Oxygenation, early resuscitation in trauma and drug treatment in cardiac arrest

Malin Jonsson Fagerlunds research group study oxygenation, early resuscitation in trauma and drug treatment in cardiac arrest. We do translational research and clinical trials based on clinical problems and with the aim to improve patient care.


Yearly, 10% of the population (almost 1 million Swedes) go through surgery. Hypoxia remains the main ultimate cause of anesthesia-related death and morbidity and most of these events occurs during induction of anesthesia or due to residual effects of anesthetics in high-risk patients.

In this project we generate and implement novel approaches for the prevention of acute hypoxia in the perioperative period that occur as a result of anesthesia. Novel technology for pre-oxygenation and oxygenation will be evaluated in clinical trials, state-of-the-art patient-centred physiological monitoring and experimental studies. This project will bring novel innovative technology to patient care and will ultimately have the potential to reduce perioperative respiratory complications and to increase patient safety. 

We have recently published promising results within the field of both pre-oxygenation and apneic oxygenation, and are currently conducting several studies in this area. The results from our studies are starting to become a game changer in the field of anesthesia and will serve as a basis for a safer perioperative patient management, an improved quality of care and a reduction of the costs, when the use of high-flow nasal oxygen is implemented within the coming years.


This project evaluate pathophysiology, biomarker patterns and novel treatments in the early resuscitation phase of patients with severe bleeding and hemorrhagic shock following trauma. This research project will address factors important for survival and will bring potential new treatment strategies into the clinic and could ultimately improve outcomes for a patient group with low survival.

Cardiac arrest

This project investigate the potential of levosimendan as a therapeutic intervention for cardiac arrest with STEMI, with a focus on understanding its underlying mechanisms. We have demonstrated that levosimendan improve survival and improves cardiac performance in an experimental model. Introduction of levosimendan as a potential pharmacological intervention to patients with cardiac arrest has the potential to dramatically change the care and outcome for these patients.

Other projects that the research group is involved in included perioperative care of patients with obstructive sleep apnea, control of ventilation, COVID-19 and emergency laparotomy project.

Support our research

Group members

Malin Jonsson Fagerlund MD, Research Group Leader

Magnus Hedberg MD, Senior Consultant


Ida-Maria Forsberg, Consultant ( ida-maria.forsberg@regionstockholm.se)

Erik von Oelreich, Consultant (erik.von.oelreich@regionstockholm.se)

Susanne Rysz, Senior Consultant (Susanne.rysz@regionstockholm.se)


Albin Sjöblom, Resident

Benjamin Flam, Consultant

Daniel Ohlén, Consultant

Atosa Nejatian, Consultant

Frida Hoffman, Consultant

Tommy Batz, Anesthesia nurse

Bjarni Arnason, Consultant

In collaboration with Therese Djärv, Jessica Kåhlin, Emma Larsson, Johan Lundberg


