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de Vos MS, Hamming JF, Boosman H, Marang-van de Mheen PJ. The Association Between Complications, Incidents, and Patient Experience: Retrospective Linkage of Routine Patient Experience Surveys and Safety Data. J Patient Saf 2021; 17:e91-e97. [PMID: 30865163 DOI: 10.1097/pts.0000000000000581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Linkage of safety data to patient experience data may provide information to improve surgical care. This retrospective observational study aimed to assess associations between complications, incidents, patient-reported problems, and overall patient experience. METHODS Routinely collected data from safety reporting on complications and incidents, as well as patient-reported problems and experience on the Picker Patient Experience Questionnaire 15, covering seven experience dimensions, were linked for 4236 surgical inpatients from an academic center (April 2014-December 2015, 41% response). Associations between complication and/or incident occurrence and patient-reported problems, regarding risk of nonpositive experience (i.e., grade of 1-5 of 10), were studied using multivariable logistic regression. RESULTS Patient-reported problems were associated with occurrence of complications/incidents among patients with nonpositive experiences (odds ratio [OR] = 2.8, 95% confidence interval [CI] = 1.6-4.9), but not among patients with positive experiences (OR = 1.0, 95% CI = 0.6-1.5). For each experience dimension, presence of patient-reported problems increased risk of nonpositive experience (OR range = 2.7-4.4). Patients with complications or incidents without patient-reported problems were at lower risk of a nonpositive experience than patients with neither complications/incidents nor reported problems (OR = 0.5; 95% CI = 0.3-0.9). Occurrence of complications/incidents only increased risk of nonpositive experience when patients also had problems on "continuity and transition" or "respect for patient preferences" dimensions. CONCLUSIONS Linking safety data to patient experience data can reveal ways to optimize care. Staff seem able to ensure positive patient experiences despite complications or incidents. Increased attention should be paid to respecting patient preferences, continuity, and transition, particularly when complications or incidents occur.
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Affiliation(s)
| | | | - Hileen Boosman
- Quality and Patient Safety, Leiden University Medical Centre, Leiden, the Netherlands
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von Itzstein MS, Gupta A, Kernstine KH, Mara KC, Khanna S, Gerber DE. Increased reporting but decreased mortality associated with adverse events in patients undergoing lung cancer surgery: Competing forces in an era of heightened focus on care quality? PLoS One 2020; 15:e0231258. [PMID: 32271810 PMCID: PMC7145007 DOI: 10.1371/journal.pone.0231258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 03/19/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Advances in surgical techniques have improved clinical outcomes and decreased complications. At the same time, heightened attention to care quality has resulted in increased identification of hospital-acquired adverse events. We evaluated these divergent effects on the reported safety of lung cancer resection. METHODS AND MATERIALS We analyzed hospital-acquired adverse events in patients undergoing lung cancer resection using the National Hospital Discharge Survey (NHDS) database from 2001-2010. Demographics, diagnoses, and procedures data were abstracted using ICD-9 codes. We used the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSI) to identify hospital-acquired adverse events. Weighted analyses were performed using t-tests and chi-square. RESULTS A total of 302,444 hospitalizations for lung cancer resection and were included in the analysis. Incidence of PSI increased over time (28% in 2001-2002 vs 34% in 2009-2010; P<0.001). Those with one or more PSI had increased in-hospital mortality (aOR = 11.1; 95% CI, 4.7-26.1; P<0.001) and prolonged hospitalization (12.5 vs 7.8 days; P<0.001). However, among those with PSI, in-hospital mortality decreased over time, from 17% in 2001-2002 to 2% in 2009-2010. CONCLUSIONS In a recent ten-year period, documented rates of adverse events associated with lung cancer resection increased. Despite this increase in safety events, we observed that mortality decreased. Because such metrics may be incorporated into hospital rankings and reimbursement considerations, adverse event coding consistency and content merit further evaluation.
