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Mitrea N, Brown B, Charpentier M, Mullalli HA, Laska I, Sinani A, Banu R, Paice JA, Ancuta C. Translating Knowledge Into Clinical Practice: A Unique End-of-Life Nursing Education Consortium Teleconferencing Program. J Hosp Palliat Nurs 2023; 25:E109-E115. [PMID: 37535329 DOI: 10.1097/njh.0000000000000969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
For learning to influence change in palliative clinical practice, education needs to be ongoing, incorporating specific interventions targeted to the learner, in a format that enhances knowledge and networking. This novel, online, interactive, case-based educational offering provided a method to allow ongoing integration of palliative care principles for health care professionals who attended the End-of-Life Nursing Education Consortium/Open Medical Institute courses in Salzburg during 2019-2022. Eight monthly teleconferences based on challenging clinical cases allowed discussion between palliative care professionals from 9 countries, serving as a mechanism for deepening theoretical information, allowing incorporation of best practice into the clinical setting, and, ultimately, improving care for all with serious illness. Many of the challenges encountered providing palliative care are universal. Through case vignettes, the group has been able to offer specific interventions, advances in practice, and discussions of approaches toward family and other health care professionals to provide optimal care. The participants report that the opportunity to learn from and support peers in other countries has been a rewarding and emotionally uplifting experience. These discussions were highly rated by participants who strongly voiced that the interactions would change their clinical practice to positively impact patient care.
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Segarmurthy MV, Lim RBL, Yeat CL, Ong YX, Othman S, Taher SW, Spence D, Ahmad F, Sullivan R, Rosa WE, Bhoo-Pathy N. Mapping Palliative Care Availability and Accessibility: A First Step to Eradicating Access Deserts in the Low- and Middle-Income Settings. J Palliat Care 2023:8258597231214485. [PMID: 37981855 PMCID: PMC11102529 DOI: 10.1177/08258597231214485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
OBJECTIVE Palliative care is unavailable and/or inaccessible for the majority of people in low- and middle-income countries (LMIC). This study aims to determine the availability and accessibility of palliative care services in Malaysia, a middle-income country that has made good progress toward universal health coverage (UHC). METHOD Publicly available data, and databases of registered palliative care services were obtained from governmental and nongovernmental sources. Google Maps and Rome2Rio web-based applications were used to assess geographical disparities by estimating the median distance, travel time, and travel costs from every Malaysian district to the closest palliative care service. RESULTS Substantial variations in availability, components, and accessibility (distance, time, and cost to access care) of palliative care services were observed. In the highly developed Central Region of Peninsular Malaysia, specialty care was available within 4 km whereas in the less-developed East Coast of Peninsular Malaysia, patients had to travel approximately 46 km. In the predominantly rural East Malaysia, basic palliative care services were 82 km away and, in some instances, where land connectivity was scarce, it took 2.5 h to access care via boat. The corresponding median travel costs were USD2 (RM9) and USD23 (RM114) in Peninsular Malaysia and East Malaysia. CONCLUSION The stark urban-rural divide in the availability and accessibility of palliative care services even in a setting that has made good progress toward UHC highlights the urgent need for decentralization of palliative care in the LMICs. This may be achieved by capacity building and task shifting in primary care and community settings.
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Affiliation(s)
- Malar Velli Segarmurthy
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Training Division, Ministry of Health Malaysia, Putrajaya Wilayah, Persekutuan, Malaysia
| | - Richard Boon-Leong Lim
- Department of Palliative Care, Hospital Selayang, Ministry of Health Malaysia, Putrajaya Wilayah, Persekutuan, Malaysia
| | - Choi Ling Yeat
- Department of Palliative Care, Hospital Raja Permaisuri Bainun, Ipoh, Ministry of Health Malaysia, Putrajaya Wilayah, Persekutuan, Malaysia
| | - Yu-Xiang Ong
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Salimah Othman
- Family Health Development Division, Ministry of Health Malaysia, Putrajaya Wilayah, Persekutuan, Malaysia
| | | | - Dingle Spence
- Oncology and Palliative Care Unit, Hope Institute Hospital, Jamaica
| | - Fazlina Ahmad
- Palliative Care Unit, Department of Medicine, Hospital Sultanah Bahiyah Kedah, Malaysia
| | - Richard Sullivan
- Palliative Care Unit, Department of Medicine, Institute of Cancer Policy, School of Cancer Sciences, King’s College London, London, UK
| | - William E. Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Nirmala Bhoo-Pathy
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Arora S, Brakey HR, Jones JL, Hood N, Fuentes JE, Cirolia L. Project ECHO for Cancer Care: a Scoping Review of Provider Outcome Evaluations. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1509-1521. [PMID: 37002507 DOI: 10.1007/s13187-023-02292-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
The Project ECHO model of telementoring has been used for the past 10 years to expand access to specialized cancer care. This scoping review identifies evidence for the model's ability to improve provider outcomes, synthesizing findings from existing studies within Moore et al.'s (2009) framework for continuing medical education outcomes. We search two large research databases and a collection maintained by Project ECHO staff for articles that focus on cancer ECHO programs, involve primary data collection, and were published between December 1, 2016, and November 30, 2021. We identified 25 articles for inclusion in our scoping review. Most articles reported results for outcomes related to program participation: attendance, satisfaction, and learning. Yet, just under half reported changes in provider practices. Results demonstrate widespread participation and improved learning resulting from ECHO programs focused on cancer care. There is also evidence of improved practices related to HCV vaccination and palliative care. We highlight examples of best practices as well as opportunities to improve provider outcome evaluations for cancer ECHO programs.
