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Eden J, Dutkowski P, Schlegel A. Reply to: "How many liver grafts could be recovered after implementation of donation after cardiac death in Germany?". J Hepatol 2023; 79:e120-e121. [PMID: 37245704 DOI: 10.1016/j.jhep.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/20/2023] [Indexed: 05/30/2023]
Affiliation(s)
- Janina Eden
- Department of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Switzerland
| | - Philipp Dutkowski
- Department of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Switzerland.
| | - Andrea Schlegel
- Transplantation Center, Digestive Disease and Surgery Institute and Department of Immunity and Inflammation, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Centre of Preclinical Research, Milan, 20122, Italy
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Jonczyk MM, Homsy C, Naber S, Chatterjee A. Examining a decade of racial disparity in partial mastectomy and oncoplastic surgery. J Surg Oncol 2023; 127:541-549. [PMID: 36507913 DOI: 10.1002/jso.27173] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/25/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Understanding racial disparity is crucial to addressing health equity and access to care. Our study aims to examine racial differences in breast conserving surgery (BCS) utilization rates and determine how these rates have changed over time. METHODS This retrospective cohort analysis utilized the NSQIP database to identify women diagnosed with breast cancer who underwent BCS procedures between 2008 and 2019. Racial utilization trends were analyzed using a Cochran-Armitage test and Index of Disparity analysis. RESULTS In the 12-year period, 202 492 women underwent a breast cancer surgery, of which 47% underwent BCS. Within the BCS subgroup, oncoplastic surgery utilization increased from 3% to 10%, leading to a declining proportion of partial mastectomies: 97% to 90.0% (both p < 0.01). The racial index of disparity for overall BCS patients decreased from 7% to 6%, remained unchanged (1%) for partial mastectomies, and significantly decreased in oncoplastics (23%-7.6%). CONCLUSION BCS represents a mainstay option for early-staged breast cancer interventions, this study demonstrate promising progress in decreasing the index of disparity among races and persistent racial inequalities.
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Affiliation(s)
- Michael M Jonczyk
- Department of General Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.,Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Christopher Homsy
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Stephen Naber
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, Massachusetts, USA
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Zeana C, Palmieri FE, Gupta V, Ye G, Lao P, Yu K, Kang KS, Schiller L, Purswani M. Association between fluoroquinolone utilization rates and susceptibilities of gram-negative bacilli: Results from an 8-year intervention by an antibiotic stewardship program in an inner-city United States hospital. Sci Prog 2021; 104:368504211011876. [PMID: 33908291 PMCID: PMC10455014 DOI: 10.1177/00368504211011876] [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: 11/16/2022]
Abstract
This study evaluated an antibiotic stewardship program (ASP) intervention aimed at reducing inpatient fluoroquinolone (FQ) use and examined its impact on ciprofloxacin susceptibilities of gram-negative bacteria in a large 611-bed community hospital. A two-step ASP intervention was implemented: an electronic medical record algorithm that prompted physicians to re-evaluate FQ use shortly after admission and changed institutional UTI/pneumonia guidelines that recommended options alternate to FQs for first-line empiric antibiotic therapy in 2010 and 2011 respectively. Between 2007 and 2017 FQ use and ciprofloxacin susceptibilities of all non-duplicate cultured isolates of Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, and Pseudomonas aeruginosa obtained ≥72 h after admission were reviewed. Ambulatory care isolates served as a comparison group. FQ utilization rates and relationships to ciprofloxacin susceptibility were evaluated using interrupted time series models. Over the 11-year period, FQ use decreased from 110.0 (2007) to 26.2 (2017) days of therapy/1000 days at risk (p < 0.001). Compared to pre-intervention, the estimated (post-intervention) reduction in FQ utilization was 28.4 (95% CI: 10.9-46) days of therapy/1000 days at risk. Reduced FQ utilization was correlated with increase susceptibilities to ciprofloxacin of hospital onset isolates of Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis (p < 0.02), and Pseudomonas aeruginosa (p = 0.07). No significant susceptibility change was observed in the ambulatory care isolates. Persuasive interventions by an ASP successfully modified physicians' inpatient empiric antibiotic use, produced a sustained reduction in FQ utilization rates and increased ciprofloxacin susceptibility to four commonly encountered gram-negative bacteria in a community hospital.
