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Lazarus JE, Green CV, Jerry MS, Germaine L, McEvoy DS, Dugdale CM, Hysell KM, Craig RL, Paras ML, Heller HM, Ard KL, Albin JS, Lee H, Shenoy ES. Separating the rash from the chaff: novel clinical decision support deployed during the mpox outbreak. Infect Control Hosp Epidemiol 2024:1-3. [PMID: 38561199 DOI: 10.1017/ice.2024.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
A clinical decision support system, EvalMpox, was developed to apply person under investigation (PUI) criteria for patients presenting with rash and to recommend testing for PUIs. Of 668 patients evaluated, an EvalMpox recommendation for testing had a positive predictive value of 35% and a negative predictive value of 99% for a positive mpox test.
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Affiliation(s)
- Jacob E Lazarus
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Chloe V Green
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Infection Control Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Michelle S Jerry
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Infection Control Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Lindsay Germaine
- Clinical Informatics and Decision Support, Digital Health, Mass General Brigham, Somerville, MA, USA
| | - Dustin S McEvoy
- Clinical Informatics and Decision Support, Digital Health, Mass General Brigham, Somerville, MA, USA
| | - Caitlin M Dugdale
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kristen M Hysell
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rebecca L Craig
- Infection Control Unit, Massachusetts General Hospital, Boston, MA, USA
- Infection Control, Mass General Brigham, Boston, MA, USA
| | - Molly L Paras
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Howard M Heller
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kevin L Ard
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - John S Albin
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Hang Lee
- Harvard Medical School, Boston, MA, USA
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Erica S Shenoy
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Infection Control Unit, Massachusetts General Hospital, Boston, MA, USA
- Infection Control, Mass General Brigham, Boston, MA, USA
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2
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Heyne TF, Negishi K, Choi DS, Al Saud AA, Marinacci LX, Smithedajkul PY, Devaraj LR, Little BP, Mendoza DP, Flores EJ, Petranovic M, Toal SP, Shokoohi H, Liteplo AS, Geisler BP. Handheld Lung Ultrasound to Detect COVID-19 Pneumonia in Inpatients: A Prospective Cohort Study. POCUS JOURNAL 2023; 8:175-183. [PMID: 38099168 PMCID: PMC10721309 DOI: 10.24908/pocus.v8i2.16484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Background: Chest imaging, including chest X-ray (CXR) and computed tomography (CT), can be a helpful adjunct to nucleic acid test (NAT) in the diagnosis and management of Coronavirus Disease 2019 (COVID-19). Lung point of care ultrasound (POCUS), particularly with handheld devices, is an imaging alternative that is rapid, highly portable, and more accessible in low-resource settings. A standardized POCUS scanning protocol has been proposed to assess the severity of COVID-19 pneumonia, but it has not been sufficiently validated to assess diagnostic accuracy for COVID-19 pneumonia. Purpose: To assess the diagnostic performance of a standardized lung POCUS protocol using a handheld POCUS device to detect patients with either a positive NAT or a COVID-19-typical pattern on CT scan. Methods: Adult inpatients with confirmed or suspected COVID-19 and a recent CT were recruited from April to July 2020. Twelve lung zones were scanned with a handheld POCUS machine. Images were reviewed independently by blinded experts and scored according to the proposed protocol. Patients were divided into low, intermediate, and high suspicion based on their POCUS score. Results: Of 79 subjects, 26.6% had a positive NAT and 31.6% had a typical CT pattern. The receiver operator curve for POCUS had an area under the curve (AUC) of 0.787 for positive NAT and 0.820 for a typical CT. Using a two-point cutoff system, POCUS had a sensitivity of 0.90 and 1.00 compared to NAT and typical CT pattern, respectively, at the lower cutoff; it had a specificity of 0.90 and 0.89 compared to NAT and typical CT pattern at the higher cutoff, respectively. Conclusions: The proposed lung POCUS protocol with a handheld device showed reasonable diagnostic performance to detect inpatients with a positive NAT or typical CT pattern for COVID-19. Particularly in low-resource settings, POCUS with handheld devices may serve as a helpful adjunct for persons under investigation for COVID-19 pneumonia.
