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

Cases of Acute Poisoning in Southeast Anatolia of Turkey

This study was conducted to determine the biological effects of acute poisoning, nature ofagents involved and pattern of poisoning during 2000 in Diyarbakır City in Southeast AnatolianRegion of Turkey.Data from hospital records of all admissions to Emergency Department (ED) of Dicle UniversityHospital following acute poisoning collected retrospectively were analysed for the period January toDecember in 2000. Present study included 44 (25.9%) male (M) and 126 (74.1%) female (F), a total170 consecutive patients. A M/F ratio was found as 1.0/3.5 in the study.Mean age of cases was 23.3±6.3 years old; 63 (37.1%) of them were under age of 20 years oldand 147 (86.5%) of them were under age of 30 years old. Cases of intoxication have admitted insummer season (93 of 170 patients), especially in April, May and July (24, 26 and 30 patients),respectively. Sixty-two (36.5%) cases due to accidental, 108 (63.5%) cases due to suicidal goal. Thecases of suicidal purposeful intoxications were mostly determined in females (77 cases, 71.3%,p<0.05), and singles (74 cases, 68.5%, p<0.05). There were only two deaths (1.2%) among the 170admissions of acute poisonings during hospitaliztion. One of the deaths was due to pesticides; otherone was due to abuse of medical drug. According to physical examination, tachycardia (59, 34.7%),vomit history (55, 32.4%), and unconsciousness (42, 24.7%) were frequently observed; however,hypersecretion (15, 8.8%), bradycardia (5, 2.9%), convulsion (8, 4.7%), and hipertension (2, 1.2%),were seen rarely. Cases who poisoned with pesticide compared other cases have had significantlyhigher rate of convulsion (6, 10.2%), miosis (6, 10.2%), and hypersecretion (12, 20.3%) (p=0.018,p<0.0001 and p<0.0001), respectively.In our region, pesticides intoxication especially affected to young unmarried females, and mostof them resulted from suicidal purpose. The annual rate of poisoning-related ED visits and mortalitywere within the reported ranges, psychoactive agents being the most common cause of poisonings

Smoking initiation in primary school students in Southeast of Turkey: The roles of sociodemographic factors, gender and parental characteristics

Aim: The objective of this survey was to determine the socio-demographic and the parental features and the extent of active and passive smoking among primary school children in Diyarbakir Province in Southeast Anatolian Region of Turkey. Material and Methods: This survey is an epidemiological study with cross-sectional design. According to the layered random sampling method, 15 schools were visited and taking into account the age and gender distribution a total number of 1124 students filled the questionnaire. The survey included questions about the parental and the socio-demographic features, the social and economic status of the family, number of brothers and sisters, the housing and living conditions, as well as the smoking status of students. Results: 1124 students, consisting of 630 boys (%56.0) and 494 girls (%44.0) had an average age of 11.1±2.4 yr. A total of 771 (68.6%) students told that there were smoking family members living in their houses (p<0.0001). The number of students with smoking habit was 136 (92 male, 44 female) (%12.2). The number of family members and sleeping rooms were 7.5±2.8, 4.5±2.1 and 2.1±0.9, respectively. The reason behind smoking addiction was generally related with either peers (45 person, 52.3%) or relatives (10 person, %11.6). The rate of smokers among boys is 1.38 times (OR: 1.38, %95 CI: 1.070-1.778) greater than that of girls. Conclusions: The survey results show that smoking among primary school students is becoming prevalent, the rate of passive smoking is increasing, and the number of family members living in the house is generally beyond the shelter capacity. Especially most of the mothers are found to be uneducated. Therefore, more effort should be directed to address the problems of smoking and lack of education which have the utmost importance among these related negative factors. © 2010 Düzce Medical Journal

