Medical Specialties Commons^™

Relationship Between Surpoint Tag Index, A Radiofrequency Ablation Lesion Quality Indicator, And Atrial Wall Thickness In Cavotricuspid Isthmus Ablations Exhibiting Bidirectional Block., Alexander Smith, Anish K Amin, Rayan El-Zein, Sreedhar R Billakanty, Nagesh Chopra

Heart and Vascular Articles

BACKGROUND: An RFA lesion quality indicator, Surpoint Tag Index

OBJECTIVE: To describe the relationship between atrial wall thickness and TI in CTI exhibiting bidirectional block.

METHODS: Data from 492 RFA lesions from 25 patients undergoing PVI and CTI ablations in SR with point-by-point RF lesions (< 45 W) utilizing a Thermocool Smarttouch

RESULTS: In lesions exhibiting bidirectional block, the thinnest (1-2 mm; 5% lesions) and thickest (8-10 mm; 6% lesions) portions of the CTI correlated with the lowest (429 ± 75) and highest (516 ± 64) TI. The bulk of thickness (2-6 mm; 80%) correlated with a TI of 455 ± 72 (

CONCLUSION: A mean …

Long-Term Results Of Delta Ceramic-On-Ceramic Total Hip Arthroplasty., Thomas J Blumenfeld, Joel Politi, Sean Coker, Tammy O'Dell, William Hamilton

Ambulatory and Primary Care Articles

BACKGROUND: Ceramic-on-ceramic (COC) bearings in total hip arthroplasty (THA) have long been considered the coupling with the lowest overall wear. However, concerns about complications such as ceramic breakage and noise, combined with the improved performance of polyethylene, have limited its use in the United States. This postapproval follow-up reports long-term (10 years) results of Delta COC in THA patients primarily enrolled in an Investigational Device Exemption study.

METHODS: Patients received Delta COC THA in a prospective multicenter study with either 28-mm (N = 105 hips in 104 patients) or 36-mm (N = 81) articulations. Annual clinical and radiographic evaluations were …

Urachal Mucinous Cystic Tumor Of Low Malignant Potential In A Polymorbid Female: A Case Report And Review Of The Literature., Benjamin Schmeusser, Joseph Wiedemer, Dana Obery, Kaila Buckley, Michael Yu

Oncology Articles

Neoplasms of the urachus are exceedingly rare, representing 0.17% of all bladder cancers. The mucinous cystic tumor of low malignant potential (MCTLMP) subtype is particularly rare with just 25 previous cases reported in the literature. Although rare, MCTLMPs are important to identify due to potential devastating complications and good cure rates with surgical removal. We present a 43 year old female with a nuanced constellation of comorbidities and confirmed MCTLMP following a workup for abdominal pain and irritative lower urinary tract symptoms. Notably, this tumor did not change in size over a 3-year course of serial imaging prior to surgical …

Identification Of Circulating Plasma Ceramides As A Potential Sexually Dimorphic Biomarker Of Pancreatic Cancer-Induced Cachexia., Jeffery M Chakedis, Mary E Dillhoff, Carl R Schmidt, Priyani V Rajasekera, David C Evans, Terence M Williams, Denis C Guttridge, Erin E Talbert

Oncology Articles

BACKGROUND: Cancer patients who exhibit cachexia lose weight and have low treatment tolerance and poor outcomes compared to cancer patients without weight loss. Despite the clear increased risk for patients, diagnosing cachexia still often relies on self-reported weight loss. A reliable biomarker to identify patients with cancer cachexia would be a valuable tool to improve clinical decision making and identification of patients at risk of adverse outcomes.

METHODS: Targeted metabolomics, that included panels of amino acids, tricarboxylic acids, fatty acids, acylcarnitines, and sphingolipids, were conducted on plasma samples from patients with confirmed pancreatic ductal adenocarcinoma (PDAC) with and without cachexia …

Video Game Rehabilitation For Outpatient Stroke (Vigorous): A Multi-Site Randomized Controlled Trial Of In-Home, Self-Managed, Upper-Extremity Therapy., Lynne V Gauthier, Deborah S Nichols-Larsen, Gitendra Uswatte, Nancy Strahl, Marie Simeo, Rachel Proffitt, Kristina Kelly, Roger Crawfis, Edward Taub, David Morris, Linda Pax Lowes, Victor Mark, Alexandra Borstad

Neuroscience Articles

BACKGROUND: Integrating behavioral intervention into motor rehabilitation is essential for improving paretic arm use in daily life. Demands on therapist time limit adoption of behavioral programs like Constraint-Induced Movement (CI) therapy, however. Self-managed motor practice could free therapist time for behavioral intervention, but there remains insufficient evidence of efficacy for a self-management approach.

