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Nagaraj MB, Wick N, AbdelFattah KR. Assessing Videoconference Etiquette in Academia: Determining Positive and Negative Associations With Online Interactions. J Surg Res 2022; 275:129-136. [DOI: 10.1016/j.jss.2022.01.017] [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] [Received: 09/23/2021] [Revised: 11/12/2021] [Accepted: 01/25/2022] [Indexed: 10/18/2022]
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Wick N, Hitto I, Welder D, Slone T, Koduru P, Fuda F, Rakheja D, Weinberg O. Acute myeloid leukemia with RAM immunophenotype presenting with extensive mesenteric and retroperitoneal lymphadenopathy: A case report and review of the literature. Leuk Res Rep 2022; 17:100287. [PMID: 34976721 PMCID: PMC8683846 DOI: 10.1016/j.lrr.2021.100287] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/06/2021] [Accepted: 12/13/2021] [Indexed: 11/25/2022] Open
Abstract
Acute myeloid leukemia (AML) with RAM immunophenotype is a rare recently described AML subtype. It is defined by blasts with strong expression of CD56 and weak to absent expression of CD45, HLA-DR....., and CD38 and characterized by significantly worse outcome [1]. Little is known about the clinical presentation and this immunophenotype is not widely recognized in clinical practice. We describe a case of AML with RAM immunophenotype in a 5-year-old male patient with a unique presentation, including extensive mesenteric and retroperitoneal lymphadenopathy. Diagnostic studies included bilateral bone marrow and lymph node biopsies, flow cytometry, cytogenetics, fluorescence in-situ hybridization (FISH), and next generation sequencing. Bone marrow biopsy revealed >90% blasts, positive for CD34, CD117, and CD56 by flow cytometry and immunohistochemistry. Next generation sequencing revealed BCOR loss and CBFA2T3-GLIS2 fusion. Following induction chemotherapy, bone marrow biopsy showed residual disease and a stem cell transplant was performed. The patient relapsed three months after transplant and subsequently passed away eleven months after initial diagnosis. Limited literature is available describing this newly identified AML subset. The RAM immunophenotype has been identified as an independent prognostic factor for relapse rate and overall and disease-free survival [1]. Few case reports are available to characterize the genetic profile, typical presentation, and clinical course of patients with this unique immunophenotype.
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Affiliation(s)
- N Wick
- UT Southwestern: The University of Texas Southwestern Medical Center 2230 Inwood Rd, EB03.220 G, Dallas, TX, 75235 United States
| | - I Hitto
- UT Southwestern: The University of Texas Southwestern Medical Center 2230 Inwood Rd, EB03.220 G, Dallas, TX, 75235 United States
| | - D Welder
- UT Southwestern: The University of Texas Southwestern Medical Center 2230 Inwood Rd, EB03.220 G, Dallas, TX, 75235 United States
| | - T Slone
- UT Southwestern: The University of Texas Southwestern Medical Center 2230 Inwood Rd, EB03.220 G, Dallas, TX, 75235 United States
| | - P Koduru
- UT Southwestern: The University of Texas Southwestern Medical Center 2230 Inwood Rd, EB03.220 G, Dallas, TX, 75235 United States
| | - F Fuda
- UT Southwestern: The University of Texas Southwestern Medical Center 2230 Inwood Rd, EB03.220 G, Dallas, TX, 75235 United States
| | - D Rakheja
- UT Southwestern: The University of Texas Southwestern Medical Center 2230 Inwood Rd, EB03.220 G, Dallas, TX, 75235 United States
| | - O Weinberg
- UT Southwestern: The University of Texas Southwestern Medical Center 2230 Inwood Rd, EB03.220 G, Dallas, TX, 75235 United States
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He L, Wick N, Germans SK, Peng Y. The Role of Breast Cancer Stem Cells in Chemoresistance and Metastasis in Triple-Negative Breast Cancer. Cancers (Basel) 2021; 13:cancers13246209. [PMID: 34944829 PMCID: PMC8699562 DOI: 10.3390/cancers13246209] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/05/2021] [Accepted: 12/08/2021] [Indexed: 02/05/2023] Open
Abstract