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Affiliation(s)
- Thomas F Heyne
- Department of Medicine, Massachusetts General HospitalBoston, MAUSA
- Department of Pediatrics, Massachusetts General HospitalBoston, MAUSA
| | - Kay Negishi
- Department of Medicine, Massachusetts General HospitalBoston, MAUSA
| | - Daniel S Choi
- Department of Emergency Medicine, Massachusetts General HospitalBoston, MAUSA
| | - Ahad A Al Saud
- Department of Emergency Medicine, Massachusetts General HospitalBoston, MAUSA
- Department of Emergency Medicine, King Saud University College of MedicineRiyadhSaudi Arabia
| | - Lucas X Marinacci
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical CenterBoston, MAUSA
| | | | - Lily R Devaraj
- Department of Medicine, Massachusetts General HospitalBoston, MAUSA
- Department of Pediatrics, Massachusetts General HospitalBoston, MAUSA
| | - Brent P Little
- Department of Radiology, Massachusetts General HospitalBoston, MAUSA
| | - Dexter P Mendoza
- Department of Radiology, Massachusetts General HospitalBoston, MAUSA
| | - Efren J Flores
- Department of Radiology, Massachusetts General HospitalBoston, MAUSA
| | - Milena Petranovic
- Department of Radiology, Massachusetts General HospitalBoston, MAUSA
| | - Steven P Toal
- Department of Medicine, Massachusetts General HospitalBoston, MAUSA
| | - Hamid Shokoohi
- Department of Emergency Medicine, Massachusetts General HospitalBoston, MAUSA
| | - Andrew S Liteplo
- Department of Emergency Medicine, Massachusetts General HospitalBoston, MAUSA
| | - Benjamin P Geisler
- Department of Medicine, Massachusetts General HospitalBoston, MAUSA
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig Maximilian UniversityMunichGermany
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3
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Albin JS, Lazarus JE, Hysell KM, Rubins DM, Germaine L, Dugdale CM, Heller HM, Hohmann EL, Baugh JJ, Shenoy ES. Development and implementation of a clinical decision support system tool for the evaluation of suspected monkeypox infection. J Am Med Inform Assoc 2022; 29:2124-2127. [PMID: 36036367 PMCID: PMC9667162 DOI: 10.1093/jamia/ocac151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Abstract
Monkeypox virus was historically rare outside of West and Central Africa until the current 2022 global outbreak, which has required clinicians to be alert to identify individuals with possible monkeypox, institute isolation, and take appropriate next steps in evaluation and management. Clinical decision support systems (CDSS), which have been shown to improve adherence to clinical guidelines, can support frontline clinicians in applying the most current evaluation and management guidance in the setting of an emerging infectious disease outbreak when those guidelines are evolving over time. Here, we describe the rapid development and implementation of a CDSS tool embedded in the electronic health record to guide frontline clinicians in the diagnostic evaluation of monkeypox infection and triage patients with potential monkeypox infection to individualized infectious disease physician review. We also present data on the initial performance of this tool in a large integrated healthcare system.
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Affiliation(s)
- John S Albin
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jacob E Lazarus
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Kristen M Hysell
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - David M Rubins
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Digital eCare, Mass General Brigham, Boston, Massachusetts, USA
| | | | - Caitlin M Dugdale
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Howard M Heller
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth L Hohmann
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua J Baugh
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Erica S Shenoy
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Digital eCare, Mass General Brigham, Boston, Massachusetts, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Regional Emerging Special Pathogens Treatment Center, Massachusetts General Hospital, Boston, Massachusetts, USA
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Nair SS, Li C, Doijad R, Nagy P, Lehmann H, Kharrazi H. A scoping review of knowledge authoring tools used for developing computerized clinical decision support systems. JAMIA Open 2021; 4:ooab106. [PMID: 34927003 PMCID: PMC8677433 DOI: 10.1093/jamiaopen/ooab106] [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: 07/21/2021] [Accepted: 11/30/2021] [Indexed: 11/20/2022] Open
Abstract
Objective Clinical Knowledge Authoring Tools (CKATs) are integral to the computerized Clinical Decision Support (CDS) development life cycle. CKATs enable authors to generate accurate, complete, and reliable digital knowledge artifacts in a relatively efficient and affordable manner. This scoping review aims to compare knowledge authoring tools and derive the common features of CKATs. Materials and Methods We performed a keyword-based literature search, followed by a snowball search, to identify peer-reviewed publications describing the development or use of CKATs. We used PubMed and Embase search engines to perform the initial search (n = 1579). After removing duplicate articles, nonrelevant manuscripts, and not peer-reviewed publication, we identified 47 eligible studies describing 33 unique CKATs. The reviewed CKATs were further assessed, and salient characteristics were extracted and grouped as common CKAT features. Results Among the identified CKATs, 55% use an open source platform, 70% provide an application programming interface for CDS system integration, and 79% provide features to validate/test the knowledge. The majority of the reviewed CKATs describe the flow of information, offer a graphical user interface for knowledge authors, and provide intellisense coding features (94%, 97%, and 97%, respectively). The composed list of criteria for CKAT included topics such as simulating the clinical setting, validating the knowledge, standardized clinical models and vocabulary, and domain independence. None of the reviewed CKATs met all common criteria. Conclusion Our scoping review highlights the key specifications for a CKAT. The CKAT specification proposed in this review can guide CDS authors in developing more targeted CKATs.
