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

Challenge-Based Learning Strategies Using Technological Innovations in Industrial, Mechanical and Mechatronics Engineering Programs

Our university has implemented the Tec21 educational model, based on four fundamental pillars: Challenge-Based Learning (CBL), flexibility, inspiring trained faculty, and a memorable educational experience. The purpose of this study was to evaluate the results of CBL implementation experiences at the beginning of undergraduate engineering programs using technological innovations such as 3D printing, DC motors, and microcontrollers. Three challenges were designed: Rube Goldberg, Cable Car, and Mini Drag Race. The challenges were implemented during at least two years where over 1,000 engineering freshmen took part. The challenges were evaluated by quantitative and qualitative methods. Overall, students enjoyed the learning experiences, learnt new technologies, and developed disciplinary and transversal competencies. Students were also more engaged and motivated to pursue their engineering academic program. These strategies challenged the students with the basic characteristics of the new Tec21 educational model. Finally, faculty involved in the implementation of these challenges expressed they required to get out of their comfort zone, learn new technologies, and change their traditional role to become a coach