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Choi JJ, Rosen MA, Shapiro MF, Safford MM. Towards diagnostic excellence on academic ward teams: building a conceptual model of team dynamics in the diagnostic process. Diagnosis (Berl) 2023; 10:363-374. [PMID: 37561698 DOI: 10.1515/dx-2023-0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/31/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVES Achieving diagnostic excellence on medical wards requires teamwork and effective team dynamics. However, the study of ward team dynamics in teaching hospitals is relatively underdeveloped. We aim to enhance understanding of how ward team members interact in the diagnostic process and of the underlying behavioral, psychological, and cognitive mechanisms driving team interactions. METHODS We used mixed-methods to develop and refine a conceptual model of how ward team dynamics in an academic medical center influence the diagnostic process. First, we systematically searched existing literature for conceptual models and empirical studies of team dynamics. Then, we conducted field observations with thematic analysis to refine our model. RESULTS We present a conceptual model of how medical ward team dynamics influence the diagnostic process, which serves as a roadmap for future research and interventions in this area. We identified three underexplored areas of team dynamics that are relevant to diagnostic excellence and that merit future investigation (1): ward team structures (e.g., team roles, responsibilities) (2); contextual factors (e.g., time constraints, location of team members, culture, diversity); and (3) emergent states (shared mental models, psychological safety, team trust, and team emotions). CONCLUSIONS Optimizing the diagnostic process to achieve diagnostic excellence is likely to depend on addressing all of the potential barriers and facilitators to ward team dynamics presented in our model.
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Affiliation(s)
- Justin J Choi
- Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Michael A Rosen
- Department of Anesthesiology and Critical Care Medicine, Armstrong Institute for Patient Safety and Quality, Institute for Clinical and Translational Research, and JHSOM Simulation Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Martin F Shapiro
- Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Monika M Safford
- Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
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2
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Zeb H, Inayat S, Younas A. Organizational support and Nurse-Physician collaboration during SARS-CoV-2 pandemic: A qualitative study. Nurs Health Sci 2023; 25:9-17. [PMID: 36581738 PMCID: PMC9880708 DOI: 10.1111/nhs.13012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022]
Abstract
Health care professionals experienced multiple uncertainties during the pandemic. Exploring health care professionals' views about collaboration and organizational support can offer insights into organizational processes and issues during the pandemic. This research explored the perspectives of nurses and physicians about organizational support and nurse-physician collaboration during the SARS-CoV-2 pandemic. Using a qualitative descriptive design, interviews were conducted with nurses and physicians working in hospital settings. The interviews lasted for 24-61 min. Reflexive thematic analysis was used for data analysis. Nurses and physicians were disappointed with the organizational support, but they were satisfied with nurse-physician collaboration. The theme "Management Abusing Authority and Blaming the Victimized Workforce" included organizational nepotism, unethical managerial actions, and neglecting frontline workforce. Nurses and physicians supported each other in tackling the intensive and complex demands of the pandemic. The theme "Demonstrating Professional Humility and Overcoming Patient Care Issues at Hand" entailed subthemes - negotiating conflicts and prioritizing patient care, practicing kindness, and jointly managing conflicts with patients' families. Nurses and physicians reported frustrations with limited organizational support and abusive practices of managers. Still, they prioritized patient care needs and family-related conflicts over interprofessional tensions.
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Affiliation(s)
| | - Shahzad Inayat
- Faculty of NursingAl‐Nafees Medical College, Isra UniversityIslamabadPakistan
| | - Ahtisham Younas
- Faculty of NursingMemorial University of NewfoundlandSt. John'sNewfoundland and LabradorCanada
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3
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Physician-Nurse and Nurse-Nurse Collaboration From the Perspective of Nurses: A Cross-Sectional Study. J Nurses Prof Dev 2023; 39:E8-E17. [PMID: 34516465 DOI: 10.1097/nnd.0000000000000779] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The study aims to determine the physician-nurse and nurse-nurse collaboration levels of nurses and effective factors. A cross-sectional study was conducted with a sample of 477 nurses from five hospitals using a questionnaire. It was determined that the characteristics of working life explained 10% of the Nurse-Nurse Collaboration Scale and the regression model between variables and the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration was not statistically significant. Physician-nurse and nurse-nurse collaboration are affected by a variety of factors.
