Revolutionizing Women’s health: the quest for materials for next-generation, non-hormonal intrauterine devices

With over 200 million users worldwide, copper intrauterine devices (Cu-IUDs) are the world’s most popular, non-hormonal, long-acting, and reversible contraception method. Cu-IUDs cause uncomfortable side effects such as longer and heavier menstruation and cramping, all of which persist for the duration of use and often lead to early removal. With the rise in concern about potential physical and psychological side effects from hormonal contraceptive use, an improvement in non-hormonal contraceptive options is needed to alleviate discomforting side effects and inhibit costs. This perspective article provides an overview of the current state of non-hormonal IUDs and experimental factors to consider when developing new materials that have potential as alternative contraceptives, including copper alloys, zinc, iron, and passive metals. It also explores the sustainability and socioeconomic impact of advancing non-hormonal contraceptive options and considers international policy, cultural factors, and costs that must be considered when developing these options. Overall, the article highlights the interdisciplinary nature of this field, the complexities involved in creating effective non-hormonal contraceptives, and the need for innovation and equity in contraceptive care

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