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

Remaking urban worlds : New Delhi in the time of economic liberalization

textThis dissertation examines the impact of neoliberal economic reform on New Delhi's urban landscape. It shows how the city has transformed since 1991 through two distinct, but interlinked processes: firstly massive 'upgradation' and place-marketing efforts, initiated and supported by the state, to create for the city a global identity worthy of the capital of a newly resurgent and aspirational nation, one that is also welcoming to new capital flows and forms as Delhi undergoes massive spatial, and economic expansion. Secondly, neoliberal urban development is also marked by a series of mass evictions of the city's existing informal, indigenous economy as degraded urban forms. In tracking the unfolding 'worlding' of the city, the dissertation is interested in the production of locality at the scale of the city, the ways by different sites, networks and neighborhoods articulate with the process, and how locality is produced through a series of inclusions and exclusions. In the first half of the dissertation, the focus is the conjectural emergence of conditions of transformation, mainly through the articulation of state urban renewal policies which promote privatized urban development, judicial eviction orders and media circulated calls for the building of a new 'upgraded' city to replace the old. This, as a new 'globalized' and aestheticized imaginary of the nation, city and its citizens takes shape. In the second half, the dissertation examines shows how upgradation and mass eviction have played out in Delhi neighborhoods, juxtaposing the experience of middle class areas, who's activism has been vital in putting forth a new vision of the city, with two cases of displacement. These are the demolition of the city's slums, and secondly the sealing or closure of large networks of indigenous/informal traders. In all three cases, the dissertation outlines ethnographically how residents receive, perceive and negotiate changes in relation to their memories, habitus, and local knowledges of the old, and how they engage with state and political actors, judicial fiat, party politics and the structures of the city's mass democracy to encourage or oppose urban reforms. In its conclusion, it argues that upgradation and eviction notwithstanding, activism across classes has engendered a common critique of governance among residents.Anthropolog

Ravi Sundaram, Pirate Modernity: Delhi’s Media Urbanism

The field of urban studies is a growing one as Indian cities transform beyond recognition. In his book Pirate Modernity: Delhi’s Media Urbanism, Ravi Sundaram tries to capture this transformation, using a theoretical lens little explored in existing literature. To wit, Sundaram is interested in ‘the evaporation of the boundary between technology and urban life’ which has produced ‘a delirious disorientation of the senses’ (p. 7). The examples of such evaporation and of a newly technologized u..

What Kind of Urban? A Case Study of Kullu, A Small Indian Town

This article examines the kind of urbanisation that is emerging in Kullu, a small but quickly growing North Indian mountain town. It does this both within the context of the town itself, but also by studying its relationship to nearby villages that are increasingly a part of the town’s remit as it emerges as a new metropolitan region. What the article seeks to highlight is that despite rising incomes, urban and spatial expansion and in-migration, many of the markers of new urban growth commonly found in other metropolitan Indian cities are absent in Kullu. These include increasing corporate real estate development, middle class and public consumptive cultures, neoliberal experiments with governance and rising urban inequality. The article locates the area’s tepid response to the templated ‘new’ Indian urban in a continuing orientation and attunement of Kullu residents to the high alpine Himalayan landscape within which the town is located and by which it is hemmed wherein belonging and dwelling are predicated on a continuing attentiveness to the unfolding landscape, and on rurality, in which many urban residents continue to have a stake. This, even as relatively widespread land distribution among those considered ‘local’ ensures a relatively well-distributed and languid prosperity in the area as a whole. In this context, the article argues for the rethinking of singular definitions of urbanisation and of the relationship between urban and rural areas, particularly in light of dominant metropolitan experiences, and to consider the alternative forms of urban life that Kullu presents. Simultaneously, however, it discusses new and emerging fault lines that threaten Kullu’s existing rural–urban compact in the concluding section, namely new youth cultures and the building practices of locals themselves. </jats:p

A Novel Approach to Solve Numerical Methods Using MATLAB Programming

Numerical techniques is a branch of mathematics that explores problem-solving methods that account for approximation errors. This paper defines the algorithms for some of the most popular iterative procedures for solving polynomial problems, including the Bisection Method, Newton- Raphson Method, Secant Method, and Gauss-Jacobi Method and many more. The purpose of this research is to use MATLAB software to solve numerical method problems. The primary goal of this study is to describe and resolve various numerical methodologies using a single platform. We also provide a brief overview of different methodologies and their underlying algorithms, which may make them easier to comprehend.</jats:p

Borrowing, loss of income and related sociodemographic factors in post-traumatic stress disorder in COVID-19 patients: A cross-sectional study from a government hospital in Mumbai, India

Introduction: Socioeconomic and related demographic characteristics may contribute to psychological distress following hospitalization with COVID-19. Financial strain experienced during the hospital stay may be associated with a heightened risk for posttraumatic stress disorder (PTSD). Material and Methods: The present study aimed to assess the prevalence and socioeconomic correlates of PTSD among patients previously hospitalized with COVID-19 in a government hospital in Mumbai, India, through a cross-sectional, questionnaire-based study design. Patients were contacted through telephonic interviews 3 months following discharge. The questionnaire included demographic and socioeconomic details in relation with COVID-19 hospitalization and the PTSD Checklist for DSM-5 (PCL-5). Results: Only (6.7%) patients received a provisional diagnosis of PTSD, while 12/89 (13.5%) were classified as having subthreshold PTSD. 10/89 (11.2%) scored ≥31 on the PCL 5 and had probable PTSD. 10/89 (11.2%) scored ≥31 on the PCL-5. On bivariate analyses, being unmarried or divorced or separated (P = 0. 037), having children who were minors (P = 0. 002), traveling from outside the state for hospitalization (P < 0.001), borrowing (P = 0.002), or loss of income (P = 0.028) due to hospitalization were significantly associated with subthreshold PTSD. On multivariable analysis, borrowing (adjusted odds ratio [AOR] 9.45, 95% CI 1.08–82.72) and traveling from outside the state (AOR 35.75, 95% CI 1.46–875.45, P = 0.028) retained significance for subthreshold PTSD. Conclusion: Socioeconomic factors may contribute to PTSD burden in previously hospitalized COVID-19 patients. This points to a need for mental health screening and economic relief measures in financially vulnerable patients