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Punja V, Capasso T, Stokes L, Ray K, Narveson JR, Walters RW, Fernandez C, Patel ND, Ewing K, Kuncir E. The Impact of Relocating a Trauma Center: Retrospective Observations on Payer Demographics and Cost-Analysis. Am Surg 2023; 89:5682-5689. [PMID: 37139931 DOI: 10.1177/00031348231175482] [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] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Standardization of trauma centers improves quality of care, yet that comes with financial challenges. The decision to designate a trauma center typically focuses on access, quality of care, and the needs of the local community, but less often considers the financial viability of the trauma center. A level-1 trauma center was relocated in 2017 and this presented an opportunity to compare financial data at two separate locations in the same city. METHODS A retrospective review was performed on the local trauma registry and billing database in all patients aged ≥19 years on the trauma service before and after the move. RESULTS 3041 patients were included (pre-move: 1151; post-move: 1890). After the move, patients were older (9.5 years), and more were females (14.9%) and white (16.5%). Increases in blunt injuries (7.6%), falls (14.8%), and motor vehicle accidents (1.7%) were observed after the move. After the move, patients were less likely to be discharged home (6.5%) and more likely to go to a skilled nursing facility (3%) or inpatient rehabilitation (5.5%). Post-move more patients had Medicare (12.6%) or commercial (8.5%) insurance and charges per patient decreased by $2,833, while charges collected per patient increased by $2425. Patients were seen from a broader distribution of zip codes post-move. DISCUSSION Relocating a trauma center did improve financial viability for this institution. Future studies should consider the impact on the surrounding community and other trauma centers. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Viren Punja
- Department of Trauma Surgery and Critical Care, Creighton University Medical Center, Omaha, NE, USA
- Department of Surgery, Creighton University School of Medicine, Omaha, NE, USA
| | - Thomas Capasso
- Department of Trauma Surgery and Critical Care, Creighton University Medical Center, Omaha, NE, USA
- Department of Surgery, Creighton University School of Medicine, Omaha, NE, USA
| | - Laura Stokes
- Creighton University School of Medicine, Omaha, NE, USA
| | - Kelley Ray
- Creighton University School of Medicine, Omaha, NE, USA
| | - Joel R Narveson
- Department of Trauma Surgery and Critical Care, Creighton University Medical Center, Omaha, NE, USA
| | - Ryan W Walters
- Division of Clinical Research and Evaluative Sciences, Creighton University School of Medicine, Omaha, NE, USA
| | - Carlos Fernandez
- Department of Trauma Surgery and Critical Care, Creighton University Medical Center, Omaha, NE, USA
- Department of Surgery, Creighton University School of Medicine, Omaha, NE, USA
| | - Neil D Patel
- Department of Trauma Surgery and Critical Care, Creighton University Medical Center, Omaha, NE, USA
- Department of Surgery, Creighton University School of Medicine, Omaha, NE, USA
| | - Kaily Ewing
- Department of Trauma Surgery and Critical Care, Creighton University Medical Center, Omaha, NE, USA
- Department of Surgery, Creighton University School of Medicine, Omaha, NE, USA
| | - Eric Kuncir
- Department of Trauma Surgery and Critical Care, Creighton University Medical Center, Omaha, NE, USA
- Department of Surgery, Creighton University School of Medicine, Omaha, NE, USA
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Jahansouz C, Xu H, Hertzel AV, Kizy S, Steen KA, Foncea R, Serrot FJ, Kvalheim N, Luthra G, Ewing K, Leslie DB, Ikramuddin S, Bernlohr DA. Correction to: Partitioning of adipose lipid metabolism by altered expression and function of PPAR isoforms after bariatric surgery. Int J Obes (Lond) 2019; 43:1880-1881. [PMID: 31388095 DOI: 10.1038/s41366-019-0425-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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Affiliation(s)
- C Jahansouz
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - H Xu
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN, USA
| | - A V Hertzel
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN, USA
| | - S Kizy
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - K A Steen
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN, USA
| | - R Foncea
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN, USA
| | - F J Serrot
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - N Kvalheim
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN, USA
| | - G Luthra
- Park Nicollet Bariatric Surgery Center, St. Louis Park, MN, USA
| | - K Ewing
- CentraCare Bariatric Center, St. Cloud, MN, USA
| | - D B Leslie
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - S Ikramuddin
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
| | - D A Bernlohr
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN, USA.
