Types Of Medical Interventions Research Articles

Perfusionist removal of intra-aortic balloon pump catheters improves efficiency without an increase in complication rates.

The intra-aortic balloon pump (IABP) is one of the most utilized cardiac assist devices. Patients receiving IABP therapy are typically managed in high acuity clinical care areas with limited bed space and high demand. Our center instituted a certified clinical perfusionist (CCP) led initiative to remove IABP catheters in order to reduce IABP therapy time, hasten removal and improve efficiency. The purpose of the study is to compare outcomes for IABP removal by a certified clinical perfusionist to a physician. The primary outcome measures were site hematoma score and limb related complications. A survey was submitted to bedside nurses, managers/patient care coordinators, CCP's and physicians. The IABP quality assurance database was interrogated for the study. There were 350 patients eligible for inclusion. The cohort was well balanced between CCP (n = 284) and physician (n = 66) groups for patient demographics, indication, insertion specifics and type of medical intervention. The majority of patients had no bruise or hematoma with perfusionist (n = 246, 87%) or physician (n = 58, 88%) (p = 0.78) removal. The physician group demonstrated a higher rate of grade 3 hematomas (p = 0.03). There was no statistically significant difference between CCP and physician groups for limb complications and mortality. Survey results showed an improved efficiency in bed space allocation, physician workload and a decreased IABP support time. There is no difference in limb complications between perfusionist and physician removal of IABP catheters. The survey demonstrate an improvement in resource allocation and efficiency. A perfusionist led IABP removal program can be done safely and may help improve program efficiency.

Improper informed consent of the patient: legal and expert assessment

The purpose of the study is to draw the attention of the legal and medical community to the problem of insufficient awareness of the patient about the upcoming medical intervention; to identify the scope of interaction between the court and the expert in relation to disputes related to improper information. Despite the fact that the conclusion about improper informing of the patient implies a legal assessment of the circumstances, special medical knowledge is needed to identify some defects of voluntary informed consent. The expert, in particular, can answer the questions of the court about what risks are characteristic of a certain type of medical intervention (perforations, bleeding, etc.) and how high their probability was in relation to a particular patient (taking into account his state of health, anatomical features); whether there were alternative treatment options. Based on the explanations received, the court will be able to assess whether the patient's attention was focused on the relevant circumstances, whether his consent was conscious, and the complications that occurred were foreseeable.

CRIMINAL AND LEGAL PROTECTION OF RELATIONS IN THE FIELD OF 3D-BIOPRINTING

The presented publication is devoted to identifying criminal risks and threats arising from the active use of 3D bioprint technologies in medicine and developing proposals for improving criminal legislation in this area. The choice of this topic is updated by the fact that at the moment there is no comprehensive study of issues related to 3D bioprinting, including the consideration of legal issues. The active introduction of biotechnologies can contribute to the emergence of biocrime. Due to the fact that the use of bioprinting is a type of medical intervention and a type of high-tech medical care, there is a risk of harm to life and health to patients who plan to transplant a bioprinted organ or tissue, or to donors who donate cells for the subsequent bioprinting procedure, as well as personnel involved in the bioprinting process (bioengineers, doctors). The methodological basis of the study is general scientific (synthesis, generalization, analysis, deduction, induction) and special (formal legal, comparative legal) methods of scientific knowledge. As a result of the study, measures were proposed to improve criminal legislation in the field of bioprinting, as well as rules were developed for qualifying illegal actions of persons in the field of bioprinting technologies. The results obtained can be used in the development of proposals for improving the current criminal legislation, as well as in educational and scientific processes.