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Affiliation(s)
- Cosmina Zeana
- Division of Adult Infectious Disease, Department of Medicine, BronxCare Health System, Bronx, NY, USA
| | | | - Vikas Gupta
- Becton, Dickinson and Company, Franklin Lakes, NJ, USA
| | - Gang Ye
- Becton, Dickinson and Company, Franklin Lakes, NJ, USA
| | - Peter Lao
- Department of Pharmacy, BronxCare Health System, Bronx, NY, USA
| | - Kalvin Yu
- Becton, Dickinson and Company, Franklin Lakes, NJ, USA
| | - Kyoung-Sil Kang
- Department of Pharmacy, BronxCare Health System, Bronx, NY, USA
| | - Larry Schiller
- Department of Pharmacy, BronxCare Health System, Bronx, NY, USA
| | - Murli Purswani
- Division of Pediatric Infectious disease, Department of Pediatrics, BronxCare Health System, Bronx, NY, USA
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4
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Spittel S, Maier A, Kettemann D, Walter B, Koch B, Krause K, Norden J, Münch C, Meyer T. Non-invasive and tracheostomy invasive ventilation in amyotrophic lateral sclerosis: Utilization and survival rates in a cohort study over 12 years in Germany. Eur J Neurol 2020; 28:1160-1171. [PMID: 33210770 DOI: 10.1111/ene.14647] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/29/2020] [Accepted: 11/08/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to investigate utilization rates, treatment pathways and survival prognosis in patients with amyotrophic lateral sclerosis (ALS) undergoing non-invasive (NIV) and tracheostomy invasive ventilation (TIV) in a real-world setting. METHODS A prospective cohort study using a single-centre register of 2702 ALS patients (2007 to 2019) was conducted. Utilization of NIV/TIV and survival data were analysed in three cohorts: (i) non-NIV; (ii) NIV (NIV without subsequent TIV); and (iii) TIV (including TIV preceded by NIV). RESULTS A total of 1720 patients with available data were identified, 72.0% of whom (n = 1238) did not receive ventilation therapy. NIV was performed in 20.8% of patients (n = 358). TIV was performed in 9.5% of patients (n = 164), encompassing both primary TIV (7.2%, n = 124) and TIV with preceding NIV (2.3%, n = 40). TIV was more often utilized without previous NIV (25.7% vs. 8.3% of all ventilated patients), demonstrating that primary TIV was the prevailing pathway for invasive ventilation. The median (range) survival was significantly longer in the NIV cohort (40.8 [37.2-44.3] months) and the TIV cohort (82.1 [68.7-95.6] months) as compared to the non-NIV cohort (33.6 [31.6-35.7] months). CONCLUSIONS Although NIV represents the standard of care, its utilization rate was low. TIV was mainly started without preceding NIV, suggesting that TIV may not be confined to NIV treatment escalation. However, TIV was pursued in a minority of patients who had previously undergone NIV. The survival benefit observed in the patients with NIV was equal to that reported in a controlled pivotal trial, but the prognosis with TIV is highly variable. The determinants of utilization of NIV/TIV and of survival (bulbar syndrome, availability of ventilation-related home nursing, cultural factors) warrant further investigation.
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Affiliation(s)
- Susanne Spittel
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - André Maier
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dagmar Kettemann
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bertram Walter
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Birgit Koch
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kerstin Krause
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jenny Norden
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Münch
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - Thomas Meyer
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
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Shamir SB, Schwartz C, Morrone K, Taragin B, Liszewski MC. Acute Appendicitis in Pediatric Patients With Sickle Cell Disease: Lower Incidence, More Imaging, and More False-Positives. J Am Coll Radiol 2020; 18:257-264. [PMID: 33096090 DOI: 10.1016/j.jacr.2020.09.052] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/09/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Patients with sickle cell disease (SCD) experience recurrent pain crises, which may mimic appendicitis. A prior study found a significantly lower rate of appendicitis in patients with SCD compared with national averages. We investigate the incidence of appendicitis and number of imaging studies for appendicitis in pediatric patients with SCD. METHODS Using a retrospective study design from a single institution, SCD and control cohorts were created. Inclusion criteria included age 0 to 21years and at least one follow-up appointment within 24 months. Length of observation was calculated from initial presentation to either inpatient admission for appendicitis or last clinic visit. Analysis of an SCD subgroup and a control subset (n = 1,596) was used to compare the number of imaging studies. Incidence rates of appendicitis and number of appendicitis studies were determined. Z-tests, binomial enumeration exact tests, and Fischer's exact tests were used. RESULTS The SCD cohort included 1,064 patients between January 1, 2001, to December 31, 2014, and the control cohort included 115,109 patients without SCD between January 1, 2011, and December 31, 2011. Incidence rate of appendicitis per 10,000 patient-years was significantly lower in the SCD group compared with controls (2.9 cases versus 10.7 cases per 10,000 patient-years; P = .044). Additionally, the SCD group received significantly more ultrasounds (148 versus 60 per 10,000 patient-years; P< .0001) and CTs (94 versus 27 per 10,000 patient-years; P< .0001) for appendicitis, which remained significant when controlling for race. Patients with SCD also received more false-positive scans. DISCUSSION Patients with SCD had a significantly lower incidence of appendicitis than controls, yet had a higher number of imaging tests performed for appendicitis. Appendicitis should be viewed as a less common cause of acute abdominal pain in SCD. This consideration should help guide imaging strategy.