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Jahansouz C, Xu H, Hertzel AV, Kizy S, Steen KA, Foncea R, Serrot FJ, Kvalheim N, Luthra G, Ewing K, Leslie DB, Ikramuddin S, Bernlohr DA. Partitioning of adipose lipid metabolism by altered expression and function of PPAR isoforms after bariatric surgery. Int J Obes (Lond) 2017; 42:139-146. [PMID: 28894292 PMCID: PMC5803459 DOI: 10.1038/ijo.2017.197] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/10/2017] [Accepted: 08/02/2017] [Indexed: 12/16/2022]
Abstract
Background Bariatric surgery remains the most effective treatment for reducing adiposity and eliminating type 2 diabetes, however the mechanism(s) responsible have remained elusive. Peroxisome proliferator activated receptors (PPAR) encompass a family of nuclear hormone receptors that upon activation exert control of lipid metabolism, glucose regulation, and inflammation. Their role in adipose tissue following bariatric surgery remains undefined. Materials and Methods Subcutaneous adipose tissue biopsies and serum were obtained and evaluated from at time of surgery and on postoperative day 7 in patients randomized to Roux-en-Y gastric bypass (n=13) or matched caloric restriction (n=14), as well as patients undergoing vertical sleeve gastrectomy (n=33). Fat samples were evaluated for changes in gene expression, protein levels, β-oxidation, lipolysis, and cysteine oxidation. Results Within 7 days, bariatric surgery acutely drives a change in the activity and expression of PPARγ and PPARδ in subcutaneous adipose tissue thereby attenuating lipid storage, increasing lipolysis and potentiating lipid oxidation. This unique metabolic alteration leads to changes in downstream PPARγ/δ targets including decreased expression of FABP4 and SCD1 with increased expression of carnitine palmitoyl transferase 1 (CPT1) and uncoupling protein 2 (UCP2). Increased expression of UCP2 not only facilitated fatty acid oxidation (increased 15-fold following surgery) but also regulated the subcutaneous adipose tissue redoxome by attenuating protein cysteine oxidation and reducing oxidative stress. The expression of UCP1, a mitochondrial protein responsible for the regulation of fatty acid oxidation and thermogenesis in beige and brown fat, was unaltered following surgery. Conclusions These results suggest that bariatric surgery initiates a novel metabolic shift in subcutaneous adipose tissue to oxidize fatty acids independently from the beiging process through regulation of PPAR isoforms. Further studies are required to understand the contribution of this shift in expression of PPAR isoforms as a contributor to weight loss following bariatric surgery.
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Affiliation(s)
- C Jahansouz
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - H Xu
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN, USA
| | - A V Hertzel
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN, USA
| | - S Kizy
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - K A Steen
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN, USA
| | - R Foncea
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN, USA
| | - F J Serrot
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - N Kvalheim
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN, USA
| | - G Luthra
- Park Nicollet Bariatric Surgery Center, St. Louis Park, MN, USA
| | - K Ewing
- CentraCare Bariatric Center, St. Cloud, MN, USA
| | - D B Leslie
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - S Ikramuddin
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - D A Bernlohr
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN, USA
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Stas NM, Ellis M, Grohmann NS, Schwab CR, Shull CM, Ewing K. 030 Effect of swine sire line and selection index category on wean-to-finish growth performance and carcass characteristics. J Anim Sci 2017. [DOI: 10.2527/asasmw.2017.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Singh JK, Ewing K, Howell S, Howe M, Cramer A, Bundred NJ. P1-12-16: HER-2 Testing and Treatment – Is Age a Factor? Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p1-12-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Aims: Elderly breast cancer patients have a poorer prognosis due to late diagnosis and sub-optimal treatment. In the UK, HER-2 testing was introduced in 2005 and we sought to determine whether HER-2 testing was performed on patients of all ages and whether HER-2 positive patients of all ages subsequently received Herceptin, from implementation in 2005 until 2008.
Methods: Review of all newly diagnosed breast cancers in women over 50 in our Unit between January 2005 and December 2008 was performed. Cases were identified from the hospital pathology electronic database. Patients were considered HER-2 positive if tissue sections scored 3+ on immunohistochemical analysis (intense membranous staining) or if gene amplification was detected using fluorescence in-situ hybridisation (FISH). Patients were eligible for treatment with Herceptin if the tumour exceeded 1cm in size or if they had lymph-node positive disease, per UK guidelines. Herceptin treatment was determined for all patients.