METHODS: This completed, parallel, five-site, pragmatic, single-blind trial established the comparative effectiveness of using in-home gaming self-management as a vehicle to redirect valuable therapist time towards behavioral intervention. Community-dwelling adults with post-stroke (>6 months) mild/moderate upper extremity hemiparesis were randomized to receive one of 4 different …

Response To "Lt's A Win-Win: The Effect Of Medical Students On Clinic Productivity"., Nicholas Anderson

Medical Education Articles

No abstract provided.

Factors Influencing Fellowship Training Among Ophthalmology Residents: A Pilot Study., Craig N Czyz, Rahul Kashyap, Laura L Wayman

Medical Education Articles

OBJECTIVE: There has been an increase in ophthalmology fellowship training programs and applicants. The current ophthalmology literature lacks any recent study examining factors influencing residents' decisions to pursue subspecialty fellowship training.

METHODS: An anonymous, 16-item survey was distributed to residents from a convenience sample of ophthalmology residency programs by their program directors or administrators.

RESULTS: A total of 72 residents and 9 interns from 9 distinct programs completed the survey. Eighty-two percent of respondents reported they have either applied or will apply for a fellowship position. Gender and race showed no significant association with fellowship application. Respondents perceived that obtaining …

Systematic Review To Evaluate Algorithms For Reboa Use In Trauma And Identify A Consensus For Patient Selection., Amelia Walling Maiga, Rishi Kundi, Jonathan James Morrison, Chance Spalding, Juan Duchesne, John Hunt, Jonathan Nguyen, Elizabeth Benjamin, Ernest E Moore, Ryan Lawless, Andrew Beckett, Rachel Russo, Bradley M Dennis

Trauma and Acute Care Articles

BACKGROUND: Patient selection for resuscitative endovascular balloon occlusion of the aorta (REBOA) has evolved during the last decade. A recent multicenter collaboration to implement the newest generation REBOA balloon catheter identified variability in patient selection criteria. The aims of this systematic review were to compare recent REBOA patient selection guidelines and to identify current areas of consensus and variability.

METHODS: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic review of clinical practice guidelines for REBOA patient selection in trauma. Published algorithms from 2015 to 2022 and institutional guidelines from a seven-center …

A Novel Simulation-Based Multidisciplinary Verbal De-Escalation Training., Gary Duncan, Megan Schabbing, Brad D Gable

Trauma and Acute Care Articles

Background Agitated or aggressive patients pose a high risk of emotional and physical harm to hospital staff. Healthcare associates have the highest rate of workplace violence among studied fields. Learning to effectively de-escalate a patient who is a danger to self or others is key to reducing these incidents. This course was designed to improve education and communication among staff on a hospital surgical floor when verbal de-escalation is needed. Methods A ninety-minute simulation-based multidisciplinary curriculum was developed. This included a 30-minute didactic discussion, 10-minute simulation, and 50-minute debrief. Learners included nurses, patient service associates, and protective services officers from …

Nutrition, Atherosclerosis, Arterial Imaging, Cardiovascular Risk Stratification, And Manifestations In Covid-19 Framework: A Narrative Review., Smiksha Munjral, Puneet Ahluwalia, Ankush D Jamthikar, Anudeep Puvvula, Luca Saba, Gavino Faa, Inder M Singh, Paramjit S Chadha, Monika Turk, Amer M Johri, Narendra N Khanna, Klaudija Viskovic, Sophie Mavrogeni, John R Laird, Gyan Pareek, Martin Miner, David W Sobel, Antonella Balestrieri, Petros P Sfikakis, George Tsoulfas, Athanasios Protogerou, Prasanna Misra, Vikas Agarwal, George D Kitas, Raghu Kolluri, Jagjit Teji, Mustafa Al-Maini, Surinder K Dhanjil, Meyypan Sockalingam, Ajit Saxena, Aditya Sharma, Vijay Rathore, Mostafa Fatemi, Azra Alizad, Vijay Viswanathan, P K Krishnan, Tomaz Omerzu, Subbaram Naidu, Andrew Nicolaides, Jasjit S Suri