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Affiliation(s)
- Stephanie B Shamir
- Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, New York.
| | - Carly Schwartz
- Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, New York
| | - Kerry Morrone
- Assistant Professor of Pediatrics, Director of the Pediatric Sickle Cell Program, Director of the Pediatric Hematology Oncology Fellowship Program, Division of Pediatric Hematology/Oncology and Cellular Therapy, The Children's Hospital at Montefiore and Montefiore Medical Center, Bronx, New York
| | - Benjamin Taragin
- Soroka University Medical Center, Beer Sheva, Israel; Ben-Gurion University, Beer Sheva, Israel
| | - Mark C Liszewski
- Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, New York; Director of Outpatient Imaging, Montefiore Medical Center; Director, Division of Pediatric Radiology; Associate Program Director, Diagnostic Radiology Residency; Associate Professor of Radiology Departments of Radiology and Pediatrics, Montefiore Medical Center and The Children's Hospital at Montefiore Albert Einstein College of Medicine Bronx, New York
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Aufricht G, Hoang J, Iglesias J, Latiolais H, Sheffield H, Trejo C, Holder M, Smith S, Garrett J, Columbus C. Analysis of central venous catheter utilization at a quaternary care hospital. Proc (Bayl Univ Med Cent) 2019; 32:1-4. [PMID: 30956569 DOI: 10.1080/08998280.2018.1542651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/24/2018] [Accepted: 10/25/2018] [Indexed: 12/14/2022] Open
Abstract
Central line-associated bloodstream infections (CLABSIs) are one of the most dangerous and costly types of hospital-acquired infections. Incidence of CLABSI can be significantly reduced through proper aseptic techniques, surveillance, and active management strategies, including elimination of idle central line days. This quality improvement project examined two central venous catheter (CVC) cohorts. The institutional electronic health record (EHR) was utilized to generate a daily report indicating CVC utilization by patient care unit. The EHR was further scrutinized for documentation of appropriate indications for CVC use employing an appropriateness tool developed by the institutional vascular access team. Cohort 1 included 12 National Healthcare Safety Network-reportable units audited on a daily basis over a 4-week time period; cohort 2 included selected National Healthcare Safety Network-nonreportable units audited on a daily basis over a 2-week time period. Central venous catheters that did not meet defined indications as outlined by the institutional vascular access team's data collection checklist were escalated the same day to the unit clinical nurse manager for review and possible removal. The percentage of clinically nonindicated CVCs in cohort 1 fell by 65% over the 4-week period of daily audit and real-time feedback, with similar results noted for cohort 2. In conclusion, real-time audit and feedback regarding appropriate clinical indications for CVC use can result in decreased idle or nonindicated central line days, potentially contributing to decreased CLABSI rates.
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Affiliation(s)
| | - Joseph Hoang
- College of Medicine, Texas A&M UniversityDallasTexas
| | - Jose Iglesias
- College of Medicine, Texas A&M UniversityDallasTexas
| | | | | | | | - Max Holder
- IV Services, Baylor University Medical CenterDallasTexas
| | - Susan Smith
- Department of Nursing Education, Baylor University Medical CenterDallasTexas
| | - John Garrett
- College of Medicine, Texas A&M UniversityDallasTexas.,Department of Emergency Medicine, Baylor University Medical CenterDallasTexas
| | - Cristie Columbus
- College of Medicine, Texas A&M UniversityDallasTexas.,Division of Infectious Diseases, Department of Internal Medicine, Baylor University Medical CenterDallasTexas
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Abstract
Five background articles in Section 2 of the "Advancing Dental Education in the 21st Century" project examined some of the factors likely to impact the number of dentists needed in 2040: 1) the oral health of the population, 2) changes in the utilization of dental services, 3) new technologies, 4) the growth of large capitated dental group practices, and 5) the demand for dental care. With this information, a sixth background article estimated the number of dentists needed in 2040 compared to the number expected if current trends continue. This executive summary provides an overview of findings from these six articles. The data indicate major improvements in oral health, especially in upper income groups that account for 65% of practice revenues. At the same time, per capita utilization of restorative and prosthetic services has declined dramatically. No major new technologies are likely to impact the need for dentists by 2040. In a large capitated group practice, full-time general dentists treated an average of 2,100 patients per year; solo general dentists averaged 1,350. Based on the examined factors, growth in demand for traditional forms of care may slow substantially, raising the potential for a surplus of dentists in 2040. If these trends continue, the key national policy issue then would be: should schools reduce the number of graduates before market forces require them to downsize or close, or are other alternatives available?
