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

CONTENT-AWARE PARAMETER SELECTION FOR HEVC DEBLOCKING FILTER

24th Signal Processing and Communication Application Conference (SIU) -- MAY 16-19, 2016 -- Zonguldak, TURKEYWOS: 000391250900280The deblocking filter in the upcoming High Efficiency Video Coding (HEVC) standard improves both subjective and objective quality of the coded video sequences. Since different video sequences have different characteristics, deblocking strength should be adjusted on a sequence and even on a picture or slice basis for perceptual optimization. In this paper, we do first blind search in all possible values of the two offset parameters of the deblocking filter and then find optimal offset values heuristically for four different video sequences. Subjective tests show that with the best offsets visual artifacts reduced significantly when compared to the worst offsets and blockiness measure is promising to find the best offset.IEEE, Bulent Ecevit Univ, Dept Elect & Elect Engn, Bulent Ecevit Univ, Dept Biomed Engn, Bulent Ecevit Univ, Dept Comp Eng