Results: In total 703 patients with a median age of 68 years (range 56 to 98) were identified and 628 (89.3%) underwent definitive surgery (mastectomies: 246; wide local excisions: 382) and axillary surgery. In total 371 patients (52.8%) underwent HER-2 testing by immunohistochemistry or FISH. HER-2 tests performed by year: 2005 (51/131; 38.9%); 2006 (59/187; 31.6%); 2007 (71/189; 37.6%) and 2008 (190/196; 96.9%). Fifty six patients (15.1%) were HER-2 positive by immunohistochemistry or FISH. Median age of HER2 positive patients was 66 years (range 57 to 98); median age of HER2 negative patients was 68 years (range 56 to 96). Forty four HER-2 positive patients (78.6%) were eligible for treatment with Herceptin; of these 28 patients (63.6%) were treated with Herceptin. HER2 testing, treatment with Herceptin and overall 5-year mortality rate for patients between 50 to 69 years and patients aged 70 years or older is summarised in Table1.
Twenty percent of patients aged between 50 to 69 years and 71.4% of patients aged 70 years or older eligible for Herceptin were not treated. Reasons for non-treatment included: multiple co-morbidities (4); treatment declined by oncologists (1); no referral to oncologists (1); death prior to treatment (2) and unknown (8). Median follow up time was 43.3 months (range 0.2 to 73.8). All cause mortality was higher in the over 70 year old breast cancer group (Log Rank Test p=0.001) regardless of HER-2 status.
Conclusions: National introduction of routine HER-2 testing for all newly diagnosed breast cancers led to a testing rate increase to almost 97%. Despite this only 63.6% of HER-2 positive patients eligible for treatment with Herceptin received it. Patients aged 70 years or older were less likely to receive Herceptin due to multiple factors.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-12-16.
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Affiliation(s)
- JK Singh
- 1School of Cancer and Enabling Sciences, University of Manchester, Paterson Institute for Cancer Research, Manchester, United Kingdom; Univeristity Hospital of South Manchester, Wythenshawe Hospital, Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - K Ewing
- 1School of Cancer and Enabling Sciences, University of Manchester, Paterson Institute for Cancer Research, Manchester, United Kingdom; Univeristity Hospital of South Manchester, Wythenshawe Hospital, Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - S Howell
- 1School of Cancer and Enabling Sciences, University of Manchester, Paterson Institute for Cancer Research, Manchester, United Kingdom; Univeristity Hospital of South Manchester, Wythenshawe Hospital, Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - M Howe
- 1School of Cancer and Enabling Sciences, University of Manchester, Paterson Institute for Cancer Research, Manchester, United Kingdom; Univeristity Hospital of South Manchester, Wythenshawe Hospital, Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - A Cramer
- 1School of Cancer and Enabling Sciences, University of Manchester, Paterson Institute for Cancer Research, Manchester, United Kingdom; Univeristity Hospital of South Manchester, Wythenshawe Hospital, Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - NJ Bundred
- 1School of Cancer and Enabling Sciences, University of Manchester, Paterson Institute for Cancer Research, Manchester, United Kingdom; Univeristity Hospital of South Manchester, Wythenshawe Hospital, Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom
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Hough-Snee N, Bakker JD, Ewing K. Long-Term Effects of Initial Site Treatment on Fescue in a Novel Prairie Ecosystem (Washington). ECOL RESTOR 2011. [DOI: 10.3368/er.29.1-2.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hiris E, Ewing K. The Perceived Sex of Biological Motion Displays is Influenced by Adaptation to Biological Motion but Not Adaptation to Static Faces. J Vis 2010. [DOI: 10.1167/10.7.781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Stoutenburg SK, Kalita J, Ewing K, Hines LM. Scaling alignment of large ontologies. Int J Bioinform Res Appl 2010; 6:384-401. [PMID: 20940125 DOI: 10.1504/ijbra.2010.036001] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In recent years, the number of shared biomedical ontologies has increased dramatically, resulting in a need for integration of these knowledge sources. Automated solutions to aligning ontologies address this growing need. However, only very recently, solutions for scalability of ontology alignment have begun to emerge. This research investigates scalability in alignment of large-scale ontologies. We present an alignment algorithm that bounds processing by selecting optimal subtrees to align and show that this improves efficiency without significant reduction in precision. We apply the algorithm in conjunction with our approach that includes modelling ontology alignment in a Support Vector Machine.
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Affiliation(s)
- Suzette K Stoutenburg
- The College of Engineering and Applied Science, University of Colorado, Colorado Springs, CO 80918, USA.