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Affiliation(s)
- Howard L Bailit
- Dr. Bailit is Professor Emeritus, Department of Community Medicine, School of Medicine, University of Connecticut.
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Khatib O, Onyekwelu I, Yu S, Zuckerman JD. Shoulder arthroplasty in New York State, 1991 to 2010: changing patterns of utilization. J Shoulder Elbow Surg 2015; 24:e286-91. [PMID: 26190667 DOI: 10.1016/j.jse.2015.05.038] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 04/24/2015] [Accepted: 05/04/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Shoulder arthroplasty is now used to treat an expanding variety of glenohumeral disorders. METHODS This study assessed the demographic patterns and utilization rates of shoulder hemiarthroplasty (HA) and anatomic or reverse total shoulder arthroplasty (TSA) within New York State (NYS) from 1991 to 2010. Using the New York Statewide Planning and Research Cooperative System database, all shoulder arthroplasty procedures that occurred within NYS during the study period were retrospectively identified and analyzed. RESULTS During the 20-year period, 24,040 shoulder arthroplasty procedures were performed. During the second decade (2001-2010), there was a 393% increase in utilization of TSA with a 98% increase in HA. This disproportionate increase is likely due to the introduction and expanding indications of reverse TSA as an effective procedure in place of HA for the treatment of proximal humerus fractures and rotator cuff arthropathy, as rotator cuff arthropathy as a primary indication for HA was significantly less prevalent in period 2. Also notable was an identifiable disparity in race; whites represented approximately 80% of the shoulder arthroplasty procedures in both decades, whereas African Americans made up <5%. This is significantly different from the general racial demographics of NYS during both periods analyzed. DISCUSSION It is clear that the volume of shoulder arthroplasty procedures performed in NYS is increasing, mirroring the national experience. This trend reflects the expanding indications, the general success of these procedures, the aging demographic of our population, and a greater desire and willingness of patients to consider operative management to maintain or to improve quality of life.
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Affiliation(s)
- Omar Khatib
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - Ikemefuna Onyekwelu
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - Stephen Yu
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - Joseph D Zuckerman
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA.
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Viola KV, Rezzadeh KS, Gonsalves L, Patel P, Gross CP, Yoo J, Stamell E, Turner RB. National utilization patterns of Mohs micrographic surgery for invasive melanoma and melanoma in situ. J Am Acad Dermatol 2015; 72:1060-5. [PMID: 25824274 DOI: 10.1016/j.jaad.2015.02.1122] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [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: 10/11/2013] [Revised: 01/09/2015] [Accepted: 02/14/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Although wide local excision continues to be commonly used for melanoma treatment, Mohs micrographic surgery (MMS) for the treatment of melanomas remains controversial. OBJECTIVE We sought to determine national utilization patterns for MMS in the treatment of invasive melanoma and melanoma in situ. METHODS A retrospective analysis of patients receiving surgical excision (MMS or wide local excision) for the treatment of invasive melanoma and melanoma in situ was performed using data from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) program. RESULTS A total of 195,768 melanomas were diagnosed from 2003 through 2009 from the 17 SEER registries. Utilization of MMS for invasive melanoma and melanoma in situ increased by 60% from 2003 to 2008. Of all SEER-captured lesions treated by surgical excision in this time period, 3.5% (6872) were excised by MMS. LIMITATIONS Patient insurance status, physician reimbursement practices, and health care provider type were not addressed in this article. CONCLUSION Use of MMS for melanoma appears to be increasing. Future studies should explore whether this is associated with better outcomes.
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Affiliation(s)
- Kate V Viola
- Albert E. Einstein College of Medicine, Bronx, New York.
| | - Kameron S Rezzadeh
- Rutgers University-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Lou Gonsalves
- Connecticut Tumor Registry, State of Connecticut Department of Public Health, Hartford, Connecticut
| | - Payal Patel
- Albert E. Einstein College of Medicine, Bronx, New York
| | - Cary P Gross
- Cancer Outcomes Policy and Effectiveness Research Center, Yale University School of Medicine, New Haven, Connecticut
| | - Jane Yoo
- Albert E. Einstein College of Medicine, Bronx, New York
| | - Emily Stamell
- Albert E. Einstein College of Medicine, Bronx, New York
| | - Ryan B Turner
- Albert E. Einstein College of Medicine, Bronx, New York
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