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

Chinese Migrants' Perceptions of the Queensland Criminal Justice System

Research on perceptions of the criminal legal system has tended to mainly focus on attitudes toward the police and on minority groups other than Chinese communities. The aim of the present study is to measure perceptions of the integrity, competence, and fairness of the various elements of the criminal justice system among a Chinese migrant population residing in Brisbane, Queensland, Australia. Findings indicate that demographic variables have little impact on attitudes. But those who have experienced victimization, particularly male victims, see the justice system in a less favorable way. Policy implications of these results are also discussed

The guilty plea process in the Hong Kong magistrates' courts

Guilty pleas are the primary mode of criminal case dispositions in the common law world. Given how guilty pleas effectively waive the need for trials, it has been regarded as undermining due process safeguards. Although the written law in Hong Kong emphasizes the importance of ensuring defendants make their plea decisions free from any improper pressure, it neglects the intrinsic pressures brought upon by having to go through the criminal justice process. This is particularly true in the lower courts in Hong Kong and other common law jurisdictions. According to the Pre-trial Process Model (Feeley, 1979), because the offences that appear in the lower courts are relatively minor, the time and effort required of defendants often outweigh the sentences imposed on them. A lacuna however, exists in Hong Kong where guilty pleas have not been systematically analysed. The research questions of this study are: 1) Which factors influence decisions to plead guilty?; 2) Why are these factors salient in the plea decision-making process?; 3) What are the considerations of defence lawyers behind plea advices; and 4) How do plea negotiations operate in Hong Kong? Data collection involved courtroom observations in two Hong Kong Magistrates’ Courts (N = 1,008 cases) and in-depth interviews with defence lawyers (N = 26). Quantitative data were collected for both legal and extra-legal variables that were relevant to plea decisions. Legal variables included: the types of offence, the number of charges and whether an admission was made under caution. Extra-legal factors included: bail status, type of legal representation and demographic characteristics of defendants. Logistic regression analyses indicate that defendants who made an admission under caution, represented themselves in-person, and were remanded in custody, are more likely to plead guilty. Interviews and courtroom interactions are used to shed light on decision-making during the pre-trial stages of criminal procedure including lawyers’ advices and the practice of plea bargaining, and moreover substantiate the quantitative findings. Thematic analyses reveal that most defendants plead guilty in order to terminate as quickly as possible the stress and sanctions of being caught up in the criminal process and also to secure sentencing discounts for guilty pleas. This lends support to the notion that the process itself is already the punishment and that enticements to plead guilty are significant. As there is little empirical research into the daily operations of the justice system in Hong Kong, this study offers important insights. Theoretically, this study enhances the Pre-trial Process Model, and expands on it by focusing not only on the costs of going through the criminal justice process but also the benefits secured in return for a guilty plea. This revised version of the Pre-trial Process Model, named the Cost and Benefit Model, can be used to predict the likelihood of guilty pleas and explain the phenomenon of guilty pleas. As for practical significances, it illuminates on which groups of defendants are most susceptible to pleading guilty and provides recommendations in order to safeguard against the innocent pleading guilty.published_or_final_versionSocial Work and Social AdministrationDoctoralDoctor of Philosoph

Criminal sentiments and behaviours among young people in Hong Kong

Criminal attitudes have been found to influence criminal behaviour. Yet this is an understudied area in Hong Kong despite the scholarly interests in youth delinquency. In this study, we tested the relationship between criminal sentiments and social factors and illegal conduct among 942 Chinese youths (aged 14–18) in Hong Kong using the Criminal Sentiments Scale-Modified (CSS-M). The results were mixed. While all the underlying factors of the CSS-M were found to be significant, only negative attitudes towards the Law–Court–Police and Identifications with Criminal Others had a positive relationship. Contrary to expectations, Tolerance for Law Violations had a negative correlation. Moreover, both social factors and criminal attitudes were found to be significant in influencing youths' criminal behaviour. The results are discussed in the Hong Kong Chinese context

Early sepsis care with the National Early Warning Score 2-guided Sepsis Hour-1 Bundle in the emergency department: hybrid type 1 effectiveness-implementation pilot stepped wedge randomised controlled trial (NEWS-1 TRIPS) protocol

Introduction Early sepsis treatment in the emergency department (ED) is crucial to improve patient survival. Despite international promulgation, the uptake of the Surviving Sepsis Campaign (SSC) Hour-1 Bundle (lactate measurement, blood culture, broad-spectrum antibiotics, 30 mL/kg crystalloid for hypotension/lactate ≥4 mmol/L and vasopressors for hypotension during/after fluid resuscitation within 1 hour of sepsis recognition) is low across healthcare settings. Delays in sepsis recognition and a lack of high-quality evidence hinder its implementation. We propose a novel sepsis care model (National Early Warning Score, NEWS-1 care), in which the SSC Hour-1 Bundle is triggered objectively by a high NEWS-2 (≥5). This study aims to determine the feasibility of a full-scale type 1 hybrid effectiveness-implementation trial on the NEWS-1 care in multiple EDs.Methods and analysis We will conduct a pilot type 1 hybrid trial and prospectively recruit 200 patients from 4 public EDs in Hong Kong cluster randomised in a stepped wedge design over 10 months. All study sites will start with an initial period of standard care and switch in random order at 2-month intervals to the NEWS-1 care unidirectionally. The implementation evaluation will employ mixed methods guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, which includes qualitative and quantitative data from focus group interviews, staff survey and clinical record reviews. We will analyse the 14 feasibility outcomes as progression criteria to a full-scale trial, including trial acceptability to patients and staff, patient and staff recruitment rates, accuracy of sepsis screening, protocol adherence, accessibility to follow-up data, safety and preliminary clinical impacts of the NEWS1 care, using descriptive statistics.Ethics and dissemination The institutional review boards of all study sites approved this study. This study will establish the feasibility of a full-scale hybrid trial. We will disseminate the findings through peer-reviewed publications, conference presentations and educational activities.Trial registration number NCT05731349