Swedish Research Council

ALF, Region Stockholm

Laerdal Fundation




  1. Cardiopulmonary haemodynamic effects and gas exchange during apnoeic oxygenation with high-flow and low-flow nasal oxygen: A large animal study.
    Forsberg IM, Al-Saadi J, Sjöblom A, Grape L, Petersson J, Lundberg J, Lodenius A, Eriksson LI, Fagerlund MJ
    Eur J Anaesthesiol 2023 Aug;40(8):568-577
  2. Pre-oxygenation using high-flow nasal oxygen in parturients undergoing caesarean section in general anaesthesia: A prospective, multi-centre, pilot study.
    Sjöblom A, Hedberg M, Johansson S, Henningsson R, Soumpasis I, Lafrenz H, Törnberg D, Lodenius Å, Fagerlund MJ
    Acta Anaesthesiol Scand 2023 Sep;67(8):1028-1036
  3. Awake prone positioning in patients with hypoxemic respiratory failure due to COVID-19: the PROFLO multicenter randomized clinical trial.
    Rosén J, von Oelreich E, Fors D, Jonsson Fagerlund M, Taxbro K, Skorup P, Eby L, Campoccia Jalde F, Johansson N, Bergström G, Frykholm P, 
    Crit Care 2021 Jun;25(1):209
  4. Biomarkers for oxidative stress and organ injury during Transnasal Humidified Rapid-Insufflation Ventilatory Exchange compared to mechanical ventilation in adults undergoing microlaryngoscopy: A randomised controlled study.
    Forsberg IM, Mkrtchian S, Ebberyd A, Ullman J, Eriksson LI, Lodenius Å, Jonsson Fagerlund M
    Acta Anaesthesiol Scand 2021 Oct;65(9):1276-1284
  5. Letter to the Editor in response to "Find the real responders and improve the outcome of awake prone positioning".
    Rosén J, von Oelreich E, Fors D, Jonsson Fagerlund M, Taxbro K, Frykholm P
    Crit Care 2021 Aug;25(1):273
  6. Positive Expiratory Pressure Therapy on Oxygen Saturation and Ventilation After Abdominal Surgery: A Randomized Controlled Trial.
    Spyckerelle I, Jonsson Fagerlund M, Holmgren E, Johansson G, Sahlin C, Thunberg J, Franklin KA
    Ann Surg Open 2021 Dec;2(4):e101
  7. Pre-oxygenation using high-flow nasal oxygen vs. tight facemask during rapid sequence induction.
    Sjöblom A, Broms J, Hedberg M, Lodenius Å, Furubacke A, Henningsson R, Wiklund A, Nabecker S, Theiler L, Jonsson Fagerlund M
    Anaesthesia 2021 Sep;76(9):1176-1183
  8. Pre-oxygenation using high-flow nasal oxygen vs. tight facemask during rapid sequence induction: a reply.
    Sjöblom A, Lodenius Å, Hedberg M, Fagerlund MJ
    Anaesthesia 2021 Sep;76(9):1275
  9. Pre-oxygenation using high-flow nasal oxygen vs. tight facemask during rapid sequence induction: a reply.
    Sjöblom A, Hedberg M, Lodenius Å, Jonsson Fagerlund M
    Anaesthesia 2021 Sep;76(9):1277-1278
  10. Dexmedetomidine Sedation and Airway Collapsibility: Reply.
    Lodenius Å, Jonsson Fagerlund M
    Anesthesiology 2020 Jun;132(6):1609-1610
  11. Lung volume changes in Apnoeic Oxygenation using Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) compared to mechanical ventilation in adults undergoing laryngeal surgery.
    Forsberg IM, Ullman J, Hoffman A, Eriksson LI, Lodenius Å, Fagerlund MJ
    Acta Anaesthesiol Scand 2020 Nov;64(10):1491-1498
  12. The impact of damage-associated molecular patterns on the neurotransmitter release and gene expression in the ex vivo rat carotid body.
    Mkrtchian S, Kåhlin J, Gómez-Galán M, Ebberyd A, Yoshitake T, Schmidt S, Kehr J, Hildenborg M, Jonsson Fagerlund M, Erlandsson Harris H, Eriksson LI
    Exp Physiol 2020 Sep;105(9):1634-1647
  13. Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) vs. facemask breathing pre-oxygenation for rapid sequence induction in adults: a prospective randomised non-blinded clinical trial.
    Lodenius Å, Piehl J, Östlund A, Ullman J, Jonsson Fagerlund M
    Anaesthesia 2018 May;73(5):564-571
  14. Apnoeic oxygenation in adults under general anaesthesia using Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) - a physiological study.
    Gustafsson IM, Lodenius Å, Tunelli J, Ullman J, Jonsson Fagerlund M
    Br J Anaesth 2017 Apr;118(4):610-617


  1. Characteristics and outcome of traumatic cardiac arrest at a level 1 trauma centre over 10 years in Sweden.
    Ohlén D, Hedberg M, Martinsson P, von Oelreich E, Djärv T, Jonsson Fagerlund M
    Scand J Trauma Resusc Emerg Med 2022 Oct;30(1):54

