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

DEFECT SEGMENTATION TECHNIQUES FOR CERAMIC WALL TILE

This paper discussed the image processing algorithms that can be used to segment defects from the acquired ceramic tiles image. The paper proposed two gray-level threshold algorithms, a fixed threshold algorithm and an adoptive interpolating threshold algorithm. The two thresholding algorithms are tested across a set of test images and their performance compared using the area under receiver operator characteristic curves. The experimental results showed that the fixed threshold algorithm produces the receiver operator characteristic curve that encloses the greatest area and provides promising results in preference to the adaptive threshold algorithm

BINARY MORPHOLOGICAL IMAGE PROCESSING ALGORITHM IN COMPUTER VISION APPLICATION

Binary morphological image processing algorithm in computer vision application is reported.  The algorithm is simple in implementation and efficient in computation.  It is divided into two main parts, firstly method of enhancing occurring defects on the surface of manufactured product is introduced and secondly binary morphological filtering technique is developed to remove noise and other artifacts completely from the product binary images before feature extraction.  It has been shown that the algorithm produces good results when tested on a number of manufactured products.  The results presented in real images of a ceramic wall tile and biscuit shows the effectiveness of the algorithm

APPLICATION OF RING LIGHT IN AUTOMATIC SURFACE QUALITY INSPECTION

The most important factor for detecting defects in machine vision inspection is illumination.  This paper describes the basic lighting concepts and lighting techniques for industrial applications of machine vision.  In the paper analytical equations for illumination on the inspected objects using ring-light are determined. Application to the production line shows that ring-light illumination is an effective means of providing constant illumination and perfectly detects defects such as cracks when tested on a number of ceramic tiles with real defects