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Mefford B, Wallace KL, Donaldson JC, Bissell Turpin BD, Sen P, Schadler AD, Liu LJ, Thompson Bastin ML. Effect modification of dosing strategy (AUC or trough) on AKI associated with vancomycin in combination with piperacillin/tazobactam or cefepime and meropenem. Antimicrob Agents Chemother 2024; 68:e0108523. [PMID: 38606975 PMCID: PMC11064542 DOI: 10.1128/aac.01085-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/06/2024] [Indexed: 04/13/2024] Open
Abstract
Piperacillin-tazobactam (TZP), cefepime (FEP), or meropenem (MEM) and vancomycin (VAN) are commonly used in combination for sepsis. Studies have shown an increased risk of acute kidney injury (AKI) with TZP and VAN compared to FEP or MEM. VAN guidelines recommend area under the curve (AUC) monitoring over trough (Tr) to minimize the risk of AKI. We investigated the association of AKI and MAKE-30 with the two VAN monitoring strategies when used in combination with TZP or FEP/MEM. Adult patients between 2015 and 2019 with VAN > 72 hours were included. Patients with AKI prior to or within 48 hours of VAN or baseline CrCl of ≤30 mL/min were excluded. Four cohorts were defined: FEP/MEM/Tr, FEP/MEM/AUC, TZP/Tr, and TZP/AUC. A Cox Proportional Hazard Model was used to model AKI as a function of the incidence rate of at-risk days, testing monitoring strategy as a treatment effect modification. Multivariable logistic regression was used to model MAKE-30. Overall incidence of AKI was 18.6%; FEP/MEM/Tr = 115 (14.6%), FEP/MEM/AUC = 52 (14.9%), TZP/Tr = 189 (26%), and TZP/AUC = 96 (17.1%) (P < 0.001). Both drug group [(TZP; P = 0.0085)] and monitoring strategy [(Tr; P = 0.0007)] were highly associated with the development of AKI; however, the effect was not modified with interaction term [(TZP*Tr); 0.085)]. The odds of developing MAKE-30 were not different between any group and FEP/MEM/AUC. The effect of VAN/TZP on the development of AKI was not modified by the VAN monitoring strategy (AUC vs trough). MAKE-30 outcomes were not different among the four cohorts.
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Affiliation(s)
- Breanne Mefford
- Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky, USA
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky, USA
| | - Katie L. Wallace
- Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky, USA
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky, USA
| | - J. Chris Donaldson
- Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky, USA
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky, USA
| | - Brittany D. Bissell Turpin
- Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky, USA
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky, USA
| | - Parijat Sen
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Aric D. Schadler
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky, USA
- University of Kentucky Children’s Hospital, Lexington, Kentucky, USA
| | - Lucas J. Liu
- Department of Computer Science, University of Kentucky, Lexington, Kentucky, USA
| | - Melissa L. Thompson Bastin
- Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky, USA
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky, USA
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Grube PM, Autry EB, Kormelink LN, Young DC, Zobell JT, Bhakta ZN, Schadler AD, Kuhn RJ. A decade of change: The evolution of pharmacy services at U.S. cystic fibrosis centers. Pediatr Pulmonol 2024; 59:652-661. [PMID: 38050809 DOI: 10.1002/ppul.26798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/09/2023] [Accepted: 11/27/2023] [Indexed: 12/06/2023]
Abstract
INTRODUCTION People with cystic fibrosis (pwCF) require a multidisciplinary care team due to disease complexity. The Cystic Fibrosis Foundation (CFF) notes that pharmacists are recommended, while other organizations consider pharmacists required. In 2016, the CFF initiated a grant program for CFF-accredited care centers and affiliate programs (CFF-ACCAP) to implement outpatient pharmacy services. The primary objective of this study was to compare surveys regarding pharmacy involvement in CFF-ACCAP pre- and post-grant implementation. METHODS This was an IRB-approved, survey-based study. The surveys were distributed via the CF pharmacist-pharmacy technician and center director e-mail exchanges. RESULTS There are currently 244 CFF-ACCAP and 158 pharmacists. Forty-two pharmacists completed the 2013 survey and 77 completed the 2023 survey. Practice site shifted from primarily the inpatient (58.5%) to outpatient settings (67.5%; p < .001). Most positions were created in the past 7 years (81%) with 50% currently or previously funded by the CFF grant program. CFF center director response decreased from 2013 to 2023 (106 vs. 48) but centers with a dedicated CF pharmacist increased from 2013 to 2023 (66%-86%; p = .014). In the 2023 survey, we received responses from 17 pharmacy technicians, who were newly included. Most of these technicians (64%) reported working in outpatient clinics. CONCLUSIONS Since 2013, pharmacy presence has grown at CFF-ACCAP, partly due to the CFF grant program. Despite pharmacists not being required members of the multidisciplinary care team, their presence is notable in 65% of CFF-ACCAP centers, where they contribute significantly to improving the care provided for pwCF.
