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To determine the preferences and attitudes of members of regional anesthesia societies during the COVID-19 pandemic.We distributed an electronic survey to members of the American Society of Regional Anesthesia and Pain Medicine, Regional Anaesthesia-UK, and the European Society of Regional AnaesthesiaPain Therapy. A questionnaire consisting of 19 questions was developed by a panel of experienced regional anesthesiologists and distributed by email to the participants. The survey covered the following domains: participant information, practice settings, preference for the type of anesthetic technique, the use of personal protective equipment, and oxygen therapy.The survey was completed by 729 participants from 73 different countries, with a response rate of 20.1% (729/3,630) for the number of emails opened and 8.5% (729/8,572) for the number of emails sent. Most respondents (87.7%) identified as anesthesia staff (faculty or consultant) and practiced obstetric and non-obstetric anesthesia (55.3%). The practice of regional anesthesia either expanded or remained the same, with only 2% of respondents decreasing their use compared with the pre-pandemic period. The top reasons for an increase in the use of regional anesthesia was to reduce the need for an aerosol-generating medical procedure and to reduce the risk of possible complications to patients. The most common reason for decreased use of regional anesthesia was the risk of urgent conversion to general anesthesia. Approximately 70% of the responders used airborne precautions when providing care to a patient under regional anesthesia. The most common oxygen delivery method was nasal prongs (cannula) with a surgical mask layered over it (61%).Given the perceived benefits of regional over general anesthesia, approximately half of the members of three regional anesthesia societies seem to have expanded their use of regional anesthesia techniques during the initial surge of the COVID-19 pandemic.RéSUMé: OBJECTIF: Déterminer les préférences et les attitudes des membres des sociétés d’anesthésie régionale pendant la pandémie de COVID-19. MéTHODE: Nous avons distribué un sondage électronique aux membres de l’American Society of Regional Anesthesia and Pain Medicine, de Regional Anesthesia-UK et de l’European Society of Regional AnaesthesiaPain Therapy. Un questionnaire composé de 19 questions a été élaboré par un panel d’anesthésiologistes régionaux d’expérience et distribué par courriel aux participants. Le sondage couvrait les domaines suivants : les renseignements sur les participants, les contextes de pratique, leur préférence quant au type de technique d’anesthésie, l’utilisation d’équipement de protection individuelle et l’oxygénothérapie RéSULTATS: Le sondage a été complété par 729 participants provenant de 73 pays différents, avec un taux de réponse de 20,1 % (729/3630) pour le nombre de courriels ouverts et de 8,5 % (729/8572) pour le nombre de courriels envoyés. La plupart des répondants (87,7 %) se sont identifiés comme anesthésiologistes (académique ou consultant) et pratiquaient l’anesthésie obstétricale et non obstétricale (55,3 %). Leur pratique de l’anesthésie régionale s’est étendue ou est demeurée inchangée, et seulement 2 % des répondants ont indiqué avoir diminué leur utilisation de cette pratique par rapport à la période pré-pandémique. Les principales raisons d’une augmentation de l’utilisation de l’anesthésie régionale étaient de réduire la nécessité d’une intervention médicale générant des aérosols et de réduire le risque de complications potentielles pour les patients. La raison la plus courante de diminution du recours à l’anesthésie régionale était le risque de conversion urgente à une anesthésie générale. Environ 70 % des intervenants ont utilisé des précautions en matière de propagation des aérosols lorsqu’ils procuraient des soins à un patient sous anesthésie régionale. La méthode d’administration d’oxygène la plus fréquemment utilisée était les canules nasales avec un masque chirurgical superposé (61 %). CONCLUSION: Compte tenu des avantages perçus de l’anesthésie régionale par rapport à l’anesthésie générale, environ la moitié des membres de trois sociétés d’anesthésie régionale semblent avoir élargi leur utilisation des techniques d’anesthésie régionale pendant la vague initiale de la pandémie de COVID-19.

