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

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Erythrocyte and glomerular C4d deposits as a biomarker for active lupus nephritis

Introduction: Lupus nephritis (LN) is a serious manifestation of systemic lupus erythematosus (SLE) and histologically evident even in those without clinical manifestations of renal disease. Aim of the work: To assess C4d on erythrocytes (E-C4d) and glomerular deposits (G-C4d) in SLE patients and study its association to LN and disease activity. Patients and methods: 61 subjects were enrolled including 15 with LN (study group); 15 with renal disease not due to SLE (control A group); 16 SLE patients with no renal affection (control B group) and 15 healthy individuals (control C group). Flow cytometry system was used for C4d immunohistochemical staining. SLE disease activity index (SLEDAI) was assessed for SLE patients. Results: The age was comparable among groups; for LN patients was 28.3 ± 8.2 years; group A (35.9 ± 13.3); group B (27.1 ± 8.8) and group C (29.4 ± 7.1) (p = .06). Patients were mostly females. The disease duration of LN patients was 1–2 years; group A (3–5 years) and group B (5–10 years). E-C4d and G-C4d deposits were significantly higher in LN patients (8.08 ± 2.93 and 2.3 ± 0.97) in comparison to the control groups (A/B/C) (A: 3.78 ± 0.38 and 0.6 ± 1.12; B: 3.72 ± 0.32; C: 3.55 ± 0.44 p < .001, p < .001, p < .001 MFI respectively). E-C4d and G-C4d significantly correlated with LN activity (r = 0.8, p < .001 and r = 0.7, p = .005) and with SLEDAI (r = 0.9, p = .005 and r = 0.8, p = .002, respectively). Conclusion: Erythrocytic C4d correlated significantly with the LN activity which might serve as a potential biomarker for renal activity in the future instead of biopsy and may further help in the optimum follow up of LN patients. Keywords: SLE, C4d, LN, Renal biopsy, SLEDA

Primary membranous glomerulonephritis-associated with schistosomal nephropathy

The association of bilharziasis with membranous nephropathy (MN) has long been debated. The relatively recent use of antibodies against the M-type phospholipase A2 receptor (PLA2R) has been proposed as a valuable tool to discriminate the idiopathic from secondary MNs. Anti-PLA2R antibodies are found in sera from about 70% of iMN patients, in contrast to patients with secondary MN, in whom serum anti-PLA2R antibodies could not be detected. In the current case report, we detected anti-PLA2R antibodies both in serum and renal biopsy from a patient with MN associated with Schistosoma mansoni. This finding confirms the idiopathic nature of the MN and excludes schistosomiasis as the triggering agent of MN. After treating bilharziasis, Ponticelli regimen was initiated without a significant improvement

Effect of combination sildenafil and gemfibrozil on cisplatin-induced nephrotoxicity; role of heme oxygenase-1

Background/aim: Cisplatin-induced nephrotoxicity in large proportion of patients. The aim of this work is to clarify the effect of combination of sildenafil and gemfibrozil on cisplatin-induced nephrotoxicity either before or after cisplatin treatment and determination of nephrotoxicity predictors among the measured tissue markers. Methods: Thirty two adult male albino rats were divided into four equal groups (G) GI control, GII received cisplatin, GIII received sildenafil and gemfibrozil before cisplatin, GIV received sildenafil and gemfibrozil after cisplatin. Creatinine and urea were measured and animals were sacrificed and kidney was taken for histopathology. The following tissue markers were measured, heme oxygenase-1 (HO-1) activity, reduced glutathione, quantitative (real-time polymerase chain reaction) RT-PCR for gene expression of tumor necrosis factor alpha (TNF-α) and endothelial nitric oxide synthase (ENOS) level. Results: GII developed AKI demonstrated by significantly high urea and creatinine and severe diffuse (80–90%) tubular necrosis. TNF-α was highly and significantly elevated while the rest of tissue markers were significantly reduced in GI1 compared to other groups. GIV showed better results compared to GIII. There was a significant positive correlation between creatinine and TNF-α when combining GI and GII while there were significant negative correlation between creatinine and other tissue markers in same groups. Linear regression analysis demonstrated that HO-1 was the independent predictor of AKI demonstrated by elevated creatinine among GI and GII. Conclusions: Combination of sildenafil and gemfibrozil can be used in treatment of cisplatin-induced nephrotoxicity. HO-1 is a promising target for prevention and/or treatment of cisplatin-induced nephrotoxicity