Therapeutic Abortion Methods in Women Referring to Educational and Medical Centers in Shiraz

Background: Abortion is one of the most common side effects of pregnancy, which has had shown a steady or even growing trend over the past few decades despite extensive efforts in prenatal care. Objective: This study aimed to investigate medical interventions for abortions in pregnant women referring to educational and medical centers in Shiraz, Iran, in 2018. Methods: In this cross-sectional study, 437 pregnant women referred to Shiraz Educational and Forensic Medicine Centers were selected. A questionnaire including demographic characteristics, midwifery information and types of medical interventions was completed for each. Data were analyzed by SPSS software using statistical tests. Results: According to the results of the present study, most subjects were aged 31-40 years (202 (46%)), had a high school diploma (183 (41%)), and were housewives (331 (57%)). Most of their gestational age was in the range of 16-20 weeks (184 (41%)). There was also a significant positive relationship observed between maternal age and gestational age (p = 0.01). Misoprostol and cervical Foley were the most used methods in induced abortions with a forensic permit (44.3%), vaginal misoprostol was the most used method in induced abortions with other indications (43.9%), and most spontaneous abortions involved no intervention (41.9%). Conclusion: Considering the importance of the medical abortion method, it is suggested to be considered for patients with different conditions in interventional studies. Also, the correct use of different family planning methods and identification of factors affecting the use of contraceptives are recommended after an abortion. Women’s education and men’s participation should be considered in the prevention of high-risk and unwanted pregnancies.

Effects of non-pharmacological coping strategies for reducing labor pain: A systematic review and network meta-analysis.

BackgroundFacilitating the childbirth process is a global issue. Many strategies have been developed to cope with labor pain and improve the delivery experience and satisfaction of pregnant women. The results of different types of medical intervention on women’s expectant pain have been varied. Therefore, this systematic review was aimed at summarizing the body of evidence regarding the effects of various non-pharmacological coping strategies for reducing labor pain.MethodsThe review was conducted according to guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We systematically searched the articles published between 1989 and 2020 in six electronic databases: PubMed, MEDLINE, CINAHL, WOS, PsycARTICLES, and Airiti Library, and the reference lists of the Clinical Trial Registry. Twenty studies were identified, with eight eligible studies included in the Bayesian network meta-analysis.ResultsEight studies with 713 participants were included in the meta-analysis with nine different non-pharmacological strategies for reducing labor pain. The traditional meta-analysis demonstrated that the non-pharmacological coping strategies were effective in reducing labor pain. Of these interventional strategies, the ranking probabilities analysis of the network meta-analysis suggested that the Bonapace Method may be the most effective strategy in reducing labor pain, followed by acupressure.ConclusionsNon-pharmacological coping strategies can reduce labor pain while maintaining an effective and satisfactory delivery experience. This systematic review, by synthesizing the body of evidence, demonstrated that non-pharmacological coping strategies are effective in reducing labor pain. Furthermore, as demonstrated in the network meta-analysis, the Bonapace Method, modulating birth pain by involving the father, is the most effective non-pharmacological intervention for reducing labor pain.

Особенности приверженности лечению и типа отношения к болезни пациентов терапевтического и хирургического профиля

The aim of this study is to study the characteristics of treatment adherence and the types of attitude to the disease of patients with various diseases. Special attention is paid to the study of these characteristics in patients with therapeutic and surgical profiles. The article describes the relevance of scientific work, analyzes recent studies and identifies general patterns in the structure of treatment adherence and types of attitude to the disease in patients with various types of medical intervention. The paper presents a scheme of experimental research of the types of reactions to the disease and components of treatment adherence, describes the results of the study of the features of treatment adherence and the type of attitude to the disease of patients with therapeutic and surgical profiles The use of the obtained results will allow us to identify the main targets of influence on patients ' adherence to treatment in order to increase it, to ensure the fastest and most effective adaptation of patients to the conditions of the treatment process. It is also important to have the ability to increase the effectiveness of the treatment itself by reducing stress reactions. In addition, the use of data obtained during the study can be useful for doctors and medical personnel working with such patients. This will allow you to adjust and optimize the process of treatment and recovery of patients, taking into account the characteristics of the response to the disease and, as a result, the implementation or non-implementation of individual recommendations and prescriptions of the attending physician.

