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

Investigating students' understandings of probability : a study of a grade 7 classroom

This research study probes students’ understandings of various aspects of probability in a 3-week Probability unit in a Grade 7 classroom. Informing this study are the perspectives of constructivism and sociocultural theory which underpin the contemporary reform in mathematics education as codified in the NCTM standards and orient much of the teaching and learning of mathematics in today’s classrooms. Elements of culturally responsive pedagogy were also adopted within the research design. The study was carried out in an urban school where I collaborated with the teacher and students as co-teacher and researcher. As the population of this school was predominantly Aboriginal, the lessons included discussion of the tradition and significance of Aboriginal games of chance and an activity based on one of these games. Data sources included the responses in the pre- and post-tests, fleidnotes of the lessons, and audiotapes of student interviews. The key findings of the study are that the students had some understanding of formal probability theory with strongly-held persistent alternative thinking, some of which did not fit the informal conceptions of probability noted in the literature such as the outcome approach and the gambler’s fallacy. This has led to the proposal of a Personal Probability model in which the determination of a probability or a probability decision is a weighting of components such as experience, intuition and judgment, some normative thinicing, and personal choice, beliefs and attitudes. Though the alternative understandings were explored in interviews and resolved to some degree, the study finds that the probability understandings of students in this study are still fragile and inconsistent. Students demonstrated marked interest in tasks that combined mathematics, culture and community. This study presents evidence that the current prescribed learning outcomes in the elementary grades are too ambitious and best left to the higher grades. The difficulties in the teaching and learning of the subject induced by the nuances and challenges of the subject as well as the dearth of time that is needed for an adequate treatment further direct that instructional resources at this level be focused on deepening and strengthening the basic ideas.Education, Faculty ofCurriculum and Pedagogy (EDCP), Department ofGraduat