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Affiliation(s)
- Paige M Grube
- Department of Pharmacy Services, University of Kentucky Healthcare Kentucky Children's Hospital, Lexington, Kentucky, USA
| | - Elizabeth B Autry
- Department of Pharmacy Services, University of Kentucky Healthcare Kentucky Children's Hospital, Lexington, Kentucky, USA
| | - Lauren N Kormelink
- Department of Pharmacy Services, University of Kentucky, Lexington, Kentucky, USA
| | - David C Young
- Department of Pharmacy Services, University of Utah Health, Salt Lake City, Utah, USA
| | - Jeffery T Zobell
- Department of Pharmacy Services, Intermountain Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Zubin N Bhakta
- Department of Pharmacy Services, University of Utah Health, Salt Lake City, Utah, USA
| | - Aric D Schadler
- College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
| | - Robert J Kuhn
- College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
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Hall HM, Ashley KC, Schadler AD, Naseman KW. Evaluation of a Pharmacist-Managed Diabetes Transitions of Care Medication Management Clinic. Sci Diabetes Self Manag Care 2024; 50:32-43. [PMID: 38243762 DOI: 10.1177/26350106231221463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
PURPOSE The purpose of this study was to determine the impact of a pharmacist-managed transitions of care (TOC) clinic on outcomes in a posthospitalization population with diabetes. METHODS A retrospective single center cohort study utilized electronic health records to identify discharged patients followed by the inpatient endocrinology team. The primary outcome was 30-day readmission rates in the target population. Secondary outcomes include 90-day readmission rates, time to first follow-up, emergency department/urgent care encounters, change in A1C, retention with endocrinology, referrals for diabetes education, and types of interventions. The control group included patients prior to the initiation of the TOC clinic compared to patients seen in the TOC clinic, evenly matched by A1C. Readmission rates and other clinical data were queried up to 4 months after discharge. RESULTS Patients in the TOC cohort had similar 30-day readmission rates compared to the non-TOC cohort and were found to have lower A1C values within 120 days of discharge. Overall, patients in the TOC cohort were more likely to have a follow-up appointment and had closer follow-up after discharge. CONCLUSION This study highlights that although there was no difference in readmission rates, a pharmacist-managed diabetes TOC clinic may decrease time to follow-up and improve long-term diabetes outcomes.