Rationale for revascularization to improve prognosis in stable coronary artery disease: the data from ISCHEMIA trial

Although myocardial revascularization is one of the most studied types of medical interventions, there is a heated discussion in cardiology about the feasibility and indications for it in patients with stable coronary artery disease (chronic coronary syndrome). The recently completed ISCHEMIA trial is the largest current study comparing conservative versus invasive strategies in this category of patients. The article discusses the rationale for revascularization to improve prognosis according to the ISCHEMIA trial.

Недобровольное медицинское вмешательство: опыт судебного санкционирования

We analyze the features of the legal regulation of the issues of providing medical care in an involuntary manner in connection with infectious diseases that pose a danger to society. We formulate the grounds for compulsory application of medical interventions to people with or suspected of having COVID-19. We substantiate the need for involuntary use of various types of medical intervention in situations of mass spread of dangerous infectious diseases. We propose a mechanism for compulsory implementation of medical intervention measures, which involves mandatory judicial control over the legality, necessity and proportionality of their application. It is sub-stantiated that in an epidemic or pandemic, all medical interventions that are authorized to use by health care professionals should be supported by an en-forcement mechanism. In addition, we assume that the court can authorize not only compulsory hospitalization, which is currently explicitly specified in the legislation, but also compulsory medical examination (inspection), re-strictive quarantine measures (isolation), preventive vaccination in a situation of infectious diseases mass spread. We justify the possible allocation of a single section in the Code of Administrative Judicial Procedure of the Russian Federation on judicial control over various types of involuntary medical intervention.

Ethical issues about the paradigm shift in the treatment of children with trisomy 18.

Until recently, trisomy 18 was considered a disease incompatible with life, with a high percentage of electively terminated pregnancies. The usual behavior was denial of treatment. But some medical interventions have changed the survival of children. A search for articles published in the PubMed database on the latest medical decisions in newborns with trisomy 18 was done. Two main subjects were examined: (1) the chances of survival and (2) the perception of quality of life. Trisomy 18 is no longer considered a disease incompatible with life, and the discussion has shifted towards the type of treatment that is appropriate to initiate at birth. There are two medical attitudes towards these children: either palliative care or life-prolonging interventions. With medical intervention, the survival is as high as 23% at 5years of age. Regarding the quality of life, all decision-makers emphasize the possibility of taking the child home. The physicians' perception is more pessimistic than that of the parents. Only a few children benefit from medical interventions.Conclusion: There is a rethinking of treatment behavior in children with trisomy 18. The possible quality of life achieved should be further investigated. It seems inappropriate to simply dismiss medical interventions.What is Known• Until recently, trisomy 18 was considered a disease incompatible with life. The most common behavior was abortion and denial of treatment.What is New• It is no longer considered a lethal disease. The type of medical intervention that is appropriate to perform is now being discussed. Selected children benefit from an interventionist approach.

Variation in Dysphagia Assessment and Management in Acute Stroke: An Interview Study.

(1) Background: Patients with dysphagia are at increased risk of stroke-associated pneumonia. There is wide variation in the way patients are screened and assessed. The aim of this study is to explore staff opinions about current practice of dysphagia screening, assessment and clinical management in acute phase stroke. (2) Methods: Fifteen interviews were conducted in five English National Health Service hospitals. Hospitals were selected based on size and performance against national targets for dysphagia screening and assessment, and prevalence of stroke-associated pneumonia. Participants were purposefully recruited to reflect a range of healthcare professions. Data were analysed using a six-stage thematic process. (3) Results: Three meta themes were identified: delays in care, lack of standardisation and variability in resources. Patient, staff, and service factors that contribute to delays in dysphagia screening, assessment by a speech and language therapist, and delays in nasogastric tube feeding were identified. These included admission route, perceived lack of ownership for screening patients, prioritisation of assessments and staff resources. There was a lack of standardisation of dysphagia screening protocols and oral care. There was variability in staff competences and resources to assess patients, types of medical interventions, and care processes. (4) Conclusion: There is a lack of standardisation in the way patients are assessed for dysphagia and variation in practice relating to staff competences, resources and care processes between hospitals. A range of patient, staff and service factors have the potential to impact on stroke patients being assessed within the recommended national guidelines.

