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

MATHEMATICS ANXIETY OF SECONDARY SCHOOL STUDENTS

The present investigation has been conducted to study the Mathematics Anxiety and its effect on a set of independent variables (gender,school board, fathers qualification, mothers qualification and with respect to their types of family). To achieve this aim the researcher has adopted survey method. The tool used for the data collection was Mathematics Anxiety Scale (MAS) developed by Dr. (Mrs.) Sadia Mahmood and Dr. (Mrs.) TahiraKhatoon.Tool was administered on 195 secondary school students drawn randomly from two schools of Patna. For the analysis of data, the investigator has used mean, standard deviation andt test. The results found that there is no significant difference in MathematicsAnxiety of students with respect to their gender, school board, fathers qualification and with respect to their types of family. Another major finding is that, students whose mothers qualification is above intermediate they are having high MathematicsAnxiety in comparison to those whose mothersqualification is intermediate and below intermediate.</jats:p

Authentication Aspects of Dynamic Routing Protocols: Associated Problem &amp; Proposed Solution

Cryptography as a stream is very important for communication security. Cryptography provides many goals for communication security and authentication is one of them. Routing is an integral part of computer networks and router security is extremely important because routing provides suitable path to the traffic generated in the network. Authentication is very important for routing protocols. In this paper we discuss security flaws in routing authentication and provide a unique solution which is never presented to overcome this problem. We also discuss the security analysis of the proposed method which proves that the proposed method is robust in various aspects. The proposed method provides many advantages and the method is so simple that anybody can use it.</jats:p