Risultati per: Short Acting Opioid

Introduction
Efforts have focused in recent decades on developing anaesthetic strategies that limit the use of morphine because of its known side effects. This study aims to compare postoperative morphine consumption between opioid-free anaesthesia (OFA) and conventional opioid-based general anaesthesia.

Methods and analysis
Phase III, multicentre, randomised controlled study comparing morphine consumption in the immediate postoperative period (first 48 hours) between OFA and conventional general anaesthesia (CGA). The study is conducted across three French academic cancer centres, with a planned enrolment of 158 patients, randomly assigned (1:1) to the OFA and CGA. The primary outcome is morphine consumption during the first 48 hours postoperatively.

Ethics and dissemination
The study has been approved by the National Research Ethics Committee (CPP, reference number 1-22–036/22.01675.000085) and the French National Agency for Medicines and Health Products Safety (ANSM, reference number MEDAECNAT-2022-04-0057). Written, informed consent to participate will be obtained from all participants. Results will be published in international peer-reviewed journals.

Trial registration number
This trial has been registered in the Clinical Trials in the European Union database (CTIS number: 2024-513308-32-00) and in ClinicalTrials.gov (NCT05439005).

Objective
The primary study aims were to evaluate the implementation, mechanisms and context of a timely short-term specialised palliative care intervention for older people with frailty (Frailty+ intervention) as well as to assess the feasibility of a randomised controlled trial to evaluate Frailty+. Our secondary aim was to describe any preliminary effects of Frailty+.

Design
Pilot randomised controlled trial with process evaluation.

Setting/Participants
We aimed to recruit 50 adults (≥70 years) with Clinical Frailty Scale score 5–7, and complex care needs and their main family carer, if available, from two Belgian hospitals on discharge.

Interventions
Patients were randomised to the Frailty+ intervention alongside standard care or standard care alone.

Outcome measures
Implementation and trial feasibility were assessed through interviews, focus groups and quantitative data. The primary outcome to be used in a potential full-scale trial if the study is feasible and implementable was mean change in five palliative care symptoms over 8 weeks.

Results
We enrolled 37 patients (19 intervention, 18 control) and 26 family carers (15 intervention, 11 control). Patients and family carers valued the home visits from palliative care nurses, and nurses saw value in Frailty+. But most patients received only one visit over 8 weeks, and nurses did not organise foreseen multidisciplinary meetings, referring to absence of urgent needs. Many aspects of the trial methods were feasible, but recruitment was challenging. The baseline mean score on the five palliative care symptoms was 6.0 and 5.6 in intervention and control group, respectively; and 4.5 and 4.1 at 8 weeks (adjusted ratio 1.0, ie, no effects on symptoms).

Conclusions
While Frailty+ was generally welcomed by older people with frailty, families and palliative care nurses, our process evaluation uncovered multiple barriers, mostly rooted in the current organisation of specialised palliative care that is tailored to advanced stages of illness. Ensuring timely access requires efforts beyond timely referral alone, and implies profound organisational and cultural change.

Trial registration number
ISRCTN39282347.

This cross-sectional study assesses acquisitions of US opioid treatment programs by private equity firms overall and at the zip-code level.

This randomized clinical trial compares the effectiveness of an integrated pain team vs pharmacist collaborative management on pain and opioid dosage.

Stroke, Volume 56, Issue Suppl_1, Page A16-A16, February 1, 2025. Background:Colchicine has shown to reduce major adverse cardiovascular events and stroke among patients with coronary artery disease. However, its efficacy with short and long use and risk of stroke has not been well studied with conflicting results till date.Objective:We sought to evaluate the short and long term efficacy of Colchicine for prevention of stroke and major adverse cardiovascular events (MACE).Methods:We performed a systematic literature search on PubMed, EMBASE, and Clinicaltrial.gov for relevant randomized controlled trials (RCTs) from inception until July 20th, 2024. Odds ratios (OR) were pooled using a random-effect model, and a p-value of