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Affiliation(s)
- Mitchell S. von Itzstein
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Arjun Gupta
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Kemp H. Kernstine
- Department of Cardiothoracic Surgery, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Kristin C. Mara
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States of America
| | - Sahil Khanna
- Division of Gastroenterology, Mayo Clinic, Rochester, MN, United States of America
| | - David E. Gerber
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States of America
- Department of Population & Data Sciences, UT Southwestern Medical Center, Dallas, TX, United States of America
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center Dallas, TX, United States of America
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von Itzstein MS, Gupta A, Mara KC, Khanna S, Gerber DE. Increasing Numbers and Reported Adverse Events in Patients with Lung Cancer Undergoing Inpatient Lung Biopsies: A Population-Based Analysis. Lung 2019; 197:593-599. [PMID: 31367886 DOI: 10.1007/s00408-019-00255-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/22/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The use of molecular biomarkers to guide lung cancer management has led to increasing frequency and amounts of tissue required for repeat lung biopsies. While patient safety and reporting of adverse events has been increasingly emphasized in recent decades, the safety of lung biopsies in patients with lung cancer has only been studied in small cohorts. We therefore analyzed adverse events in patients with lung cancer undergoing lung biopsies in the National Hospital Discharge Survey (NHDS) database. METHODS Data were abstracted using ICD-9 lung cancer diagnosis (162.X) and lung biopsy procedure codes (33.20, 33.24, 33.25, 33.26, 33.27, 33.28) from 2001 to 2010. Agency for Healthcare Research and Quality (AHRQ) Patient-Safety Indicators (PSI) were used to identify hospital-acquired adverse events. Weighted analyses were performed using SAS version 9.4. RESULTS A total of 540,747 patients were included for analysis. The number of biopsies increased over time, from 51,221 in 2001, to 63,239 in 2010 (P < 0.001). Overall, 159,683 (30%) patients suffered ≥ 1-PSI event during their hospitalization. Incidence of PSI varied by biopsy type: bronchoscopic (26%), percutaneous (34%), surgical (39%). The proportion of patients with ≥ 1 PSI event increased from 24% in 2001 to 38% in 2010 (P < 0.001). Patients with ≥ 1 PSI had longer length of stay (mean, 11.6 vs 8.1 days; P < 0.001) and higher in-hospital mortality (adjusted odds ratio, 5.9, 95% CI 3.9-8.9; P < 0.001). CONCLUSIONS The frequency of lung biopsies performed and rate of documented adverse events in hospitalized lung cancer patients have increased. These findings have policy, funding, research, and practice implications.
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Affiliation(s)
| | - Arjun Gupta
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, USA
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Kristin C Mara
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Sahil Khanna
- Division of Gastroenterology, Mayo Clinic, Rochester, MN, USA
| | - David E Gerber
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, USA.
- Department of Population & Data Sciences, UT Southwestern Medical Center, Dallas, USA.
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, 75390-9093, USA.
- Division of Hematology-Oncology, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Mail Code 8852, Dallas, TX, 75390-8852, USA.
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Abstract
Patient harm continues to be a leading cause of morbidity and mortality in the United States. Among high-risk industries, the health care system has a significantly lower safety profile than that of others. There are many driving forces behind this, including significant resistance within the medical community in the late 1960s to consumer demand of patient-centered and family-centered care. In subsequent decades the voice of the customer has taken center stage. The mounting research linking patient experience and engagement to patient safety and positive clinical outcomes is indisputable.
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Patient Complaints in Image-Guided Interventions: Evaluation of Multifactorial Issues Using a Coding Taxonomy. AJR Am J Roentgenol 2018; 210:1288-1291. [PMID: 29547056 DOI: 10.2214/ajr.17.19104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to classify complaints from patients undergoing image-guided interventions using a coding taxonomy and to test whether single-coded complaints were resolved satisfactorily compared with multifactorial (multiple codes) complaints. MATERIALS AND METHODS In this retrospective study, patients' complaint narratives between April 1999 and December 2012 were reviewed and categorized according to a three-level taxonomy into domains and codes. Resolutions were categorized as satisfactory or unsatisfactory to the patient and were classified as follows: clarification, apology, manager notification, change of provider, reimbursement, and quality review. Complaints were classified as single coded (only one code identified in the patients' description) and multifactorial (multiple codes identified). Statistical analysis was performed with the Fisher test, with the significance level set at 0.05. A run chart with the distribution of complaints by domains (relationships, management, and clinical) by year was performed. RESULTS A total of 146 codes were extracted from 71 narratives (2.06 codes/complaint) and were classified into the following domains: clinical (52%; n = 76), management (24%; n = 35), and relationships (24%; n = 35). The most common codes included quality of care, safety, and communication breakdown issues. A run chart found a decline in absolute numbers of complaints over the years in the domains studied. The frequency of satisfactory resolution was 86% for multifactorial versus 81% for single-coded complaints with no statistically significant differences observed (p = 0.72). Over 50% of complaints were resolved by providing clarification to patients (n = 36). CONCLUSION There were no statistically significant differences between multifactorial and single-coded complaints. Clinical codes and communication breakdown were the most common reasons for patient-reported complaint, with most complaints successfully resolved with clarification.
