Pain in labour and the intrapartum use of intramuscular opioids—how effective are they?

Although widely used, there are observable differences in the level of satisfaction that women receive from opioids. This review examines some of the factors impacting this satisfaction, considering both physiological and psychological differences.Many women choose pharmacological methods for pain management in labour, with 25% using an opiate-based analgesic (Redshaw and Henderson, 2015). Statistics suggest that the level of intravenous or intramuscular opiate ranges from 5% to 66% between hospital trusts (Healthcare Commission, 2007).This review will consider the evidence and management options regarding the role of pain in labour; provide an overview of the research, evidence and practices concerning the intrapartum use of opiates versus other methods of pain management; detail the pharmacokinetics of opiates that are used in the UK and their effects on the woman, fetus and neonate; and identify some of the gaps in the literatur

Complexity, Problem-Solving, Sustainability and Resilience

Societies often solve problems by developing more complex technologies and institutions. Sustainability emerges from success at solving problems. Complexity is a powerful problem-solving tool, but increased complexity requires resources and carries a metabolic cost. Resilience, a condition of vulnerability or the capacity to recover from a setback, helps achieve sustainability goals. Resilient societies must have reserve problem-solving capacity to adjust to major challenges. The abilities of ancient and modern societies to respond to crises at different states of complexity illustrate the relationship between problem-solving capacity and resilience. Increasing complexity, effective at first, seems inexorably to accumulate and to evolve to diminishing returns, undermining the ability to solve future problems. These processes are illustrated through historical case studies, including urban resilience

Single-access transumbilical laparoscopic appendectomy and cholecystectomy using new curved reusable instruments: a pilot feasibility study.

The umbilicus can be considered as the embryological opening for single-access laparoscopic procedures. We report on single-access transumbilical laparoscopic appendectomy (SATLA) and cholecystectomy (SATLC), performed using new curved reusable instruments.Evaluation StudiesJournal ArticleSCOPUS: ar.jinfo:eu-repo/semantics/publishe