Stroke, Volume 56, Issue Suppl_1, Page ATP137-ATP137, February 1, 2025. Subarachnoid hemorrhage can cause debilitating headaches, affecting 90% of these patients in the intensive care unit, and 40% at 32 month follow up. Current literature suggests that opioids are ineffective for treating subarachnoid hemmorhage pain, despite their widespread use and perceived efficacy. There is evidence that dot-phrase implementation and electronic medical record alerts can positively influence physician behavior, including with reducing opioid prescriptions in the primary care setting. We added a standardized dot-phrase to discharge summaries for our subarachnoid hemmorhage patients, prompting providers to answer whether the patient was being prescribed opioids, the rationale for this, and plan for weaning. Rates of opioid prescription inpatient were 93%, but inclusion of the dot phrase reduced opioid prescription at discharge to 14% compared to 43% in patients who did not have dot phrase included. Our results suggest that dot-phrase implementation can successfully reduce opioid prescription at discharge for this patient population.

Stroke, Volume 56, Issue Suppl_1, Page AWP368-AWP368, February 1, 2025. Introduction:Oxidative stress plays an important role in both early brain injury and delayed cerebral ischemia after subarachnoid hemorrhage (SAH). Despite the beneficial effects demonstrated in preclinical studies with drugs targeting oxidative stress, their clinical translation has been hindered. There were critical issues in previous preclinical studies underpinning clinical translation, including inadequate demonstration of blood-brain barrier (BBB) penetration and insufficient assessment of drug concentration and biological activity in brain tissue. MnP-05 is a novel manganese porphyrin-based superoxide-dismutase mimic, which penetrates the BBB far better than previous compounds and exhibits superior anti-free radical properties compared to previous free radical scavenger. In this study, we evaluated the effect of MnP-05 on short-term outcomes of SAH in mice.Methods:We used 12-week-old male C57BL/6J mice. We induced SAH by an endovascular perforation of the right internal carotid artery. Mice (n = 31) were started on treatment with either MnP-05 or PBS 60 minutes after the induction of SAH. We set the dosing regimen as 1 mg/kg intravenous bolus followed by 5 mg/kg/day continuous intraperitoneal injection for 72 hours. We compared a composite neurological score, and rotarod performance (%baseline), between the two treatment groups for 7 days. We also compared the mRNA expression of oxidative stress and apoptosis markers in perihematomal brain tissue between the groups.Results:There were no specific side effects found in MnP-05 treatment group. There were no differences in blood pressure or body weight between the two groups. Seven-day neurological outcomes were better in MnP-05 group as evidenced by the significantly better composite neurological scores (22.9 vs. 19.4, P

Stroke, Volume 56, Issue Suppl_1, Page AWP373-AWP373, February 1, 2025. Cardiac arrest (CA) often leads to severe memory impairment, largely due to extensive neuronal loss in brain areas critical for cognitive function, including the hippocampus and amygdala. We demonstrated that physical exercise (PE) following asphyxia CA (ACA) mitigates contextual memory deficits in male rats. Intriguingly, this effect occurs without direct protection of the hippocampus and amygdala, as evidenced by significant cell death in both regions. Instead, PE post-ACA reduces neuronal loss in the medial septum (MS), a forebrain structure essential for regulating limbic system oscillations, and thus memory. This study aims to investigate whether PE post-ACA preserves oscillatory activity within the limbic circuitry and whether it ameliorates other forms of cognitive deficits in both sexes.Methods:Male and female rats are subjected to 8’ ACA. After 5 days of recovery, the animals undergo 5 consecutive days of treadmill running, followed by a battery of cognitive tests. Approximately one-month post-ACA, the animals are anesthetized with urethane for in vivo oscillatory recordings.Results:Having acquired fear conditioning (Figs. 1a and 1d), the animals were tested for cued fear memory and extinction two days later. Post-ACA exercised animals displayed a significant increase in freezing levels compared to non-exercised animals in response to a single re-exposure to the tone, indicating preserved cued fear memory (Fig. 1c). After continuous tone presentations, only the exercised animals displayed a significant decrease in freezing, suggesting they were able to extinguish their fear response (Fig. 1f). The Y-maze test revealed a significant increase in spontaneous alternation in exercised animals (Fig. 1g), indicating improved working memory. These outcomes were not influenced by locomotion (Fig. 1h) or anxiety (Fig. 1i), as confirmed by the open field test. We are currently performing the oscillatory recordings in different limbic system regions.Conclusion:PE post-ACA mitigates different forms of long- and short-term memory deficits in both sexes. This improvement is likely mediated by the preservation of oscillatory power in the MS and hippocampus (to be confirmed), highlighting a potential mechanism by which PE exerts its neuroprotective effects.