The impact of cybercrime and social media on intellectual security and awareness with University students in KSA: a field study on students of Imam Abdulrahman Bin Faisal University

AbstractThe study aimed to show the impact of cybercrime and social media on intellectual security and awareness with university students in KSA. To achieve the objectives of the study, a descriptive approach was used through designing an 18-item questionnaire and then administering it to 94 female students at Imam Abdulrahman Bin Faisal University, KSA. After analysing the data statistically, the study revealed a number of findings. The most significant ones were: there was an overall negative effect for cybercrime and social media on intellectual security with Saudi youths (M = 4.24/5); the society had a significant role in enhancing the intellectual security with Saudi youth at Saudi universities (M = 4.37/5); and the solutions proposed in the study were effectively tangible in solving the problems of cybercrime and social media (M = 4.49/5). Then, a number of recommendations were introduced; for example, activating the role of dialogues with young people and students in universities in order to clarify the ambiguous concepts concerning cybercrime and social media for them to be aware of them

BIM Application in Construction Projects: Quantifying Intangible Benefits

Building information modelling (BIM) has been considered an effective and efficient tool among stakeholders of the construction sector as it delivers prominent results. Hence, this work aimed to determine the intangible benefits of BIM in construction projects. Various statistical analyses were performed to identify the most critical intangible benefits of BIM required for justification. To rank the intangible benefits of BIM, the relative importance index was adopted. Then, the rotated component matrix was conducted to correlate each intangible benefit to its estimated components. In the last phase of the research, interviews were conducted to validate and confirm the critical intangible benefits. Five critical intangible benefits were identified: better understanding of design, better information received and given, improved communication through visualization, reduce design error and improved accuracy of drawings. By knowing these five critical benefits, clients should prioritise these benefits in their justification of BIM implementation

Adherence and treatment satisfaction in liver transplant recipients

Background/Aims: Liver transplantation (LT) is a life-saving intervention for patients with liver failure. LT recipients' adherence to their therapeutic regimen is an essential element for graft survival. According to WHO, the impact of medication non-adherence in solid organ transplantation has shown to cost $15–100 million annually. The aim of the present study was to identify the factors that best predict medication adherence and to explore the relationship between treatment satisfaction and medication adherence in liver transplant recipients. Patients and Methods: Adult liver transplant patients at King Abdulaziz Medical City were included in the study. Patients completed the 8-item Morisky Medication Adherence Scale (MMAS-8) and the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4) in addition to several socio-demographic and transplant-related data. Results: A total of 154 patients were included in the study and of these 59.7% were adherent. Older age was a significant predictor of adherence (P < 0.05). The mean treatment satisfaction score was 91.9 ± 12.7 in Effectiveness, 80.0 ± 25.9 in Side Effects, 83.5 ± 15.7 in Convenience, and 94.6 ± 8.6 in Global Satisfaction. Further analysis indicated that patients in the adherent group had reported significantly higher satisfaction scores than those in the non-adherent group (P < 0.05) in all treatment satisfaction domains: Effectiveness (94.4 ± 10.4 vs. 88.6 ± 14.8), Side Effects (83.9 ± 22.0 vs. 74.2 ± 30.1), Convenience (87.0 ± 13.9 vs. 77.2 ± 16.1), and Global Satisfaction (96.9 ± 6.6 vs. 91.2 ± 8.6). Conclusion: Older patients and those who were more satisfied with their treatment tend to have better adherence to the prescribed medications. Therefore, increasing patients' satisfaction with their treatment should be an integral element of future care plans designed to improve treatment outcomes in liver transplant recipients