Heart and Vascular Articles

Background: Atherosclerosis is the primary cause of the cardiovascular disease (CVD). Several risk factors lead to atherosclerosis, and altered nutrition is one among those. Nutrition has been ignored quite often in the process of CVD risk assessment. Altered nutrition along with carotid ultrasound imaging-driven atherosclerotic plaque features can help in understanding and banishing the problems associated with the late diagnosis of CVD. Artificial intelligence (AI) is another promisingly adopted technology for CVD risk assessment and management. Therefore, we hypothesize that the risk of atherosclerotic CVD can be accurately monitored using carotid ultrasound imaging, predicted using AI-based algorithms, and reduced …

Letermovir Prophylaxis And Cytomegalovirus Reactivation In Adult Hematopoietic Cell Transplant Recipients With And Without Acute Graft Versus Host Disease., Delaney Wolfe, Qiuhong Zhao, Emma Siegel, Marcin Puto, Danielle Murphy, Julianna Roddy, Yvonne Efebera, Justin Tossey

Oncology Articles

Cytomegalovirus (CMV) is the most clinically significant infection after allogeneic hematopoietic-cell transplantation (allo-HCT) and is associated with increased mortality. The risk for CMV reactivation increases with graft versus host disease (GVHD). GVHD contributes to significant morbidity and mortality and is treated with immunosuppressive therapies that can further increase CMV infection risk. Prophylaxis with letermovir, an oral antiviral approved to prevent CMV, has been shown to decrease the incidence of CMV infection post-allo-HCT in patients at high risk of CMV reactivation, but there is a lack of data confirming this benefit in patients with GVHD. In this single-center, retrospective study, we …

Incidence And Outcomes Of Infective Endocarditis After Transcatheter Or Surgical Aortic Valve Replacement., Jonas Lanz, Michael J Reardon, Thomas Pilgrim, Stefan Stortecky, G Michael Deeb, Stanley Chetcuti, Steven J Yakubov, Thomas G Gleason, Jian Huang, Stephan Windecker

Heart and Vascular Articles

Background Data comparing the frequency and outcomes of infective endocarditis (IE) after transcatheter (TAVR) to surgical aortic valve replacement (SAVR) are scarce. The objective of this study is to compare the incidence and outcomes of IE after TAVR using a supra-annular, self-expanding platform (CoreValve and Evolut) to SAVR. Methods and Results Data of 3 randomized clinical trials comparing TAVR to SAVR and a prospective continued TAVR access study were pooled. IE was defined on the basis of the modified Duke criteria. The cumulative incidence of IE was determined by modeling the cause-specific hazard. Estimates of all-cause mortality were calculated by …

4-Dimensional Intracardiac Echocardiography In Transcatheter Mitral Valve Repair With The Mitraclip System., Carlos E Sanchez, Steven J Yakubov, Gagan Singh, Jason H Rogers, Nathan H Kander, Gilbert H L Tang

Heart and Vascular Articles

No abstract provided.

So Much Moulage, So Little Time: A Guide To Performing Moulage For Mass Casualty Scenarios., Josh Brooks, Asit Misra, Brad D Gable

Trauma and Acute Care Articles

Simulation has become a central component of healthcare education. Allowing learners to experience low-frequency high-risk situations, such as a mass casualty event, in a safe learning environment is a basic tenet of simulation-based education in healthcare. Creating realistic simulations often involves advanced moulage to accurately represent illness and injury. However, providing advanced moulage for mass casualty exercises can be time-consuming, resource-intensive, and costly. Here we discuss a novel means to execute moulage for multiple victims while maintaining a high level of realism. We executed two simultaneous mass casualty exercises as part of medical student education and employed our novel 3-step …

Surgical Stabilization Of Rib Fractures In Symptomatic Covid-19: A Case Report., Jin Wu, Nirvana Saraswat, Kevin Harris, Brent Goslin, William Devoe