Cardiac arrest


  1. In-situ simulation of CPR in the emergency department - A tool for continuous improvement of the initial resuscitation.
    Sundelin A, Fagerlund MJ, Flam B, Djärv T
    Resusc Plus 2023 Sep;15():100413
  2. Trends in Incidence and Outcomes of Cardiac Arrest Occurring in Swedish ICUs.
    Flam B, Andersson Franko M, Skrifvars MB, Djärv T, Cronhjort M, Jonsson Fagerlund M, Mårtensson J
    Crit Care Med 2023 Sep;():
  3. The Use of Levosimendan after Out-of-Hospital Cardiac Arrest and Its Association with Outcome-An Observational Study.
    Rysz S, Fagerlund MJ, Lundberg J, Ringh M, Hollenberg J, Lindgren M, Jonsson M, Djärv T, Nordberg P
    J Clin Med 2022 May;11(9):
  4. The effect of levosimendan on survival and cardiac performance in an ischemic cardiac arrest model - A blinded randomized placebo-controlled study in swine.
    Rysz S, Lundberg J, Nordberg P, Eriksson H, Wieslander B, Lundin M, Fyrdahl A, Pernow J, Ugander M, Djärv T, Jonsson Fagerlund M
    Resuscitation 2020 May;150():113-12

Obstructive sleep apnea


  1. Identification of Sleep Medicine and Anesthesia Core Topics for Anesthesia Residency: A Modified Delphi Technique Survey.
    Berezin L, Nagappa M, Wong J, Clivatti J, Singh M, Auckley D, Charchaflieh JG, Jonsson Fagerlund M, Gali B, Joshi GP, Overdyk FJ, Margarson M, Mokhlesi B, Moon T, Ramachandran SK, Ryan CM, Schumann R, Weingarten TN, Won CHJ, Chung F
    Anesth Analg 2021 May;132(5):1223-1230
  2. Perioperative Continuous Positive Airway Pressure Therapy: A Review With the Emphasis on Randomized Controlled Trials and Obstructive Sleep Apnea.
    Jonsson Fagerlund M, Franklin KA
    Anesth Analg 2021 May;132(5):1306-1313
  3. Whole blood gene expression signature in patients with obstructive sleep apnea and effect of continuous positive airway pressure treatment.
    Christensson E, Mkrtchian S, Ebberyd A, Österlund Modalen Å, Franklin KA, Eriksson LI, Jonsson Fagerlund M
    Respir Physiol Neurobiol 2021 Dec;294():103746
  4. Hypoxic ventilatory response after rocuronium-induced partial neuromuscular blockade in men with obstructive sleep apnoea.
    Christensson E, Ebberyd A, Hårdemark Cedborg A, Lodenius Å, Österlund Modalen Å, Franklin KA, Eriksson LI, Jonsson Fagerlund M
    Anaesthesia 2020 Mar;75(3):338-347
  5. Sleep disturbances and residual neuromuscular blockade: future research possibilities: a reply.
    Christensson E, Fagerlund MJ
    Anaesthesia 2020 Apr;75(4):553
  6. Can STOP-Bang and Pulse Oximetry Detect and Exclude Obstructive Sleep Apnea?
    Christensson E, Franklin KA, Sahlin C, Palm A, Ulfberg J, Eriksson LI, Lindberg E, Hagel E, Jonsson Fagerlund M
    Anesth Analg 2018 Sep;127(3):736-743


  1. Chronic dysglycemia and risk of SARS-CoV-2 associated respiratory failure in hospitalized patients.
    Rysz S, Jonsson Fagerlund M, Rimes-Stigare C, Larsson E, Campoccia Jalde F, Mårtensson J
    Acta Anaesthesiol Scand 2022 Jan;66(1):48-55
  2. COVID-19 pathophysiology may be driven by an imbalance in the renin-angiotensin-aldosterone system.
    Rysz S, Al-Saadi J, Sjöström A, Farm M, Campoccia Jalde F, Plattén M, Eriksson H, Klein M, Vargas-Paris R, Nyrén S, Abdula G, Ouellette R, Granberg T, Jonsson Fagerlund M, Lundberg J
    Nat Commun 2021 Apr;12(1):2417
  3. Emergency Airway Management in Patients with COVID-19: A Prospective International Multicenter Cohort Study.
    Wong DJN, El-Boghdadly K, Owen R, Johnstone C, Neuman MD, Andruszkiewicz P, Baker PA, Biccard BM, Bryson GL, Chan MTV, Cheng MH, Chin KJ, Coburn M, Jonsson Fagerlund M, Lobo CA, Martinez-Hurtado E, Myatra SN, Myles PS, Navarro G, O'Sullivan E, Pasin L, Quintero K, Shallik N, Shamim F, van Klei WA, Ahmad I
    Anesthesiology 2021 Aug;135(2):292-303
  4. Risks to healthcare workers following tracheal intubation of patients with COVID-19: a prospective international multicentre cohort study.
    El-Boghdadly K, Wong DJN, Owen R, Neuman MD, Pocock S, Carlisle JB, Johnstone C, Andruszkiewicz P, Baker PA, Biccard BM, Bryson GL, Chan MTV, Cheng MH, Chin KJ, Coburn M, Jonsson Fagerlund M, Myatra SN, Myles PS, O'Sullivan E, Pasin L, Shamim F, van Klei WA, Ahmad I
    Anaesthesia 2020 Nov;75(11):1437-1447
  5. Treatment with angiotensin II in COVID-19 patients may not be beneficial.
    Rysz S, Jalde FC, Oldner A, Eriksson LI, Lundberg J, Fagerlund MJ
    Crit Care 2020 Sep;24(1):546


