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

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

Enabling high performance fog computing through fog-2-fog coordination model

Fog computing is a promising network paradigm in the IoT area as it has a great potential to reduce processing time for time-sensitive IoT applications. However, fog can get congested very easily due to fog resources limitations in term of capacity and computational power. In this paper, we tackle the issue of fog congestion through a request offloading algorithm. The result shows that the performance of fogs nodes can be increased be sharing fog's overload over several fog nodes. The proposed offloading algorithm could have the potential to achieve a sustainable network paradigm and highlights the significant benefits of fog offloading for the future networking paradigm

Fog computing framework for internet of things applications

Within the Internet of Things (IoT) era, a big volume of data is generated/gathered every second from billions of connected devices. The current network paradigm, which relies on centralised data centres (a.k.a. Cloud computing), becomes impractical solution for IoT data storing and processing due to the long distance between the data source (e.g., sensors) and designated data centres. In other words, by the time the data reaches a far data centre, the importance of the data would be vanished. Therefore, the network topologies have been evolved to permit data processing and storage at the edge of the network, introducing what so-called "Fog computing". The later will obviously lead to improvements in quality of service (QoS) via processing and responding quickly and efficiently to varieties of data processing requests. Therefore, understanding Fog computing architecture and its role in improving QoS is a paramount research topic. In this research, we are proposing a Fog computing architecture and framework to improve QoS for IoT applications. Proposed system supports cooperation among Fog nodes in a given location, in order to permit data processing in a shared mode, hence satisfies QoS and serves largest number of service requests. The proposed framework could have the potential in achieving sustainable network paradigm and highlights significant benefits of Fog computing into the computing ecosystem

Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin

Background: A set of enduring conditions have been reported in the literature involving persistent sexual dysfunction after discontinuation of serotonin reuptake inhibiting antidepressants, 5 alpha-reductase inhibitors and isotretinoin. Objective: To develop diagnostic criteria for post-SSRI sexual dysfunction (PSSD), persistent genital arousal disorder (PGAD) following serotonin reuptake inhibitors, post-finasteride syndrome (PFS) and post-retinoid sexual dysfunction (PRSD). Methods: The original draft was designed using data from two published case series (Hogan et al., 2014 and Healy et al., 2018), which represent the largest public collections of data on these enduring conditions. It was further developed with the involvement of a multidisciplinary panel of experts. Results: A set of criteria were agreed upon for each of the above conditions. Features of PSSD, PFS and PRSD commonly include decreased genital and orgasmic sensation, decreased sexual desire and erectile dysfunction. Ancillary non-sexual symptoms vary depending on the specific condition but can include emotional blunting and cognitive impairment. PGAD presents with an almost mirror image of unwanted sensations of genital arousal or irritability in the absence of sexual desire. A new term, post-SSRI asexuality, is introduced to describe a dampening of sexual interest and pleasure resulting from a pre-natal or pre-teen exposure to a serotonin reuptake inhibitor. Conclusions: These criteria will help in both clinical and research settings. As with all criteria, they will likely need modification in the light of developments