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Affiliation(s)
- Hayley M Hall
- University of Kentucky HealthCare, Lexington, Kentucky
| | | | - Aric D Schadler
- Kentucky Children's Hospital - Pediatrics and University of Kentucky College of Pharmacy, Lexington, Kentucky
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Miracle DK, Thomas J, Keenan NF, Kuhn RJ, Schadler AD, Taylor S. A Survey of Pandemic Impacts on Pharmacy Residency Applications, Interviews, and Selection Factors. Am J Pharm Educ 2023; 87:ajpe8954. [PMID: 35351797 PMCID: PMC10159506 DOI: 10.5688/ajpe8954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/24/2022] [Indexed: 05/06/2023]
Abstract
Objective. To assess the impact of the COVID-19 pandemic on pharmacy residency application/interview processes, match rate, and factors influencing match rankings at a single college of pharmacyMethods. In spring of 2020 and 2021, an anonymous survey of fourth-year pharmacy school (P4) residency applicants at one college of pharmacy was administered. Survey responses were compared to explore trends in showcase participation, number/type/geographic dispersion of applications submitted, interview invitations, grade point average (GPA), research experience, and match rate. A thematic analysis evaluated common factors influencing match rankings.Results. Responses were collected from 75 of 99 (75.8% response rate) residency-seeking students in 2020 and 79 of 94 (84.0% response rate) in 2021. Students in 2021 reported applying to a higher median number of programs, with no significant differences in mean reported number of interview invitations or match rate. The virtual American Society of Health-System Pharmacists (ASHP) Midyear Showcase led to a median reported savings of $1000 with no significant impact on perceived value. Virtual interviews led to a median reported savings of $430. Thematic analysis revealed feel/culture, location, and learning experience options as the most prevalent deciding factors for match rankings in both years.Conclusion. The pandemic led to an increase in the number of residency applications per student and yielded a net cost savings. There were no differences in number of interviews offered, match rate, or in deciding factors influencing match rankings. As the pandemic evolves, schools should maintain a flexible and dynamic approach to support students.
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Affiliation(s)
- Dustin K Miracle
- University of Kentucky, College of Pharmacy, Lexington, Kentucky
| | | | - Nicole F Keenan
- University of Kentucky, College of Pharmacy, Lexington, Kentucky
| | - Robert J Kuhn
- University of Kentucky, College of Pharmacy, Lexington, Kentucky
| | - Aric D Schadler
- University of Kentucky, College of Pharmacy, Lexington, Kentucky
| | - Stacy Taylor
- University of Kentucky, College of Pharmacy, Lexington, Kentucky
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Schaefer MC, Naseman KW, Schadler AD. Evaluation of a Pharmacist-Managed Medication Adjustment Clinic Within an Academic Endocrinology Practice. Diabetes Spectr 2022; 35:377-383. [PMID: 36082017 PMCID: PMC9396724 DOI: 10.2337/ds21-0060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Margaret C. Schaefer
- University of Kentucky HealthCare, University of Kentucky College of Pharmacy, Lexington, KY
| | - Kristina W. Naseman
- University of Kentucky HealthCare, University of Kentucky College of Pharmacy, Lexington, KY
- Corresponding author: Kristina W. Naseman,
| | - Aric D. Schadler
- University of Kentucky HealthCare, University of Kentucky College of Pharmacy, Lexington, KY
- Kentucky Children’s Hospital, Lexington, KY
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Wright BC, Schadler AD, Swanson HI. Mentorship in Undergraduate Biomedical Education: Identifying Student Opinions and Expectations. J Med Educ Curric Dev 2022; 9:23821205221096101. [PMID: 35558549 PMCID: PMC9087238 DOI: 10.1177/23821205221096101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate undergraduate biomedical education student opinions and expectations on mentorship. METHODS A survey was administered to students enrolled in the undergraduate biology, neuroscience and nursing programs at a large public research-intensive university. The survey queried demographics, previous mentorship experiences, ideal qualities of mentors, benefits/value of mentorship and future plans for seeking mentorship. Survey responses were evaluated using either t-test comparisons or one-way ANOVA. RESULTS The majority of the respondents were female and were interested in pursuing professional schools (nursing and medicine). Survey results indicate high student interest in receiving mentoring, but few were active participants in a mentoring relationship. Respondents indicated either lack of knowledge or discomfort in identifying a mentor. While faculty mentors versus peer mentors were preferred, respondents indicated that mentoring by either faculty or peers would be of value. Survey results indicate that desired benefits of mentoring included guidance in future education and career decisions, networking and career advice. CONCLUSION The major conclusions are that despite high student interest in being mentored, their participation in mentoring is very low. These finding are supportive of the development of structured mentoring programs to facilitate and enhance mentoring of undergraduate STEM students and aid in their academic career progression.