  1. Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents III: The 2023 Geneva revision.
    Fuchs-Buder T, Brull SJ, Fagerlund MJ, Renew JR, Cammu G, Murphy GS, Warlé M, Vested M, Fülesdi B, Nemes R, Columb MO, Damian D, Davis PJ, Iwasaki H, Eriksson LI
    Acta Anaesthesiol Scand 2023 Sep;67(8):994-1017
  2. Association between cerebrospinal fluid biomarkers of neuronal injury or amyloidosis and cognitive decline after major surgery.
    Danielson M, Wiklund A, Granath F, Blennow K, Mkrtchian S, Nellgård B, Oras J, Fagerlund MJ, Granström A, Schening A, Rasmussen LS, Harris HE, Zetterberg H, Ricksten SE, Eriksson LI
    Br J Anaesth 2021 Feb;126(2):467-476
  3. Neuroinflammatory markers associate with cognitive decline after major surgery: Findings of an explorative study.
    Danielson M, Wiklund A, Granath F, Blennow K, Mkrtchian S, Nellgård B, Oras J, Jonsson Fagerlund M, Granström A, Schening A, Rasmussen LS, Erlandsson Harris H, Zetterberg H, Ricksten SE, Eriksson LI
    Ann Neurol 2020 Mar;87(3):370-382
  4. Circulatory Collapse due to Hyperinflation in a Patient with Tracheobronchomalacia: A Case Report and Brief Review.
    Lundström N, Henriksson G, Börjesson O, Jonsson Fagerlund M, Petersson J
    Case Rep Crit Care 2019 ;2019():2921819
  5. Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study.
    Kirmeier E, Eriksson LI, Lewald H, Jonsson Fagerlund M, Hoeft A, Hollmann M, Meistelman C, Hunter JM, Ulm K, Blobner M, 
    Lancet Respir Med 2019 Feb;7(2):129-140
  6. Upper Airway Collapsibility during Dexmedetomidine and Propofol Sedation in Healthy Volunteers: A Nonblinded Randomized Crossover Study.
    Lodenius Å, Maddison KJ, Lawther BK, Scheinin M, Eriksson LI, Eastwood PR, Hillman DR, Fagerlund MJ, Walsh JH
    Anesthesiology 2019 Nov;131(5):962-973
  7. Does apnoeic oxygenation during rapid sequence induction prolong the procedure, or increase patient safety? A reply.
    Lodenius Å, Jonsson Fagerlund M
    Anaesthesia 2018 Aug;73(8):1039-1040
  8. Hypoxia Regulates MicroRNA Expression in the Human Carotid Body.
    Mkrtchian S, Lee KL, Kåhlin J, Ebberyd A, Poellinger L, Fagerlund MJ, Eriksson LI
    Adv Exp Med Biol 2018 ;1071():25-33
  9. Hypoxia regulates microRNA expression in the human carotid body.
    Mkrtchian S, Lee KL, Kåhlin J, Ebberyd A, Poellinger L, Fagerlund MJ, Eriksson LI
    Exp Cell Res 2017 Mar;352(2):412-419
  10. In-hospital clinical outcomes after upper gastrointestinal surgery: Data from an international observational study.
    Szakmany T, Ditai J, Kirov M, Protsenko D, Osinaike B, Venara A, Demartines N, Hubner M, Pearse RM, Prowle JR, 
    Eur J Surg Oncol 2017 Dec;43(12):2324-2332
  11. The immune response of the human brain to abdominal surgery.
    Forsberg A, Cervenka S, Jonsson Fagerlund M, Rasmussen LS, Zetterberg H, Erlandsson Harris H, Stridh P, Christensson E, Granström A, Schening A, Dymmel K, Knave N, Terrando N, Maze M, Borg J, Varrone A, Halldin C, Blennow K, Farde L, Eriksson LI
    Ann Neurol 2017 Apr;81(4):572-582
  12. Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries: a 7-day cohort study of elective surgery.
    Ahmad T, Bouwman RA, Grigoras I, Aldecoa C, Hofer C, Hoeft A, Holt P, Fleisher LA, Buhre W, Pearse RM, 
    Br J Anaesth 2017 Aug;119(2):258-266
  13. Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