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Montañés Muro MP, Ayala Calvo JC, Manzano García G. Burnout in nursing: A vision of gender and “invisible” unrecorded care. J Adv Nurs 2022; 79:2148-2154. [DOI: 10.1111/jan.15523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/22/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022]
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Yilmaz K, Taşçi-Duran E. Examining the views of nurses working in gynecology and obstetrics clinics on collaborative practice. Health Care Women Int 2022:1-21. [PMID: 36409711 DOI: 10.1080/07399332.2022.2144861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 11/03/2022] [Accepted: 11/03/2022] [Indexed: 11/22/2022]
Abstract
We aimed to reveal the attitudes and perceptions of a group of nurses toward collaborative work and the barriers to collaborative practice. At the end of the study, we obtained four main themes: leadership in health services, interpersonal interaction factors, cooperation in patient care, standardization. The nurses emphasized the critical elements of respect, relationships and communication as components of effective collaborative practice. As a result, it was stated that the practice of cooperation between doctors and nurses is weak and there are some difficulties and obstacles.
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Affiliation(s)
- Kubra Yilmaz
- Health Sciences Faculty, Obstetrics and Gynecology Nursing Department, Süleyman Demirel University, Isparta, Turkey
| | - Emel Taşçi-Duran
- Health Sciences Faculty, Obstetrics and Gynecology Nursing Department, Süleyman Demirel University, Isparta, Turkey
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7
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Respectful Maternity Care Framework and Evidence-Based Clinical Practice Guideline. J Obstet Gynecol Neonatal Nurs 2022; 51:e3-e54. [PMID: 35101344 DOI: 10.1016/j.jogn.2022.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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8
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Cortés-Rodríguez AE, Roman P, López-Rodríguez MM, Fernández-Medina IM, Fernández-Sola C, Hernández-Padilla JM. Role-Play versus Standardised Patient Simulation for Teaching Interprofessional Communication in Care of the Elderly for Nursing Students. Healthcare (Basel) 2021; 10:healthcare10010046. [PMID: 35052210 PMCID: PMC8775804 DOI: 10.3390/healthcare10010046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/17/2021] [Accepted: 12/23/2021] [Indexed: 01/08/2023] Open
Abstract
This study aims to describe and compare the effects of standardised patient simulation and role-play in the acquisition and retention of interprofessional communication in elderly care competence amongst nursing students. In this controlled clustered randomised trial, 121 nursing students attended a workshop on interprofessional communication in elderly care using role-play or standardised patient simulation. The study was conducted between September 2017 and February 2018. Participants’ knowledge, self-efficacy and communication skills were assessed using a simulated scenario at pre-test, post-test and 6-week follow-up points. Between-subject and within-subject differences were measured using counts and proportions of participants who achieved competence. Regardless of the strategy applied, a significant improvement in knowledge, skills, self-efficacy and overall interprofessional communication competence was found between pre-test and post-test. Moreover, there were significant differences between pre-test and follow-up for all the studied variables, but no differences were found between post-test and follow-up. Lastly, when comparing the success rates of both strategies, no significant differences were observed (p > 0.05). In conclusion, standardised patient simulation and role-play have been shown to promote an improvement on knowledge, self-efficacy and interprofessional communication skills in nursing students, although it is not possible to state which strategy is the most adequate for teaching this competency.
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Affiliation(s)
- Alda Elena Cortés-Rodríguez
- Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (A.E.C.-R.); (M.M.L.-R.); (I.M.F.-M.); (C.F.-S.); (J.M.H.-P.)
- Health Sciences Research Centre, University of Almería, 04120 Almería, Spain
| | - Pablo Roman
- Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (A.E.C.-R.); (M.M.L.-R.); (I.M.F.-M.); (C.F.-S.); (J.M.H.-P.)
- Health Sciences Research Centre, University of Almería, 04120 Almería, Spain
- Correspondence: ; Tel.: +34-950214563
| | - María Mar López-Rodríguez
- Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (A.E.C.-R.); (M.M.L.-R.); (I.M.F.-M.); (C.F.-S.); (J.M.H.-P.)
- Health Sciences Research Centre, University of Almería, 04120 Almería, Spain
| | - Isabel María Fernández-Medina
- Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (A.E.C.-R.); (M.M.L.-R.); (I.M.F.-M.); (C.F.-S.); (J.M.H.-P.)
- Health Sciences Research Centre, University of Almería, 04120 Almería, Spain
| | - Cayetano Fernández-Sola
- Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (A.E.C.-R.); (M.M.L.-R.); (I.M.F.-M.); (C.F.-S.); (J.M.H.-P.)
- Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco 4810101, Chile
| | - José Manuel Hernández-Padilla
- Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (A.E.C.-R.); (M.M.L.-R.); (I.M.F.-M.); (C.F.-S.); (J.M.H.-P.)