Non-occupational allergic contact dermatitis caused by long-lasting nail polish kits for home use: 'the tip of the iceberg'.

Allergic contact dermatitis (ACD) from (meth)acrylates caused by long lasting nail polish (also known as "permanent", "semi-permanent" or "gel nail polish") has been described both in occupational and non-occupational settings. Inexpensive kits for home use have been available for purchase in many stores or through the Internet. To report on several further cases of consumers sensitised to these nail products. Patch test results and evaluation of ingredient labelling of products brought in by the patients. Four new cases are presented. Three of the patients reacted to 2-hydroxypropyl methacrylate, 2-hydroxyethyl methacrylate and ethyleneglycol dimethacrylate (EGDMA), and all 4 to 2-hydroxy ethylacrylate. Acrylates are present in a wide range of products including medical materials. Sensitization from (meth)acrylates caused by a merely aesthetic procedure might significantly impact health by jeopardizing access to several types of medical interventions. Policies should be implemented restricting the use of long-lasting nail polishes to qualified professionals and banning the indiscriminate sale of kits for home use.

Patient benefit of dog-assisted interventions in health care: a systematic review

BackgroundDogs are the most common companion animal, and therefore not surprisingly a popular choice for animal-assisted interventions. Dog-assisted interventions are increasingly used in healthcare. The aim of the review was to conduct a systematic literature review of quantitative studies on dog-assisted interventions in healthcare, with the intention of assessing the effects and cost-effectiveness of the interventions for different categories of patients.MethodsA systematic review of the scientific literature reporting results of studies in healthcare, nursing home or home care settings, was conducted. The inclusion criteria applied for this review were: quantitative studies, inclusion of at least 20 study subjects, existence of a control and performed in healthcare settings including nursing homes and home care. The electronic databases PubMed, AMED, CINAHL and Scopus were searched from their inception date through January 2017, for published articles from peer-reviewed journals with full text in English.ResultsEighteen studies that fulfilled the inclusion criteria, and were judged to be of at least moderate quality, were included in the analysis. Three of them showed no effect. Fifteen showed at least one significant positive effect but in most studied outcome measures there was no significant treatment effect. Dog-assisted therapy had the greatest potential in treatment of psychiatric disorders among both young and adult patients. Dog-assisted activities had some positive effects on health, wellbeing, depression and quality of life for patients with severe cognitive disorders. Dog-assisted support had positive effects on stress and mood.ConclusionsThe overall assessment of the included studies indicates minor to moderate effects of dog-assisted therapy in psychiatric conditions, as well as for dog-assisted activities in cognitive disorders and for dog-assisted support in different types of medical interventions. However, the majority of studied outcome measures showed no significant effect.

Abstract P3-09-01: BRCAsearch - results of population-based screening of BRCA1 and BRCA2 germline mutations in incident breast cancer in South Sweden

Abstract P3-09-01: BRCAsearch - results of population-based screening of BRCA1 and BRCA2 germline mutations in incident breast cancer in South Sweden

Use of antidepressants during pregnancy in the Netherlands: observational study into postpartum interventions

BackgroundPsychiatric disorders and use of selective antidepressants during pregnancy can have negative effects on mother and infant postpartum. This study aimed to provide evidence-based recommendations on observation of antidepressant-exposed mother-infant dyads.MethodsIn this observational study, mother-infant dyads were observed for possible consequences of either the maternal psychiatric disorder or fetal exposure to selective antidepressants during pregnancy. These possible complications can lead to medical interventions, including 1. adjustment of antidepressants 2. admission to the psychiatric department 3. additional investigations due to indistinctness about the origin of neonatal symptoms 4. treatment of poor neonatal adaptation and 5. consultation of an external organization for additional care. The type, number and time to medical interventions were analyzed.ResultsIn 61% of the 324 included mother-infant dyads one or more intrventions were performed. Adjustment of antidepressants and treatment of poor neonatal adaptation were most prevalent. In 75% of dyads the final intervention was performed within 48 h.ConclusionsThe high prevalence and type of medical interventions requires professional observation of all mother-infant dyads exposed to selective antidepressants. In the absence of specialized home care, hospital admission is indicated whereby an observational period of 48 h seems sufficient for most dyads.

