Lancet
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Randomized Controlled Trial Multicenter Study Comparative Study
Intravenous remifentanil patient-controlled analgesia versus intramuscular pethidine for pain relief in labour (RESPITE): an open-label, multicentre, randomised controlled trial.
What did they do?
Wilson et al randomized 401 laboring women across multiple centers to either remifentanil PCA or pethidine/meperidine IM, then compared the progression of these women to labour epidural.
On the surface... this might appear disingenuous, as it compares remifentanil PCA to widely-shown-to-be-ineffective parenteral pethidine – rather than to the gold standard labour epidural. But it's also a study of how the technique might practically be used in the real world.
What they found
Women with remifentanil PCA progressed half as often to require epidural analgesia than those receiving pethidine (19% vs 41%).
Though it's one of the secondary findings that is most interesting: the remifentanil group were less likely to need instrumental delivery (15% vs 26%).
But don't get carried away
Despite the demonstrated superiority of remi PCA to pethidine, the technique is not without it's issues:
- Safety concerns regarding respiratory depression cannot be ignored, and because managing this relies upon staff vigilance, increased PCA use may conversely lead to a normalisation of risk and institutional complacency, rather than safety improvement.
- Analgesia is still inferior to epidural, even if maternal satisfaction is comparable.
- Technique acceptability might not be as good in communities with high pre-existing epidural use.
And finally... why are we so eager to do away with the labour epidural? Serious complications are very uncommon to rare, the technique is widely acceptable to women, and it is more effective than any other modality.
Is this change driven by the needs of pregnant women, or the health system's limited resources?
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Randomized Controlled Trial Multicenter Study Comparative Study
Efficacy and safety of semaglutide compared with liraglutide and placebo for weight loss in patients with obesity: a randomised, double-blind, placebo and active controlled, dose-ranging, phase 2 trial.
Obesity is a major public health issue, and new pharmaceuticals for weight management are needed. Therefore, we evaluated the efficacy and safety of the glucagon-like peptide-1 (GLP-1) analogue semaglutide in comparison with liraglutide and a placebo in promoting weight loss. ⋯ Novo Nordisk A/S.
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Snakebite envenoming is a frequently overlooked cause of mortality and morbidity. Data for snake ecology and existing snakebite interventions are scarce, limiting accurate burden estimation initiatives. Low global awareness stunts new interventions, adequate health resources, and available health care. Therefore, we aimed to synthesise currently available data to identify the most vulnerable populations at risk of snakebite, and where additional data to manage this global problem are needed. ⋯ Bill & Melinda Gates Foundation.
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Female, male, and transgender sex workers continue to have disproportionately high burdens of HIV infection in low-income, middle-income, and high-income countries in 2018. 4 years since our Lancet Series on HIV and sex work, our updated analysis of the global HIV burden among female sex workers shows that HIV prevalence is unacceptably high at 10·4% (95% CI 9·5-11·5) and is largely unchanged. Comprehensive epidemiological data on HIV and antiretroviral therapy (ART) coverage are scarce, particularly among transgender women. Sustained coverage of treatment is markedly uneven and challenged by lack of progress on stigma and criminalisation, and sustained human rights violations. ⋯ Evidence-based progress on full decriminalisation grounded in health and human rights-a key recommendation in our Lancet Series-has stalled, with South Africa a notable exception. Additionally, several countries have rolled back rights to sex workers further. Removal of legal barriers through the decriminalisation of sex work, alongside political and funding investments to support community and structural interventions, is urgently needed to reverse the HIV trajectory and ensure health and human rights for all sex workers.