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

Флора Сыдинской и Прибайтакской степей (Красноярский край) : автореферат диссертации на соискание ученой степени кандидата биологических наук : 03.02.01.

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The Relationship between the Level of Principals' Leadership Roles and Organizational Culture

3rd World Conference on Learning, Teaching and Educational Leadership (WCLTA) -- OCT 25-28, 2012 -- Brussels, BELGIUMWOS: 000342763100071The purpose of this study is to investigate the relationship between the level of principals' leadership roles and organizational culture according to teachers' perception about principals. The sample of this study is 290 teachers chosen among 1001 teachers in Usak, Turkey by stratified sampling model. Data were collected by two different measurements developed by the authors. Data were analyzed by using percent, frequency, one way ANOVA and correlation analysis. According to the findings, teachers do not separate principals' leadership roles as human or job oriented and they perceive principals as a whole and teachers think that both job and human oriented leaders are more preferable principals. (C) 2013 The Authors. Published by Elsevier Ltd.Acad World Educ & Res Ct

Synthesis of New S-, S,S-, And N,S-Substituted Nitrodienes By Reaction Of Halo-2-Nitrodienes With Thiols and Amines

Novel S- and S,S-substituted nitrobutadienes were synthesized by reaction of halo-2-nitrodienes with thiols. New N,S-substituted nitrobutadiene derivatives were obtained by reaction of mono(thio)substituted 1,3-butadienes with amines in dichloromethane. The structures of the new compounds were determined by spectroscopic methods