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Abstract
Objective Patient‐reported outcome measure (PROM) conceived to enable description of treatment‐related effects, from the patient perspective, bring the potential to improve in clinical research, and to provide patients with accurate information. Therefore, the aim of this study was to develop a patient‐centred peptic ulcer patient‐reported outcome measure (PU‐PROM) and evaluate its reliability, validity, differential item functioning (DIF) and feasibility. Method To develop a conceptual framework and item pool for the PU‐PROM, we performed a literature review and consulted other measures created in China and other countries. Beyond that, we interviewed 10 patients with peptic ulcers, and consulted six key experts to ensure that all germane parameters were included. In the first item selection phase, classical test theory and item response theory were used to select and adjust items to shape the preliminary measure completed by 130 patients and 50 controls. In the next phase, the measure was evaluated used the same methods with 492 patients and 124 controls. Finally, we used the same population in the second item reselection to assess the reliability, validity, DIF and feasibility of the final measure. Results The final peptic ulcer PRO measure comprised four domains (physiology, psychology, society and treatment), with 11 subdomains, and 54 items. The Cronbach's α coefficient of each subdomain for the measure was >0.800. Confirmatory factory analysis indicated that the construct validity fulfilled expectations. Model fit indices, such as RMR, RMSEA, NFI, NNFI, CFI and IFI, showed acceptable fit. The measure showed a good response rate. Conclusions The peptic ulcer PRO measure had good reliability, validity, DIF and feasibility, and can be used as a clinical research evaluation instrument with patients with peptic ulcers to assess their condition focus on treatment. This measure may also be applied in other health areas, especially in clinical trials of new drugs, and may be helpful in clinical decision making.
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Affiliation(s)
- Na Liu
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Shanxi Medical University molecular imaging precision medicine Collaborative Innovation Center, Taiyuan, Shanxi Province, China
| | - Jing Lv
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Shanxi Medical University molecular imaging precision medicine Collaborative Innovation Center, Taiyuan, Shanxi Province, China
| | - Jinchun Liu
- Department of Gastroenterology, The First Hospital, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Yanbo Zhang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Shanxi Medical University molecular imaging precision medicine Collaborative Innovation Center, Taiyuan, Shanxi Province, China
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Kemp KA, Santana MJ, Southern DA, McCormack B, Quan H. Association of inpatient hospital experience with patient safety indicators: a cross-sectional, Canadian study. BMJ Open 2016; 6:e011242. [PMID: 27371554 PMCID: PMC4947763 DOI: 10.1136/bmjopen-2016-011242] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 05/02/2016] [Accepted: 06/10/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES There remains concern regarding the use of survey data to assess aspects of healthcare quality. The relationship between patient experience and adverse events as documented by patient safety indicators (PSIs) is a timely research topic. The objectives were to document the association of PSIs and patient experience scores, and to determine risk-adjusted odds of high experience scores versus PSI presence. SETTING AND PARTICIPANTS From April 2011 to March 2014, 25 098 patients completed a telephone survey following discharge from 93 inpatient hospitals in Alberta, Canada. RESEARCH DESIGN A modified version of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) instrument was used. Surveys were linked to inpatient records and PSI presence was documented using a validated algorithm. MEASURES Three questions about overall hospital, physician and nurse ratings were scored on an 11-point Likert scale from 0 (worst) to 10 (best). Experience was classified as high (9 or 10) versus low (0-8). Demographic/clinical differences between respondents with/without a PSI were assessed. Logistic regression examined the relationship between factors including PSI and experience ratings. RESULTS Overall, physician and nurse care was rated high by 61.9%, 73.7% and 66.2% of respondents. 1085 patients (4.3%) had a documented PSI. Most frequent PSIs were haemorrhagic events (n=502; 2.0% of sample), events relating to obstetrics (n=373; 1.5%) and surgical-related events (n=248; 1.0%). Risk-adjusted models showed patients with PSIs had decreased odds of having high overall (OR=0.86; 95% CI 0.75 to 0.97), physician (OR=0.76; 95% CI 0.66 to 0.87) and nurse (OR=0.83; 95% CI 0.73 to 0.94) ratings. CONCLUSIONS There is clear evidence that inpatient experience ratings are associated with PSIs, one element of quality of care. Future research, examining individual PSIs and patient experience questions, is warranted, as this may inform targeted quality improvement initiatives.
