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

High Hopes, Few Opportunities (Full Report): The Status of Elementary Science Education in California

This report, produced by the Center for the Future of Teaching and Learning at WestEd, Lawrence Hall of Science at University of California, Berkeley, and SRI International,?addresses how well California is doing to prepare its young people for the evolving economy and societal challenges. Specifically, it describes the status of science teaching and learning in California public elementary schools

College Bound in Middle School and High School: How Math Course Sequences Matter

Research shows that success in high-level mathematics in high school predicts postsecondary success and careers in the science, technology, engineering, and math (STEM) fields. Similarly, students' academic successes in middle school can determine their performance in high school

Untapped Potential: The Status of Middle School Science Education in California

California's middle schools have the potential to give students the kind of science instruction consistent with the National Research Council's Framework for K-12 Science Education. However, major challenges limit opportunities for science learning, leaving that potential unfulfilled

High Hopes, Few Opportunities (Summary Report & Recommendations): The Status of Elementary Science Education in California

This report, prepared by the Center for the Future of Teaching and Learning at WestEd, summarizes extensive new research examining science education in California's classrooms, schools, and school districts. A key finding? Students have little access to high-quality science education

High hopes few opportunities: The status of elementary science education in California

This report, produced by the Center for the Future of Teaching and Learning at WestEd, Lawrence Hall of Science at University of California, Berkeley, and SRI International, addresses how well California is doing to prepare its young people for the evolving economy and societal challenges. Specifically, it describes the status of science teaching and learning in California public elementary schools.Among the findings:- Forty percent of elementary teachers say they spend 60 minutes or less teaching science each week- Only one third of elementary teachers say they feel prepared to teach science- Eighty-five percent of teachers say they have not received any professional development in science during the last three years- 9 in 10 principals say science education is very important and should start early- Less than half of principals (44%) believe it is likely that a student would receive high-quality science instruction in his or her schoolThe reasons underlying the lack of high-quality learning opportunities in the state's elementary schools are many. For example:- Teachers do not feel prepared to teach science -- especially in comparison to their preparation to teach English language arts and mathematics.- Districts and schools do not have the resources (staff, time, or funds) to provide the needed professional development.- High-quality science teaching requires specialized materials, which teachers also say they lack, and districts and schools are strapped to provide these resources.These shortcomings are rooted in part in the state and federal accountability systems that place the greatest emphasis on English language arts and mathematics, which receive the lion's share of political and practical attention. The end result? California does not have a coherent system that enables teachers and schools to consistently provide students with high-quality science learning