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

New IoT proximity service based heterogeneous RFID readers collision control

Purpose – Internet of Things’ (IoT’s) first wave started with tracking services for better inventory management mainly using radio frequency identification (RFID) technology. Later on, monitoring services became one of the major interests, including sensing technologies, and then more actuation for remote control-type of IoT applications such as smart homes, smart cities and Industry 4.0. In this paper, the authors focus on the RFID technology impairment. They propose to take advantage of the mature IoT technologies that offer native service discovery such as blutooth or LTE D2D ProSe or Wifi Direct. Using the automatic service discovery in the new framework will make heterogeneous readers aware of the presence of other readers and this will be used by the proposed distributed algorithm to better control the multiple RFID reader interference problem. The author clearly considers emerging Industry 4.0 use case, where RFID technology is of major interest for both identification and tracking. To enhance the RFID tag reading performance, collisions in the RFID frequency should be minimized with reader-to-reader coordination protocols. In this paper, the author proposes a simple distributed reader anti-collision protocol named DiSim that makes use of proximity services of IoT network and is compliant with the current RFID standards. The author evaluates the efficiency of the proposal via simulation. Design/methodology/approach – In this paper, the author proposes a simple distributed reader anti-collision protocol named DiSim that makes use of proximity services of IoT network and is compliant with the current RFID standards. The author evaluates the efficiency of the proposal via simulation to study its behavior in very dense and heterogeneous RFID environments. Specifically, the author explores the coexistence of powerful static readers and small mobile readers, comparing the proposal with a standard ETSI CSMA method. The proposal reduces significantly the number of access attempts, which are resource-expensive for the readers. The results show that the objectives of DiSim are met, producing low reader collision probability and, however, having lower average readings per reader per time. Findings – DiSim is evaluated with the ETSI standard LBT protocol for multi-reader environments in several environments with varied levels of reader and tag densities, having both static powerful RFID readers and heterogeneous randomly moving mobile RFID readers. It effectively reduces the number of backoffs or contentions for the RFID channel. This has high reading success rate due to the avoided collisions; however, the readers are put to wait, and DiSim has less average readings per reader per time. As an additional side evaluation, the ETSI standard LBT mechanism was found to present a good performance for low-density mid-coverage scenarios, however, with high variability on the evaluation results. Research limitations/implications – To show more results, the author needs to do real experimentation in a warehouse, such as Amazon warehouse, where he expects to have more and more robots, start shelves, automatic item finding on the shelve, etc. Practical implications – Future work considers experimentation in a real warehouse equipped with heterogeneous RFID readers and real-time analysis of RFID reading efficiency also combined with indoor localization and navigation for warehouse mobile robots. Social implications – More automatization is expected in the future; this work makes the use of RFID technology more efficient and opens more possibilities for services deployment in different domains such as the industry which was considered not only in this paper but also in smart cites and smart homes. Originality/value – Compared to the literature, the proposal offers the advantage to not be dependent on a centralized server controlling the RFID readers. It also offers the possibility for an existing RFID architecture to add new readers from a different manufacturer, as the readers using the approach will have the possibility to discover the capabilities of the new interaction other RFID readers. This solution takes advantage of the available proximity service that will be more and more offered by the IoT technologies