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

Exploring the Future of the Piano with Ergonomically Scaled Piano Keyboards (ESPK): A Study of Student Learning on ESPK

One solo recital, one lecture recital, and a pedagogy workshop were given in partial fulfillment of the degree requirements for Doctor of Musical Arts (Performance: Piano Performance and Pedagogy) degree at the University of Michigan. The first recital was a lecture recital titled “Reaching Beyond Our Grasp: Making Rachmaninoff’s Music Accessible for Smaller Hands”, took place on July 18, 2022, in McIntosh Hall. This recital addressed the challenges faced by small-handed pianists and offered innovative solutions. The lecture covered essential principles such as hand arrangements, selectively releasing notes while holding others, and changing hand positions more frequently and in different places. Additionally, it addressed some of the technical dogmas that often lead to injuries for smaller-handed pianists. The recital featured excerpts from Rachmaninoff’s Preludes and Etudes, showcasing the principles of redistribution, fingering choices, and sustaining notes with skillful use of pedal. In addition, the following preludes and etudes were performed in their entirety: Étude-Tableaux op. 39, nos. 2, 4; op. 33, nos. 3, 7; Prelude op. 32, no. 9; Preludes op. 23, nos. 4, 7. The second recital took place on July 9, 2023, in Britton Hall. It included the following works: Partita No. 2 in C Minor, BWV 826 by Johann Sebastian Bach; Petrarch Sonnets 47, 104, and 123 by Franz Liszt; Variations sérieuses, op. 54 by Felix Mendelssohn; and Liszt's transcription from Richard Wagner's "Isolde's Liebestod" from Tristan und Isolde. he third recital was a pedagogy workshop entitled “Exploring the Future of the Piano with Ergonomically Scaled Piano Keyboards (ESPK): A Study of Student Learning on ESPK”, presenting this written dissertation with the addition of visual demonstrations. It took place on July 13, 2023, in McIntosh Hall. This workshop demonstrated research data on pianists’ hand sizes from different studies according to gender and level of professional attainment. More data was shown on gender issues through the history of piano, on competition winners according to gender, and on the keyboard sizes of early pianos. The collected hand span data of University of Michigan piano students were discussed with tables showing the injury rates, and scarcity of small-handed pianists in this institution. Lastly, the case study results of five small-handed pianists who practiced on smaller keyboards were examined. The workshop included video demonstrations that showcased specific passages played on different keyboard sizes by both small and large-handed pianists, providing a valuable basis for comparison and analysis.AMUMusic: PerformanceUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/177874/1/cerensu_1.pd