Harefuah
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Preterm labor is defined as delivery before 37 weeks of gestation. Up to 17% of twin pregnancy are preterm. Arabin cervical pessary has been proven as preventing preterm labor in singleton pregnancies. The benefit of it in twin pregnancy is controversial. ⋯ Considering the conclusion in this research it seems that the combination of the mechanical effect of the pessary by embracing the cervix, keeping the cervical mucus, bending it in a way that the pressure is towards the anterior cervical wall together with the progestative effect which increases the estrogen/progesterone ratio, creating uterine quiescence and keeping the structural connective tissue of the cervix have an added benefit. It seems that the combined use of Arabin cervical pessary and vaginal progesterone in twin pregnancy with short cervical length have a synergic effect which may have a benefit in preventing preterm labor. The combination of cervical pessary and progesterone does not negatively affect twin pregnancy outcome and does not cause preterm birth.
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This article describes the COVID19 effects on telehealth, which is becoming an integral part of medical treatment. In telehealth, healthcare personnel are required to follow the legislation which applies to more traditional medical encounters. ⋯ We focus on informed consent, medical confidentiality and privacy, documentation and liability. Finally, we raise the issue of artificial intelligence in telehealth and resulting future legal challenges.
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Improved medical technology is associated with rapidly growing sub-populations suffering from incurable co-morbidities for prolonged periods of time before death. Although there is no evidence based medicine (EBM) proving positive benefit/risk ratios for most medications in these sub-populations, it is evident that they are attended by an increased number of specialists, each of whom add medications based on "their" guidelines. Eventually, more people suffer from inappropriate medication use and polypharmacy (IMUP); IMUP's negative medical, economic and social consequences represent the 21st-century iatrogenic pandemic. ⋯ Partnership with patients/families in decision-making is essential in geriatric-palliative ethical approaches, to overcome barriers to de-prescribing. Borrowing the language of epidemics, several approaches of "curing the infected" (reducing polypharmacy) were suggested; Israeli studies have proven improved functional, mental and cognitive status and patient/family satisfaction, following massive de-prescribing, compared with those who adhered to standard recommendations. "Immunization" (prevention), should concentrate on early education of professionals and laymen about IMUP and de-prescribing. Rational de-prescribing represents "a triple-win-win game"- improves life quality in the last years of life and has huge economic benefits.
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To review the literature, to present the experience with MMS of a single medical center in Israel and to compare findings to worldwide MMS trends. ⋯ The upward trends found in this study correlate with the worldwide MMS trends and the rising incidence of cutaneous malignancy in Israel. More specialists are needed due to the increase in demand of MMS procedures.
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Lung cancer patients who contract the new coronavirus, appear to have a greater risk for severe COVID-19 illness along with early deterioration and death. However, the prognosis may depend on the cancer stage and the type of treatment administered. ⋯ The present summary of guideline recommendations provides different management strategies for patients with lung cancer. These care approaches attempt to solve new challenges raised by the COVID-19 pandemic. Each specific case must be considered individually.