El presente trabajo tiene por objetivo analizar el conflicto existente entre el derecho a la vida y las libertades religiosas en la jurisprudencia, a propósito del rechazo a ciertos procedimientos médicos como las transfusiones de sangre. Luego de reconstruir la postura mayoritaria, cuestionaré dos de sus fundamentos esenciales: que el derecho a la vida es un derecho absoluto y que se trata de un derecho indisponible.

Discounting is a description of the devaluing of an outcome based on increased delay or decreased probability of that outcome. This framework can be extended to virtually any choice situation, including preventive medical procedures. One third of Americans will be diagnosed with cancer in their lifetimes. Identifying how key factors affect decisions to engage in preventive care could inform interventions that are designed to promote equitable access to care. Therefore, the purpose of this study was to better understand how individuals would weigh key factors in the decision to have surgery to remove a premalignant tumor. Two experiments were conducted. In each experiment, participants (n = 50) were provided with hypothetical situations in which they were faced with the decision to undergo surgery to remove a premalignant tumor. Probability of cancer, delay to onset of cancer, frame, and cost of surgery were varied across questions. Surgical cost and probability of malignancy had the most effect on tumor removal. Delay of cancer onset and the question being framed as malignant or benign also had a small effect on tumor removal. Most participants also reported having delayed a real medical procedure due to cost, indicating that cost is a major factor in health-related decision making. Likelihood of cancer and cost of health care is a major determinant of decision making when removing a premalignant tumor. Changes in the U.S. health-care system that decrease direct costs to patients could encourage important preventative procedures, and lower potentially worse long-term cancer outcomes and increased costs due to treatment.

Background Emergence delirium is one of the problems that occur when a child wakes from anesthesia. Research results indicate that psychological factors are associated with this phenomenon. The relationship between adult behavior before child surgery and pediatric emergence delirium has not been investigated before. Aims The aim of this study was to explore the associations of parent, anesthesiologist, and nurse behaviors before child surgery with pediatric emergence delirium. Methods The study included 99 pediatric patients (aged 2-17 years) undergoing surgery with general anesthesia, their accompanying parents, an anesthesiologist, and nurses. The study was conducted directly before surgery and after recovery from anesthesia. Before surgery, the behaviors of children, parents, and medical staff were videotaped and then scored using the Child-Adult Medical Procedure Interaction Scale-Revised. Emergence delirium was measured with the Pediatric Anesthesia Emergence Delirium Scale. Results Parent reassuring comments (ꞵ = 0.22, B=1.32, 95% CI 0.14-2.49, P=0.028) and parent giving control to child (ꞵ = 0.21, B=7.02, 95% CI 0.68-13.56, P=0.031) were positive predictors of emergence delirium in the group of children aged 2-8 years. Parent behavior explained an additional 10% of the variance in pediatric emergence delirium. Conclusions Our results suggest that parent reassuring comments and giving control to the child before surgery are related to the level of child emergence delirium in children aged 2 to 8 years.

The long-acting antiretroviral cabotegravir and rilpivirine combination has just received FDA, EMA and Health Canada approval. This novel drug delivery approach is about to revolutionize the therapy of people living with HIV, decreasing the 365 daily pill burden to only six intramuscular injections per year. In addition, islatravir, a first-in-class nucleoside reverse transcriptase translocation inhibitor, is intended to be formulated as an implant with a dosing interval of 1 year or more. At present, long-acting antiretroviral therapies (LA-ARTs) are given at fixed standard doses, irrespectively of the patient’s weight and BMI, and without consideration for host genetic and non-genetic factors likely influencing their systemic disposition. Despite a few remaining challenges related to administration (e.g. pain, dedicated medical procedure), the development and implementation of LA-ARTs can overcome long-term adherence issues by improving patients’ privacy and reducing social stigma associated with the daily oral intake of anti-HIV treatments. Yet, the current ‘one-size-fits-all’ approach does not account for the recognized significant inter-individual variability in LA-ART pharmacokinetics. Therapeutic drug monitoring (TDM), an important tool for precision medicine, may provide physicians with valuable information on actual drug exposure in patients, contributing to improve their management in real life. The present review aims to update the current state of knowledge on these novel promising LA-ARTs and discusses their implications, particularly from a clinical pharmacokinetics perspective, for the future management and prevention of HIV infection, issues of ongoing importance in the absence of curative treatment or an effective vaccine.