Triple negative breast cancer (TNBC) remains an aggressive disease due to the lack of targeted therapies and low rate of response to chemotherapy that is currently the main treatment modality for TNBC. Breast cancer stem cells (BCSCs) are a small subpopulation of breast tumors and recognized as drivers of tumorigenesis. TNBC tumors are characterized as being enriched for BCSCs. Studies have demonstrated the role of BCSCs as the source of metastatic disease and chemoresistance in TNBC. Multiple targets against BCSCs are now under investigation, with the considerations of either selectively targeting BCSCs or co-targeting BCSCs and non-BCSCs (majority of tumor cells). This review article provides a comprehensive overview of recent advances in the role of BCSCs in TNBC and the identification of cancer stem cell biomarkers, paving the way for the development of new targeted therapies. The review also highlights the resultant discovery of cancer stem cell targets in TNBC and the ongoing clinical trials treating chemoresistant breast cancer. We aim to provide insights into better understanding the mutational landscape of BCSCs and exploring potential molecular signaling pathways targeting BCSCs to overcome chemoresistance and prevent metastasis in TNBC, ultimately to improve the overall survival of patients with this devastating disease.
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Affiliation(s)
- Lin He
- Department of Pathology, University of Texas Southwestern Medical Center, 6201 Harry Hines Blvd, Dallas, TX 75235, USA; (L.H.); (N.W.); (S.K.G.)
| | - Neda Wick
- Department of Pathology, University of Texas Southwestern Medical Center, 6201 Harry Hines Blvd, Dallas, TX 75235, USA; (L.H.); (N.W.); (S.K.G.)
| | - Sharon Koorse Germans
- Department of Pathology, University of Texas Southwestern Medical Center, 6201 Harry Hines Blvd, Dallas, TX 75235, USA; (L.H.); (N.W.); (S.K.G.)
| | - Yan Peng
- Department of Pathology, University of Texas Southwestern Medical Center, 6201 Harry Hines Blvd, Dallas, TX 75235, USA; (L.H.); (N.W.); (S.K.G.)
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75235, USA
- Correspondence:
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Kulak O, Drobysheva A, Wick N, Arvisais-Anhalt S, Germans SK, Timmons CF, Park JY. Smart Glasses as a Surgical Pathology Grossing Tool. Arch Pathol Lab Med 2021; 145:457-460. [PMID: 32823276 DOI: 10.5858/arpa.2020-0090-oa] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Smart glasses are a wearable technology that enable hands-free data acquisition and entry. OBJECTIVE.— To develop a surgical pathology grossing application on a smart glass platform. DESIGN.— An existing logistics software for the Google Glass Enterprise smart glass platform was used to create surgical pathology grossing protocols. The 2 grossing protocols were developed to simulate grossing a complex (heart) and a simple (kidney) specimen. For both protocols, users were visually prompted by the smart glass device to perform each task, record measurements, or document the field of view. In addition to measuring the total time of the protocol performance, each substep within the protocol was automatically recorded. Subsequently, a report was generated that contained the dictation, images, voice recordings, and the timing of each step. The application was tested by 3 users using the 2 grossing protocols. The users were tracked across 3 grossing procedures for each protocol. RESULTS.— For the complex specimen grossing the average time across repeated procedures was not significantly different between users (P > .99). However, when grossing times of the complex specimen were compared for repeated performances of the same user, a significant reduction in grossing times was observed with each repetition (P = .002). For the simple specimen, the average grossing time across multiple attempts was different among users (P = .03); however, no improvement in grossing time was observed with repeated performance (P = .499). CONCLUSIONS.— Augmented reality based grossing applications can provide automated data collection to track the changes in grossing performance over time.