A Survey on the Willingness of Clinical Research Professionals to Participate in Clinical Research

Objective: To identify the impact of professional knowledge and education on willingness to participate in clinical trials. Methods: The study was conducted during January 2017 at Eastern Michigan University, Michigan, United States. It was a cross-sectional quantitative study in which clinical research professionals were invited to complete a shortened version of the Center for Information and Study on Clinical Research Participation (CISCRP) survey assessing their willingness to participate in clinical trials. A comparison was made between the sample of this study and the results of the CISCRP survey. Results: The 83 people who answered the survey represent 20% of the total number of people, which are 415, who were invited to participate. The study found that 80.6% of the survey respondents were willing to participate in clinical trials, significantly less than the results of the CISCRP survey on postgraduates, which found that 96.3% of respondents were willing to participate in clinical trials. In the present study, willingness was significantly higher among females and those with previous clinical trials experience. Willingness to participate correlated positively with perception of clinical trials safety (r=0.503, p<0.001). Conclusion: Overall, the clinical research professionals were moderately willing to participate in clinical trials but they were less willing to participate in clinical trials than the postgraduate participants of the CISCRP survey. Although some factors such as safety and type of medical intervention must be considered when attempting actual participation, knowledge and professional background affected the willingness to participate in clinical trials. These findings should not discourage efforts to recruit clinical research professionals into clinical trials.

EXAMINING EVIDENCE IN U.S. PAYER COVERAGE POLICIES FOR MULTI-GENE PANELS AND SEQUENCING TESTS

The aim of this study was to examine the evidence payers cited in their coverage policies for multi-gene panels and sequencing tests (panels), and to compare these findings with the evidence payers cited in their coverage policies for other types of medical interventions. We used the University of California at San Francisco TRANSPERS Payer Coverage Registry to identify coverage policies for panels issued by five of the largest US private payers. We reviewed each policy and categorized the evidence cited within as: clinical studies, systematic reviews, technology assessments, cost-effectiveness analyses (CEAs), budget impact studies, and clinical guidelines. We compared the evidence cited in these coverage policies for panels with the evidence cited in policies for other intervention types (pharmaceuticals, medical devices, diagnostic tests and imaging, and surgical interventions) as reported in a previous study. Fifty-five coverage policies for panels were included. On average, payers cited clinical guidelines in 84 percent of their coverage policies (range, 73-100 percent), clinical studies in 69 percent (50-87 percent), technology assessments 47 percent (33-86 percent), systematic reviews or meta-analyses 31 percent (7-71 percent), and CEAs 5 percent (0-7 percent). No payers cited budget impact studies in their policies. Payers less often cited clinical studies, systematic reviews, technology assessments, and CEAs in their coverage policies for panels than in their policies for other intervention types. Payers cited clinical guidelines in a comparable proportion of policies for panels and other technology types. Payers in our sample less often cited clinical studies and other evidence types in their coverage policies for panels than they did in their coverage policies for other types of medical interventions.