Stroke, Volume 56, Issue Suppl_1, Page ADP39-ADP39, February 1, 2025. Background:Patients with atrial fibrillation were excluded from clinical trials evaluating carotid artery stent(CAS) or carotid endarterectomy (CEA).We performed this analysis to identify the prevalence of atrial fibrillation and associated outcomes in symptomatic internal carotid artery stenosis patients undergoing CAS or CEA.Methods:We analyzed the data from the National inpatient sample (NIS) between January 2016 to December 2021. We used the ICD-10 to identify patients hospitalized with diagnosis of stroke, TIA, or retinal ischemia with stenosis of carotid artery who underwent CAS or CEA. We divided patients based on presence or absence of atrial fibrillation. We ascertained the end points of intra-procedural and post-procedural cerebral infarction, hemorrhage, discharge home and death in CAS and CEA patients with atrial fibrillation. We compared the endpoints between patients who underwent CAS and those who underwent CEA after propensity score matching.Results:Atrial fibrillation was present in 3,785 (18.3%) of 20,645 patients underwent either CAS or CEA between 2016 and 2021 [18.0% versus 18.8% for CAS or CEA, respectively, p=0.50]. The proportions of patients who developed acute myocardial infarction, respiratory failure, acute kidney injury, or required blood transfusion was higher in patients with atrial fibrillation in both CAS and CEA groups. There was no difference in odds of post-operative stroke and/or death in patients with atrial fibrillation (compared with those without atrial fibrillation) who were treated with CAS (OR 0.99, 95% CI 0.62-1.60, p=0.98) and those treated with CEA (OR 1.09, 95% CI 0.69-1.73, p=0.72) in the multivariate analysis after adjusting for confounders. The length of stay and hospitalization cost was significantly higher in patients with atrial fibrillation (compared with those without atrial fibrillation who were treated with CAS and those treated with CEA). There was no difference in post-operative stroke and/or death (10.7% versus 8.7%, p=0.41) and discharge home (32.4% versus 26.8%, p=0.13) in atrial fibrillation patients who underwent CEA with compared to those underwent CAS in propensity matched analysis.Conclusion:Approximately 1 in 5 patients with symptomatic internal carotid artery stenosis who undergo CAS or CEA have atrial fibrillation in the United States, we did not identify any higher risk of post-operative stroke and/or death in atrial fibrillation patients irrespective of which procedure was undertaken

Stroke, Volume 56, Issue Suppl_1, Page ATP289-ATP289, February 1, 2025. Introduction:Cardiac complications following ischemic stroke are common. The term “stroke-heart syndrome” describes new adverse cardiac events post-stroke, with QTc prolongation being the most frequent electrocardiographic abnormality. Elevated brain natriuretic peptide (BNP) levels, indicating myocardial damage and increased cardiac load, may lead to prolonged myocardial repolarization. This study examines the interaction between BNP levels and QTc interval and their impact on the short-term prognosis of stroke-heart syndrome patients.Methods:The study included patients who presented to the emergency department from January 2021 to July 2022 with acute ischemic stroke complicated by stroke-heart syndrome, defined as new-onset cardiac dysfunction within three days post-stroke, including acute coronary syndrome, heart failure, and arrhythmias. All patients underwent routine laboratory tests and ECG evaluations. QTc prolongation was defined as >430 ms for males and >450 ms for females. Patients were followed for three months, with outcomes including all-cause and cardiovascular-related mortality. The optimal BNP cutoff for predicting mortality was determined using ROC curve analysis. The relationship between BNP, QTc interval, and mortality was evaluated using Cox proportional hazards regression, with further assessment of the interaction between BNP and QTc interval.Results:The study included 448 patients, with 14 deaths during follow-up, 9 of which were cardiovascular-related. QTc prolongation was observed in 217 patients (48.44%), who also had significantly higher BNP levels (p=0.008). High BNP was significantly associated with QTc prolongation (OR, 1.90; 95% CI, 1.20-3.01, p=0.006)(Table 1). The optimal BNP cutoff was 122.5 pg/mL. High BNP increased the risk of all-cause mortality (HR, 5.94; 95% CI, 1.22-29.03, p=0.028), while QTc prolongation increased mortality risk only in patients with high BNP (HR, 2.22; 95% CI, 0.53-9.25, p=0.273; p for interaction

Measles cases worldwide rose by 20% in a single year—from about 8.6 million in 2022 to 10.3 million in 2023, which the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC) attributed to insufficient immunization coverage.

