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

Modelling of a recirculating photocatalytic microreactor implementing mesoporous N-TiO2 modified with graphene

The use of microreactors in (photo)catalytic processes offers new possibilities for studying and optimizing many mass and photon transfer limited reactions. In this study, we propose a scalable computational fluid dynamics (CFD) model for the prediction of photocatalytic degradation of a model pollutant (4-nitrophenol) using immobilized N-doped TiO2 grown over reduced graphene oxide (N-TiO2/rGO) in a photocatalytic microreactor working in continuous flow-recirculation mode. The mode of operation used in this study allows the reduction of mass transfer limitations inherent to heterogeneous photocatalytic reactions taking place on immobilized catalysts. A CFD model was developed for effective prediction of experimental results using COMSOL multi-physics. The experiment and the model results clearly showed a good agreement. The model parameters were determined through fitting the model with the experimental data, adsorption rate constants were estimated to be 1.76 × 104 m3 mol−1 h−1 and 0.0252 h−1 for monolayer (kads,m and kdes,m), 1.76 × 104 m3 mol−1 h−1 and 0.0126 h−1 for multilayer (kads,n and kdes,n); and the intrinsic rate constant (ks) was 2.02 h−1. This proposed model herein could serve as a practical tool to improve and optimize an extensive number of photocatalytic reactions for (waste)water applications in microreactors operating in recirculation mode

Contact injuries of the female field hockey players

WOS: 000445197700010BACKGROUND: Field hockey is classified as a non-contact sport, however it is clear from literature review that most injuries occur by contact. Despite the old history of the sport, field hockey has only recently started to develop in Turkey. This is the first research about the field hockey injuries which take place especially due to contact. METHODS: Ninety six Turkish female field hockey players took part in this study and they filled an anonymous questionnaire including field hockey information (position, and playing experience) and contact injury history of players in the 2011-2012 season (numbers of contact injuries, type of injuries, contact mechanism of injuries and detailed body parts injured with positions of players). RESULTS: The most common type of injury was contusion (50% of the total 382 contact injuries). Injuries caused by the contact of the ball are the main reasons of such injuries and they constitute 46% of the contact injuries. Besides, it was found out that the body part affected most commonly by contact injuries is the upper limb (48%). Defenders have the highest rate of contact injury as common as 41%. There were significant differences between types of injuries and mechanisms of the contact injuries (P=0.001). CONCLUSIONS: In sum, it was concluded that more protective clothes and equipment would make contact injuries less common and probably make field hockey more popular. The regular and systematic data collection about sport injuries will improve the prevention and control of these injuries

Brevibacillus themoruber: a promising microbial cell factory for exopolysaccharide production

Aims: This study aims to identify a high level exopolysaccharide (EPS) producer thermophile that in turn could be used as a model organism to study the biological mechanisms and whole genome organization of EPS-producing thermophilic bacteria. Methods and Results: Thermophilic isolates were screened, and then growth and EPS production of the best producer Brevibacillus thermoruber strain 423 were investigated under different carbon and nitrogen sources, temperature, pH and agitation rates. Rheological characterization revealed that the EPS behaved like a typical Newtonian fluid and viscosity of the EPS solution increased with increasing Ca2+ ion concentration. Chemical characterization by TLC, GC-MS, FT-IR and NMR suggested a heteropolymer structure with glucose as major monomer unit. High biocompatibility of pure EPS fractions suggested their potential use in biomedical applications. Conclusions: This study reports on the comprehensive description of microbial production conditions as well as chemical, rheological and biological characterization of the EPS produced by B. thermoruber strain 423. The bioreactor cultures were found to reach two times higher yields and three times higher productivities when compared with literature. Significance and Impact of the Study: Brevibacillus thermoruber strain 423 combined the advantages of its nonpathogenicity with the advantages of fast productivity and hence proved to be a very promising model organism and cell factory for microbial EPS production

Prognostic factors for survival in metastatic renal cell carcinoma patients with brain metastases receiving targeted therapy

PMID = 2873149

Importance Of Inhaler Device Use Status In The Control Of Asthma In Adults: The Asthma Inhaler Treatment Study

BACKGROUND: Proper education and training in correct inhalation technique has been reported to have a substantial role in the achievement of optimal therapeutic benefit and asthma control. The present study was designed to evaluate inhaler technique and the role of education in relation to asthma control among patients with persistent asthma in Turkey. METHODS: A total of 572 patients with persistent asthma (mean +/- SD age 42.7 +/- 12.2 y, 76% females) were included in this non-interventional, observational, registry study conducted across Turkey. Data on the effective and correct use of inhaler devices were collected via the Ease of Use for the Inhaler Device Questionnaire to patients and physicians. RESULTS: Asthma control (overall 61.5% at baseline, and increased to 87.3% during follow-up) was better, with significant improvement in technique and decrease in basic errors to the range 0-1, regardless of the inhaler type. Overall, the most common basic error associated with inhalation maneuvers was failure to exhale before inhaling through the device (18.9%). There was concordance between the patients and physicians in the ratio of correct inhaler technique only for spray-type inhalers. CONCLUSIONS: Close follow-up with repeated checking of the patient's inhaler technique and correction of errors each time by a physician seem to be associated with a significant decrease in the percent of patients who make basic errors in inhalation maneuvers and device-independent errors, and with better control of persistent asthma.WoSScopu