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

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Abstract Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions. </jats:sec

Psychometric Properties of the Acculturation Rating Scale for Mexican Americans-II

The Acculturation Rating Scale for Mexican Americans-II is one of the most frequently used measures of acculturation, despite lack of validation. This study analyzed the structure of the Marginality Scale of the Acculturation Rating Scale for Mexican Americans-II using data from a diverse Latino sample of residents. Confirmatory factor analysis of the Marginality Scale yielded poor model-to-data fit for the hypothesized scales. Exploratory analysis and tests of construct validity were performed to further analyze the Marginality Scale. Results indicate that the revised version needs further work and should be validated with the original intended population for the scale. The utility of the marginality concept is questioned overall considering its history of lack of clear conceptualization and validity

Psychometric Properties of the Acculturation Rating Scale for Mexican Americans—II

The Acculturation Rating Scale for Mexican Americans—II is one of the most frequently used measures of acculturation, despite lack of validation. This study analyzed the structure of the Marginality Scale of the Acculturation Rating Scale for Mexican Americans—II using data from a diverse Latino sample of residents. Confirmatory factor analysis of the Marginality Scale yielded poor model-to-data fit for the hypothesized scales. Exploratory analysis and tests of construct validity were performed to further analyze the Marginality Scale. Results indicate that the revised version needs further work and should be validated with the original intended population for the scale. The utility of the marginality concept is questioned overall considering its history of lack of clear conceptualization and validity. </jats:p

PER- AND POLYFLUOROALKYL SUBSTANCE (PFAS) TRANSPORT FROM GROUNDWATER TO STREAMS NEAR A PFAS MANUFACTURING FACILITY IN NORTH CAROLINA, USA

We quantified per- and polyfluoroalkyl substance (PFAS) transport from groundwater to five tributaries of the Cape Fear River near a PFAS manufacturing facility in North Carolina (USA). Hydrologic and PFAS data were coupled to quantify PFAS fluxes from groundwater to the tributaries. Up to 29 PFAS were analyzed, including perfluoroalkyl acids and recently identified fluoroethers. Total quantified PFAS (ΣPFAS) in groundwater was 20−4773 ng/L (mean = 1863 ng/L); the range for stream water was 426−3617 ng/L (mean = 1717 ng/L). Eight PFAS constituted 98% of ΣPFAS; perfluoro-2-(perfluoromethoxy)propanoic acid (PMPA) and hexafluoropropylene oxide dimer acid (GenX) accounted for 61%. For PFAS discharge from groundwater to one tributary, values estimated from stream water measurements (18 ± 4 kg/yr) were similar to those from groundwater measurements in streambeds (22−25 ± 5 kg/yr). At baseflow, 32 ± 7 kg/yr of PFAS discharged from groundwater to the five tributaries, eventually reaching the Cape Fear River. Given the PFAS emission timeline at the site, groundwater data suggest the abundant fluoroethers moved through the subsurface to streams in ≪50 yr. Discharge of contaminated groundwater may lead to long-term contamination of surface water and impacts on downstream drinking water supplies. This work addresses a gap in the PFAS literature: quantifying PFAS mass transfer between groundwater and surface water using field data

Depressive symptoms, avoidant coping, and alcohol use: differences based on gender and posttraumatic stress disorder in emerging adults

Trauma exposure and alcohol use often co-occur. Unveiling predictors of drinking behavior, including among those with varying levels of trauma exposure, can inform behavioral health prevention and treatment efforts in at-risk populations. The current study examined associations between depressive symptoms, avoidant coping, gender, and alcohol use among emerging adults with and without trauma exposure and posttraumatic stress disorder (PTSD). Participants were 238 emerging adults between the ages of 21 and 30 years (M = 24.75; SD = 2.61) in one of three groups: trauma-exposed with PTSD (n = 70); trauma-exposed with no PTSD (n = 83); or a no trauma (control) group (n = 85). Demographics, parental alcohol problems, depressive symptoms, and avoidant coping were examined as predictors of drinks per drinking day. Chi-square, t-test, bivariate, and group path analysis were conducted. Among participants, men consumed greater amounts of alcohol than women across all three groups. Group assignment based on trauma history and PTSD significantly moderated the association between avoidant coping and alcohol use such that avoidant coping had a significant effect on alcohol use among participants in the trauma-exposed and PTSD groups. There was also a significant group × gender × avoidant coping interaction such that, among participants in the control group, men had attenuated alcohol use at low levels of avoidant coping and increased at high levels of avoidant coping. No effects of race were observed. Results highlight the importance of avoidant coping as a risk factor for problematic drinking, unveiling a specific intervention target for reducing co-occurring PTSD and problematic alcohol use

schermi/screens

La rivoluzione digitale ha prodotto un’evoluzione e una proliferazione degli schermi che paiono inarrestabili. L’esperienza che ne facciamo è diventata definitivamente plurale e si è arricchita di altre novità quali mobilità, tattilità, interattività, connettività, peculiare “carattere immersivo”. Perciò gli schermi s’impongono ormai come il decisivo elemento propulsore non solo delle incessanti trasformazioni all’opera nel nostro rapporto con le immagini, ma, più in generale, di quella rivoluzione percettiva che continuamente c’incalza. Insomma, essi sono diventati, in modo più o meno consapevole, il dispositivo ottico di riferimento nonché l’interfaccia abituale dei nostri rapporti col mondo, con gli altri, con noi stessi. Interrogare le attuali esperienze degli schermi è dunque un crocevia inaggirabile per la filosofia da fare oggi