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

Micro-patterned Nafion membranes for direct methanol fuel cell applications

In this work, we report the direct methanol fuel cell (DMFC) performance of micro-patterned (μp) Nafion® 117 (N117) membranes prepared by hot embossing and compare them with that of normal N117 and heat and pressure treated (hp) N117 non-patterned (smooth) membranes.\ud \ud Our results suggest that the heat and pressure treatment during hot embossing probably makes the membrane structure more compact and decreases the membrane swelling due to decrease of amount of freezable water in the membrane. This leads to lower methanol flux for both hp N117 and μp N117 membranes in comparison to the non-patterned N117. Nonetheless, all three membranes have similar electrical resistance because they probably have the same amount of non-freezable water. Non-freezable water is the one which is strongly bound to the ionic groups and facilitates the proton transport and it is not influenced by the heat treatment.\ud \ud In the DMFC, the hp N117 has rather similar performance with normal N117 membrane despite its lower methanol crossover. The μp N117, however, has better performance than normal N117 probably due to better catalyst utilization by the micro-pattern. In DMFC stacks, which contain multiple MEAs, this can lead to a higher power output gain and/or lower system volume

Effect of ozone and methylprednisolone treatment following crush type sciatic nerve injury

PURPOSE: To assess and compare the histopathological effects of ozone therapy and/or methylprednisolone (MPS) treatment on regeneration after crush type sciatic nerve injury

Evaluation of macular changes after uncomplicated phacoemulsification surgery by optical coherence tomography

Purpose: To evaluate the effect of uncomplicated phacoemulsification surgery on macula by optical coherence tomography (OCT). Methods: A total of 110 eyes of 102 patients who underwent uncomplicated phacoemulsification and foldable intraocular lens implantation at Beyoglu Eye Research and Training Hospital between February and March 2005 and who were without any systemic disease, fundus or other ocular pathology were included. Post-operatively, topical prednisolone acetate (6 x 1) and ofloxacine (5 x 1) was started, and by decreasing the dosage progressively, treatment was continued for 6 weeks. Full ophthalmologic and OCT examinations were done preoperatively and at the postoperative 1st day, 1st week, 1st, 3rd, and 6th months. Mean retinal thicknesses, volumetric analyses at central fovea, superior, inferior, temporal, and nasal macular quadrants, and thinnest foveal retinal thicknesses were recorded. Preoperative and postoperative measurements were analyzed statistically by using ANOVA test, paired samples t-test with Bonferroni correction, and Pearson's correlation test. Results: The mean central foveal retinal thickness was preoperatively 202.4 +/- 25.9 mu m, postoperatively 200.4 +/- 26.1 mu m at 1st day (p = 0.29), 208.4 +/- 27.6 mu m at 1st week (p = 0.29), 226.2 +/- 54.9 mu m at 1st month, 215.2 +/- 24.0 mu m at 3rd month, 213.5 +/- 29.4 mu m at 6th month (p 0.05), and significant at 1st week, 1st, 3rd, and 6th months (p < 0.05 for all measurements). Conclusions: Statistically significant increase in macular thickness was detected at postoperative early periods, after the 1st week after uncomplicated cataract operation. The increase in macular thickness starts from parafoveal regions. Longer follow-up of patients is required for the macular consequences, and different treatment protocols should be studied in a randomized controlled fashion

The Effect of Silicone Tube and Silicone Tube plus Hyaluronic Acid Application on Adhesion Formation in Experimental Peri- and Epi-neurorrhaphy in A Rat Model

Following neurorrhaphy in Wistar albino rats with experimental sciatic nerve cut, the effectiveness of solely silicone tube (ST) and ST plus hyaluronic acid application on preventing fibrosis was clinically and histopathologically examined. After a total nerve cut is created in sciatic nerve, interfascicular and epineural anastomosis was used. While only anastomosis was applied for the first group (Control Group), for the second group (ST Group) anastomosis + silicone tube and for the third group (ST + HA Group) anastomosis + silicone tube + hyaluronic acid (HA) were applied. Animals in each group were divided into 2 sub-groups and macroscopic and histopathological examinations were conducted on the 30th and 60th postoperative day. On day 30 of the study all the animals had problematic walks. On the 60th day while animals in groups ST and ST + HA were walking normally, the problem was still going on for the control group. In the postmortem macroscopic examinations performed in the control group on the 30th and 60th days an irregular morphology and adhesion to surrounding in nerve tissue were seen. Whereas in group ST, in the anastomosis line within the tube, scar tissue which was clearer on the 60th day was observed, in group ST + HA it was seen that nerve anastomosis line was smooth on the 30th and 60th days. As a consequence, the reduction in myelin thickness and the increase in degenerated myelin for groups ST and ST + HA in 30 day show that HA does not create a positive effect on axon regeneration in the short run, on the other hand, the reduction in myelin degenerated along with the increase of axon myelin thickness and axon cross section areas in groups ST and ST + HA in day 60 has shown that silicone tube and HA application creates a positive impact on myelination in the long run

Blood Based Biomarkers as Predictive Factors for Hyperprogressive Disease

Purpose: With the widespread use of immunotherapy agents, we encounter treatment responses such as hyperprogression disease (HPD) that we have not seen with previous standard chemotherapy and targeted therapies. It is known that survival in patients with HPD is shorter than in patients without HPD. Therefore, it is important to know the factors that will predict HPD. We aimed to identify HPD-related factors in patients treated with immunotherapy. Methods: A total of 121 adult metastatic cancer patients treated with immunotherapy for any cancer were included. Baseline demographics, the ECOG performance status, type of tumors and baseline blood count parameters were recorded. Possible predisposing factors were evaluated with univariate and multivariate analyses. Results: The median age was 62.28 (interquartile range (IQR) 54.02&ndash;67.63) years, and the median follow-up was 12.26 (IQR 5.6&ndash;24.36) months. Renal cell carcinoma (33%) and melanoma (33.8%) were the most common diagnoses. Twenty patients (16.5%) had HPD. A high LDH level (p: 0.001), hypoalbuminemia (p: 0.016) and an NLR &gt; 5 (p: 0.007) were found to be associated with hyperprogression. Sex (female vs. male, p: 0.114), age (&gt;65 vs. &lt;65, p: 0.772), ECOG (0 vs. 1&ndash;4, p: 0.480) and the line of treatment (1&ndash;5, p: 0.112) were not found to be associated with hyperprogression. Conclusions: In this study, we observed HPD in 16.5% of immunotherapy-treated patients and increased HPD risk in patients with a high LDH level (p: 0.001), hypoalbuminemia (p: 0.016) and an NLR &gt; 5 (p: 0.007)