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

Motivational Factors and Training Aspects in Postgraduate Students of Anaesthesiology: A Survey

Introduction: Anaesthesiology is a fast growing branch of medicine. There is marked shortage of anaesthesiologists in India and this hinders the growth of surgical and interventional specialities which hinges on well-trained, enthusiastic anaesthesiology support. Exploring the perceptions about the speciality among Postgraduate (PG) students could help in planning strategies to make a career choice in anaesthesiology look more attractive. Aim: To explore the motivational factors for the choice of anaesthesiology for postgraduation, various aspects of PG training, stress among PGs and satisfaction with career choice in order to delineate the perceptions about the speciality among the medical graduates and to find out avenues for improvement to make the speciality more attractive. Materials and Methods: A cross-sectional questionnaire-based survey was distributed among 300 PG students in anaesthesiology who attended various national level conferences in India and state level conferences in Kerala between November 2015 and March 2018. Data collected was statistically analysed using R software version 3.1. All the quantitative variables were summarised as mean±SD (Standard Deviation) or median with IQR (Inter Quartile Range) depending on the distribution. Qualitative variables were summarised as proportions. Association between factors was analysed using Chi-square test or Fisher’s-exact test. Results: Anaesthesiology was the first career preference for only 34.63% (n=88) of the participants. Predominant reasons for choosing anaesthesiology included unavailability of other specialities (32.8%, n=82) and good job opportunities without need of super specialisation (32%, n=80). After joining anaesthesiology, majority (68%, n=175) were satisfied with their career choice. Satisfaction with PG training, assessed by the Likert scale was high among the participants and majority suggested improvements especially in theory classes, case discussions and simulation. Stress was experienced by 60% (n=154) of participants ascribed mainly due to lack of time for academics due to high workload. Conclusion: Improving awareness among public health professionals and medical students and increasing Undergraduate (UG) exposure to the subject would increase the proportion of students joining anaesthesiology with genuine interest and improve the recruitment profile. Modifications in training and measures to reduce stress during training should also be considered.</jats:p

Motivational Factors and Training Aspects in Postgraduate Students of Anaesthesiology: A Survey

Introduction: Anaesthesiology is a fast growing branch of medicine. There is marked shortage of anaesthesiologists in India and this hinders the growth of surgical and interventional specialities which hinges on well-trained, enthusiastic anaesthesiology support. Exploring the perceptions about the speciality among Postgraduate (PG) students could help in planning strategies to make a career choice in anaesthesiology look more attractive. Aim: To explore the motivational factors for the choice of anaesthesiology for postgraduation, various aspects of PG training, stress among PGs and satisfaction with career choice in order to delineate the perceptions about the speciality among the medical graduates and to find out avenues for improvement to make the speciality more attractive. Materials and Methods: A cross-sectional questionnairebased survey was distributed among 300 PG students in anaesthesiology who attended various national level conferences in India and state level conferences in Kerala between November 2015 and March 2018. Data collected was statistically analysed using R software version 3.1. All the quantitative variables were summarised as mean±SD (Standard Deviation) or median with IQR (Inter Quartile Range) depending on the distribution. Qualitative variables were summarised as proportions. Association between factors was analysed using Chi-square test or Fisher’s-exact test. Results: Anaesthesiology was the first career preference for only 34.63% (n=88) of the participants. Predominant reasons for choosing anaesthesiology included unavailability of other specialities (32.8%, n=82) and good job opportunities without need of super specialisation (32%, n=80). After joining anaesthesiology, majority (68%, n=175) were satisfied with their career choice. Satisfaction with PG training, assessed by the Likert scale was high among the participants and majority suggested improvements especially in theory classes, case discussions and simulation. Stress was experienced by 60% (n=154) of participants ascribed mainly due to lack of time for academics due to high workload. Conclusion: Improving awareness among public health professionals and medical students and increasing Undergraduate (UG) exposure to the subject would increase the proportion of students joining anaesthesiology with genuine interest and improve the recruitment profile. Modifications in training and measures to reduce stress during training should also be considered

Dynamics of Marketing Behaviour among the Traditional Rice Farmers in Kerala

There are many traditional rice varieties being cultivated in various parts of Kerala. While cultivating them, farmers follow traditional practices using special type of implements and tools. But now the area has drastically declined and they are confined to certain pockets and mostly taken up by older farmers. Wayanad and Malappuram districts of Kerala were purposively selected for the study. Sixty farmers from Wayanad district and thirty farmers from Malappuram district were randomly selected. Marketing behaviour of farmers has a great role in the sustainable development and promotion of traditional rice varieties. The study revealed that marketing behaviour of majority of the farmers could not be rated as high. Marketing behaviour of farmers was significantly influenced by age, education, gender, occupation and experience. Higher level of education had a significant role in the development of marketing behaviour among farmers. Shortage of skilled labour, lack of irrigation facilities and lack of transportation facilities were the main constraints faced by the traditional rice farmers.</jats:p

Sustainability of Traditional Rice Cultivation in Kerala, India—A Socio-Economic Analysis

Traditional rice cultivars and cultivation are on the decline in most rice-growing areas, mainly as a result of their low productivity. Packed with nutritionally, environmentally and locally superior qualities, traditional cultivars hold the key for sustainability in rice cultivation. This study explored the dynamics of traditional rice cultivation in Kerala, India. It examined the economic, institutional and socio demographic factors involved in the production and marketing of traditional rice. We employed a multinomial logit model and discriminant function analysis to extract the key factors governing farmers’ marketing behaviour, and various cost measures to study the economics of rice enterprises. The socio-demographic factors were analysed using descriptive statistical tools. Holding size and institutional support were the main factors governing the marketing behaviour of farmers. Even though traditional rice farming was not found to be cost-effective in implicit terms, it was remunerative when imputed personal labour and owned land costs were not considered. The study found that traditional farmers are ageing, have a lower education and use limited marketing channels. However, the majority of them were satisfied with their farm enterprise. By streamlining the market support mechanism and processing facilities, traditional rice would most likely gain momentum in key areas

Sustainability of Traditional Rice Cultivation in Kerala, India—A Socio-Economic Analysis

Traditional rice cultivars and cultivation are on the decline in most rice-growing areas, mainly as a result of their low productivity. Packed with nutritionally, environmentally and locally superior qualities, traditional cultivars hold the key for sustainability in rice cultivation. This study explored the dynamics of traditional rice cultivation in Kerala, India. It examined the economic, institutional and socio demographic factors involved in the production and marketing of traditional rice. We employed a multinomial logit model and discriminant function analysis to extract the key factors governing farmers’ marketing behaviour, and various cost measures to study the economics of rice enterprises. The socio-demographic factors were analysed using descriptive statistical tools. Holding size and institutional support were the main factors governing the marketing behaviour of farmers. Even though traditional rice farming was not found to be cost-effective in implicit terms, it was remunerative when imputed personal labour and owned land costs were not considered. The study found that traditional farmers are ageing, have a lower education and use limited marketing channels. However, the majority of them were satisfied with their farm enterprise. By streamlining the market support mechanism and processing facilities, traditional rice would most likely gain momentum in key areas.</jats:p