Objective
The purpose of the study was to examine the association between short-acting beta agonist (SABA), antibiotic and oral corticosteroid (OCS) use and mortality and cardiopulmonary outcomes in chronic obstructive pulmonary disease (COPD).

Design
Retrospective cohort study using administrative health data from 1 April 2011 to 31 March 2020.

Setting
Alberta, Canada.

Participants
Patients ≥35 years old with COPD were identified using diagnostic codes.

Primary and secondary outcome measures
Patient characteristics included age, sex, geographical zone and comorbidities (as defined by the Charlson Comorbidity Index). Outcome variables included all-cause and COPD-related mortality. Outcomes were assessed in consecutive 90-day intervals, starting from cohort entry, paired with time-varying COPD-related medication history in the 1 year preceding each interval. Associations were modelled between mortality and SABA, antibiotic and OCS history, and between major adverse cardiac events (MACE) and cardiovascular disease (CVD) death and SABA history.

Results
Among 188 969 patients, dose–response effects were observed. Adjusting for covariates, rates were higher for patients with 6+ (vs 1) SABA dispenses (all-cause mortality HR: 1.20, 95% CI 1.16 to 1.24, p

Introduction
Nociception monitoring has recently gained recognition as a valuable tool for guiding intraoperative opioid administration. Several nociception monitors, including the Surgical Pleth Index, the Index of Consciousness (IoC) and the Nociception Level, have been introduced for managing intraoperative analgesia. While these technologies show promise in initial applications, the effectiveness of IoC2 in guiding pain management during anaesthesia, particularly in elderly patients who require precise opioid use, remains unclear. This study aims to evaluate the effectiveness of IoC2 in guiding intraoperative opioid use in elderly patients.

Methods and analysis
We will conduct a prospective, randomised, controlled, single-blind, single-centre study with recruitment carried out from 1 February to 30 November 2025. Patients will be randomly assigned to either the IoC2 group or the control group. In the IoC2 group, sufentanil dosing will be guided by intraoperative IoC2 measurements, while in the control group, it will be guided by haemodynamic parameters. The primary outcome will be to compare intraoperative sufentanil consumption between the two groups to assess the potential role of IoC2 in optimising perioperative analgesia in elderly patients.

Ethics and dissemination
This study has been approved by the ethics committee of China-Japan Friendship Hospital (2024-KY-148-3) and registered in the Chinese Clinical Trial Registry (ChiCTR2400089115). The findings will be disseminated through academic presentations and peer-reviewed journal publications, providing valuable data and insights into the role of IoC2 in guiding intraoperative pain management.

Trial registration number
ChiCTR2400089115.

Introduction
Long-acting injectable (LAI) cabotegravir is a promising new method for preventing HIV. Safe and effective long-acting agents for pre-exposure prophylaxis (PrEP) for HIV infection are needed to increase preventive options among sexual and gender minority adolescents.

Methods and analysis
This is a multisite, prospective implementation study of three PrEP modalities (LAI-PrEP, event-driven (ED) and daily oral), using a mixed-method design with quantitative and qualitative approaches. The study will include a sample of 550 HIV-negative adolescent men who have sex with men, non-binary individuals assigned male at birth, transgender men and women, aged 15–19 years, in three Brazilian capital cities. Participants will be allocated into two arms, according to their choice of PrEP modalities, and followed up to 36 months. Switching between oral and LAI-PrEP will be allowed, according to the participants’ needs and preferences. The qualitative studies will focus on investigating the processes involved in linkage and retention in care, switching between PrEP modalities and strategies of the implementation process of LAI-PrEP in the current PrEP programming and acceptability from health providers, policymakers and stakeholders’ perspectives.

