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

Designing, developing and testing of a seeder for tree seeding and in situ water harvesting

Current methods of collection and processing of tree seed is difficult and expensive. Moreover, the germination of tree seeds and establishment of seedlings requires sufficient soil moisture over adequate periods of time. The objective of this research was to develop a tree seeder to: regulate spacing between tree seeds; harvest and conserve rain water; conserve tree seeds and optimize its seeding cost; test the developed seeder at different ecological sites; and conduct a socioeconomic evaluation for the developed seeder. Findings show the developed seeder is acceptable and technically viable while it reduces the costs of thinning

Effect of planting methods and drip irrigation intervals on onion (Allium cepa L.) yield under silt-loamy soil, Kassala State, Sudan

The objective of this research work was to investigate the effects of planting methods and drip irrigation intervals on onion yield under silt-loamy soil. An experiment was conducted for two consecutive seasons (2014/15 and 2015/16). The experiment was composed of planting methods and drip irrigation intervals. The planting methods were flat, ridge and bed planting, whereas drip irrigation intervals were daily, every 3 days and every 5 days. The nine treatments were randomly laid out in a split-plot design with three replicates, the main plots were irrigation intervals and the subplots were allotted to planting methods. The calculated total water requirement for onion crop was 8113 and 7633 m3/ha in the first and second seasons, respectively. The results showed that the combination of flat planting and daily irrigation produced significantly the highest bulb weight (218.4g), marketable yield (43.8ton/ha) and highest total yield (46.6 ton/ha). The results revealed that flat planting and daily irrigation was the most economical combination for producing onion crop in Kassala state.            الهدف الرئيسي من هذه الدراسة هو دراسة تأثير طرق الزراعة وفترات الري بالتنقيط على نمو وانتاجية البصل تحت التربة الطميية في كسلا لموسمين متتاليين  ( 2014/15و(16/2015. تتكون التجربة من عاملين هما طريقة الزراعة وفترات الري بالتنقيط. طرق الزراعة هي احواض مسطحة، سراب وزراعة في مساطب، في حين كانت فترات الري بالتنقيط يوميا و3 أيام و 5 أيام. التسع معاملات وزعت عشوائيا في تصميم القطع المنشقة بثلاث مكررات، حيث وضعت فترات الري في الأحواض الرئيسية وطرق الزراعة في الأحواض الفرعية.  أظهرت النتائج أن طريقة الزراعة في احواض مسطحة مع الري اليومي اعطت أعلى وزن للبصلة مقارنة مع الزراعة في سراب ومساطب. تم الحصول على أعلى انتاجية تسويقية باستخدام الزراعة في احواض مسطحة والري اليومي. اثبتت النتائج ان الزراعة في احواض مسطحة والري بالتنقيط اليومي هي المعاملة الاقتصادية الاجدي لإنتاج محصول البصل في التربة الطميية في كسلا. وفقا للنتائج فإن أفضل طريقة لإنتاج البصل في كسلا هي باستخدام  الزراعة في احواض مسطحة والري اليومي. &nbsp