Surgery Articles

Severe chest wall injury following trauma is a significant contributing factor to respiratory failure and need for mechanical ventilation in multiply injured patients. Surgical stabilization of rib fractures (SSRF) is increasingly considered to be advantageous in this population. Surgical stabilization has been shown to improve multiple outcomes including ventilator avoidance, liberation from mechanical ventilation, and diminished pulmonary complications in the trauma population, particularly when performed early. During the coronavirus disease 2019 (COVID-19) pandemic, ventilators have become a scarce resource, and conservative strategies have become a critical component of intensive care. We present a report of the perioperative outcome of SSRF …

Transcatheter Aortic Valve Replacement With Self-Expandable Supra-Annular Valves For Degenerated Surgical Bioprostheses: Insights From Transcatheter Valve Therapy Registry., Luis Augusto P Dallan, John K Forrest, Michael J Reardon, Wilson Y Szeto, Isaac George, Susheel Kodali, Neal S Kleiman, Steven J Yakubov, Kendra J Grubb, Fang Liu, Cristian Baeza, Guilherme F Attizzani

Heart and Vascular Articles

Background Transcatheter aortic valve replacement with supra-annular transcatheter heart valves has been adopted in patients with degenerated surgical aortic valves. The next generation self-expanding Evolut PRO valve has not been evaluated in patients with surgical valve failure. Methods and Results Patients undergoing transcatheter aortic valve replacement in degenerated surgical aortic valve procedures using the Evolut R or Evolut PRO transcatheter heart valves in the Society of Thoracic Surgeons and American College of Cardiology Transcatheter Valve Therapy Registry between April 2015 and June 2019 were evaluated. Transcatheter valve performance was evaluated by clinical site echocardiography. In-hospital, 30-day, and 1-year clinical outcomes …

Airway Obstacle Course For Teaching Prehospital Providers Airway Techniques., Robert Young, John O Elliott, Brad D Gable

OhioHealth Research Institute Articles

BACKGROUND:  Early airway intervention is a vital step in the management of critically ill patients. Emergency medical service (EMS) providers are often first in the chain of survival with equipment to manage airway problems that arise. Therefore, it is paramount that they receive thorough training in aspects of airway management. Often, the training providers currently undergo does not reflect the environmental challenges inherent in EMS. Our obstacle course not only offers trainees a situational environment that simulates common challenges associated with the prehospital environment, but also provides a break from traditional tabletop and lecture-based training methods.

METHODS:  An airway obstacle …

Expandable Intravertebral Implants: A Narrative Review On The Concept, Biomechanics, And Outcomes In Traumatology., Diogo L Moura, Josue P Gabriel

Surgery Articles

Expandable intravertebral implants are self-expanding devices applied percutaneously by the posterior transpedicular approach. These devices introduce the concept of anatomical restoration of vertebral body endplates and direct anatomical reduction performed from the interior of the vertebral body with a compression fracture. This paper aims to provide a narrative review on the concept, indications, biomechanical characteristics, as well as functional and radiographic outcomes of the main expandable intravertebral implants currently available, in terms of their application to thoracolumbar spine traumatology. To this end, we performed a search in July 2021 on the MEDLINE/PubMed platform with the words "expandable intravertebral implant", "armed …

Daratumumab In Patients With Bortezomib-Refractory Proliferative Glomerulonephritis With Monoclonal Immunoglobulin Deposits., Salem Almaani, Samir V Parikh, Anjali A Satoskar, Naresh Bumma, Brad H Rovin, Nidhi Sharma, Yvonne Efebera, Isabelle Ayoub

Ambulatory and Primary Care Articles

No abstract provided.