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Affiliation(s)
- Sanjeev Arora
- ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Heidi Rishel Brakey
- Community Engagement and Research Core, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Jessica L Jones
- ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
| | - Nancy Hood
- ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Jesus E Fuentes
- Community Engagement and Research Core, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Lucca Cirolia
- ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Chang O, Ryan B, Rokoduru A, Hill A, Hataogo S, Naidu V. The Pasifika Veilomani Project: a pilot online training programme for healthcare workers in managing gender-based violence and family violence and sharing experiences. Australas Psychiatry 2022; 30:762-767. [PMID: 34781772 DOI: 10.1177/10398562211045090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Pacific Island Countries (PICs) record high rates of gender-based violence (GBV). COVID-19 has significantly increased the number of GBV cases globally. This research aims to understand educational pathways for PICs' healthcare workers (HCWs) to strengthen GBV clinical practices in the Pasifika Veilomani (sharing the love) project. METHOD A literature review, content experts' discussion and review of stakeholder governance documents were used to inform the design of the telehealth training. HCWs were invited to share experiences, further exploring the capacity of online learning to meet clinical practice needs. RESULTS Global health guidance was adapted by Pacific experts to deliver a 12-week multidisciplinary course. One hundred and thirty-six participants from nine PICs registered and participated in the telehealth sessions. Despite internet and technical difficulties, participants' responses were positive. Results indicated the online training improved their confidence, helped them to reflect on practice and that more training would be valued. CONCLUSIONS The Pasifika Veilomani Project engaged HCW and clinical leaders to inform current practices, education, and public health approaches on GBV as a public health priority. This project demonstrates the potential for engaging and supporting HCW remotely across challenging geographic, service and cultural domains in the context of COVID-19 social and service demands.
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Affiliation(s)
- Odille Chang
- School of Medical Sciences, Fiji National University, Nasinu, Fiji
| | - Brigid Ryan
- International Unit, St. Vincent's Mental Health Hospital, Melbourne, VIC, Australia
| | - Avelina Rokoduru
- Pacific Sexual & Reproductive Health Research Centre, Fiji National University, Tamavua, Fiji
| | - Amanda Hill
- Anaesthesia and Women's Health, School of Medical Sciences, Fiji National University, Lautoka, Fiji
| | - Senimelia Hataogo
- Head of Department Midwifery, Obstetrics and Paediatrics, School of Nursing, Fiji National University, Tamavua, Fiji
| | - Varsha Naidu
- Office of the Registrar, Fiji National University, Nasinu, Fiji
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Dowling MJ, Molloy U, Payne C, McLean S, McQuillan R, Noonan C, Ryan DJ. Hospital transfer rates and advance care planning following a nursing home-targeted video-conference education series (Project ECHO): a prospective cohort study. Eur Geriatr Med 2022; 13:941-949. [PMID: 35438449 PMCID: PMC9016377 DOI: 10.1007/s41999-022-00624-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 02/08/2022] [Indexed: 11/17/2022]
Abstract
Purpose Nursing home staff manage increasingly complex patients yet struggle to access education. This study measured the impact of a novel education programme on emergency transfers from nursing homes. Methods In this prospective experimental cohort study, ten interactive sessions were provided to 20 nursing homes, using teleconferencing technology through the “Project ECHO” (Extension for Community Healthcare Outcomes) model. Details of all emergency hospital transfers were submitted by participating nursing homes 6 months before and 6 months from commencement of ECHO. Results Of 20 nursing homes, 13 submitted sufficient data for inclusion. In these 13, there were 260 emergency transfers over a year. There was no significant difference in the number of transfers before and after ECHO (137/260 pre-ECHO vs 123/260 post-ECHO, p = 0.62). Post-ECHO, it was 50% more likely that transfer wishes were discussed in advance of transfer (62 of 137 (45%) transferred pre-ECHO vs 82 of 123 (67%) post-ECHO, p < 0.001). There was a significant increase in compliance with resident wishes post-ECHO in that transferred residents were less likely to have a documented “Not for Transfer” wish (29/137 pre-ECHO (21%) vs 10/123 post-ECHO (8%), p < 0.001). Point prevalence surveys of residents demonstrated significant increases in “Do Not Resuscitate” orders; 286/589 (49%) residents pre-ECHO vs 386/594 (65%) post-ECHO, p < 0.001. Post-ECHO, pain was less frequently the primary cause for transfer (11/137 (8%) pre-ECHO vs 1/123 (0.8%) post-ECHO, p = 0.006). Conclusion ECHO did not affect rates of emergency hospital transfers but did increase advance care planning discussions ahead of hospital transfer by 50% and compliance with the results of those discussions. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-022-00624-6. Aim What effect does a novel education programme have on emergency hospital transfers of, and advance care planning decisions among, nursing home residents? Findings This education programme did not affect overall rates of emergency hospital transfer. It did increase advance care planning discussions, increase compliance with the results of these discussions and increase “DNR” orders among nursing home residents. Message Novel tele-education programmes have the potential to improve advance care planning discussions in nursing homes. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-022-00624-6.