When mature minors face a decision with important consequences, such as whether to undergo a risky but potentially life-saving medical procedure, who should decide? Relying on liberal political theory's account of the importance of decisional autonomy for adults, and given the scalar nature of the capacities needed to exercise decisional autonomy, I argue that mature minors with the requisite capacities and commitments have a right to decisional autonomy though they are not yet 18. I argue for this right using a 'balancing of interest' account of rights: the interest mature minors have in decisional autonomy outweighs their parents' interest in shaping their children as a means of 'creative self-extension'. But I propose two limitations on this right: requests for waivers of the rule that one must be at least 18 to decide cannot be so numerous as to make adjudication impractical; and though a competent adult's voluntary decision to refuse medical treatment should generally be respected, the state may reject a mature minor's decision upon review by an indifferent judge of the minor's capacities and reasons. The judge reviews not the substantive merits or prudence of the decision, but whether the decision promotes the interest in decisional autonomy, by asking among other things whether the decision is the minor's own, is tethered to core commitments rather than based on arbitrary preferences, and could be regarded as reasonable to the minor's 'future self'.

Heart failure (HF) and myocardial infarction are serious complications of major noncardiac surgery in older adults. Many factors can contribute to the development of HF during the postoperative period. The incidence of, and risk factors for, procedure-associated heart failure (PHF) occurring at the time of, or shortly after, medical procedures in a population-based sample ≥ 65 years of age have not been fully characterized, particularly in comparison with HF not proximate to medical procedures. This analysis comprises 5,121 men and women free of HF at baseline from the Cardiovascular Health Study who were followed up for 12.0 years (median). HF events were documented by self-report at semi-annual contacts and confirmed by a formal adjudication committee using a review of the participants' medical records and standardized criteria for HF. Incident HF events were additionally adjudicated as either being related or unrelated to a medical procedure (PHF and non-PHF, respectively). We estimated cause-specific hazards ratios for the association of covariates with PHF and non-PHF. There were 1,728 incident HF events in the primary analysis: 168 (10%) classified as PHF, 1,526 (88%) as non-PHF, and 34 unclassified (2%). For those 1,045 participants in whom LV ejection fraction was known at the time of the HF event, it was ≥45% in 89 of 118 participants (75%) with PHF, compared to 517 of 927 participants (55%) with non-PHF (p0.001). Increased age, male gender, diabetes, and angina at baseline were associated with both PHF and non-PHF (range of hazard ratios (HR): 1.04-2.05]. Being Black was inversely associated with PHF [HR: 0.46, 95% confidence interval: 0.25-0.86]. Participants with increased age, without baseline angina, and with baseline LVEF55% were at a significantly lower risk for PHF compared to non-PHF. Among those with PHF, surgical procedures-including cardiac, orthopedic, gastrointestinal, vascular, and urologic-comprised 83.3%, while percutaneous procedures comprised 8.9% (including 6.5% represented by cardiac catheterizations and pacemaker placements). Another group composed of a variety of procedures commonly requiring large fluid volume administration comprised 7.7%. There was a lower all-cause 30-day mortality in the PHF versus the non-PHF group (2.2% vs 5.7%), with a nonsignificant odds ratio of 0.39 in a minimally adjusted model. When individuals with prior myocardial infarction (MI) were excluded in a sensitivity analysis, the proportion of incident HF with concurrent MI was greater for PHF (32.9%) than for non-PHF (19.8%). In conclusion, PHF in older adults is a common entity with relatively low 30-day mortality. Baseline angina, lower age, and LVEF ≥ 55% were associated with a higher risk of PHF compared to non-PHF. Being Black was associated with a lower risk of PHF and PHF as a proportion of HF was lower in Black than in non-Black participants. Compared to non-PHF, PHF more frequently presented with concurrent MI and with preserved LV ejection fraction.