For All Humanity: Mesoamerican and colonial medicine in Enlightenment Guatemala by Martha Few

Reviewed by: For All Humanity: Mesoamerican and colonial medicine in Enlightenment Guatemala by Martha Few Laura Matthew For All Humanity: Mesoamerican and colonial medicine in Enlightenment Guatemala By Martha Few. Tucson: University of Arizona Press, 2015. Martha Few's fascinating book establishes the colonial precedents of Enlightenment-era humanitarianism and medical science, and describes public health campaigns initiated and executed far from imperial centers of power. She details the contributions of remarkable individuals like Chiapas-born Creole physician José Flores, Maya diviner-healer Miguel Chonay, Franciscan friar and ethnobotanist Mariano José Herrarte, and other Central American men and women of European, Mesoamerican and African descent who drew on and contributed to medical knowledge that circulated the globe. Successful inoculation campaigns against smallpox in Central America in the 1780s and 1790s influenced future medical humanitarian efforts across the Spanish empire. At the same time, Few emphasizes the expanded state power that such campaigns implied and the distrust they aroused even after significant success in the reduction of disease. The book is organized thematically and by types of medical intervention. Chapter 1 provides a general history of epidemic disease in Central America since the sixteenth century. Chapters 2 and 3 consider Guatemalan campaigns against typhus and promoting cesarean operations, respectively, in the late eighteenth and early nineteenth centuries. Relying on an impressive variety of sources, Few presents some of the most evocative accounts of the devastating experience of epidemic disease in Central America that I have seen, calling to mind Gabriela Ramos's sensitive portrayal of end-of-life practices amongst urban Andeans in the sixteenth century and Miguel León Portilla's poetic rendering of Nahuatl lamentations from central Mexico.1 Although she does not engage the history of emotions directly, Few helps us consider the early modern devastation of the Native population in new, not merely statistical or biological ways. By the late eighteenth century, Mesoamerican and European practitioners had been working sometimes in tandem, sometimes in opposition, for centuries to treat and comfort the sick. According to Few, the resulting patterns of collaboration, syncretism, resistance, and enforcement prefigured regional smallpox inoculation campaigns in 1780 and 1794, covered in Chapters 4 and 5. Traditionally Christian views of the poor, the enslaved and "Indians" as deserving of aid were integrated into a modernizing Enlightenment vision of science and the state. Nowhere is this integration more apparent than in the late eighteenth-century Catholic concern for the soul of a living fetus "imprisoned" within the womb of a dead mother. Guatemalan authorities trained practitioners in new surgical techniques and mandated post-mortem cesareans in the 1790s regardless of the desires of the family of the woman or the father of the child, instituting a "policy of surveillance" (113) in which women self-reported their pregnancies to priests and fetuses acquired the status of colonial subjects. Similarly, churchmen and women of all ethnicities helped implement state inoculation policies by reassuring parishioners, acting as interpreters, mobilizing local resources and learning inoculation methods themselves. Community funds gathered by the Catholic church helped to pay for massive distributions of food and blankets and to set up clinics to care for the sick. Longstanding colonial institutions and policies thereby helped the state assume unprecedented responsibility for the wellbeing of its subjects' bodies as well as their souls, according to the latest advances in medical science. Throughout, Few emphasizes the "tensions between compassion and coercion" (163) that underlay these humanitarian efforts. On the one hand, Protomedicato Florés and other Guatemalan officials were surprisingly solicitous of the colonial subjects they were trying to help and surprisingly open to Mesoamerican healing practices. They used powders made from local insects to raise blisters for inoculation in order to frighten children less, considered Mesoamerican preferences when establishing invalids' diets, and preferred obsidian blades for bloodletting. Public displays of mutual respect between medical and local officials helped ensure cooperation. The Jenner cowpox vaccine, independently acquired in Central America during an energetic campaign to harvest the virus regionally in advance of samples being sent from Europe, was tested first on the children of urban Creole elites who had contributed the funds to obtain it. On the other hand, the heavy hand of the...