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Affiliation(s)
- Bradley C. Wright
- Pharmacology and Nutritional Sciences, University of Kentucky,
Lexington, KY, USA
| | | | - Hollie I. Swanson
- Pharmacology and Nutritional Sciences, University of Kentucky,
Lexington, KY, USA
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Lawrence JN, Schadler AD, Shenoi AN. Relationship Distress at Home and Burnout Among 254 Pediatric Intensive Care Nurses. Pediatr Crit Care Med 2021; 22:1074-1082. [PMID: 34034306 DOI: 10.1097/pcc.0000000000002778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess the prevalence of relationship distress and burnout among PICU nurses. DESIGN Cross-sectional, web-based survey. SETTING Pediatric intensive care nursing practices in the United States. SUBJECTS Pediatric intensive care nurses. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 254 pediatric intensive care nurses in the United States completed the survey consisting of demographic data, practice, and personal characteristics, Revised Dyadic Adjustment Scale, and modified Maslach Burnout Inventory. Relationship distress in consensus was noted in 45.6% of participants, and 26.3% reported distress in relationship satisfaction. Moderate to high burnout was reported by 65% nurses in the emotional exhaustion domain, 43% in depersonalization, and 27% of nurses reported low personal accomplishment. A significant difference in relationship satisfaction was found among nurses identified in different domains of burnout, showing that nurses who scored higher in depersonalization also reported higher distress in relationship satisfaction (p = 0.045). Interestingly, nurses who reported high personal accomplishment (thereby less burnout) reported higher distress in relationship consensus (p = 0.015). The difference in the satisfaction subscale between different age groups was significant, suggesting distress in satisfaction among nurses over the age of 40 (p = 0.004). Comparison of nurses actively involved in marriage counseling with those not actively involved in marriage counseling demonstrated a significant difference in relationship consensus (p = 0.046; odds ratio = 2.46; 95% CI, 0.99-6.06) and satisfaction (p = 0.004; odds ratio = 3.26; 95% CI, 1.42-7.47), suggesting an association between higher relationship distress and counseling. CONCLUSIONS This study reflects the prevalence of relationship distress and its association with burnout and other practice and personal factors among PICU nurses. Nurses with high depersonalization experienced significantly higher distress in relationship satisfaction, and nurses who reported high personal satisfaction had significantly higher distress in relationship consensus.
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Affiliation(s)
- Jessica N Lawrence
- All authors: Department of Pediatrics, University of Kentucky, Lexington, KY
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Kebodeaux C, Woodyard JL, Kachlic MD, Allen SM, Schadler AD, Vouri SM. Student Pharmacists' Ability to Organize Complex Medication Regimens According to the Universal Medication Schedule. Am J Pharm Educ 2020; 84:ajpe7531. [PMID: 32934380 PMCID: PMC7473225 DOI: 10.5688/ajpe7531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 01/23/2020] [Indexed: 06/11/2023]
Abstract
Objective. To assess student pharmacists' ability to impact the administration of complex prescription regimens using the universal medication schedule in a standardized laboratory exercise. Methods. First and third professional year (P1 and P3) student pharmacists at three colleges of pharmacy completed a required activity to simplify and organize a complex medication regimen. Using a medication box, students planned how and when they would advise a patient to take seven fictitious medications over a 24-hour period. Picture documentation of each students' activity was used for data analysis. Descriptive statistics were used to compare P1 and P3 students' performance, and an independent t test was used to assess the frequency of daily dosing. A chi-square analysis was used to compare differences between P1 and P3 students, and analysis of variance was used to compare differences among individual institutions. Results. Of 842 students invited, 459 P1 and 372 P3 students (98.7%) consented to participate. Student pharmacists recommended 5.1 (SD=1.0; Range=3-11) dosing intervals per 24 hours, with 27% of students successfully reducing the regimen to four total intervals. The P3 students were more effective than the P1 students in planning the number of dosing intervals (4.9 vs 5.4 per 24 hours). Conclusion. Student pharmacists may become more effective at organizing complex medication regimens as they proceed through the pharmacy curriculum and gain experience. Student pharmacists can translate what they learned from this exercise to potentially improve patients' self-organized medication regimens.