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Affiliation(s)
- Michael J Dowling
- Age-Related Healthcare Department, Tallaght University Hospital, Dublin 24, Ireland.
| | | | - Cathy Payne
- All-Ireland Institute of Hospice and Palliative Care, Dublin, Ireland
| | | | | | - Claire Noonan
- Age-Related Healthcare Department, Tallaght University Hospital, Dublin 24, Ireland
| | - Dan J Ryan
- Age-Related Healthcare Department, Tallaght University Hospital, Dublin 24, Ireland.,Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
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Chicoine G, Côté J, Pepin J, Pluye P, Boyer L, Fontaine G, Rouleau G, Dubreucq S, Jutras-Aswad D. Impact of a videoconferencing educational programme for the management of concurrent disorders on nurses' competency development and clinical practice: protocol for a convergent mixed methods study. BMJ Open 2021; 11:e042875. [PMID: 33727265 PMCID: PMC7970219 DOI: 10.1136/bmjopen-2020-042875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Extension for Community Healthcare Outcomes (Project ECHO©) is an innovative model for continuing professional development that uses videoconferencing technology to support and train general practitioners remotely. The model has been replicated to a variety of settings and locations for capacity building in healthcare professionals caring for patients with chronic and complex health conditions. Limited research has been conducted so far on the impact of ECHO in the field of concurrent mental health and substance use disorders (ie, concurrent disorders (CDs)). Therefore, this mixed methods study aims to develop a comprehensive understanding of an ECHO programme impact for CD management on nurses' competency development and clinical practice. METHODS AND ANALYSIS The proposed mixed methods study, based on a convergent parallel design, will be conducted in the province of Quebec, Canada, to collect, analyse and interpret quantitative (QUAN) and qualitative (QUAL) data from a specific ECHO Program on CDs. In the QUAN component, an observational prospective cohort study will be conducted over a 12-month period. All nurses who participated in the programme between 2018 and 2020 and who consent to research will be recruited to collect data on the extent of their learning and practice outcomes at three time points. Alongside the surveys, nurses will be invited to participate in individual semistructured interviews. In-depth QUAL data will be subjected to a thematic analysis and will assist in exploring how and in which conditions nurses developed and mobilised their competencies in clinical practice. A comparison-of-results strategy will be used in the final integration component of the study. ETHICS AND DISSEMINATION This study protocol was approved by the Ethics Committee of the Université de Montréal Hospital Center (#19.295) and the Université de Montréal Ethics Committee (CERSES-20-017 R). We aim to disseminate the findings through international academic conferences, international peer-reviewed journals and professional media.
