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

Quantifying intelligence cooperation: The United States International Intelligence Behavior (USIIB) dataset

This report describes the creation of the United States International Intelligence Behavior dataset (USIIB). The USIIB represents the first collection of event data specifically intended for exploring in a quantifiable manner the international intelligence cooperation behaviors of the United States. A total of 293,615 events are recorded in the USIIB, covering the years 2000-09. The report first provides a detailed description of the steps involved in building such a dataset, including the development of search terms, the use of a machine coding program (TABARI - Text Analysis by Augmenting Replacement Instructions) to extract data from wire news releases, and the extension of an existing coding scheme (CAMEO) to include intelligence behaviors. Following a discussion of issues related to the reliability and validity of event datasets in general and the USIIB in particular, the report then includes suggestions and examples for how the data in the current USIIB dataset may be used in order to add to our understandings of patterns and anomalies in international intelligence cooperation behavior. As a specific example, it offers results from an empirical test exploring variation in intelligence cooperation behaviors among democracies and non-democracies, asking specifically whether the United States has been more likely in the early 21st century to cooperate on intelligence matters with democratic states, and finding this not to have been the case. Finally, it aims to provide a guide for others who would like to extend this dataset to explore intelligence cooperation activity of other countries or regions.event dataset; intelligence cooperation; security