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Affiliation(s)
- Ozlem Kulak
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Kulak, Wick, Arvisais-Anhalt, Germans, Timmons, Park). Kulak and Drobysheva contributed equally to this work
| | - Anastasia Drobysheva
- From the Department of Pathology, Boston Children's Hospital, Boston, Massachusetts (Drobysheva)
| | - Neda Wick
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Kulak, Wick, Arvisais-Anhalt, Germans, Timmons, Park). Kulak and Drobysheva contributed equally to this work
| | - Simone Arvisais-Anhalt
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Kulak, Wick, Arvisais-Anhalt, Germans, Timmons, Park). Kulak and Drobysheva contributed equally to this work
| | - Sharon Koorse Germans
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Kulak, Wick, Arvisais-Anhalt, Germans, Timmons, Park). Kulak and Drobysheva contributed equally to this work
| | - Charles F Timmons
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Kulak, Wick, Arvisais-Anhalt, Germans, Timmons, Park). Kulak and Drobysheva contributed equally to this work
| | - Jason Y Park
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Kulak, Wick, Arvisais-Anhalt, Germans, Timmons, Park). Kulak and Drobysheva contributed equally to this work
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Covin Y, Longo P, Wick N, Gavinski K, Barker B, Wagner J. Using the NAM diagnostic process framework to teach clinical reasoning in computerized case presentations to 251 medical students. Diagnosis (Berl) 2021; 8:161-166. [PMID: 32628629 DOI: 10.1515/dx-2020-0031] [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] [Received: 03/02/2020] [Accepted: 05/03/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Explicit education on diagnostic reasoning is underrepresented relative to the burden of diagnostic errors. Medical educators report curricular time is a major barrier to implementing new curricula. The authors propose using concise student-identified educational opportunities -- differential diagnosis and summary statement writing -- to justify curriculum development in diagnostic reasoning. METHODS Eighteen clerkship and 235 preclinical medical students participated in a 1 h computerized case presentation and facilitated discussion. Students were surveyed on their attitudes toward the case. RESULTS All 18 (100% response) clerkship students and 121 of the 235 preclinical students completed the survey. Students felt the module was effective and relevant. They proposed medical schools consider longitudinal computerized case presentations as an educational strategy. CONCLUSIONS A computerized case presentation is a concise instructional strategy to teach critical points in diagnosis to clerkship and preclinical medical students.
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Affiliation(s)
- Yvonne Covin
- Department of Internal Medicine, Division of General and Hospital Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Palma Longo
- Department of Healthcare Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Neda Wick
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Katherine Gavinski
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Blake Barker
- Division of General Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jim Wagner
- Department of Internal Medicine, Division of General Medicine, UT Southwestern Medical Center, Dallas, TX, USA
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Covin Y, Longo P, Wick N, Gavinski K, Wagner J. Empirical comparison of three assessment instruments of clinical reasoning capability in 230 medical students. BMC Med Educ 2020; 20:264. [PMID: 32787953 PMCID: PMC7425135 DOI: 10.1186/s12909-020-02185-3] [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] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/04/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Several instruments intend to measure clinical reasoning capability, yet we lack evidence contextualizing their scores. The authors compared three clinical reasoning instruments [Clinical Reasoning Task (CRT), Patient Note Scoring rubric (PNS), and Summary Statement Assessment Rubric (SSAR)] using Messick's convergent validity framework in pre-clinical medical students. Scores were compared to a validated clinical reasoning instrument, Clinical Data Interpretation (CDI). METHOD Authors administered CDI and the first clinical case to 235 students. Sixteen randomly selected students (four from each CDI quartile) wrote a note on a second clinical case. Each note was scored with CRT, PNS, and SSAR. Final scores were compared to CDI. RESULTS CDI scores did not significantly correlate with any other instrument. A large, significant correlation between PNS and CRT was seen (r = 0.71; p = 0.002). CONCLUSIONS None of the tested instruments outperformed the others when using CDI as a standard measure of clinical reasoning. Differing strengths of association between clinical reasoning instruments suggest they each measure different components of the clinical reasoning construct. The large correlation between CRT and PNS scoring suggests areas of novice clinical reasoning capability, which may not be yet captured in CDI or SSAR, which are weighted toward knowledge synthesis and hypothesis testing.