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Affiliation(s)
- Gabrielle Chicoine
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
- Research Center, Université de Montréal Hospital Center, Montreal, Quebec, Canada
- Research Chair in Innovative Nursing Practices, Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
| | - José Côté
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
- Research Center, Université de Montréal Hospital Center, Montreal, Quebec, Canada
- Research Chair in Innovative Nursing Practices, Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
| | - Jacinthe Pepin
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
| | - Pierre Pluye
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Louise Boyer
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
| | - Guillaume Fontaine
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
- Research Center, Institut de Cardiologie de Montréal, Montreal, Quebec, Canada
| | - Geneviève Rouleau
- Research Chair in Innovative Nursing Practices, Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
- Institute for Health System Solutions and Virtual Care, Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Simon Dubreucq
- Research Center, Université de Montréal Hospital Center, Montreal, Quebec, Canada
- Psychiatry Department, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Didier Jutras-Aswad
- Research Center, Université de Montréal Hospital Center, Montreal, Quebec, Canada
- Psychiatry Department, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
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Iida K, Ryan A, Hasson F, Payne S, McIlfatrick S. Palliative and end-of-life educational interventions for staff working in long-term care facilities: An integrative review of the literature. Int J Older People Nurs 2020; 16:e12347. [PMID: 32918793 DOI: 10.1111/opn.12347] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/01/2020] [Accepted: 08/18/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Given the increase in the number of deaths within long-term care facilities (LTCFs), the need for palliative and end-of-life (EOL) care education among such facilities has been increasing. As such, a systematic synthesis of global palliative and EOL care educational approaches and evaluation can aid further educational development. OBJECTIVE To synthesise the current literature on palliative and EOL care educational interventions for staff working in LTCFs and identify barriers to, and facilitators of, intervention implementation. METHODS The study used an integrative review framework wherein indexed databases, namely, CINAHL, EMBASE, MEDLINE, PsycINFO, Web of Science, Cochrane Library and Japan Medical Abstract Society, were systematically searched for studies published in English and Japanese between 2007 and 2019. Search terms that are related to palliative care, LTCF, and education were combined to increase search sensitivity. The quality of the papers was assessed using Joanna Briggs Institute Critical Appraisal Tools and the Mixed-Methods Appraisal Tool. RESULTS A total of 52 studies were included in the review. Our results suggested that although studies in this area and setting have been evolving, suboptimal developmental research and educational practices, global variability and unstandardised approaches to education and lacking viewpoints from service users have remained. Barriers to intervention implementation were also reported due to the specific characteristics of LTCFs, which include high staff turnover and considerable variation in professional skills and experience. CONCLUSIONS Given the different LTCF types, systems and policies across each country or region, further research on standardised educational interventions with contextual considerations using large-scale studies with robust methodology is needed to meet the increasing demand for palliative and EOL care among the global ageing population. IMPLICATIONS FOR PRACTICE Palliative and EOL care educational intervention for LTCF staff need to include more consideration of context, organisational culture and the user involvement throughout the process of education and research to enhance the quality of care in this complex setting.
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Affiliation(s)
- Kieko Iida
- Institute of Nursing and Health Research and School of Nursing, Ulster University, Newtownabbey, UK
| | - Assumpta Ryan
- Institute of Nursing and Health Research and School of Nursing, Ulster University, Londonderry, UK
| | - Felicity Hasson
- Institute of Nursing and Health Research and School of Nursing, Ulster University, Newtownabbey, UK
| | - Sheila Payne
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - Sonja McIlfatrick
- Institute of Nursing and Health Research and School of Nursing, Ulster University, Newtownabbey, UK
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Archbald-Pannone LR, Harris DA, Albero K, Steele RL, Pannone AF, Mutter JB. COVID-19 Collaborative Model for an Academic Hospital and Long-Term Care Facilities. J Am Med Dir Assoc 2020; 21:939-942. [PMID: 32563752 PMCID: PMC7247468 DOI: 10.1016/j.jamda.2020.05.044] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/17/2020] [Accepted: 05/19/2020] [Indexed: 02/01/2023]
Abstract
The COVID-19 pandemic is devastating post-acute and long-term care (PA/LTC). As geriatricians practicing in PA/LTC and a regional academic medical center, we created this program for collaboration between academic medical centers and regional PA/LTC facilities. The mission of the Geriatric Engagement and Resource Integration in Post-Acute and Long-Term Care Facilities (GERI-PaL) program is to support optimal care of residents in PA/LTC facilities during the COVID-19 pandemic. There are 5 main components of our program: (1) Project ECHO; (2) nursing liaisons; (3) infection advisory consultation; (4) telemedicine consultation; and (5) resident social contact remote connections. Implementation of this program has had positive response from our local PA/LTC facilities. A key component of our program is our interprofessional team, which includes physicians and nursing, emergency response, and public health experts. With diverse professional backgrounds, our team members have created a new model for academic medical centers to collaborate with local PA/LTC facilities.
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Affiliation(s)
- Laurie R Archbald-Pannone
- Department of Medicine, Division of General, Geriatric, Hospital & Palliative Medicine, University of Virginia, Charlottesville, VA, USA; Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA.
| | - Drew A Harris
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, VA, USA
| | - Kimberly Albero
- Project ECHO, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA
| | - Rebecca L Steele
- Project ECHO, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA; Karen S. Rheuban Center for Telehealth at the University of Virginia, University of Virginia, Charlottesville, VA, USA
| | - Aaron F Pannone
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Justin B Mutter
- Department of Medicine, Division of General, Geriatric, Hospital & Palliative Medicine, University of Virginia, Charlottesville, VA, USA
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