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Affiliation(s)
- Clark Kebodeaux
- University of Kentucky College of Pharmacy, Lexington, Kentucky
| | | | | | - Sheila M. Allen
- University of Illinois at Chicago College of Pharmacy, Chicago, Illinois
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Atyia SA, Paloucek FP, Butts AR, Oyler DR, Martin CA, Schadler AD, Cook AM. Impact of PhORCAS references on overall application score for postgraduate year 1 pharmacy residency candidates. Am J Health Syst Pharm 2020; 77:1237-1242. [DOI: 10.1093/ajhp/zxaa152] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Purpose
The disparity between the number of applicants for postgraduate year 1 (PGY1) pharmacy residency positions and the number of available residency positions increases the need to optimize how applicants are evaluated. The purpose of the study described here was to evaluate the correlation of ratings of residency candidate characteristics by academic and professional references listed on residency applications with overall application score, applicant ranking, and the likelihood of candidates receiving an invitation to interview.
Methods
A multicenter, retrospective study was conducted to evaluate the correlation of reference writers’ ratings of 13 candidate characteristics and their overall recommendations with program-determined outcomes (eg, final application score, applicant ranking, and invitation to interview) through analysis of PGY1 applications submitted through the Pharmacy Online Residency Centralized Application System (PhORCAS) from 2015 through 2018. Keywords and themes within the open-ended section of letters of reference were also analyzed for correlation with overall application score.
Results
A total of 5,923 references listed on 1,867 applications to 4 PGY1 pharmacy residency programs processed by PhORCAS were included in the analysis. For the majority of applicant characteristic ratings (ie, 74% of 56,872 ratings overall), reference writers rated candidates as exceeding expectations, and applicants were “highly recommended” by these evaluators in 91% of cases. References’ average characteristic ratings and overall recommendations were poorly correlated with final application score (R2 = 0.12 [P < 0.0001] and R2 = 0.08 [P < 0.0001], respectively), final ranking (R2 = 0.02 [P < 0.0001] and R2 = 0.03 [P < 0.0001], respectively), and invitation to interview (R2 = 0.07 [P < 0.0001] and R2 = 0.04 [P < 0.0001], respectively). For the themes evaluated, references’ use of teaching words best correlated with normalized final application score, although the correlation was poor (R2 = 0.007, P = 0.0001).
Conclusion
Reference writers’ ratings of PGY1 residency candidate characteristics in PhORCAS are poorly correlated with application score, applicant ranking, and invitation to interview. The results of this study suggest that the existing PhORCAS standardized form for submitting references is of limited utility in its current state.
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Affiliation(s)
- Sara A Atyia
- Department of Pharmacy, Ohio State University Wexner Medical Center, Columbus, OH
| | - Frank P Paloucek
- Department of Pharmacy Practice, University of Illinois Chicago, Chicago, IL
| | - Allison R Butts
- Department of Pharmacy, University of Kentucky HealthCare, Lexington, KY
| | - Douglas R Oyler
- Department of Pharmacy, University of Kentucky HealthCare, Lexington, KY
| | - Craig A Martin
- Department of Pharmacy, University of Kentucky HealthCare, Lexington, KY
| | - Aric D Schadler
- Department of Pharmacy, University of Kentucky HealthCare, Lexington, KY
| | - Aaron M Cook
- Department of Pharmacy, University of Kentucky HealthCare, Lexington, KY
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