    Br J Anaesth 2016 Oct;117(5):601-609
  14. Postanaesthesia pulmonary complications after use of muscle relaxants in Europe: Study protocol of the POPULAR study.
    Fagerlund MJ, Fink H, Baumüller E, Ulm K, Hollmann MW, Meistelman C, Hunter J, Leva B, Damster S, Eriksson LI, Blobner M
    Eur J Anaesthesiol 2016 May;33(5):381-3
  15. Propofol and AZD3043 Inhibit Adult Muscle and Neuronal Nicotinic Acetylcholine Receptors Expressed in Xenopus Oocytes.
    Jonsson Fagerlund M, Krupp J, Dabrowski MA
    Pharmaceuticals (Basel) 2016 Feb;9(1):
  16. Sedation with Dexmedetomidine or Propofol Impairs Hypoxic Control of Breathing in Healthy Male Volunteers: A Nonblinded, Randomized Crossover Study.
    Lodenius Å, Ebberyd A, Hårdemark Cedborg A, Hagel E, Mkrtchian S, Christensson E, Ullman J, Scheinin M, Eriksson LI, Jonsson Fagerlund M
    Anesthesiology 2016 Oct;125(4):700-15
  17. Seizures associated with intentional severe nutmeg intoxication.
    Flam B, Bendz E, Jonsson Fagerlund M, Höjer J
    Clin Toxicol (Phila) 2015 Nov;53(9):917
  18. The Human Carotid Body Gene Expression and Function in Signaling of Hypoxia and Inflammation.
    Kåhlin J, Mkrtchian S, Ebberyd A, Eriksson LI, Fagerlund MJ
    Adv Exp Med Biol 2015 ;860():371-7
  19. The human carotid body releases acetylcholine, ATP and cytokines during hypoxia.
    Kåhlin J, Mkrtchian S, Ebberyd A, Hammarstedt-Nordenvall L, Nordlander B, Yoshitake T, Kehr J, Prabhakar N, Poellinger L, Fagerlund MJ, Eriksson LI
    Exp Physiol 2014 Aug;99(8):1089-98
  20. Prolonged attenuation of acetylcholine-induced phosphorylation of extracellular signal-regulated kinase 1/2 following sevoflurane exposure.
    Wiklund A, Gustavsson D, Ebberyd A, Sundman E, Schulte G, Jonsson Fagerlund M, Eriksson LI
    Acta Anaesthesiol Scand 2012 May;56(5):608-15
  21. Reduced efficacy of the intravenous anesthetic agent AZD3043 at GABA(A) receptors with β2 (N289M) and β3 (N290M) point-mutations.
    Jonsson Fagerlund M, Sjödin J, Dabrowski MA, Krupp J
    Eur J Pharmacol 2012 Nov;694(1-3):13-9
  22. The human carotid body transcriptome with focus on oxygen sensing and inflammation--a comparative analysis.
    Mkrtchian S, Kåhlin J, Ebberyd A, Gonzalez C, Sanchez D, Balbir A, Kostuk EW, Shirahata M, Fagerlund MJ, Eriksson LI
    J Physiol 2012 Aug;590(16):3807-19
  23. Resolving postoperative neuroinflammation and cognitive decline.
    Terrando N, Eriksson LI, Ryu JK, Yang T, Monaco C, Feldmann M, Jonsson Fagerlund M, Charo IF, Akassoglou K, Maze M
    Ann Neurol 2011 Dec;70(6):986-995
  24. Inhibition of muscle acetylcholine receptors by nondepolarizing drugs: humans are not unique.
    Dilger JP, Steinbach JH
    Anesthesiology 2010 Jan;112(1):247-9; author reply 249-50