Air MEDEVAC in case of multiple casualties -The experience of civilian-military cooperation in RoAF

Introduction: Starting September 2010 in Romania was created the Military Emergency Medical Service (SMMU) by the Ministry of National Defense, which has as main mission to provide first aid and save the lives of military personnel during military operations using special equipped MEDEAVC aircraft. Nationwide exist the national emergency system which operates thru 112- SMURD acting in support of the civilian population. In case of accidents with multiple victims the experience has shown the need for collaboration between the two systems, in order to save lives. In the last 5 years there has been an increasing Airlift missions (MEDEVAC) with multiple victims executed by joint civil-military medical teams using military aircraft. Material and methods. This paper provides a review of the most important aspects of particularities, advantages and disadvantages of this type of medical transport using the MEDEVAC missions based study carried out by the Air Force in recent years. Results and conclusions. Performing these tasks presents challenges to mission planning, use of medical equipment and procedures, command-control system, exercise programs jointly joint medical teams and, of course, managing a large number of patients in flight. The large number of patients transported safely and in the shortest time, regardless of weather conditions recommends this type of medical intervention. Given the Romanian military presence in various theaters and that NATO strategic medical evacuation is a national responsibility, the capacity of air transport in case multiple casualties is a priority.

Older Women Want to Look Good Despite Media Pressure to Look Young

Abstract: The media’s obsession with a youthful appearance can have detrimental effects on older adults’ well-being. Scholars have argued that the anti-ageing movement, rather than ageing itself, should be contested. From an evolutionary psychology perspective attractiveness is related to mating preference. This poses an issue for older women who are bombarded with idealised images of youthfulness equating to beauty in media and society. For many, the result is distorted body image, low self-esteem and poor health. It is clear that appearance matters and therefore many women manage the appearance of their ageing skin by using cosmetics or medical interventions. The main objective of this paper was to investigate the influence of the media’s obsession with youthful appearance on women aged over 60 and the impact of this on their attitudes towards managing the skin ageing process. Individual semi-structured interviews were conducted with 21 participants whose mean age was 65.38 years. Ten of the participants had used some type of medical intervention (chemical peels, Botox, skin fillers, cosmetic surgery, laser and HRT). These formed the Medical group; the other eleven used skin care products and regimes but had not undergone medical interventions. These were the Nonmedical group. The transcripts were thematically analysed and showed that although the participants objected to the negative portrayal of older women in the media and to pressures to conform to a youthful appearance, they were not unduly influenced by this. Instead they were overwhelmingly in favour of looking good rather than looking young or even looking younger and the majority was not interested in cosmetic surgery. Taking a social constructivist approach, the findings challenge those which suggest women are weakened by the pressures of media representations of youthfulness as the only goal. The women in our study were aware of the pressures to look young, but were generally more concerned with looking good.

Is Individualized Medicine More Cost-Effective? A Systematic Review

Individualized medicine (IM) is a rapidly evolving field that is associated with both visions of more effective care at lower costs and fears of highly priced, low-value interventions. It is unclear which view is supported by the current evidence. Our objective was to systematically review the health economic evidence related to IM and to derive general statements on its cost-effectiveness. A literature search of MEDLINE database for English- and German-language studies was conducted. Cost-effectiveness and cost-utility studies for technologies meeting the MEDLINE medical subject headings (MeSH) definition of IM (genetically targeted interventions) were reviewed. This was followed by a standardized extraction of general study characteristics and cost-effectiveness results. Most of the 84 studies included in the synthesis were from the USA (n = 43, 51 %), cost-utility studies (n = 66, 79 %), and published since 2005 (n = 60, 71 %). The results ranged from dominant to dominated. The median value (cost-utility studies) was calculated to be rounded $US22,000 per quality-adjusted life year (QALY) gained (adjusted to $US, year 2008 values), which is equal to the rounded median cost-effectiveness in the peer-reviewed English-language literature according to a recent review. Many studies reported more than one strategy of IM with highly varying cost-effectiveness ratios. Generally, results differed according to test type, and tests for disease prognosis or screening appeared to be more favorable than tests to stratify patients by response or by risk of adverse effects. However, these results were not significant. Different definitions of IM could have been used. Quality assessment of the studies was restricted to analyzing transparency. IM neither seems to display superior cost-effectiveness than other types of medical interventions nor to be economically inferior. Instead, rather than 'whether' healthcare was individualized, the question of 'how' it was individualized was of economic relevance.