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

Recognizing Cursive Typewritten Text Using Segmentation-Free System

Feature extraction plays an important role in text recognition as it aims to capture essential characteristics of the text image. Feature extraction algorithms widely range between robust and hard to extract features and noise sensitive and easy to extract features. Among those feature types are statistical features which are derived from the statistical distribution of the image pixels. This paper presents a novel method for feature extraction where simple statistical features are extracted from a one-pixel wide window that slides across the text line. The feature set is clustered in the feature space using vector quantization. The feature vector sequence is then injected to a classification engine for training and recognition purposes. The recognition system is applied to a data corpus which includes cursive Arabic text of more than 600 A4-size sheets typewritten in multiple computer-generated fonts. The system performance is compared to a previously published system from the literature with a similar engine but a different feature set

Structural Features Of Cursive Arabic Script

We presentatechnique for extracting structural features from cursive Arabic script. After preprocessing, the skeleton of the binary word image is decomposed into a number of segments in a certain order. Each segmentis transformed into a feature vector. The target features are the curvature of the segment, its length relative to other segment lengths of the same word, the position of the segmentrelative to the centroid of the skeleton, and detailed description of curved segments. The result of this method is used to train the Hidden Markov Model to perform the recognition.