Vincent Gover, Composition

Mottenquartett (2016); This is a Letter to the World (2015) / Text by Emily Dickinson; Stiller Freund (2012) / Text by R. M. Rilke; Two Songs / Text by Vincent Gover; from Troilus & Cressida: a musical comedy/history/tragedy (2015) / Text by Sara Romersberger; Alexander\u27s Song ; Ulysses\u27 Trio (PartI) ; The Light-Bearer (2016) / Text by Issac Young; *Note: [untitled chamber work] not performe

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

Vincent Gover, Composition

Mottenquartett (2016); This is a Letter to the World (2015) / Text by Emily Dickinson; Stiller Freund (2012) / Text by R. M. Rilke; Two Songs / Text by Vincent Gover; from Troilus & Cressida: a musical comedy/history/tragedy (2015) / Text by Sara Romersberger; Alexander\u27s Song ; Ulysses\u27 Trio (PartI) ; The Light-Bearer (2016) / Text by Issac Young; *Note: [untitled chamber work] not performe

Intracellular Acidification Is Associated with Changes in Free Cytosolic Calcium and Inhibition of Action Potentials in Rat Trigeminal Ganglion*

The effect of intracellular acidification and subsequent pH recovery in sensory neurons has not been well characterized. We have studied the mechanisms underlying Ca2+-induced acidification and subsequent recovery of intracellular pH (pHi) in rat trigeminal ganglion neurons and report their effects on neuronal excitability. Glutamate (500 μm) and capsaicin (1 μm) increased intracellular Ca2+ concentration ([Ca2+]i) with a following decrease in pHi. The recovery of [Ca2+]i to the prestimulus level was inhibited by LaCl3 (1 mm) and o-vanadate (10 mm), a plasma membrane Ca2+/ATPase (PMCA) inhibitor. Removal of extracellular Ca2+ also completely inhibited the acidification induced by capsaicin. TRPV1 was expressed only in small and medium sized trigeminal ganglion neurons. mRNAs for Na+/H+ exchanger type 1 (NHE1), pancreatic Na+-HCO3− cotransporter type 1 (pNBC1), NBC3, NBC4, and PMCA types 1–3 were detected by RT-PCR. pHi recovery was significantly inhibited by pretreatment with NHE1 or pNBC1 siRNA. We found that the frequency of action potentials (APs) was dependent on pHi. Application of the NHE1 inhibitor 5′-(N-ethyl-N-isopropyl) amiloride (5 μm) or the pNBC1 inhibitor 4′,4′-di-isothiocyanostilbene-2′,2′-sulfonic acid (500 μm) delayed pHi recovery and decreased AP frequency. Simultaneous application of 5′-(N-ethyl-N-isopropyl) amiloride and 4′,4′-di-isothiocyanostilbene-2′,2′-sulfonic acid almost completely inhibited APs. In summary, our results demonstrate that the rise in [Ca2+]i in sensory neurons by glutamate and capsaicin causes intracellular acidification by activation of PMCA type 3, that the pHi recovery from acidification is mediated by membrane transporters NHE1 and pNBC1 specifically, and that the activity of these transporters has direct consequences for neuronal excitability