Nevus lipomatosus cutaneous superficialis: Case report

Nevüs lipomatöz superfisiyalis (NLS) üst dermiste ektopic adipositle karakterize seyrek bir deri malformasyonudur. Özellikle lezyonlar gövdenin alt kısmında ve kalçada lokalize olurlar. Zosteri form ve lineer özelliktedir. Buradaki olgu birinci basamakta nadir görülen bir hastalık olması nedeniyle rapor edildi. Vakamızda, 42 yaşında kadın hasta beş yıldır sırt bölgesinde sayıları giderek artan ağrısız ve kaşıntısız kabarık lezyonlarla polikliniğimize başvurdu. Hastanın muayenesinde; sağ skapular bölge alt kısmında zosteri form yerleşim gösteren çok sayıda papülo-nodüller saptandı. Histopatolojik inceleme sonucunda hastamıza NLS tanısı konuldu. NLS’li hastalarda başlıca tedavi seçeneği, benign lezyon olması nedeni ile kozmetik amaçlı yapılan cerrahi eksizyondur. Bu hastada da hastanın lezyonları eksize edildi.Nevus lipomatosus cutaneous superficialis (NLS) is a rare skin malformation characterized by ectopic adipocyte in upper dermis. It is composed of multiple nodular and papular lesions localized especially on lower part of trunk and gluteal region. These lesions have linear and zoster form pattern. In our case, 42 years-old woman admitted to our clinic, presenting with non-painful and non-itchy bulky lesion gradually increased on her upper back region since 5 years. On her examination, multiple nodulo-papular lesions with zoster form pattern localized on lower margin of right scapular region were detected. It was diagnosed as NLS, depending on histopathological investigation. Treatment for NLS is cosmetically surgical excision, and the patient&#8217;s lesion was excised, because it is benign lesion

Factors affecting exhaled carbon monoxide levels in coffeehouses in the Western Black Sea region of Turkey

KARA, ISMAIL HAMDI/0000-0003-2022-1882; KARA, ISMAIL HAMDI/0000-0003-2022-1882; Kandis, Hayati/0000-0001-9151-6050WOS: 000288949000001PubMed: 20858650The aim of this study was to evaluate indoor air quality and factors affecting expired carbon monoxide (CO) levels in a coffeehouse environment. This cross-sectional study was conducted at 16 randomly selected coffeehouses in Duzce, Turkey, during November 2007 to March 2008. A total of 547 people, average age 46.72 +/- 17.03 (19-82) years, participated. The selected coffeehouses were divided into four groups: (1) smoking, (2) nonsmoking, (3) old-style and (iv) new-style coffeehouses. Prior to entering the coffeehouse, exhaled CO levels in smokers (mean 21.17 +/- 6.73 parts per million [ppm]) were significantly higher than those for nonsmokers (6.51 +/- 4.56 ppm; p < 0.001). Measurements taken after 2 hours in the coffeehouse also showed significantly higher CO concentrations for smokers (22.72 +/- 5.31 ppm), compared to nonsmokers (6.51 +/- 4.56 ppm; p < 0.001). It was determined that CO levels inside coffee shops were above the WHO guidelines. Exhaled CO levels in nonsmokers are influenced by the ambient CO levels as a result of the use of cigarettes in coffeehouses in addition to the structure of coffeehouses

Family Medicine Residency Training: Where, How Much, How and When?

KARA, ISMAIL HAMDI/0000-0003-2022-1882; KARA, ISMAIL HAMDI/0000-0003-2022-1882WOS: 000372103700013In this article, it will be discussed of the setting and the importance of the family medicine residency training in field related workshop framework that was made in the WONCA Europe Conference 2015. Family medicine residency training consists of three basic pillars: Rotations in hospital and other health care facilities, educational activities in family medicine departments and training in primary care settings. Between 1985 and 2011, formal residency training was consisted only of hospital rotations. With the rapid growth of family medicine departments in universities and clinics in research and training hospitals since 1995, educational activities of departments have increasingly been an important part of residency training. In 2011, with the acceptance of new core curriculum by TUK (Specialty Board in Medicine) obligatory rotations were decreased to 18 months. After a long term effort, necessary regulatory changes have been made to enable residency training in primary care. Although valuable contributions have been made by Turkish Association of Family Physicians (TAHUD), Turkish Board of Family Medicine (TAHYK) and Academy of Family Medicine residency training in primary care settings is still needed to be discussed and clarified

The prevalence of malnutrition and obesity in schoolchildren in the Southeast Anatolia Region of Turkey