Search string, list of included studies, additional extracted data and results.

the STATA code for conducting meta-analysis (with the exception of study level effect size calculations done in Comprehensive Meta-analysis)

All extracted data used for effect size calculation and the code for conducting meta-analysis (with the exception of study level effect size calculations done in Comprehensive Meta-analysis)

Salvadoran youth have an elevated risk of trauma exposure and related mental health problems. However, investigations of childhood trauma exposure and mental health sequelae in El Salvador are limited. The present study aimed to (a) explore the prevalence of exposure to potentially traumatic events and symptoms of posttraumatic stress, anxiety, and depression and (b) evaluate the associations between specific trauma types and emotional functioning among Salvadoran youth. A total of 1,296 youth aged 8–21 years from seven public schools completed self-report measures of trauma exposure, posttraumatic stress symptoms (PTSS), anxiety, and depression. Participants reported high levels of trauma exposure, endorsing an average of 3.62 (SD = 2.32) trauma types. In total, 34.5% of participants reported clinically elevated PTSS; fewer youths reported elevated depressive (8.7%) and anxiety symptoms (8.6%). Although boys reported exposure to more trauma types than girls, d = 0.22, girls were more likely to endorse elevated PTSS, V = .11; anxiety, V = .06; and depression, V = .10. Adolescents reported exposure to more trauma types than younger children, d = 0.23, and were more likely to endorse elevated PTSS, V = .07; anxiety, V = .13; and depression, V = .16. Undergoing a frightening medical procedure, OR = 2.30; female sex, OR = 1.92; witnessing domestic violence, OR = 1.70; and experiencing war between gangs, OR = 1.61, were strong predictors of elevated PTSS. This broad, school-based screening was a critical step toward better understanding the rate of trauma exposure and trauma-related symptoms among Salvadoran youth.

Introduction The Military Health System (MHS) is tasked with a dual mission both to provide medical services for covered patients and to ensure that its active duty medical personnel maintain readiness for deployment. Knowledge, skills, and attitudes (KSA) is a metric evaluating the transferrable skills incorporated into a given surgery or medical procedure that are most relevant for surgeons deployed to a theatre of war. Procedures carrying a high KSA value are those utilizing skills with high relevance for maintaining deployment readiness. Given ongoing concerns regarding surgical volumes at MTFs and the potential adverse impact on military surgeon mission readiness were high-value surgeries to be lost to the civilian sector, we evaluated trends in the setting of high-value surgeries for beneficiaries within the MHS. Methods We retrospectively analyzed inpatient admissions data from MTFs and TRICARE claims data from civilian hospitals, 2005-2019, to identify TRICARE-covered patients covered under “purchased care” (referred to civilian facilities) or receiving “direct care” (undergoing treatment at MTFs) and undergoing seven high-value/high-KSA surgeries: colectomy, pancreatectomy, hepatectomy, open carotid endarterectomy, abdominal aortic aneurysm (AAA) repair, esophagectomy, and coronary artery bypass grafting (CABG). Overall and procedure-specific counts were captured, MTFs were categorized into quartiles by volume, and independence between trends was tested with a Cochran–Armitage test, hypothesizing that the proportion of cases referred for purchased care was increasing. Results We captured 292,411 cases, including 7,653 pancreatectomies, 4,177 hepatectomies, 3,815 esophagectomies, 112,684 colectomies, 92,161 CABGs, 26,893 AAA repairs, and 45,028 carotid endarterectomies. The majority of cases included were referred for purchased care (90.3%), with the proportion of cases referred increasing over the study period (P Conclusion On examining volume and referral trends for high-value surgeries within the MHS, we found low surgical volumes at the vast majority of included MTFs and an increasing proportion of cases referred to civilian hospitals over the last 15 years. Our findings illustrate missed opportunities for maintaining the mission readiness of military surgical personnel. Prioritizing the recapture of lost surgical volume may improve the surgical teams’ mission readiness.