Ethics and dissemination
The adolescent’s autonomy for consenting to their participation and understanding of PrEP will be assessed by the project team before any care is given and will be recorded in their medical record. Adolescents aged 15–17 years will sign an informed assent form, waiving the need for the approval of a legal guardian, except in cases where the adolescent is found not to have the necessary autonomy. The study was approved by the WHO Ethics Review Committee and by the local IRBs from the universities coordinating the study, the University of São Paulo, the Federal University of Bahia and the Federal University of Minas Gerais. This project is part of an effort to expedite the inclusion of new modalities in the Brazilian PrEP Programme, based on the development of studies to evaluate the implementation of LAI-PrEP and ED-PrEP as a choice. The results will be published in peer-reviewed journals and presented to the study participants and communities.

Trial registration number
https://ensaiosclinicos.gov.br/rg/RBR-104736f4. The trial registration number: RBR-104736f4

Introduction
Individuals with higher neurological levels of spinal cord injury (SCI) at or above the sixth thoracic segment (≥T6), exhibit impaired resting cardiovascular control and responses during upper-body exercise. Over time, impaired cardiovascular control predisposes individuals to lower cardiorespiratory fitness and thus a greater risk for cardiovascular disease and mortality. Non-invasive transcutaneous spinal cord stimulation (TSCS) has been shown to modulate cardiovascular responses at rest in individuals with SCI, yet its effectiveness to enhance exercise performance acutely, or promote superior physiological adaptations to exercise following an intervention, in an adequately powered cohort is unknown. Therefore, this study aims to explore the efficacy of acute TSCS for restoring autonomic function at rest and during arm-crank exercise to exhaustion (AIM 1) and investigate its longer-term impact on cardiorespiratory fitness and its concomitant benefits on cardiometabolic health and health-related quality of life (HRQoL) outcomes following an 8-week exercise intervention (AIM 2).

Methods and analysis
Sixteen individuals aged ≥16 years with a chronic, motor-complete SCI between the fifth cervical and sixth thoracic segments will undergo a baseline TSCS mapping session followed by an autonomic nervous system (ANS) stress test battery, with and without cardiovascular-optimised TSCS (CV-TSCS). Participants will then perform acute, single-session arm-crank exercise (ACE) trials to exhaustion with CV-TSCS or sham TSCS (SHAM-TSCS) in a randomised order. Twelve healthy, age- and sex-matched non-injured control participants will be recruited and will undergo the same ANS tests and exercise trials but without TSCS. Thereafter, the SCI cohort will be randomly assigned to an experimental (CV-TSCS+ACE) or control (SHAM-TSCS+ACE) group. All participants will perform 48 min of ACE twice per week (at workloads corresponding to 73–79% peak oxygen uptake), over a period of 8 weeks, either with (CV-TSCS) or without (SHAM-TSCS) cardiovascular-optimised stimulation. The primary outcomes are time to exhaustion (AIM 1) and cardiorespiratory fitness (AIM 2). Secondary outcomes for AIM 1 include arterial blood pressure, respiratory function, cerebral blood velocity, skeletal muscle tissue oxygenation, along with concentrations of catecholamines, brain-derived neurotrophic factor and immune cell dynamics via venous blood sampling pre, post and 90 min post-exercise. Secondary outcomes for AIM 2 include cardiometabolic health biomarkers, cardiac function, arterial stiffness, 24-hour blood pressure lability, energy expenditure, respiratory function, neural drive to respiratory muscles, seated balance and HRQoL (eg, bowel, bladder and sexual function). Outcome measures will be assessed at baseline, pre-intervention, post-intervention and after a 6-week follow-up period (HRQoL questionnaires only).

Ethics and dissemination
Ethical approval has been obtained from the Wales Research Ethics Committee 7 (23/WA/0284; 03/11/2024). The recruitment process began in February 2024, with the first enrolment in July 2024. Recruitment is expected to be completed by January 2026. The results will be presented at international SCI and sport-medicine conferences and will be submitted for publication in peer-reviewed journals.

Trial registration number
ISRCTN17856698.