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Ewing K, Windhager S, McCaw M. Research: Effects of Summer Burning and Mowing on Central Texas Juniper-Oak Savanna Plant Communities During Drought Conditions. ECOL RESTOR 2005. [DOI: 10.3368/er.23.4.255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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McCollom RA, Lange B, Bryson SM, Levine M, Ewing K, Rabkin SW. Polyvinylchloride containers do not influence the hemodynamic response to intravenous nitroglycerin. Can J Hosp Pharm 1993; 46:165-70. [PMID: 10128359] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
In-vitro evidence of sorption of nitroglycerin (NTG) to polyvinylchloride (PVC) containers suggests that these containers may deliver less nitroglycerin to the patient than glass containers. Sorption of NTG to the PVC container may result in hemodynamic changes in the patient when a fresh solution of NTG is prepared and administered from a PVC container. This study was designed as a prospective, randomized trial to measure the hemodynamic response in patients receiving NTG in glass or PVC containers, during the first hour after a container exchange. Patients admitted to the coronary care unit in a University hospital with chest pain considered to be due to unstable angina or acute myocardial infarction were eligible. Patients who received other vasoactive drugs within one hour of container exchanges were excluded. Systolic and diastolic blood pressures, and heart rate were measured at baseline and at intervals for one hour following a container exchange. Twenty patients completed the study. There were no significant changes with time in either group (ANOVA, p > 0.05) with respect to systolic, diastolic, or mean arterial blood pressure or heart rate. No chest pain occurred during the 60 minutes following the container exchange in either group. We conclude that NTG can be administered safely and effectively in PVC containers to patients with unstable angina or acute myocardial infarction. However, it remains possible that changes in hemodynamic status could occur in patients on NTG if a change in container type (i.e., from PVC to glass or vice versa) is made during the course of therapy.
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Affiliation(s)
- R A McCollom
- University Hospital-Shaughnessy Site, Vancouver, British Colubmia
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Park JM, Ewing K, Miller F. Effects of relaxin on the fertilization capacity of human spermatozoa. Int J Gynaecol Obstet 1989. [DOI: 10.1016/0020-7292(89)90505-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Relaxin, a polypeptide hormone found in human seminal plasma, exerted favorable effects on the function of spermatozoa. This study was designed to investigate the effect of this hormone on the fertilization capacity of human spermatozoa from 10 oligospermic men (group A), 11 asthenospermic men (group B), 10 normospermic infertile men (group C), and 10 men with verified fertility (group D). We compared the effects of purified porcine relaxin at different concentrations (0, 50, and 150 ng/ml). Parameters include motility, hypoosmolar swelling test, and zona-free hamster egg penetration test. In group A and group B, relaxin increased the results of the hamster egg penetration test and motility. In group C, results of the hamster egg penetration test and motility improved only at the concentration of 50 ng/ml. In group D, relaxin increased the results of the hamster egg penetration test only at a concentration of 150 ng/ml. Results of the hypoosmolar swelling test were not consistently altered in any study group. Relaxin appears to enhance the fertilization capacity and motility of human spermatozoa in oligospermic and asthenospermic subjects.
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Affiliation(s)
- J M Park
- Department of Obstetrics and Gynecology, Ohio State University, Columbus
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Abstract
Coexistent idiopathic hypertrophic subaortic stenosis (IHSS) and coronary arterial disease (CAD) was found in 10 patients studied because of disabling angina. Only one had experienced consistent relief of angina with nitroglycerin. All had systolic murmurs which had been ascribed to valvular stenosis or papillary muscle dysfunction. Mean patient age was 57 years. Nine were males. All patients were shown to have the characteristic hemodynamic and angiographic findings of classical IHSS. Coronary cineangiography revealed severe CAD in each patient. Precatheterization diagnosis of combined IHSS and CAD was difficult to make unless a very well-documented history of prior myocardial infarction was available, and clinical evaluation revealed the typical auscultatory and pulse contour changes of IHSS. In six of the patients clinical evidence alone was not sufficient to diagnose combined disease with any certainty. There is a significant incidence of IHSS in the coronary disease-prone age group. The possible coexistence of the two diseases has not been appreciated previously. Patients with IHSS and angina should be evaluated for CAD as they may benefit if therapy is directed at both disorders. Patients with CAD, angina, and systolic murmurs should be evaluated for possible IHSS, especially if coronary artery surgery is contemplated, since such therapy may be inappropriate or incomplete.
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