Medical procedures require skilled reliability, precision, and efficiency. One way in which techniques could be taught to address these requirements is through immersive tutorials in virtual reality (VR), that employ a 3D video (filmed from the first-person point-of-view [FPV]), which is then displayed through an immersive VR application (IVRA-FPV). The present study assessed the pedagogical value of the IVRA-FPV training that taught participants how to implement a lumbar puncture. This procedure was recorded and the corresponding IVRA-FPV tutorial was produced. Medical users/learners (N = 89) were subjected to a prospective randomized comparative study comprised of one group that was assigned to the traditional lecture (n = 44) and the other group to the IVRA-FPV tutorial (n = 45). Each participant was then evaluated as they demonstrated the technique on a mannequin to assess their applied learning skillset generalization. Participants that attended the traditional lecture exhibited better answers during oral examination (p

We expanded a published mathematical model of SARS-CoV-2 transmission with complex, age-structured transmission and with laboratory-derived source and wearer protection efficacy estimates for a variety of face masks to estimate their impact on COVID-19 incidence and related mortality in the United States. The model was also improved to allow realistic age-structured transmission with a pre-specified R0 of transmission, and to include more compartments and parameters, e.g. for groups such as detected and undetected asymptomatic infectious cases who mask up at different rates. When masks are used at typically-observed population rates of 80% for those ≥ 65 years and 60% for those 0 = 10.0 and 13.0, respectively). None-the-less, the ratio of incident risk for masked vs. non-masked populations still shows a benefit of wearing masks even with the higher R0 variants.

” Do not resuscitate” order (DNR) is issued to avoid cardio-pulmonary resuscitation in situations when it becomes futile. Like any other medical procedure, it's based on the “maximum benefit – minimum risk” principle, on one hand, while also respecting the patient's autonomy and dignity. However, they are influenced by the urgency of the situation and the patient's inability to decide. The COVID-19 pandemic poses additional challenges for the process of taking a decision regarding resuscitation. The number of those who need intensive care is increasing daily and, implicitly, of the situations in which it is necessary to make decisions regarding resuscitation. In the meanwhile, health systems across the world are overwhelmed, lacking equipment, and medical staff. Doctors are facing the situation when they should assume, with a great moral burden, the responsibility for the DNR decision, taken unilaterally, by a pragmatic approach, justified by the potential wasting of time and resources, and exposure to the virus. Such a paternalistic approach ignores the patient's view on his/her own treatment, depriving him/her of the right to autonomy. However, when the alternative is death, whatever the risk, it should be accepted. It becomes a problem to determine the extent and conditions of such a decision. The international data on the DNR decisions taken by doctors and the criteria on which they were based are analyzed in the article. The authors conclude that when it is difficult to resuscitate all patients, and the DNR decision is ethically unacceptable, creating a protocol dedicated to the state of crisis, which would protect both doctors and patients is of critical importance.

The present study focuses on introducing the concept of optimisation and proposing a model, including evaluation of image quality, to be used in the clinical routines where image-guided intervention is being performed. The overall aim of the study was to develop a model for evaluating the use of imaging in X-ray-guided interventional procedures and its possible implications on optimisation of radiation protection. In the search for an adequate evaluation model, data from endovascular interventions of the aorta (EVAR procedures) were used. The procedure was schematically described in steps. Every imaging event was connected to the steps in the medical procedure and was also described with the purpose of the imaging event. Available technical, as well as procedural parameters, were studied and analysed. Data were collected from the X-ray equipment for 70 EVAR procedures and, out of these, 12 procedures were randomly selected to be recorded on video to understand the procedure better. It was possible to describe the EVAR procedures in a general way with explanations of the clinical purpose connected to each imaging event. Possible quality parameters of the procedure were identified for the imaging events (radiation dose, image quality). The model method still needs to be refined and will then be applied to clinical data and to other clinical procedures to test the validity.

