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

A Specialized Domestic Violence Court in South Carolina: An Example of Procedural Justice for Victims and Defendants

The current research details interviews with 50 victims and 50 defendants who participated in a specialized criminal domestic violence court in Lexington County, South Carolina. These victims and defendants indicated satisfaction with their court experiences, thought the process allowed them to voice their views, felt they were treated with respect, and were generally satisfied with the outcome of their cases. Court observations and interviews with court personnel confirmed that this court has successfully incorporated victims and defendants into the decision-making process while also providing a fair system to address the issue of violence against women

Integrating the American criminal justice and mental health service systems to focus on victimization

Although most research and policy in the mental health and criminal justice arenas have operated independently of one another, there is a growing consensus suggesting the need for an integration of these two disparate, yet complementary systems. Furthermore, in light of the adverse mental health consequences that often accompany victimization experiences, it is apparent that these two systems should develop and foster overlapping services for crime victims. The research reviewed herein provides an examination of issues such as these, identifies some of the barriers that stand in the way of a successful integration of the two systems, and attempts to provide some guidance and direction for future integrated mental health and criminal justice system approaches. An outline of research gaps and directions for future study are offered for the integration of criminal justice and mental health systems, as such collaborations are likely to alleviate some of the deleterious mental health outcomes evident among crime victims and at the same time reduce the occurrence of repeat victimization

Routledge International Handbook of Crime and Gender Studies

Criminological research has historically been based on the study of men, boys and crime. As a result, the criminal justice system’s development of policies, programs, and treatment regimes was based on the male offender. It was not until the 1970s that some criminologists began to draw attention to the neglect of gender in the study of crime, but today, the study of gender and crime is burgeoning within criminology and includes a vast literature. The Routledge International Handbook of Crime and Gender Studies is a collection of original, cutting-edge, multidisciplinary essays which provide a thorough overview of the history and development of research on gender and crime, covering topics based around: theoretical and methodological approaches gender and victimization gender and offending gendered work in the criminal justice system future directions in gender and crime research. Alongside these essays are boxes which highlight particularly innovative ideas or controversial topics – such as cybercrime, restorative justice, campus crime, and media depictions. A second set of boxes features leading gender and crime researchers who reflect on what sparked their interest in the subject. (Description from publisher)https://uknowledge.uky.edu/crvaw_book/1016/thumbnail.jp