  25. Presence of nicotinic, purinergic and dopaminergic receptors and the TASK-1 K+-channel in the mouse carotid body.
    Kåhlin J, Eriksson LI, Ebberyd A, Fagerlund MJ
    Respir Physiol Neurobiol 2010 Jul;172(3):122-8
  26. Reduced effect of propofol at human {alpha}1{beta}2(N289M){gamma}2 and {alpha}2{beta}3(N290M){gamma}2 mutant GABA(A) receptors.
    Jonsson Fagerlund M, Sjödin J, Krupp J, Dabrowski MA
    Br J Anaesth 2010 Apr;104(4):472-81
  27. The human carotid body: expression of oxygen sensing and signaling genes of relevance for anesthesia.
    Fagerlund MJ, Kåhlin J, Ebberyd A, Schulte G, Mkrtchian S, Eriksson LI
    Anesthesiology 2010 Dec;113(6):1270-9
  28. Basic principles of neuromuscular transmission.
    Martyn JA, Fagerlund MJ, Eriksson LI
    Anaesthesia 2009 Mar;64 Suppl 1():1-9
  29. Current concepts in neuromuscular transmission.
    Fagerlund MJ, Eriksson LI
    Br J Anaesth 2009 Jul;103(1):108-14
  30. Pharmacological characteristics of the inhibition of nondepolarizing neuromuscular blocking agents at human adult muscle nicotinic acetylcholine receptor.
    Jonsson Fagerlund M, Dabrowski M, Eriksson LI
    Anesthesiology 2009 Jun;110(6):1244-52
  31. Pronounced depression by propofol on carotid body response to CO2 and K+-induced carotid body activation.
    Akada S, Fagerlund MJ, Lindahl SG, Sakamoto A, Prabhakar NR, Eriksson LI
    Respir Physiol Neurobiol 2008 Feb;160(3):284-8
  32. Activation and inhibition of human muscular and neuronal nicotinic acetylcholine receptors by succinylcholine.
    Jonsson M, Dabrowski M, Gurley DA, Larsson O, Johnson EC, Fredholm BB, Eriksson LI
    Anesthesiology 2006 Apr;104(4):724-33
  33. Distinct pharmacologic properties of neuromuscular blocking agents on human neuronal nicotinic acetylcholine receptors: a possible explanation for the train-of-four fade.
    Jonsson M, Gurley D, Dabrowski M, Larsson O, Johnson EC, Eriksson LI
    Anesthesiology 2006 Sep;105(3):521-33
  34. Effect of propofol on carotid body chemosensitivity and cholinergic chemotransduction.
    Jonsson MM, Lindahl SG, Eriksson LI
    Anesthesiology 2005 Jan;102(1):110-6
  35. Neuromuscular blocking agents block carotid body neuronal nicotinic acetylcholine receptors.
    Jonsson M, Wyon N, Lindahl SG, Fredholm BB, Eriksson LI
    Eur J Pharmacol 2004 Aug;497(2):173-80
  36. Neuromuscular blocking agents and carotid body oxygen sensing.
    Jonsson M, Lindahl SG, Eriksson LI
    Adv Exp Med Biol 2003 ;536():135-40
  37. Atracurium and vecuronium block nicotine-induced carotid body chemoreceptor responses.
    Jonsson M, Kim C, Yamamoto Y, Runold M, Lindahl SG, Eriksson LI
    Acta Anaesthesiol Scand 2002 May;46(5):488-94

Contact us

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Malin Jonsson Fagerlund

Senior Lecturer/Senior Physician
Content reviewer:
Aline Lantz