Objective. The main objective of the research is the pathohistological consequences of colorectal adenomatosis polyps and their gender-based assessment. Gender and its connection with advanced colorectal displasia are the focus of the research study. Materials and methods. A retrospective analysis was conducted 100 patients. The age group of the patients in the research study mainly encompassed 19 to 65 aged patients. During the medical procedure, the gender distribution of the cases was determined as 60 males and 40 females respectively. Results. There is strong evidence for an association between gender and the risk of advanced colorectal neoplasia. The findings regarding the positive interrelation for gender and advanced colorectal neoplasia are consistent with other large colonoscopy-based studies. Conclusions. As a result of the study, we would like to emphasize that colorectal polyps are more common in men compared to in women

Background. The acute care surgery (ACS) system is a new model for the prompt management of diseases that require rapid treatment in patients with acute abdomen. This study compared the outcomes and characteristics of the ACS system and traditional on-call system (TROS) for acute appendicitis in South Korea. Methods. This single-center, retrospective study included all patients (aged ≥18 years) who underwent surgery for acute appendicitis in 2016 and 2018. The TROS and ACS system were used for the 2016 and 2018 groups, respectively. We retrospectively obtained data on each patient from the electrical medical records. The independent samples t-test and Mann–Whitney U-test were used for continuous and nonnormally distributed data, respectively. Results. In total, 126 patients were included. The time taken to get from the emergency room admission to the operating room, operation times, and postoperative complication rates were similar between both groups. However, the length of the hospital stay was shorter in the ACS group than in the TROS group (4.3 ± 3.2 days vs. 7.2 ± 9.6 days, p = 0.039 ). Conclusions. Since the introduction of the ACS system, the length of hospital stay for surgical patients has decreased. This may be due to the application of an integrated medical procedure, such as a new clinical pathway, rather than differences in the surgical techniques.

Introduction: In the Present study, it has been tried to assess the awareness regarding medico-legal issues those arising during medical procedure among obstetricians and gynecologists in Rajkot city of Gujarat. The present study will help to know the areas of weakness and will suggest necessary remedial measures in this regards. Materials and Methods: The present study was conducted at P. D. U. Government Medical College and Hospital. Study sample included Government and Private Obstetricians and Gynecologists of Rajkot city. Total 80 opinions were collected personally from Obstetricians & Gynecologists. Specially prepared standard questionnaire was given to them and their response was collected. The questions in questionnaire were related to promptness & procedural awareness in sexual offence cases, awareness of laws, insight about causes of negligence and awareness regarding various medicolegal issues. Collected responses were statistically analyzed using Microsoft excel. Results and Conclusions: Government hospital doctors are more aware about the medico-legal issues arising during medical practice than the private hospital doctors. Among them, male doctors are more aware than the female doctors. Male doctors are more experienced than female doctors in handling of MLC cases. Government hospital doctors are more aware about the PCPNDT act and other laws related to practice. Promptness of examination of sexual assault victim as well as knowledge of collection and preservation of evidence in such cases was observed more in government doctors than the private doctors. 32.50% practitioners know that they have to attend the MLC's as per merit of the case and 16.25% do not know about it. It was quite clear in this study that 47.50% practitioners have the insight of real causes of negligence and litigations, 16.25% are confuse, while 27.5% are not aware of the same. Keywords: PCPNDT, MTP, Medico legal, Obstetrician, Gynecologists.

Procedural complications are a common source of adverse events in hospitals, especially where bedside procedures are often performed by trainees. Medical procedure services (MPS) have been established to improve procedural education, ensure patient safety, and provide additional revenue for services that are typically referred. Prior descriptions of MPS have reported outcomes over one to 2 years. We aim to describe the implementation and 5-year outcomes of a hospitalist-run MPS.We identified all patients referred to our MPS for a procedure over the 5-year span between 2014 and 2018. We manually reviewed all charts for complications of paracentesis, thoracentesis, central venous catheterization, and lumbar punctures performed by the MPS in both inpatient and outpatient settings. Annual charges for these procedures were queried using Current Procedural Terminology (CPT) codes.We identified 3,634 MPS procedures. Of these, ultrasound guidance was used in 3224 (88.7%) and trainees performed 2701 (74%). Complications identified included pneumothorax (3.7%, n = 16) for thoracentesis, post-dural puncture headache (13.9%, n = 100) and bleeding (0.1%, n = 1) for lumbar puncture, ascites leak for diagnostic (1.6%, n = 8) and large volume (3.7%, n = 56) paracentesis, and bleeding (3.5%, n = 16) for central venous catheter placement. Prior to initiation of the MPS, total annual procedural charges were $90,437. After MPS implementation, charges increased to a mean of $787,352 annually in the last 4 years of the study period.Implementation of a hospitalist-run, academic MPS resulted in a large volume of procedures, high rate of trainee participation, low rates of complications, and significant increase in procedural charges over 5 years. Wider adoption of this model has the potential to further improve patient procedural care and trainee education.

