Glucagon-like peptide-1 receptor agonists (GLP-1RAs) such as semaglutide (Wegovy and Ozempic) and tirzepatide (Mounjaro) may increase the risk of pulmonary aspiration among patients undergoing surgery or procedures with general anaesthesia or deep sedation, the UK drugs regulator has warned.1 In an alert to patients and doctors, the Medicines and Healthcare Products Regulatory Agency (MHRA) said that the drugs, used for weight loss and diabetes, slow down the emptying of the person’s stomach. This means that, despite normal preoperative fasting advice being followed, patients taking these drugs may still have “residual gastric contents” and could experience pulmonary aspiration, potentially causing pneumonia. In light of this, patients have been told they before any surgical procedure they must tell their healthcare professional team, including their anaesthetist, if they are taking these drugs. But they must …

A culture of fear and blame, systemic problems with data collection, and lack of patient and family involvement are preventing lessons being learnt from deaths of mental health inpatients in England, a patient safety agency has concluded. The report by the Health Services Safety Investigations Body (HSSIB) examined any learning from investigations into patient deaths in mental health inpatient units and deaths that occurred up to 30 days after discharge.1 Nichola Crust, HSSIB senior safety investigator, said the report painted a “sobering picture” of the NHS “trying to implement meaningful learning and actions to prevent future deaths in a landscape that is fraught with grief and blame . . . with significant systemic issues, gaps, and poor cultures that serve to undermine patient safety in mental health care. In short: the system is still not learning …

Transfer of fresh embryos may be a better option than use of frozen embryos In vitro fertilisation (IVF) has revolutionised infertility treatment and offers each year hope to millions of couples worldwide. Embryo freezing has become an increasingly prominent part of the treatment. While initially used for the storing of excess embryos after fresh embryo transfers, the so called freeze-all strategy has now become part of IVF, where no fresh transfer and all suitable embryos are frozen for transfer in subsequent menstrual cycles. In a linked research paper, Wei and colleagues (doi:10.1136/bmj-2024-081474) studied the effectiveness of this strategy in women who have a poor prognosis of IVF treatment success (defined as nine or fewer oocytes retrieved or a poor ovarian reserve).1 One benefit of the freeze-all method is the ability to reduce the risk of ovarian hyperstimulation syndrome; although, this risk is generally low in women with poor prognosis owing to a low ovarian response. Anoth

These proposals are unlikely to succeed but remind Americans what is at stake, writes Rebecca Kluchin In January 2023, 24 Republican legislators in the US state of South Carolina sponsored the South Carolina Equal Protection Act of 2023, a bill designed to extend constitutional rights to embryos and fetuses at all stages of development, granting them equality with women already born.1 The bill makes women and pregnant people who undergo abortion subject to the state’s homicide laws and punishments, including the death penalty. It allows exceptions if they face “imminent death or great bodily injury,” as well as to save the life of the mother, but not for rape or incest. The anti-abortion movement celebrated a huge victory last summer when the US Supreme Court overturned Roe v Wade. With the ruling for Dobbs v Jackson Women’s Health Organization, the court threw abortion policy back to the judgment of individual states, making access to abortion care contingent on where one lives. Since