- Adult, Child and Midwifery Department, School of Health and Education, Middlesex University, The Burroughs, London NW4 4BT, UK
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Brydges R, Nemoy L, Campbell DM, Meffe F, Moscovitch L, Fella S, Chandrasekaran N, Bishop C, Khodadoust N, Ng SL. "We can't just have a casual conversation": An institutional ethnography-informed study of work in labour and birth. Soc Sci Med 2021; 279:113975. [PMID: 33964590 DOI: 10.1016/j.socscimed.2021.113975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/13/2021] [Accepted: 04/23/2021] [Indexed: 11/24/2022]
Abstract
Labour and delivery units often become contested workplaces with tensions between obstetrics, nursing, and midwifery practices. These tensions can impede communication and raise concerns about provider wellness and patient safety. Remedying such tensions requires inquiry into the drivers of recurrent problems in interprofessional practice. We engaged in change-oriented inquiry informed by institutional ethnography (IE) within an academic hospital in Toronto, Canada (2017-2019). Clinicians identified critical incident analysis reports used to document recurrent issues for transfers of care (TOC) and consultations between professionals. We then mapped the everyday/everynight work of midwives, nurses, and obstetricians by observing (75 h) and interviewing them (n = 15). We also traced work processes to local (forms and hospital policies) and external (national policies and evidence-based guidelines) texts. Our IE-informed analysis made visible the otherwise hidden links between the everyday work of practitioners and its social organization. Three intrapartum work processes involving midwives consulting with obstetricians were identified: induction of labour with TOC back to midwife once labour was "active", consultation without TOC, and TOC for various indications. Three points of disjuncture complicated these processes: (i) a local "3 consult rule", linked to medico-legal governance and remuneration structures; (ii) subjective interpretations of the "4-cm dilation rule", a policy meant to standardize practice; and (iii) regulations delaying the timing of consultations. The Electronic Fetal Monitoring system served as a powerful text, materializing issues of professional scope and autonomy for midwives, and medicolegal accountability for obstetricians. Our study extends extant evidence that medicine-driven governance of midwifery practices can perpetuate interprofessional challenges. While practitioners spoke of the three disjunctures as 'laws', most also viewed them as ostensibly modifiable. Interprofessional tensions may be addressed by considering how social organization, materialized in texts detailing medico-legal liability and remuneration, can constrain possible practices through regulatory protocols, local ruling policies, and cultural expectations (e.g., documentation practices).
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Affiliation(s)
- Ryan Brydges
- Allan Waters Family Simulation Centre, St. Michael's Hospital, Unity Health Toronto, Canada; Department of Medicine, University of Toronto, Canada; Wilson Centre for Research in Education, University Health Network, University of Toronto, Canada.
| | - Lori Nemoy
- Allan Waters Family Simulation Centre, St. Michael's Hospital, Unity Health Toronto, Canada
| | - Doug M Campbell
- Allan Waters Family Simulation Centre, St. Michael's Hospital, Unity Health Toronto, Canada; Department of Pediatrics, St. Michael's Hospital, Unity Health Toronto, Canada
| | - Filomena Meffe
- Department of Obstetrics and Gynecology, St. Michael's Hospital, Unity Health Toronto, Canada
| | - Linda Moscovitch
- Department of Midwifery, St. Michael's Hospital, Unity Health Toronto, Canada
| | - Sabina Fella
- Department of Midwifery, St. Michael's Hospital, Unity Health Toronto, Canada
| | - Nirmala Chandrasekaran
- Department of Obstetrics and Gynecology, St. Michael's Hospital, Unity Health Toronto, Canada
| | - Catherine Bishop
- Department of Pediatrics, St. Michael's Hospital, Unity Health Toronto, Canada
| | - Nazanin Khodadoust
- Allan Waters Family Simulation Centre, St. Michael's Hospital, Unity Health Toronto, Canada
| | - Stella L Ng
- Wilson Centre for Research in Education, University Health Network, University of Toronto, Canada; University of Toronto's Centre for Interprofessional Education, University Health Network, Canada; Department of Speech-Language Pathology, University of Toronto, Canada
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Boss RD, Hirschfeld RS, Barone S, Johnson E, Arnold RM. Pediatric Chronic Critical Illness: Training Teams to Address the Communication Challenges of Patients With Repeated and Prolonged Hospitalizations. J Pain Symptom Manage 2020; 60:959-967. [PMID: 32540469 DOI: 10.1016/j.jpainsymman.2020.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 02/04/2023]
Abstract
CONTEXT Children with chronic critical illness (CCI) have repeated and prolonged hospitalizations. Discrete communication challenges characterize their inpatient care. OBJECTIVES Develop, implement, and evaluate a communication training for inpatient clinicians managing pediatric CCI. METHODS A one-day communication training for interdisciplinary clinicians, incorporating didactic sessions and simulated family and interdisciplinary team meetings. RESULTS Learners had an average of 11 years' clinical experience. About 34% lacked prior communication training relevant to pediatric CCI. Mean baseline competence across communication skills was 2.6 (range 2.4-3.2), corresponding to less than somewhat prepared; after the training, this increased to a mean of 4.0 (range 3.5-4.5), corresponding to well prepared. Skills with greatest improvement included conducting a family meeting, delivering bad news, discussing stopping intensive care, and end-of-life communication. After one month, perceived competence was sustained for seven of 10 skills; for remaining skills, perceived competence scores decreased by 0.1-0.2. About 100% of learners would recommend the training to colleagues; 89% advocated it for all clinicians caring for children with CCI. CONCLUSION Interdisciplinary communication training regarding long stay patients is feasible and valued by novice and seasoned clinicians. The novel integration of intrateam communication skills alongside team-family skills reflects the reality that the care of children with CCI challenges clinicians to communicate well with each other and families. Teaching interdisciplinary teams to share communication skills has the potential to overcome reported limitations of existing inpatient discussions, which can be dominated by one or two physicians and lack contributions from diverse team members.
