Lancet

The SWITCH trial advances knowledge regarding the optimal management of large, deep intracerebral haemorrhage.1 This study showed a small benefit for decompressive hemicraniectomy in addition to optimal medical management for minimising death or severe disability (modified Rankin scale 5–6) at 6 months. A substantial proportion of the observed benefit was driven by reductions in mortality in the intervention group. However, the authors do not elaborate on the rates of withdrawal of life-sustaining therapy (WOLST) in each group, or if there was a protocolised approach to goals of care conversations.

The SWITCH trial by Jürgen Beck and colleagues showed a trend towards improved 6-month outcome (although not statistically significant) when deep intracerebral haemorrhage was treated with decompressive craniectomy in addition to best medical treatment, and even had no effect if the modified Rankin score of 4 was considered a poor outcome.1

I read with interest the Article by Jürgen Beck and colleagues1 presenting the SWITCH clinical trial, assessing whether decompressive craniectomy added to best medical treatment improves outcomes after spontaneous deep intracerebral haemorrhage. The Article is methodologically important because it presents a confidence distribution for the treatment effect, which is a new and advantageous approach to reporting clinical trial results.2

We thank Roberta Muriel Longo Roepke and Bruno Adler Maccagnan Pinheiro Besen, Jennifer A Frontera and Nicholas A Morris, Nicolas Engrand and Loïc Miry, and Ian C Marschner for their interest in the SWITCH trial.1 A spontaneous severe deep supratentorial intracerebral haemorrhage is a devastating disease: without treatment, more than 50% of victims die or are severely disabled. Decompressive craniectomy tends to reduce mortality without an increase in the number of severely disabled patients recovering from intracerebral haemorrhage (modified Rankin score [mRS] 5).

Watts G. Timothy Danforth Baker. Lancet 2014; 383: 690—In this Obituary, the date of birth has been corrected to July 4, 1925. This correction has been made to the online version as of Jan 2, 2025.

Rydelius J, Hognert H, Kopp-Kallner H, et al. First dose of misoprostol administration at home or in hospital for medical abortion between 12–22 gestational weeks in Sweden (PRIMA): a multicentre, open-label, randomised controlled trial. Lancet 2024; 404: 864–73—In this Article, the definition of 21 gestational weeks and 6 days should have read “153 days” in the Participants section of the Methods. This correction has been made as of Jan 2, 2025.

Werring DJ, Dehbi H-M, Ahmed N, et al. Optimal timing of anticoagulation after acute ischaemic stroke with atrial fibrillation (OPTIMAS): a multicentre, blinded-endpoint, phase 4, randomised controlled trial. Lancet 2024; 404: 1731–41—In the Summary of this Article, the first line should have read “acute ischaemic stroke”. In figure 2 of this Article, the number at risk in the delayed DOAC initiation group at 0 days should have read “1807”. These corrections have been made to the online version as of Jan 2, 2025.

A 26-year-old woman with a 2-month history of postcoital bleeding—which she described as very heavy loss and lasting 2 days—attended our unit.

Osteoarthritis is a heterogeneous disorder that is increasingly prevalent largely due to aging and obesity, resulting in a major disease burden worldwide. Knowledge about the underlying aetiology has improved, with increased understanding of the role of genetic factors, the microbiome, and existence of different pain mechanisms. However, this knowledge has not yet been translated into new treatment options. New evidence has questioned the efficacy of recommended treatments, such as therapeutic exercise programmes and the focus on weight loss, but managing obesity and maintaining activity remain important for the prevention and management of osteoarthritis.

The International Court of Justice (ICJ) in The Hague, Netherlands, concluded landmark hearings on Dec 13, 2024 that could fundamentally reshape the future of global health and human rights. The UN General Assembly had requested, by consensus, an Advisory Opinion from the world's highest judicial body on states' legal obligations to respond to climate change.1,2 The ICJ is expected to issue its opinion in 2025.