Objective: The aim of this study was to determine the frequency of malnutrition, obesity and overweight, calculated by body mass index (BMI), in elementary school children in the Southeast Anatolia Region of Turkey. Method: This research is a cross-sectional epidemiological study and elementary school children with aged 7-16 years were included randomly by layered random sampling method. A total of selected 20 schools and 1912 students filled the questionnaires in Diyarbakir and Mardin City Centers. A questionnaire included questions related to the educational and professional status of parents, siblings, household conditions, children's demographic characteristics and body mass indexes, body weight and heights was applied to each student. Determined BMIs were classified according to the percentile values of Center for Disease Control and Prevention (CDC-US) growth charts and International Obesity Task Force (IOTF). Results: Mean age of 1040 boys (52,3%) and 872 girls (47,7%), totally 1912 students was 10,8±2,4 years and mean BMI was 17,6±2,8 kg/m2. According to CDC classification, 7,2% of male students were categorized as "underweight", 12,3% of them as "overweight", and 3,4% of them as "obese" whereas 5,5% of them were categorized as "overweight" and 0,6% of them as "obese" according to IOTF classification. In female students, 8,4% were categorized as "underweight", 11,1% "overweight", and 3,3% as "obese" according to CDC classification whereas 5,2% were categorized as "overweight" and 1,2% "obese" according to IOTF. The prevalences were not between boys and girls (p>0.05). Conclusion: In school children in the Southeast Anatolia Region, one of the most important health problems was malnutrition; however prevalances of overweight and obesity had also nonignorable levels. © 2010 Düzce Medical Journal

Güneydoğu Anadolu Bölgesinde okul çocuklarında malnutrisyon ve obezite prevalansı

Amaç: Bu çalışmada, Güneydoğu Anadolu Bölgesinde, ilköğretim okullarındaki çocuklarda, vücut kitle indeksi (VKI) ile hesaplanan malnutrisyon, kilolu olma ve obezite sıklığının belirlenmesi sosyodemografik özelliklerin belirlenmesi amaçlandı. Yöntem:Araştırma, kesitsel tipte epidemiyolojik bir çalışma olup, “Tabakalı rasgele örnekleme yöntemi” kullanılarak belirlenen 7-16 yaş grubundaki ilköğretim okul çocuklarını kapsamaktadır. Diyarbakır ve Mardin iI merkezlerinde, toplam 20 okul ve 1912 öğrenci anket formlarını doldurdu. Vücut ağırlığı ve boy ölçümlerinden elde edilen vücut kitle indeksi (VKI), çocukların demografik özellikleri, kardeş sayısı, konut-yaşam koşulları, anne ve baba çalışma ve eğitim durumlarına ilişkin ile ilgili soruların yer aldığı bir anket uygulandı. VKI, International Obesity Task Force (IOTF) ve Center for Disease Control and Prevention (CDC-US) gelişim kartlarının persentil değerlerine göre sınıflandırıldı. Bulgular: 1040 erkek (%52,3) ve 872 kız (%47,7), toplam 1912 öğrencinin yaş ortalaması 10,82,4 yıl ve VKI ortalaması 17,62,8 kg/m2’dir. CDC sınıflamasına göre, erkek öğrencilerin %7,2’si “düşük kilolu” %12,3’ü “aşırı kilolu ve %3,4’ü “obez” iken; IOTF sınıflamasına gore bunların %5,5’u “aşırı kilolu”, %0,6’sı ise “obez” olarak sınıflandırılmıştı. Kız öğrencilerin, CDC sınıflamasına göre %8,4’ü “düşük kilolu” %11,1’i “aşırı kilolu ve %3,3’ü “obez” iken; IOTF sınıflamasına gore bunların %5,2’si “aşırı kilolu”, %1,2’si ise “obez” olarak sınıflandırılmıştı. Kız ve erkek öğrenciler arasında prevalanslar açısından fark bulunmuyordu (p0.05). Sonuç: Güneydoğu Anadolu Bölgesinde, ilköğretim okullarındaki çocuklarda en önemli sağlık problemlerinden birisi malnutrisyondur; ancak aşırı kilo ve obezite prevalansı da ihmal edilmeyecek düzeylerdedir.Objective: The aim of this study was to determine the frequency of malnutrition, obesity and overweight, calculated by body mass index (BMI), in elementary school children in the Southeast Anatolia Region of Turkey. Method: This research is a cross-sectional epidemiological study and elementary school children with aged 7-16 years were included randomly by layered random sampling method. A total of selected 20 schools and 1912 students filled the questionnaires in Diyarbakır and Mardin City Centers. A questionnaire included questions related to the educational and professional status of parents, siblings, household conditions, children&#8217;s demographic characteristics and body mass indexes, body weight and heights was applied to each student. Determined BMIs were classified according to the percentile values of Center for Disease Control and Prevention (CDC-US) growth charts and International Obesity Task Force (IOTF). Results: Mean age of 1040 boys (52,3%) and 872 girls (47,7%), totally 1912 students was 10,8±2,4 years and mean BMI was 17,6±2,8 kg/m2. According to CDC classification, 7,2% of male students were categorized as &#8220;underweight&#8221;, 12,3% of them as &#8220;overweight&#8221;, and 3,4% of them as &#8220;obese&#8221; whereas 5,5% of them were categorized as &#8220;overweight&#8221; and 0,6% of them as &#8220;obese&#8221; according to IOTF classification. In female students, 8,4% were categorized as &#8220;underweight&#8221;, 11,1% &#8220;overweight&#8221;, and 3,3% as &#8220;obese&#8221; according to CDC classification whereas 5,2% were categorized as &#8220;overweight&#8221; and 1,2% &#8220;obese&#8221; according to IOTF. The prevalences were not between boys and girls (p>0.05). Conclusion: In school children in the Southeast Anatolia Region, one of the most important health problems was malnutrition; however prevalances of overweight and obesity had also nonignorable levels