Risk is a concept inherent in every medical procedure. It can be defined as the probability of an adverse event in a defined population over a specified period of time. In the frame of food allergy management, it might be related to a diagnostic procedure, a treatment, or the consumption of foods. The risk of an adverse event can also be augmented by individual factors. This rostrum article discusses various aspects faced by children with food allergies in the light of risk, and their practical implications. Identifying personal risks for severe reaction, such unstable asthma, and correcting them whenever possible also contributes to a reduction of the risk inherent to food allergy. Among the facets discussed, oral food challenges (OFC) are the most common diagnostic procedures implying an inherent risk. The risk of OFCs can be minimized by correct indication and timing of the test, a safe setting, as well as by ensuring that the patient is otherwise well without potential stressor potentially increasing the risk of a more severe reaction. Oral immunotherapy (OIT) has been studied as a potential treatment for increasing the threshold dose for reaction, and thus reducing the risk of accidental reaction. Nevertheless, the procedure is not devoid of risk as the patients may, and do often react, during the course of the procedure. Ingestion of trace amounts in processed foods, mainly in community settings such as restaurants, schools or day care, represent a potential risk of reactions, although for a minority of patients. Precautionary allergen labelling (PAL) is a wide spread strategy to reduce the potential risk of reactions due to traces. However, PAL is currently inefficient due to inconsistent labelling, also not indicating a clear maximum amount possibly present in the manufactured food. Finally, cost-effectiveness needs to be considered in risk management, as many risk-reduction procedures are clearly not cost-effective.

BACKGROUND AND AIMS: The number of procedures performed by internal medicine residents in the United States (US) is declining. An increasing proportion of residents do not feel confident performing essential invasive bedside procedures and, upon graduation, desire additional training. Several residency programs have utilized the medical procedure service (MPS) to address this issue. We aim to summarize the current state of evidence by systematically evaluating the effect of the MPS on resident education, comfort, and training, as well as patient safety and procedural outcomes in the US. METHODS: We conducted a systematic review of all studies reporting the use of an MPS with supervision from a board-certified physician in internal medicine residencies in the US. Database search was performed on PubMed, Embase, ERIC, and Cochrane Library from January 2000 to November 2020 for relevant studies. Quality of evidence assessment and random-effects proportion meta-analyses were performed. RESULTS: A total of nine studies reporting on 3879 procedures performed by MPS were identified. Procedures were safely performed, with a pooled complication rate of 2.1% (95% CI: 1.0–3.5) and generally successful, with a pooled success rate of 94.7% (95% CI: 90.8–97.7). The range of procedures performed by residents under MPS was 6.7–72.8 procedures per month (n = 9) compared to 4.3–64.4 procedures (n = 4) without MPS. MPS significantly increased confidence, comfort, and use of appropriate safety measures among residents. CONCLUSION: There are a limited number of published studies on MPS supervised by a board-certified physician in US internal medicine residencies. Procedures performed by MPS are generally successfully completed and safe. MPS benefits internal medicine residents training by improving competency, comfort, and confidence. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11606-020-06526-2.

Cryonics involves the low-temperature freezing of human corpses in the hope that they will one day be reanimated. Its advocates see it as a medical treatment but as in any medical procedure, this presupposes some scientific evidence. This paper examines the scientific basis of this technology and argues that cryonics is based upon assertions which have never been (and potentially can never be empirically demonstrated) scientifically. After providing a general overview of cryogenic preservation, I discuss how advocates of this technology have conceptualized death and more specifically their notion of information-theoretic death. I conclude that cryonics is based upon a naive faith rather than upon science. It does what David Chidester (2005) calls 'religious work,' even if it is not explicitly religious. It offers transcendence over death.