Remifentanil patient controlled analgesia versus epidural analgesia in labour. A multicentre randomized controlled trial

Contains fulltext : 109349.pdf (publisher's version ) (Open Access)ABSTRACT: BACKGROUND: Pain relief during labour is a topic of major interest in the Netherlands. Epidural analgesia is considered to be the most effective method of pain relief and recommended as first choice. However its uptake by pregnant women is limited compared to other western countries, partly as a result of non-availability due to logistic problems. Remifentanil, a synthetic opioid, is very suitable for patient controlled analgesia. Recent studies show that epidural analgesia is superior to remifentanil patient controlled analgesia in terms of pain intensity score; however there was no difference in satisfaction with pain relief between both treatments. METHODS/DESIGN: The proposed study is a multicentre randomized controlled study that assesses the cost-effectiveness of remifentanil patient controlled analgesia compared to epidural analgesia. We hypothesize that remifentanil patient controlled analgesia is as effective in improving pain appreciation scores as epidural analgesia, with lower costs and easier achievement of 24 hours availability of pain relief for women in labour and efficient pain relief for those with a contraindication for epidural analgesia.Eligible women will be informed about the study and randomized before active labour has started. Women will be randomly allocated to a strategy based on epidural analgesia or on remifentanil patient controlled analgesia when they request pain relief during labour. Primary outcome is the pain appreciation score, i.e. satisfaction with pain relief.Secondary outcome parameters are costs, patient satisfaction, pain scores (pain-intensity), mode of delivery and maternal and neonatal side effects.The economic analysis will be performed from a short-term healthcare perspective. For both strategies the cost of perinatal care for mother and child, starting at the onset of labour and ending ten days after delivery, will be registered and compared. DISCUSSION: This study, considering cost effectiveness of remifentanil as first choice analgesia versus epidural analgesia, could strongly improve the care for 180.000 women, giving birth in the Netherlands yearly by giving them access to pain relief during labour, 24 hours a day. TRIAL REGISTRATION NUMBER: Dutch Trial Register NTR2551, http://www.trialregister.nl

The conservation status of the world’s reptiles

MB and MR were funded by a grant from the Esmee Fairbairn Foundation, BC by the Rufford Foundation. North American and Mexican species assessments were funded by the Regina Bauer Frankenberg Foundation for Animal Welfare. Species assessments under the Global Reptile Assessment (GRA) initiative are supported by: Moore Family Foundation, Gordon and Betty Moore Foundation, Conservation International, Critical Ecosystem Partnership Fund (CEPF), and European Commission. Additional acknowledgements are included in the online supplementary material. The assessment workshop for Mexican reptiles was kindly hosted by Ricardo Ayala and the station personnel of the Estacion de Biologia Chamela, Institut de Biologia, Universidad Nacional Autonoma de Mexico. Workshop and logistical organisation of the Philippines assessments was provided by the Conservation International Philippines Office, in particular Ruth Grace Rose Ambal, Melizar V. Duya and Oliver Coroza. Workshop and logistical organisation for the European Reptile and Amphibian Assessments was provided by Doga Dernegi, in particular Ozge Balkiz and Ozgur Koc. Workshop and logistical organisation for assessments of sea snakes and homalopsids was provided by the International Sea Turtle Symposium and Dr. Colin Limpus (Australian Government Environmental Protection Agency). Special thanks to Jenny Chapman (EPA) and Chloe Schaub le (ISTS). Thank you also to Dr. Gordon Guymer (Chief Botanist Director of Herbarium) for accommodating us at the Herbarium in the Brisbane Botanical Gardens, and Mark Read and Kirsten Dobbs (Great Barrier Reef Marine Parks Association) and Dave Pollard and Brad Warren (Ocean Watch Australia) for institutional support. Mohamed Bin Zayed Species Conservation Fund, Conservation International Madagascar and the Darwin Initiative contributed to funding the costs of the Madagascar reptile workshop.Effective and targeted conservation action requires detailed information about species, their distribution, systematics and ecology as well as the distribution of threat processes which affect them. Knowledge of reptilian diversity remains surprisingly disparate, and innovative means of gaining rapid insight into the status of reptiles are needed in order to highlight urgent conservation cases and inform environmental policy with appropriate biodiversity information in a timely manner. We present the first ever global analysis of extinction risk in reptiles, based on a random representative sample of 1500 species (16% of all currently known species). To our knowledge, our results provide the first analysis of the global conservation status and distribution patterns of reptiles and the threats affecting them, highlighting conservation priorities and knowledge gaps which need to be addressed urgently to ensure the continued survival of the world’s reptiles. Nearly one in five reptilian species are threatened with extinction, with another one in five species classed as Data Deficient. The proportion of threatened reptile species is highest in freshwater environments, tropical regions and on oceanic islands, while data deficiency was highest in tropical areas, such as Central Africa and Southeast Asia, and among fossorial reptiles. Our results emphasise the need for research attention to be focussed on tropical areas which are experiencing the most dramatic rates of habitat loss, on fossorial reptiles for which there is a chronic lack of data, and on certain taxa such as snakes for which extinction risk may currently be underestimated due to lack of population information. Conservation actions specifically need to mitigate the effects of human-induced habitat loss and harvesting, which are the predominant threats to reptiles.Esmee Fairbairn FoundationRufford FoundationRegina Bauer Frankenberg Foundation for Animal WelfareMoore Family FoundationGordon and Betty Moore FoundationConservation International, Critical Ecosystem Partnership Fund (CEPF)European Commission Joint Research CentreZayed Species Conservation FundConservation International MadagascarDarwin Initiativ

Spatial and temporal variation in reproduction of a generalist crocodilian, Caiman crocodilus yacare, in a seasonally flooded wetland

We monitored the number of caiman (Caiman crocodilus yacare) nests in two ranches in the Brazilian Pantanal that cover an area of about 50.000 ha for 28 years (1987-2014). The number of nests was related to combinations of rainfall, water level, and number of days with temperature below 20°C, depending on the area. Most of the variation in number of nests could not be predicted by the environmental variables, but could be represented mathematically by a sine wave. We were not able to identify any external driver and suspect that the regular fluctuations may have resulted from an intrinsic population process. Presently, ranches are used as management units under the legislation for ranching Pantanal caimans. However, although some breeding females were recaptured in the area after periods of up to 21 years, most were not recaptured near nests or in general surveys of the area, suggesting that females are not strongly philopatric and that ranches do not represent isolated demographic units. Copyright: © 2015 Campos et al