Predictors Of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion., Trevor Simard, Richard G Jung, Kyle Lehenbauer, Kerstin Piayda, Radoslaw Pracoń, Gregory G Jackson, Eduardo Flores-Umanzor, Laurent Faroux, Kasper Korsholm, Julian K R Chun, Shaojie Chen, Moniek Maarse, Kristi Montrella, Zakeih Chaker, Jocelyn N Spoon, Luigi E Pastormerlo, Felix Meincke, Abhishek C Sawant, Carmen M Moldovan, Mohammed Qintar, Mehmet K Aktas, Luca Branca, Andrea Radinovic, Pradhum Ram, Rayan S El-Zein, Thomas Flautt, Wern Yew Ding, Bassel Sayegh, Tomás Benito-González, Oh-Hyun Lee, Solomon O Badejoko, Christina Paitazoglou, Nabeela Karim, Ahmed M Zaghloul, Himanshu Agrawal, Rachel M Kaplan, Oluseun Alli, Aamir Ahmed, Hussam S Suradi, Bradley P Knight, Venkata M Alla, Sidakpal S Panaich, Tom Wong, Martin W Bergmann, Rashaad Chothia, Jung-Sun Kim, Armando Pérez De Prado, Raveen Bazaz, Dhiraj Gupta, Miguel Valderrabano, Carlos E Sanchez, Mikhael F El Chami, Patrizio Mazzone, Marianna Adamo, Fred Ling, Dee Dee Wang, William O'Neill, Wojtek Wojakowski, Ashish Pershad, Sergio Berti, Daniel Spoon, Akram Kawsara, George Jabbour, Lucas V A Boersma, Boris Schmidt, Jens Erik Nielsen-Kudsk, Josep Rodés-Cabau, Xavier Freixa, Christopher R Ellis, Laurent Fauchier, Marcin Demkow, Horst Sievert, Michael L Main, Benjamin Hibbert, David R Holmes, Mohamad Alkhouli

Heart and Vascular Articles

BACKGROUND: Device-related thrombus (DRT) has been considered an Achilles' heel of left atrial appendage occlusion (LAAO). However, data on DRT prediction remain limited.

OBJECTIVES: This study constructed a DRT registry via a multicenter collaboration aimed to assess outcomes and predictors of DRT.

METHODS: Thirty-seven international centers contributed LAAO cases with and without DRT (device-matched and temporally related to the DRT cases). This study described the management patterns and mid-term outcomes of DRT and assessed patient and procedural predictors of DRT.

RESULTS: A total of 711 patients (237 with and 474 without DRT) were included. Follow-up duration was similar in the …

Epiglottic Squamous Cell Carcinoma., John Carter, Jessica Ball, George Mckean, Samir Patel

Oncology Articles

No abstract provided.

Isolated Volar Dislocation Of The Distal Radioulnar Joint Treated With Successful Closed Reduction., Matthew T Glazier, Hayden B Schuette, Benjamin A Schnee, Brian Skura, Craig Goubeaux

Surgery Articles

We report the case of A 34-year-old right-hand-dominant male who presented with an isolated left volar dislocation of the distal radioulnar joint (DRUJ) without any associated fractures. The patient had sustained the injury in an altercation in the evening prior to the presentation and had woken up the next morning with left wrist pain and restricted wrist motion. Closed reduction was successful under conscious sedation and the patient was treated conservatively with splint immobilization without needing operative intervention. This report highlights a rare injury pattern - an isolated volar DRUJ dislocation - that was successfully closed reduced, despite reports that …

Behavioral Adverse Events With Brivaracetam, Levetiracetam, Perampanel, And Topiramate: A Systematic Review., Bernhard J Steinhoff, Pavel Klein, Henrik Klitgaard, Cédric Laloyaux, Brian D Moseley, Kristen Ricchetti-Masterson, Felix Rosenow, Joseph I Sirven, Brien Smith, John M Stern, Manuel Toledo, Patricia A Zipfel, Vicente Villanueva

Neuroscience Articles

PURPOSE: To understand the currently available post-marketing real-world evidence of the incidences of and discontinuations due to the BAEs of irritability, anger, and aggression in people with epilepsy (PWE) treated with the anti-seizure medications (ASMs) brivaracetam (BRV), levetiracetam (LEV), perampanel (PER), and topiramate (TPM), as well as behavioral adverse events (BAEs) in PWE switching from LEV to BRV.

