5 research outputs found
Evaluating opioid prescribing patterns following discharge from elective surgical procedures: a worrying trend during the 'opioid crisis' - an audit of elective surgical procedures.
No full textBACKGROUND The 'opioid crisis' has reached epidemic proportions globally. Importantly, 30% of opioid dependency stem from opioids obtained on hospital discharge prescriptions.
AIM The aim of this study is to evaluate opioid prescription patterns on discharge of post-operative patients in an Irish Hospital.
METHODS A retrospective cohort study was undertaken in a single institution during the 5 year eligibility period (January 2017-October 2021). Comparisons in opioid prescription patterns following minor (inguinal hernia repair (IHR), intermediate (laparoscopic cholecystectomy (LC)) and major (colonic resection (CR)) were made. Descriptive statistics were performed using SPSS version 26.0
RESULTS: In total, 300 patients were included in this study with mean age 59.6 years (range: 20-92). Of these, 112 patients underwent IHR (37.3%), 116 patients underwent LC (38.7%), and 72 patients underwent CR (24.0%). The mean age at diagnosis was 61 years, 53 years and 58 years for IHR, LC and CR, respectively (P < 0.001). Patients undergoing CR were more likely to have greater comorbidity burden (3.1 vs. 1.2 (IHR) vs. 1.8 (LC) respectively (P = 0.030). On discharge, 27.8% of CR patients received opioids (20/72) compared to 24.1% of IHR (28/116) and 15.9% of LC (18/113) patients, respectively (P = 0.126).
CONCLUSION We observed considerable variability in opioid prescribing patterns following minor, intermediate and major operations in our centre. Care is required when prescribing opioids in the post-operative setting, and opioid prescription guidelines are required to both tackle and prevent an escalation of this 'opioid crisis'
Chemical composition of zircons from the Cornubian Batholith of SW England and comparison with zircons from other European Variscan rare-metal granites
No full textThis is the author accepted manuscript. The final version is available from the Mineralogical Society via the DOI in this record.Zircon from 14 representative granite samples of the late-Variscan Cornubian Batholith in SW England was analyzed for W, P, As, Nb, Ta, Si, Ti, Zr, Hf, Th, U, Y, La, Ce, Pr, Nd, Sm, Gd, Dy, Er, Yb, Al, Sc, Bi, Mn, Fe, Ca, Pb, Cu, S, and F using EPMA. Zircons from the biotite and tourmaline granites are poor in minor and trace elements, usually containing 1.0–1.5 wt% HfO2, <0.5 wt% UO2 and P2O5, <0.25 wt% Y2O3, <0.2 wt% Sc203 and Bi2O3, and <0.1 wt% ThO2. Zircon from topaz granites from the St. Austell Pluton, Meldon Aplite and Megiliggar Rocks are slightly enriched in Hf (up to 4 wt% HfO2), U (1– 3.5 wt% UO2), and Sc (0.5–1 wt% Sc2O3). Scarce metamictized zircon grains are somewhat enriched in Al, Ca, Fe, and Mn. The decrease of the zircon Zr/Hf ratio, a reliable magma fractionation index, from 110-60 in the biotite granites to 30-10 in the most evolved topaz granites (Meldon Aplite and Megiliggar Rocks), supports a comagmatic origin of the biotite and topaz granites via long fractionation of common peraluminous crustal magma. In comparison with other European rare-metal provinces, the overall contents of trace elements in Cornubian zircons are low and the Zr/Hf- and U/Th-ratios show lower degrees of fractionation of the parental melt.This contribution was supported by the Czech Science Foundation, project No. GA14-13600S and RVO 67985831. Bernard Bingen and one anonymous member of the Editorial Board are thanked for careful review and inspiring comments
Peat slides : morphology, mechanisms and recovery
No full textEThOS - Electronic Theses Online ServiceGBUnited Kingdo
Teachers' views of the inclusion of children with "problemas mentais" (mental problems) in the educational system of the autonomous region of Madeira
No full textIn Madeira Island the Educational System has endured significant changes. The concept of education has changed in the past years as well as the need to help parents understand the new changes. This new concept of school brought a new universe into the classrooms. Teachers, students and the community in general must learn to deal with the diversity of students who now share their educational journey in the same school environment. This new challenge obliges parents, teachers, headmasters and the school community to accept, respect and provide the needed conditions for an effective education for all students. This research has explored whether inclusion of students with mental problems is working