ABSTRACT
Sexual and reproductive health (SRH) services, including contraception, save lives in humanitarian emergencies. To document practitioners’ perceptions of the effects of the Covid-19 pandemic on contraceptive programming in humanitarian settings and across the humanitarian–development nexus, the Women’s Refugee Commission conducted 29 key informant interviews with respondents from non-governmental organisations, the United Nations, and government ministries. Disruptions to contraceptive services included closures or repurposing of health facilities, limited availability of health providers, supply chain interruptions, restricted service delivery modalities, and lower demand for services. Adaptations to sustain services included telemedicine, task-shifting and sharing, community-based service delivery, and other innovations. Underlying factors affecting the types and extent of disruptions and adaptations included emergency preparedness for SRH, decision makers’ prioritisation of SRH services, funding, and coordination. Findings reinforce the need to build awareness that SRH services, including contraception, are lifesaving and essential in humanitarian settings, and to improve preparedness, including bridging gaps between humanitarian and development actors. © 2022, Institute of Development Studies.
ABSTRACT
The inodilator levosimendan, in clinical use for over two decades, has been the subject of extensive clinical and experimental evaluation in various clinical settings beyond its principal indication in the management of acutely decompensated chronic heart failure. Critical care and emergency medicine applications for levosimendan have included postoperative settings, septic shock, and cardiogenic shock. As the experience in these areas continues to expand, an international task force of experts from 15 countries (Austria, Belgium, China, Croatia, Finland, France, Germany, Greece, Hungary, Italy, the Netherlands, Spain, Sweden, Switzerland, and the USA) reviewed and appraised the latest additions to the database of levosimendan use in critical care, considering all the clinical studies, meta-analyses, and guidelines published from September 2019 to November 2021. Overall, the authors of this opinion paper give levosimendan a “should be considered” recommendation in critical care and emergency medicine settings, with different levels of evidence in postoperative settings, septic shock, weaning from mechanical ventilation, weaning from veno-arterial extracorporeal membrane oxygenation, cardiogenic shock, and Takotsubo syndrome, in all cases when an inodilator is needed to restore acute severely reduced left or right ventricular ejection fraction and overall haemodynamic balance, and also in the presence of renal dysfunction/failure.