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

Noninvasive Pulse Measurement and Wireless Transmission

Today, the rapid development in technology has given way to many innovative research activities in the field of health. In particular, wireless communication systems are increasingly used in medical device applications. Long-term or real-time monitoring of medical data and informing of relevant institutions in critical situations have become indispensable with the aging and growing population. At the same time, the patients at the hospital are cured, but the patients who need to be supervised at home need to be checked by the experts of all kinds of current health data. In this study, it was aimed to calculate pulse rate by taking a PPG (Photoplethysmography) signal on body simultaneously via a microcontroller. This calculated heart rate was sent to the mobile phone using Bluetooth wireless technology. With the developed mobile application, it is possible to send the pulse value of the phone to the desired persons via SMS. This makes it possible for the health situation to be monitored outside the hospital while the person performs daily activities.Günümüzde teknolojinin hızla gelişmesi, sağlık alanında da yenilikçi çalışmalara yön vermiştir. Özellikle kablosuz haberleşme sistemlerinin, tıbbi cihaz uygulamalarında kullanımı giderek artmıştır. Tıbbi verilerin uzun dönemli veya gerçek zamanlı izlenmesi ve acil durumlarda ilgili kurumların haberdar edilmesi yaşlanan ve artan nüfus ile birlikte vazgeçilmez olmuştur. Aynı zamanda hastanede tedavisi bitmiş, fakat evinde gözetim altında tutulması gereken hastalar??n güncel sağlık verilerinin uzman tarafından izlenmesi de çok önemli bir konudur. Bu çalışmada, bir mikrodenetleyici ile PPG (Fotopletismografi) sinyalinin vücut üzerinden eş zamanlı olarak alınarak nabız değerinin ölçülmesi ve iletilmesi amaçlanmıştır. Hesaplanan nabız değeri, bluetooth kablosuz ileti??im teknolojisi kullanılarak bir akıllı telefona iletilmiştir. Geliştirilen mobil uygulamayla, telefona gelen nabız de??erinin istenilen kişilere SMS olarak gönderilmesi sağlanmıştır. Böylelikle kişi günlük aktivitelerini yerine getirirken sağlık verilerinin de hastane ortamı dışında izlenmesi mümkün hale gelmiştir

Oral Amoxicillin/Clavulanate and Ciprofloxacin Treatment in Low-Risk Febrile Neutropenic Patients with Solid Tumors

Objective: The aim of this study was to collect the data of low-risk febrile neutropenic patients with solid tumors orally treated with amoxicillin/clavulanate and ciprofloxacin. Material and Methods: Adult patients with solid tumors who were treated with conventional dose of chemotherapy, presented with fever (axillary temperature 38 degrees C on two occasions or 38.3 degrees C on a single occasion) and neutropenia (absolute neutrophil count, 500 cells/mL), and met low risk criteria (above 20) according to "The Multinational Association for Supportive Care in Cancer" (MASCC) were eligible for this study. All patients received empirical therapy with oral ciprofloxacin (500 mg twice daily) plus amoxicillin/clavulanate (1000 mg, three times daily). Results: Twenty-one episodes of febrile neutropenia in 20 patients (including two episodes of a patient with lung cancer) were studied retrospectively. The mean age was 55.5 years (range, 30 to 77 years), and most were females (70%). On the initial evaluation, two of these patients had mild diarrhea and the others had a fever of unknown origin. Treatment was successful in 76% of the episodes. Twenty-seven percent of episodes required modification of initial antibiotic therapy to intravenous administration of antibiotics. No death was observed due to the febrile neutropenic episode. Conclusion: In low-risk patients with solid tumors who have fever and granulocytopenia, oral therapy with ciprofloxacin plus amoxicillin/clavulanate seems to be an effective alternative approach for empirical therapy

MALIGNANT PERIPHERAL NERVE SHEATH TUMOR OF THE NECK

Malignant peripheral nerve sheath tumors are highly aggressive tumors characterized by rapid growth with infiltration of surrounding tissue and hematogenous metastases. Wedescribed a 32-old male patient with malignant peripheral nerve sheath tumor of the head and neck. Surgery was the chosen method of treatment by the dissecting the mass.Even chemotherapy were administered after surgery, local recurrence occurred in the second month of the follow-up period. Then the patient underwent radical neck dissection under general anesthesia. Close follow-up was made, at first year disease hadno recurrence. We reported this case and reviewed the literature regarding malignant peripheral nerve sheath tumor by reason of this case.

Infectious disease consultations and antibiotic usage in a Turkish university hospital

Objectives: The aim of this study was to investigate the various features of infectious disease (ID) consultations and the usage of antibiotics in a Turkish university hospital

Risk of infection in health care workers following occupational exposure to a noninfectious or unknown source

Background: The major concern after occupational exposures is the possible transmission of blood-borne pathogens, especially hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). This study was undertaken to evaluate the risk of infection after exposure to blood or body fluids of an unknown or an HBV-, HCV-, and HIV-negative source and to determine the epidemiologic characteristics of these incidents in health care workers

Autologous rabbit adipose tissue-derived mesenchymal stromal cells for the treatment of bone injuries with distraction osteogenesis

Background aims. Adipose tissue-derived mesenchymal stromal cells (MSCs) have a higher capacity for proliferation and differentiation compared with other cell lineages. Although distraction osteogenesis is the most important therapy for treating bone defects, this treatment is restricted in many situations. The aim of this study was to examine the therapeutic potential of adipose tissue-derived MSCs and osteoblasts differentiated from adipose tissue-derived MSCs in the treatment of bone defects. Methods. Bone defects were produced in the tibias of New Zealand rabbits that had previously undergone adipose tissue extraction. Tibial osteotomy was performed, and a distractor was placed on the right leg of the rabbits. The rabbits were placed in control (group I), stem cell (group II) and osteoblast-differentiated stem cell (group III) treatment groups. The rabbits were sacrificed, and the defect area was evaluated by radiologic, biomechanical and histopathologic tests to examine the therapeutic effects of adipose tissue-derived MSCs. Results. Radiologic analyses revealed that callus density and the ossification rate increased in group III compared with group I and group II. In biomechanical tests, the highest ossification rate was observed in group III. Histopathologic studies showed that the quality of newly formed bone and the number of cells active in bone formation were significantly higher in group III rabbits compared with group I and group II rabbits. Conclusions. These data reveal that osteoblasts differentiated from adipose tissue-derived MSCs shorten the consolidation period of distraction osteogenesis. Stem cells could be used as an effective treatment for bone defects