effectively, from the perspective of the teachers, in the high schools located in Madeira. The study was developed to identify the gaps in the teaching/learning process for students with mental problems studying in regular high schools. A survey method was adopted for this study in which a questionnaire was developed to explore teachers? attitudes and beliefs around the education of students with mental problems studying in regular high schools. Three illustrative scenarios were selected to show different realities that may occur among these students. Teachers read the three case scenarios and related them to their own experiences as educators. Teachers? reflections upon the problems gave the researcher the opportunity to analyze how these problems are solved or ignored by educators. The questionnaire was validated and ethical permission gained from the University. Five hundred questionnaires were distributed to teachers working in different high schools in Madeira, 300 questionnaires were returned at the end of the field work. Analysis of the responses identified a significant view that teachers were concerned about inclusion, but did not engage actively to implement government policy in this area. In particular teachers with more than 10 years experience were significantly less prepared and willing to engage with this inclusive approach. The majority of teachers reported a lack of resources, inappropriate curriculum and insufficient specialist staff as excuses for not engaging in inclusive education. The guidelines laid out in the educational policy have been put to the test. This study showed that, according to the opinions of teachers, none of the requirements have been met by the 35 schools surveyed in this study. The distance between theory and practice has always been long and in the case of inclusive education, giant steps need to be taken to narrow the gap between the theory in policy and reality in the school
Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair
No full textImportance: Postoperative urinary retention (POUR) is a well-recognized complication of inguinal hernia repair (IHR). A variable incidence of POUR has previously been reported in this context, and contradictory evidence surrounds potential risk factors. Objective: To ascertain the incidence of, explore risk factors for, and determine the health service outcomes of POUR following elective IHR. Design, Setting, and Participants: The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) study, an international, prospective cohort study, recruited participants between March 1 and October 31, 2021. This study was conducted across 209 centers in 32 countries in a consecutive sample of adult patients undergoing elective IHR. Exposure: Open or minimally invasive IHR by any surgical technique, under local, neuraxial regional, or general anesthesia. Main Outcomes and Measures: The primary outcome was the incidence of POUR following elective IHR. Secondary outcomes were perioperative risk factors, management, clinical consequences, and health service outcomes of POUR. A preoperative International Prostate Symptom Score was measured in male patients. Results: In total, 4151 patients (3882 male and 269 female; median [IQR] age, 56 [43-68] years) were studied. Inguinal hernia repair was commenced via an open surgical approach in 82.2% of patients (n = 3414) and minimally invasive surgery in 17.8% (n = 737). The primary form of anesthesia was general in 40.9% of patients (n = 1696), neuraxial regional in 45.8% (n = 1902), and local in 10.7% (n = 446). Postoperative urinary retention occurred in 5.8% of male patients (n = 224), 2.97% of female patients (n = 8), and 9.5% (119 of 1252) of male patients aged 65 years or older. Risk factors for POUR after adjusted analyses included increasing age, anticholinergic medication, history of urinary retention, constipation, out-of-hours surgery, involvement of urinary bladder within the hernia, temporary intraoperative urethral catheterization, and increasing operative duration. Postoperative urinary retention was the primary reason for 27.8% of unplanned day-case surgery admissions (n = 74) and 51.8% of 30-day readmissions (n = 72). Conclusions: The findings of this cohort study suggest that 1 in 17 male patients, 1 in 11 male patients aged 65 years or older, and 1 in 34 female patients may develop POUR following IHR. These findings could inform preoperative patient counseling. In addition, awareness of modifiable risk factors may help to identify patients at increased risk of POUR who may benefit from perioperative risk mitigation strategies.