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Affiliation(s)
- Yvonne Covin
- Department of Internal Medicine, Division of General and Hospital Medicine, UT Health San Antonio, 7703 Floyd Curl Drive, MC 7982, San Antonio, TX, 78229, USA.
| | - Palma Longo
- Department of Healthcare Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Neda Wick
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Katherine Gavinski
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - James Wagner
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
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Abstract
Medical student educators have limited tools for standardized clinical reasoning assessment. The clinical reasoning task (CRT) checklist has been shown to identify specific tasks in the diagnostic process among residents and faculty. Authors assessed a novel student think aloud protocol strategy, the CRT, compared with the validated clinical data interpretation (CDI) test in six third-year medical students. The CRT was scored by two independent reviewers (kappa = 0.88). CRT and CDI scores were strongly positively correlated (r = 0.768, p = 0.074, df = 4). CRT provides both a global assessment of clinical reasoning and specific clinical reasoning deficits.
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Affiliation(s)
- Yvonne N. Covin
- Department of Internal Medicine, UT Health San Antonio, San Antonio, TX USA
| | - Neda Wick
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX USA
| | - Palma J. Longo
- Department of Healthcare Sciences, UT Southwestern Medical Center, Dallas, TX USA
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Wiedemann D, Schneeberger S, Friedl P, Wick N, Zacharowski K, Petzelbauer P, Margreiter R, Laufer G, Semsroth S. 413: The Fibrin Derived Peptide B-beta15-42 Ameliorates Ischemia-Reperfusion Injury after Heart Transplantation in Rats. J Heart Lung Transplant 2008. [DOI: 10.1016/j.healun.2007.11.425] [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: 11/25/2022] Open
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Kamolz LP, Kolbus A, Wick N, Mazal PR, Eisenbock B, Burjak S, Meissl G. Cultured human epithelium: human umbilical cord blood stem cells differentiate into keratinocytes under in vitro conditions. Burns 2005; 32:16-9. [PMID: 16368194 DOI: 10.1016/j.burns.2005.08.020] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2005] [Indexed: 11/30/2022]
Abstract
BACKGROUND Stem cells have the capacity to renew or to give rise to a specialized cell types. Human umbilical cord blood (HUCB) has been explored as an alternative source of stem cells. However, its potential to differentiate into cells of other tissues is still under discussion. The aim of our study was to evaluate if HUCB stem cells could differentiate into epithelial cells under in vitro conditions. METHODS Human keratinocytes derived from adult female skin donors, were isolated and cultured on fibrin glue/fibroblast gels-control group. In the umbilical cord blood cell group, male umbilical cord blood cells were added at a 1:10 ratio to keratinocytes and co-cultured on the fibrin glue/fibroblasts gel. After 15 days of culture, the sheets were analyzed by use of histochemistry and FISH. DNA was extracted and evaluated by use of polymerase chain reaction (PCR) for detection of Y-chromosome-specific sequences. RESULTS In both groups a regular epithelial sheet consisting of three to four layers of cells was formed. Using PCR and FISH, in the umbilical cord blood cell group the presence of Y-chromosome-specific sequences in the cultured keratinocytes could be detected. In the control group, no Y-chromosome-specific sequences could be detected. CONCLUSION Our findings indicate that umbilical cord blood stem cells differentiate into epithelial cells under in vitro conditions and thereby, might serve as a starting material for isolation and expansion of cells for transplantation in patients with large skin defects.
