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

EFFECTS OF WEATHER-INDEX INSURANCE: THE CASE OF SMALLHOLDER MAIZE FARMERS IN NORTHERN GHANA

The study investigates the effect of weather-index insurance on intensity of fertilizer use and yields among 230 smallholder maize farmers in Northern Region of Ghana. Out of the total sample of selected farmers, about 35% purchased the insurance. Using an endogenous treatment regression model, the study showed that weather-index insurance purchase increased the intensity of fertilizer use but did not have a significant effect on maize yield. Past experience of crop failure due to drought, livestock ownership as well as the total area of land owned explained weather-index insurance purchase in the study area. Based on the results of this study, the Government of Ghana can use weather-index insurance as a policy tool to increase the use of fertilizer by smallholder maize farmers

Interdependence of Extension and Improved Variety Adoption

This paper, seeks to empirically establish the complementarity or otherwise between the decision to adopt improved soybean variety and the decision to participate in extension service training. The paper departs from the traditional binary dependent regression model (probit and logit) with extension treated as one of several covariates and instead model the binary outcomes of the decisions to adopt improved varieties, and access to extension services simultaneously using bivariate probit model. Data for the study is from 1432 farmers across the three regions of northern Ghana to jointly model the determinants of access to agricultural extension services and adoption of improved soybean variety (Jenguma). We found a positive correlation between the decisions to adopt improved soybean variety (Jenguma) and access to agricultural extension services. The implication is that, the decision to adopt the variety is interrelated with access to agricultural extension services. Hence, access to agricultural extension services is complementary to the decision to adopt new soybean varieties. Findings also indicate that, the decision to adopt improved soybean varieties is influenced by younger, less educated farmers with large farms and ownership of parcels. Given that agricultural extension service is a public good, we recommend that the government of Ghana allocates more human, financial, and technical resources to the extension services to enhance the delivery of extension services to farmers so as to improve the adoption of productivity enhancing technologie