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Affiliation(s)
- Kyle A Kemp
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Primary Data Support, Analytics (DIMR), Alberta Health Services, Calgary, Alberta, Canada
| | - Maria J Santana
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Danielle A Southern
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Brandi McCormack
- Primary Data Support, Analytics (DIMR), Alberta Health Services, Calgary, Alberta, Canada
| | - Hude Quan
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Smeby SS, Johnsen R, Marhaug G. Documentation and disclosure of adverse events that led to compensated patient injury in a Norwegian university hospital. Int J Qual Health Care 2015; 27:486-91. [PMID: 26467892 DOI: 10.1093/intqhc/mzv084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2015] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Primarily, to describe to what extent patient injury, compensated by a national system of patient compensation, was reported in the mandatory incident-reporting system and documented in the patient's medical records. Secondarily, to investigate whether there is documentation of patient disclosure of the injury and documentation that the patient was informed of his or her right to apply for economic compensation. DESIGN A retrospective study of administrative data and patient records. SETTING Trondheim University Hospital, Norway. PARTICIPANTS Patients receiving financial compensation for patient injuries that occurred between the 1 March 2009 and the 31 December 2012. INTERVENTION None. MAIN OUTCOME MEASURES Documentation of injury, type of injury and consequence for the patient. Patient disclosure in medical records. Prevalence of incident reports. RESULTS 20.4% of all compensated patient injuries and 26.3% of serious compensated patient injuries, defined as death or a disability of >15%, had been reported. The injury was documented in the patient's medical records in 90.7% of cases, but as an adverse event causing patient injury in only 3.4%. Documentation about patient disclosure was missing in 32.1% of cases, and giving information of his or her legal right to claim compensation was documented in 21.6% of cases. CONCLUSION Underreporting and nondisclosure of patient injuries remain a problem, despite a mandatory reporting system. Helping physicians and surgeons recognize adverse events, reporting them and discussing them with patients should be a priority for hospitals and medical schools.
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Affiliation(s)
- Susanne Skjervold Smeby
- Faculty of Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Roar Johnsen
- Department of Public Health and General Practice, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gudmund Marhaug
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
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Harrison R, Walton M, Manias E, Smith-Merry J, Kelly P, Iedema R, Robinson L. The missing evidence: a systematic review of patients' experiences of adverse events in health care. Int J Qual Health Care 2015; 27:424-42. [PMID: 26424702 DOI: 10.1093/intqhc/mzv075] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2015] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Preventable patient harm due to adverse events (AEs) is a significant health problem today facing contemporary health care. Knowledge of patients' experiences of AEs is critical to improving health care safety and quality. A systematic review of studies of patients' experiences of AEs was conducted to report their experiences, knowledge gaps and any challenges encountered when capturing patient experience data. DATA SOURCES Key words, synonyms and subject headings were used to search eight electronic databases from January 2000 to February 2015, in addition to hand-searching of reference lists and relevant journals. STUDY SELECTION Titles and abstracts of publications were screened by two reviewers and checked by a third. Full-text articles were screened against the eligibility criteria. DATA EXTRACTION Data on design, methods and key findings were extracted and collated. RESULTS Thirty-three publications demonstrated patients identifying a range of problems in their care; most commonly identified were medication errors, communication and coordination of care problems. Patients' income, education, health burden and marital status influence likelihood of reporting. Patients report distress after an AE, often exacerbated by receiving inadequate information about the cause. Investigating patients' experiences is hampered by the lack of large representative patient samples, data over sufficient time periods and varying definitions of an AE. CONCLUSION Despite the emergence of policy initiatives to enhance patient engagement, few studies report patients' experiences of AEs. This information must be routinely captured and utilized to develop effective, patient-centred and system-wide policies to minimize and manage AEs.
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Affiliation(s)
- Reema Harrison
- School of Public Health, Sydney Medical School, University of Sydney, Rm 314 Edward Ford Building (A27), Sydney, NSW 2006, Australia
| | - Merrilyn Walton
- School of Public Health, Sydney Medical School, University of Sydney, Rm 314 Edward Ford Building (A27), Sydney, NSW 2006, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3125, Australia Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC 3125, Australia
| | - Jennifer Smith-Merry
- Faculty of Health Sciences, University of Sydney, Cumberland Campus, Sydney, NSW, Australia
| | - Patrick Kelly
- School of Public Health, Sydney Medical School, University of Sydney, Rm 314 Edward Ford Building (A27), Sydney, NSW 2006, Australia
| | - Rick Iedema
- Health Sciences, University of Tasmania and Agency for Clinical Innovation, PO Box 699, Chatswood, NSW 2057, Australia
| | - Lauren Robinson
- Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
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Zhi L, Qiaojun L, Yanbo Z. Development and validation of patient-reported outcomes scale for hypertension. Int J Qual Health Care 2015; 27:369-76. [DOI: 10.1093/intqhc/mzv060] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2015] [Indexed: 12/22/2022] Open
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Romano RC, Allen TC, Blessing MM. The essential role of pathologists in health care and health policy. Arch Pathol Lab Med 2015; 139:441-4. [PMID: 25822761 DOI: 10.5858/arpa.2014-0335-ed] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ryan C Romano
- From the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Drs Romano and Blessing); and the Department of Pathology, University of Texas Medical Branch, Galveston, Texas (Dr Allen)
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