Possibility of overcoming obstacles to adopt sustainable practices of road paving layers in Iraq

It is evident that there is an increasing need, day by day, to adopt sustainable practices due to the increasing volume of harmful impacts on the environment, especially in the transportation sector. The situation in Iraq is very clear because of the complete dependence on vehicles in the process of transporting and shipping goods due to the absence of alternatives. The previous literature on the importance of sustainable practices in improving the properties and specifications of roads has been studied, and then the current reality of roads in Iraq has been explained. In the last part, a questionnaire was conducted to clarify the obstacles that impede the use of these sustainable practices, and the reasons were reached. The study concluded that addressing this growing problem begins through education and cultural development of society by all concerned parties while supporting research. The planning process should include finding all special instructions and regulations that affect the safety of the environment, such as granting building or import permits, or in the field of agriculture and industry to serve these practices. The adoption of sustainable practices must meet the local circumstance represented in the behavior, culture and economy of the population community as well as the geographical location and climate of such environment

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