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

Computer recognition of rhythmic patterns : the applicability of neural network architectures for modelling musical rhythm

Modelling a listener's perception of musical rhythm requires both an understanding of rhythm as a whole as well as a definition of its constituent elements. The hypothesis is that once we can adequately define rhythm, we can then begin to design and implement models to gain insight into the perceptual processes which occur when listening to rhythmic sequences. This research outlines studies which have attempted to define and outline both the structure and the perception of rhythm. Based on the conclusions of these investigations, a computer model is designed and implemented using connectionist techniques. The emphases on this model are to arrive at a viable solution for extracting rhythmic material from performed input, and to implement time-scale invariance. Time-scale invariance allows the system to recognize (categorize) similar patterns played at different tempos as being the same pattern. The performance of this model is evaluated against earlier models designed with similar neural network architectures as well as in relation to the conclusions drawn by music theorists and psychologists

ISEA 95 Montréal : Actes, 6e Symposium des arts électroniques = ISEA 95 Montréal : Proceedings, 6th International Symposium on Electronic Arts

The ISEA 95 colloquim proceedings include 82 essays presenting the electronic arts in terms of a new aesthetic environment shaping both body and mind. The authors discuss virtual reality, hypertext, interactivity, and computer-generated images. Untranslated texts. Circa 350 bibl. ref