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

Providing QOS Guarantees for Disk I/O

In this paper, we address the problem of providing different levels of performance guarantees or quality-of-service (QOS) for disk I/O. We classify disk requests into three categories based on the provided level of service. We propose an integrated scheme that provides different levels of service in a single system. We propose and evaluate a mechanism for providing deterministic service for Variable Bit Rate (VBR) streams at the disk. We will show that through proper admission control and bandwidth allocation, requests in different categories can be ensured of QOS guarantees without getting impacted by requests in other categories. We evaluate the impact of scheduling policy decisions on the provided service. We also quantify the improvements in stream throughput possible by using statistical guarantees instead of deterministic guarantees

Providing deterministic I/O service for VBR streams

In this paper, we investigate mechanisms for providing deterministic service for Variable Bit Rate (VBR) streams at the disk. We propose a scheme for providing deterministic service within the I/O system. We evaluate data layout strategies and present an analysis of the results. We show that smoothing techniques can improve performance. We propose and evaluate several stream scheduling strategies. We show that the stream scheduling policies can have a significant impact on performance. We also quantify the improvements in stream throughput possible by using statistical guarantees instead of deterministic guarantees. We show that stream startup latency can be traded off for improving stream throughput (while retaining deterministic guarantees). 1 Introduction System level support of continuous media has been receiving wide attention. Continuous media impose timing requirements on the retrieval and delivery of data unlike traditional data such as text and images. Timely retrieval and de..