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

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Katalyst Pilot Study: Using Interactive Activities in Anatomy and Physiology to Teach Children the Scientific Foundation of Healthy Lifestyles

This pilot study evaluated the impact of the Katalyst curriculum, a fifth-grade experiential learning program, on students&#8217; knowledge of a healthy lifestyle&#8217;s impact on body functions. Katalyst&#8217;s interactive curriculum spans two days and includes four, 60-min stations on body systems: cardiovascular/endocrine, gastrointestinal, neurological, and respiratory/musculoskeletal. Three schools were recruited, and two schools completed the intervention sessions. Prior to beginning the stations, fifth-grade students completed a 37-item questionnaire to assess knowledge and perceptions. Students completed the same survey at the end of the Katalyst intervention. Teachers at the school also completed a survey post intervention to provide feedback on the program. Frequency and paired analyses were conducted on student responses and summative content analysis on teacher and volunteer feedback. The School 1 completer (n = 63) baseline mean knowledge score was 66.2%. The School 2 completer (n = 47) baseline mean knowledge score was 67.3%. Following the Katalyst intervention, both schools showed a statistically significant increase in the mean post score to 70.3% (p = 0.0017) and 78.4%(p &lt; 0.0001) at School 1 (n = 63) and School 2 (n = 47), respectively. Teacher feedback (n = 7) revealed that Katalyst was effective in meeting state educational health standards and teachers perceived that the students benefitted from the program more than &#8220;reading about the body systems in a textbook or health magazine&#8222;. The Katalyst pilot study appeared to improve fifth-grade students&#8217; knowledge of body systems and health. Katalyst aligned with state educational standards and is supported by teachers for an experiential learning opportunity. The Katalyst curriculum could be a potential avenue for health educators in Appalachia

Urban Forestry (semester?), IPRO 317

The goal of IPRO 317 is to create an operational and business model for Urban Forestry Management. Presently, the future of Chicago’s urban forest is in question. While few refute the claim that trees are good for our community, allocating the resources to properly maintain or even expand our urban forest remains beyond our grasp. Our team seeks to make the urban forest a viable commodity in addition to its status as an asset. This would include examining the problem as a closed loop process as well as the sustainable harvest potential of the urban forest. The overall goal would be to create a business model that would increase the number of trees within the city, turn the revenue loss of tree maintenance into a revenue gain, and create a self sustaining model which will have the ability to stand on its own.Deliverables for IPRO 317: Urban Forestry for the Fall 2007 semeste

Urban Forestry (semester?), IPRO 317: Urban Forestry IPRO 317 Project Plan F07

The goal of IPRO 317 is to create an operational and business model for Urban Forestry Management. Presently, the future of Chicago’s urban forest is in question. While few refute the claim that trees are good for our community, allocating the resources to properly maintain or even expand our urban forest remains beyond our grasp. Our team seeks to make the urban forest a viable commodity in addition to its status as an asset. This would include examining the problem as a closed loop process as well as the sustainable harvest potential of the urban forest. The overall goal would be to create a business model that would increase the number of trees within the city, turn the revenue loss of tree maintenance into a revenue gain, and create a self sustaining model which will have the ability to stand on its own.Deliverables for IPRO 317: Urban Forestry for the Fall 2007 semeste

Urban Forestry (semester?), IPRO 317: Urban Forestry IPRO 317 Abstract F07

The goal of IPRO 317 is to create an operational and business model for Urban Forestry Management. Presently, the future of Chicago’s urban forest is in question. While few refute the claim that trees are good for our community, allocating the resources to properly maintain or even expand our urban forest remains beyond our grasp. Our team seeks to make the urban forest a viable commodity in addition to its status as an asset. This would include examining the problem as a closed loop process as well as the sustainable harvest potential of the urban forest. The overall goal would be to create a business model that would increase the number of trees within the city, turn the revenue loss of tree maintenance into a revenue gain, and create a self sustaining model which will have the ability to stand on its own.Deliverables for IPRO 317: Urban Forestry for the Fall 2007 semeste

Urban Forestry (semester?), IPRO 317: Urban Forestry IPRO 317 IPRO Day Presentation F07

The goal of IPRO 317 is to create an operational and business model for Urban Forestry Management. Presently, the future of Chicago’s urban forest is in question. While few refute the claim that trees are good for our community, allocating the resources to properly maintain or even expand our urban forest remains beyond our grasp. Our team seeks to make the urban forest a viable commodity in addition to its status as an asset. This would include examining the problem as a closed loop process as well as the sustainable harvest potential of the urban forest. The overall goal would be to create a business model that would increase the number of trees within the city, turn the revenue loss of tree maintenance into a revenue gain, and create a self sustaining model which will have the ability to stand on its own.Deliverables for IPRO 317: Urban Forestry for the Fall 2007 semeste

Urban Forestry (semester?), IPRO 317: Urban Forestry IPRO 317 Poster F07

The goal of IPRO 317 is to create an operational and business model for Urban Forestry Management. Presently, the future of Chicago’s urban forest is in question. While few refute the claim that trees are good for our community, allocating the resources to properly maintain or even expand our urban forest remains beyond our grasp. Our team seeks to make the urban forest a viable commodity in addition to its status as an asset. This would include examining the problem as a closed loop process as well as the sustainable harvest potential of the urban forest. The overall goal would be to create a business model that would increase the number of trees within the city, turn the revenue loss of tree maintenance into a revenue gain, and create a self sustaining model which will have the ability to stand on its own.Deliverables for IPRO 317: Urban Forestry for the Fall 2007 semeste