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

In the context of fashion and contemporary art: body metaphors

Bu sanat eseri raporu, moda ve sanat ilişkisini, 'beden' ve onun giydirilmesi meselesi üzerinden ele almaktadır. Giyinmek, insanlık tarihinin büyük bölümünde ve her toplumda, öncelikle iklim şartlarına bağlı olarak gelişen bir durum olagelmiştir. Ancak sonrasında kültürel ve söylemsel kodlarla birlikte çeşitlenmeye, farklılaşmaya ve ayrım-laşmaya başlamıştır. Sanayi devrimi sonrası gelişen modern toplumlarda giyinmek, artık moda kavramı adı altında gelişen bir pazarın konusu olmuştur. Moda olgusu, kavramsallaştıkça birçok düşünürün ve sanatçının da ilgi alanına girmiştir. Kadın ve erkekleri tanımlanmış cinsiyetler olarak belirleyen ezeli kodlar, giyinme olgusu üzerinden, kıyafetlerle, ki bir nevi kimliklendirme denilebilir buna, ebedi kodlarla sabitlemeye çalışması modanın biyo-politika uğraşları hanesine bu anlamda yazılabilir. Kıyafetler, kimliğe ait kodlara dönüşmüştür. Hatta bu açıdan sınıfsal ayrımların en ayrıştırıcı katmanı moda olmuştur. Çağdaş sanat ve moda ilişkisi bağlamında da; 'beden' konusu önemli bir yere sahiptir. Beden, kimlik, cinsiyet gibi konular çağdaş sanatın uğraş alanlarından birini oluşturmaktadır.This artwork report approaches the relationship between fashion and art through the issue of 'body' and its dressing. Dressing has been a situation that has developed primarily in relation to climatic conditions throughout most of human history and in every society. However, it began to diversify, differentiate and differentiate with cultural and discursive codes. In modern societies that developed after the industrial revolution, dressing has subjected to developing markets under the concept of fashion. Since the concept of fashion has been conceptualized, it has been interest of many thinkers and artists. Trying to be resricted the unoriginated codes that define men and women as defined genders with clothes, through the phenomenon of dressing -which can be called a kind of identification- to the eternal codes can be added pockets of the biopolitical pursuits of fashion. Clothes have now turned into codes of identity. In the context of the relationship between contemporary art and fashion; 'Body' issue has an important place and issues such as identity and gender constitute a few of the fields of contemporary art

Remzi Aktaş’ın daktilo tamirhanesi

Ankara : İhsan Doğramacı Bilkent Üniversitesi İktisadi, İdari ve Sosyal Bilimler Fakültesi, Tarih Bölümü, 2017.This work is a student project of the The Department of History, Faculty of Economics, Administrative and Social Sciences, İhsan Doğramacı Bilkent University.by Demirakın, Nahide Işık

Comparison of infants and children with urolithiasis: a large case series.

We evaluated the demographic features, etiologic risk factors, treatment strategies, and outcome of the infants and children with urolithiasis (UL). A retrospective multicenter study was conducted including 23 Pediatric Nephrology centers in Turkey. The medical records of 2513 children with UL were reviewed. One thousand, three hundred and four boys and 1209 girls (1.1:1) were reported. The mean age at diagnosis was 39.5 +/- 35 months (0.4-231 months), and 1262 patients (50.2%) were in the first year of life (infants). Most of the cases with infantile UL were diagnosed incidentally. Microlithiasis (< 3 mm) was found in 794 patients (31.6%), and 64.5% of the patients with microlithiasis were infants. Stones were located in the pelvis-calyces in 63.2% (n: 1530) of the cases. The most common stone type was calcium oxalate (64.6%). Hypocitraturia was the most common metabolic risk factor (MRF) in children older than 12 months, but in infancy, hypercalciuria was more common. Fifty-five percent of the patients had received at least one medical treatment, mostly potassium citrate. At the end of a year's follow-up, most of the patients with microlithiasis (85%) showed spontaneous remission. The rate of spontaneous stone resolution in infants was higher than in children. Spontaneous remission rate was higher in cases with MRF ( - ) stones than in MRF ( +) stones. However, remission rate with medical treatment was higher in cases with MRF ( +) stones. This study represents the results of a large series of infants and children with UL and showed that there are several differences such as underlying metabolic and anatomic abnormalities, clinical course, and stone remission rates between infants and children with urinary stone disease