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Affiliation(s)
- L-P Kamolz
- Division of Plastic and Reconstructive Surgery, Vienna Burn Centre, Department of Surgery, Keratinocyte Research Group, General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
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Kamolz LP, Luegmair M, Wick N, Eisenbock B, Burjak S, Koller R, Meissl G, Frey M. The Viennese culture method: cultured human epithelium obtained on a dermal matrix based on fibroblast containing fibrin glue gels. Burns 2005; 31:25-9. [PMID: 15639361 DOI: 10.1016/j.burns.2004.06.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2004] [Indexed: 11/22/2022]
Abstract
The aim of this study was to develop a new keratinocyte culture system on a dermal equivalent suitable for skin wound closure. Our dermal matrix is based on a fibrin glue gel containing live human fibroblast (from human foreskin). Keratinocytes obtained from primary culture according to the Rheinwald and Green method, were seeded on to the gel. In all cases, the keratinocytes plated on the dermal equivalent grew to confluence and stratified epithelium was obtained. After 10 days an irregular multilayer could be observed. The cells showed active interaction with the fibrin support, presenting as cell formations projecting into the matrix. After 15 days a regular epithelial sheet consisting of three to four layers of cells was formed. A limiting membrane demarcating the keratinocytes from the fibrin matrix was discernible. Squamous differentiation similar to Strata reticulare and corneum found in vivo could be observed. Nuclei of basal cells were regularly spaced from each other and the chromatin was of homogeneous appearance without prominent nucleoli. The last time point (20 days) showed signs of disintegration of the epithelial sheet. A basement membrane-like structure could not be seen any more. Detachment of the basal cells was associated with subepithelial vacuoles. Basal cells contained irregular nuclei. Therefore, we conclude that 15 days of culture were optimal for the generation of a keratinocyte layers with signs of differentiation; this new culture system could be an important step forward in covering severely burned patients due to a number of advantages, as for example a large expansion factor, the shortening of the optimal culture time to 15 days, the usage of commercially available fibrin glue gels and the versatile manipulation of composite cultures.
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Affiliation(s)
- L P Kamolz
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
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Wick N, Schleiffer A, Huber LA, Vietor I. Inhibitory Effect of TIS7 on Sp1-C/EBPα Transcription Factor Module Activity. J Mol Biol 2004; 336:589-95. [PMID: 15095974 DOI: 10.1016/j.jmb.2003.11.060] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2003] [Revised: 10/14/2003] [Accepted: 11/20/2003] [Indexed: 10/26/2022]
Abstract
The transcription factors C/EBPalpha and Sp1 functionally interact to induce expression of specific genes during myeloid and epithelial cell differentiation. The C/EBPalpha-Sp1 transcription factor "module" binds to enhancer elements within the upstream regulatory sequences of target genes. In our previous study we identified mouse TPA inducible sequence 7 (TIS7) as a novel co-repressor in epithelial cells undergoing loss of polarity. Increased levels of TIS7 down-regulate the transcription of a specific set of genes. Using bioinformatic analysis we identified a common binding site for the C/EBPalpha-Spl transcription factor module within the upstream regulatory regions of TIS7-regulated genes. The inhibitory effect of TIS7 on C/EBPalpha-Sp1-mediated transcription was confirmed by reporter assays. Our data showed that the TIS7 effect was mediated through specific interference with Sp1 transcriptional activity. Furthermore, TIS7 prevented formation of a complex between Sp1 protein and its consensus DNA binding site. Data presented here further specify the mechanism of action of the transcriptional co-repressor TIS7 as well as document the strength of a bioinformatic approach for the prediction and analysis of transcription factor modules.
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Affiliation(s)
- N Wick
- Clinical Institute for Pathology, University of Vienna, Austria Waehringer Guertel 18-20, A-1190 Vienna, Austria
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Weis WL, Wick N. Increasing productivity through on-site smoking control. Health Care Strateg Manage 1985; 3:16-9. [PMID: 10270963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Smoking in the workplace is becoming an increasingly sensitive issue. For health care providers, the reasons for implementing a proscriptive smoking policy are particularly relevant. This article outlines the reasons for banning workplace smoking and provides examples of companies who have successfully implemented no smoking policies.
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Weis WL, Wick N. "Let's be cooperative" at Group Health: a case study in becoming a smoke-free workplace. Health Care Strateg Manage 1984; 2:12-5. [PMID: 10268966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Wick N. Visiting nurse service keeps respiratory patients out of hospitals and in their homes. Home Health J 1983; 4:3, 14. [PMID: 10263216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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