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

Language proficiency and school achievement among students from migrant families in Australia

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The motivational and linguistic context of the school achievement of Lebanese-background students in high schools in South-western Sydney

The purpose of this thesis is to examine the educational outcomes of Lebanese-background students in high schools in South-western Sydney, and to investigate some of the factors contributing to their pattern of achievement. The main thrust of this study is to empirically examine in detail two factors which are strong contributors to school achievement. The first is the motivational goals of these students. The second is the Language proficiency of Lebanese-background students in their first language (Arabic) and their second lanaguage (English). The study involves quantitative analyses of two sets of questionnaires administered to all the Year 9 students in three South-western metropolitan Sydney high schools. The Year 10 School Certificate results of this same group of students was then used to measure their level of achievement. Four groups were established for comparison: the non-Lebanese-, English-, Chinese- and Vietnamese- background groups. This study is contextualized within a discussion of some of the family factors which contribute to the achievement of migrant children in schools. Of particular relevance to Lebanese-background students are the socio-economic and educational background of parents, and the historical and social context of the Lebanese in Australia. The thesis concludes by putting forth some recommendations which involve the collaborative efforts of the home, the school and the community, suggesting that part of the solution lies in this collaborative effort. Boundaries can be crossed and stereotypes changed only through a concerted effort by the three side

Motivational goals and school achievement : Lebanese-background students in South Western Sydney

There is a general belief that Lebanese-background students in Australia do not usually perform well at school. This study examines the school achievement of Lebanese-background students and the major motivational factors related to their achievement. A total of 271 Year Nine students (117 Lebanese background and 154 non-Lebanese background) in three high schools in southwestern Sydney completed the Inventory of School Motivation and the Facilitating Conditions Questionnaire and this information was used to examine the students' motivational profiles and the salience of motivational and other background variables in predicting school achievement. The study indicates that the Lebanese-background group is lower on variables which predict both their English and Science results, such as their valuing of education, and their perceived family and teacher support. The strongest predictors for achievement for the Lebanese-background group were competition, social concern, recognition, and token reward; however, these variables were not the strongest motivators for the students of Lebanese background. The variable most strongly valued by the Lebanese-background group was power, and that was found to be negatively related to their school achievement. The significance of these findings is that the Lebanese-background group does not strongly value the positive predictors for school achievement and attention needs to be paid to enhance these among this group; and that the Lebanese-background group shows higher levels of the negative predictors and hence attention needs to be given to diminish the students' negative perspectives which predict lower academic performance

Saudi female students learning English: Motivation, effort, and anxiety

Female students in Saudi Arabia who learn English as a foreign language (EFL) are increasing, and they may learn English for various purposes. These purposes may be broadly defined as integrative (focusing on understanding and affiliating with English-speakers) and instrumental (focusing on gaining pragmatic rewards, such as being accepted for university or getting a better job). Targeting 3rd year Intermediate (9th grade) and 3rd year Secondary (12th grade) female students, this study examined the relationship between these motivational constructs and effort, EFL anxiety, and differences between grades. Survey data from female students from two schools in Riyadh (N=200) were analysed using 2 (grade: 9th, 12th) x 2 (school) ANOVA. Results indicated that 12th graders were higher than 9th graders in instrumental motivation and effort, but lower in integrative motivation and anxiety. Differences between schools were small. Effort was positively correlated with integrative but not instrumental motivation for 9th graders, and was positively correlated with instrumental but negatively correlated with integrative motivation for 12th graders. Educators and curriculum designers should consider students' developmental needs to capitalize on their motivations in learning EFL

Saudi female students learning English : motivation, effort, and anxiety

Female students in Saudi Arabia who learn English as a foreign language (EFL) are increasing, and they may learn English for various purposes. These purposes may be broadly defined as integrative (focusing on understanding and affiliating with English-speakers) and instrumental (focusing on gaining pragmatic rewards, such as being accepted for university or getting a better job). Targeting 3rd year Intermediate (9th grade) and 3rd year Secondary (12th grade) female students, this study examined the relationship between these motivational constructs and effort, EFL anxiety, and differences between grades. Survey data from female students from two schools in Riyadh (N=200) were analysed using 2 (grade: 9th, 12th) x 2 (school) ANOVA. Results indicated that 12th graders were higher than 9th graders in instrumental motivation and effort, but lower in integrative motivation and anxiety. Differences between schools were small. Effort was positively correlated with integrative but not instrumental motivation for 9th graders, and was positively correlated with instrumental but negatively correlated with integrative motivation for 12th graders. Educators and curriculum designers should consider students' developmental needs to capitalize on their motivations in learning EFL