METHODS: A systematic review of published literature using the Cochrane Library, PubMed/MEDLINE, and Embase was performed to identify retrospective and prospective observational studies reporting the incidence of irritability, anger, or aggression with BRV, LEV, PER, or TPM in PWE. The incidences of …

In-Situ Simulation In Interdisciplinary Family Practice Improves Response To In-Office Emergencies., Brad D Gable, Laurie Hommema

Ambulatory and Primary Care Articles

Background Medical emergencies can present to family medicine offices. For optimal patient outcomes, multiple team members must come together to provide emergency care and mobilize the appropriate resources. In-situ simulation has been used to improve provider knowledge, skills, and attitudes as well as identify latent safety threats. The aim of this training was to provide family medicine physicians, nurses, and office staff education about how to manage in-office emergencies. Specifically, we sought to clarify team members' roles, improve communication, and identify latent safety threats. Methodology Two different in-situ simulations were performed with debriefing sessions. The first was a pediatric patient …

Three-Year Outcomes From The Liberty 360 Study Of Endovascular Interventions For Peripheral Artery Disease Stratified By Rutherford Category., Stefanos Giannopoulos, Jihad Mustapha, William A Gray, Gary Ansel, George Adams, Eric A Secemsky, Ehrin J Armstrong

Heart and Vascular Articles

PURPOSE: To report the 3-year results of the LIBERTY 360 study, which investigated outcomes of endovascular treatment of symptomatic peripheral artery disease (PAD).

MATERIALS AND METHODS: The LIBERTY trial (

RESULTS: The 36-month KM survival rates were 86.0% in RC 2-3, 79.8% in RC 4-5, and 62.0% in RC 6 groups. The KM estimates of freedom from major amputation at 36 months were 98.5% in RC 2-3, 94.0% in RC 4-5, and 79.9% in RC 6. The 36-month KM estimates for freedom from TVR/TLR were 71.1% in RC 2-3, 64.2% in RC 4-5 and 61.9% in RC 6 groups. Patients …

Preventing Physician Suicide., Jennifer L Middleton

Ambulatory and Primary Care Articles

No abstract provided.

Response To "Letter Regarding: Cost Of Headless Vs Headed Screw Fixation For Calcaneal Osteotomy And Subtalar Arthrodesis"., Boren Morgan, Brian Steginsky, Mallory Suhling, Anand Vora

Surgery Articles

Morgan B, Steginsky B, Suhling M, Vora A. Response to "Letter Regarding: Cost of Headless vs Headed Screw Fixation for Calcaneal Osteotomy and Subtalar Arthrodesis". Foot Ankle Orthop. 2021 Apr 30;6(2):24730114211005770. doi: 10.1177/24730114211005770. PMID: 35097444; PMCID: PMC8702681.

Warm Autoimmune Hemolytic Anemia Associated With Asymptomatic Sars-Cov-2 Infection., Joseph R Liput, Kim Jordan, Rini Patadia, Elizabeth Kander

Ambulatory and Primary Care Articles

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the resultant coronavirus disease 2019 (COVID-19) are associated with several hematologic abnormalities, including immune thrombocytopenia, antiphospholipid syndrome, and autoimmune hemolytic anemia (AIHA). Initial case reports suggested immune dysregulation to be the underlying etiology of SARS-CoV-2-associated AIHA, as all reported cases involved patients with moderate to severe COVID-19, many of whom had underlying lymphoproliferative disorders. More recently, AIHA has been reported in patients with mildly symptomatic SARS-CoV-2 infection. Here, we detail a patient with asymptomatic SARS-CoV-2 infection who presented with severe, symptomatic anemia. Workup was consistent with warm autoimmune hemolytic anemia (WAIHA) secondary …

Perioperative Pain Management And Opioid Stewardship: A Practical Guide., Sara J Hyland, Kara K Brockhaus, William R Vincent, Nicole Z Spence, Michelle M Lucki, Michael J Howkins, Robert K Cleary

Surgery Articles

Surgical procedures are key drivers of pain development and opioid utilization globally. Various organizations have generated guidance on postoperative pain management, enhanced recovery strategies, multimodal analgesic and anesthetic techniques, and postoperative opioid prescribing. Still, comprehensive integration of these recommendations into standard practice at the institutional level remains elusive, and persistent postoperative pain and opioid use pose significant societal burdens. The multitude of guidance publications, many different healthcare providers involved in executing them, evolution of surgical technique, and complexities of perioperative care transitions all represent challenges to process improvement. This review seeks to summarize and integrate key recommendations into a "roadmap" …

Cultures Of Practice: Specialty-Specific Differences In End-Of-Life Conversations., Andre Morales, Kevan C Schultz, Shasha Gao, Alan Murphy, Amber E Barnato, Joseph B Fanning, Daniel E Hall

Ambulatory and Primary Care Articles

No abstract provided.