Investigation of the Relationship of Job Satisfaction and Depression Level among Medical Faculty Research Assistants

Amaç: Bu çalışmada, Düzce Üniversitesi Tıp Fakültesindeki araştırma görevlilerinde, iş doyumu düzeyi ile depresyon derecesi, kişisel ve çevresel faktörler arasındaki ilişkilerin değerlendirilmesi amaçlanmıştır. Yöntem: Bu tanımlayıcı ve kesitsel çalışmaya, 70i (%60) erkek, 47si (%40) kadın 26-34 yaş aralığında 117 araştırma görevlisi katıldı. Yüz yüze görüşme yöntemiyle yapılan yarı yapılandırılmış anket formunda açık uçlu sorular ile iki veya daha fazla seçenekli sorular yer almaktaydı. Anket formu demografik özellikler, antidepresan ilaç kullanımı, kronik hastalık durumu, çalışma koşulları, alışkanlıklar ve boş zaman uğraşısı ile ilgili sorular içermekteydi. Araştırmada yarı yapılandırılmış anket formuna Beck Depresyon Envanteri, Minnesota İş Doyum Ölçeği de eklenmiştir. Bulgular: Çalışmamızda Uzmanlık eğitiminin zorluğu, insan fizyolojisini zorlayan iş yükü, yoğun çalışma temposu, hekim kimliğine saygının önceki dönemlere nazaran azalması ve tabiî ki ücretteki yetersizlik gibi nedenlerle asistan hekimlerin çoğu (n74 kişi; %63,2) imkânı olduğu takdirde farklı bir fakülte (farklı bir meslek dalı) tercihi yapabileceklerini belirtmiştir. Çalışma ortamındaki fiziki yetersizlikler, yardımcı personel azlığı, nöbet sayılarının fazlalığı, nöbette kalan asistan sayısında yetersizlik ve en önemlisi nöbet sonrası izinden mahrumiyet asistanların genel, iç ve dışsal iş doyumlarında azalmaya neden olmaktadır. Sonuç: Araştırma görevlilerinin imkânı olduğu takdirde mevcut bölümünden daha az iş yükünün ve risk faktörünün olduğu alanları tercih etme düşüncesinde olduğu belirlenmiştir. Farklı uzmanlık dallarındaki hekimlerin içsel, dışsal ve genel iş doyum puan ortalamaları arasında anlamlı bir fark bulunamamıştır.Aim: The purpose of this study was to examine the relationships between job satisfaction level and depression degree, personal and environmental factors among assistants of Düzce University Medical Faculty. Methods: 117 physicians including 70 males (%60) and 47 females (%40), participated in this descriptive and cross-sectional survey. A questionnaire was applied by face-to-face interview, which consisted of open-ended questions and questions with two or multiple-choices. Questions were asked about demographic attributes, usage of anti-depressant medications, having chronic illnesses, working conditions, habits, and spare time activities. Beck Depression Scale and Minnesota Job Satisfaction Scale were added to the semi-structured questionnaire form. Results: Most of the assistant doctors joined this research (n74; 63.2%) implied that if they had a chance, they would prefer another faculty because of difficulty of doctorate education, heavy job responsibilities threatening human physiology, high intensity of working tempo, decreasing respect on doctor identity, and of course low salary. Inadequacy of physical conditions in working area, scarcity of supportive staff, high numbers of night duties, inadequacy of night duty assistant doctors and the most important factor that is deprivation from allowance after night duty cause reduction of internal and external work satisfaction. Conclusion: It was pointed out that many assistants have the idea to prefer another department that has less labor and less risk factor if they had the opportunity. There was no significant diversity between internal, external and general job satisfaction scores of doctors from different specialties