demographic transition matrices are one of the most commonly applied population models for both basic and applied ecological research. The relatively simple framework of these models and simple, easily interpretable summary statistics they produce have prompted the wide use of these models across an exceptionally broad range of taxa. Here, we provide annual transition matrices and observed stage structures/population sizes for 20 perennial plant species which have been the focal species for long-term demographic monitoring. These data were assembled as part of the ‘Testing Matrix Models’ working group through the National Center for Ecological Analysis and Synthesis (NCEAS). In sum, these data represent 82 populations with > 460 total population-years of data. It is our hope that making these data available will help promote and improve our ability to monitor and understand plant population dynamics.</p> <p><i>Key words: conservation; Demographic matrix models; ecological forecasting; extinction risk; matrix population models; plant population dynamics; population growth rate</i>.</p> </blockquote

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field

Erratum to: Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition) (Autophagy, 12, 1, 1-222, 10.1080/15548627.2015.1100356

non present