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Affiliation(s)
- Renee D Boss
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Berman Institute of Bioethics, Baltimore, Maryland, USA.
| | - Ryan S Hirschfeld
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Silvana Barone
- Department of Pediatrics, University of Montreal, Sainte Justine University Hospital Centre, Montreal, Quebec, Canada
| | - Emily Johnson
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert M Arnold
- Department of Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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11
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Boss RD, Raisanen JC, Detwiler K, Fratantoni K, Huff SM, Neubauer K, Donohue PK. Lived Experience of Pediatric Home Health Care Among Families of Children With Medical Complexity. Clin Pediatr (Phila) 2020; 59:178-187. [PMID: 31849237 DOI: 10.1177/0009922819894006] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. For children with complex medical conditions, pediatric home health care is a chronic need. It is a clinical service delivered entirely outside of clinical settings, granting families unparalleled expertise regarding service quality. Methods. Telephone interviews with parents whose children have extensive experiences with home health care. Results: Five themes emerged: (1) benefits of home health care include child survival and family stability; (2) family life is inextricable from home health care schedules, staffing, and services; (3) home health care gaps threaten family physical, mental, and financial well-being; (4) Out-of-pocket costs are common; and (5) families must fight for services as their children's medical conditions evolve. Conclusions. Families understand better than prescribers, providers, or policy makers what is working, and what is not, with home health care. Family expertise should be the foundation for training other families, clinicians, and home health care agencies, and should be a central component of policy and advocacy in this area.
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Affiliation(s)
- Renee D Boss
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA
| | | | | | | | - Susan M Huff
- Johns Hopkins Home Health Group, Baltimore, MD, USA
| | - Kathryn Neubauer
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA
| | - Pamela K Donohue
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Wittink MN, Levandowski BA, Funderburk JS, Chelenza M, Wood JR, Pigeon WR. Team-based suicide prevention: lessons learned from early adopters of collaborative care. J Interprof Care 2019; 34:400-406. [PMID: 31852272 DOI: 10.1080/13561820.2019.1697213] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Suicide prevention in clinical settings requires coordination among multiple clinicians with expertise in different disciplines. We aimed to understand the benefits and challenges of a team approach to suicide prevention in primary care, with a particular focus on Veterans. The Veterans Health Administration has both a vested interest in preventing suicide and it has rapidly and systematically adopted team-based approaches for primary care interventions, including suicide prevention. We conducted eight focus groups and eight in-depth interviews with primary care providers (PCPs), behavioral health providers and nurses located in six regions within one Veterans Administration Catchment Area in the northeast of the US. Transcripts were analyzed using simultaneous deductive and inductive content analysis. Findings revealed that different clinicians were thought to have particular expertise and roles. Nurses were recognized as being well positioned to identify subtle changes in patient behavior that could put patients at risk for suicide; behavioral health providers were recognized for their skill in suicide risk assessment; and PCPs were felt to be an integral conduit between needed services and treatment. Our findings suggest that clinician role-differentiation may be an important by-product of team-based suicide prevention efforts in VHA settings. We contextualize our findings within both a processual and relational interprofessional framework and discuss implications for the implementation of team-based suicide prevention.
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Affiliation(s)
- Marsha N Wittink
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, USA.,Department of Family Medicine, University of Rochester School of Medicine, Rochester, NY, USA
| | - Brooke A Levandowski
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine, Rochester, NY, USA
| | - Jennifer S Funderburk
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, USA.,VA Center for Integrated Healthcare, Syracuse Veterans Affairs Medical Center, Syracuse, NY, USA.,Center of Excellence for Suicide Prevention, Canandaigua Veterans Affairs Medical Center, Canandaigua, NY, USA
| | - Melanie Chelenza
- Wilmot Cancer Institute, University of Rochester, Rochester, NY, USA
| | - Jane R Wood
- Rochester Calkins Veterans Administration Clinic, Rochester, NY, USA
| | - Wilfred R Pigeon
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, USA.,Center of Excellence for Suicide Prevention, Canandaigua Veterans Affairs Medical Center, Canandaigua, NY, USA.,Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, NY, USA
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