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Affiliation(s)
- Sujith Surendran Nair
- Division of General Internal Medicine, Section of Biomedical Informatics and Data Science, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,Informatics, American College of Radiology, Virginia, USA
| | - Chenyu Li
- Division of General Internal Medicine, Section of Biomedical Informatics and Data Science, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ritu Doijad
- Division of General Internal Medicine, Section of Biomedical Informatics and Data Science, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Paul Nagy
- Division of General Internal Medicine, Section of Biomedical Informatics and Data Science, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Harold Lehmann
- Division of General Internal Medicine, Section of Biomedical Informatics and Data Science, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Hadi Kharrazi
- Division of General Internal Medicine, Section of Biomedical Informatics and Data Science, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
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Coronavirus disease 2019 (COVID-19) screening system utilizing daily symptom attestation helps identify hospital employees who should be tested to protect patients and coworkers. Infect Control Hosp Epidemiol 2021; 43:1656-1660. [PMID: 34753527 PMCID: PMC8649359 DOI: 10.1017/ice.2021.461] [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] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate the effectiveness of a daily attestation system used by employees of a multi-institutional academic medical center, which comprised of symptom-screening, self-referrals to the Occupational Health Services team, and/or a severe acute respiratory coronavirus virus 2 (SARS-CoV-2) test. DESIGN We conducted a retrospective cohort study of all employee attestations and SARS-CoV-2 tests performed between March and June 2020. SETTING A large multi-institutional academic medical center, including both inpatient and ambulatory settings. PARTICIPANTS All employees who worked at the study site. METHODS Data were combined from the attestation system (COVIDPass), the employee database, and the electronic health records and were analyzed using descriptive statistics including χ2, Wilcoxon, and Kruskal-Wallis tests. We investigated whether an association existed between symptomatic attestations by the employees and the employee testing positive for SARS-CoV-2. RESULTS After data linkage and cleaning, there were 2,117,298 attestations submitted by 65,422 employees between March and June 2020. Most attestations were asymptomatic (99.9%). The most commonly reported symptoms were sore throat (n = 910), runny nose (n = 637), and cough (n = 570). Among the 2,026 employees who ever attested that they were symptomatic, 905 employees were tested within 14 days of a symptomatic attestation, and 114 (13%) of these tests were positive. The most common symptoms associated with a positive SARS-CoV-2 test were anosmia (23% vs 4%) and fever (46% vs 19%). CONCLUSIONS Daily symptom attestations among healthcare workers identified a handful of employees with COVID-19. Although the number of positive tests was low, attestations may help keep unwell employees off campus to prevent transmissions.
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Egbuonu K, Hyle EP, Hurtado RM, Alba GA, Zachary KC, Branda JA, Hibbert KA, Hooper DC, Shenoy ES, Turbett SE, Dugdale CM. Yield of Severe Acute Respiratory Syndrome Coronavirus 2 Lower Respiratory Tract Testing After a Negative Nasopharyngeal Test Among Hospitalized Persons Under Investigation for Coronavirus Disease 2019. Open Forum Infect Dis 2021; 8:ofab257. [PMID: 34113690 PMCID: PMC8186245 DOI: 10.1093/ofid/ofab257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/14/2021] [Indexed: 12/18/2022] Open
Abstract
Among hospitalized persons under investigation for coronavirus disease 2019 (COVID-19), more repeated severe acute respiratory syndrome coronavirus 2 nucleic acid amplification tests (NAATs) after a negative NAAT were positive from lower than from upper respiratory tract specimens (1.9% vs 1.0%, P = .033). Lower respiratory testing should be prioritized among patients displaying respiratory symptoms with moderate-to-high suspicion for COVID-19 after 1 negative upper respiratory NAAT.
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Affiliation(s)
| | - Emily P Hyle
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Rocio M Hurtado
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Global Health Committee, Boston, Massachusetts, USA
| | - George A Alba
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kimon C Zachary
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John A Branda
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kathryn A Hibbert
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David C Hooper
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Erica S Shenoy
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarah E Turbett
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Caitlin M Dugdale
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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7
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Thomas RE. Reducing Morbidity and Mortality Rates from COVID-19, Influenza and Pneumococcal Illness in Nursing Homes and Long-Term Care Facilities by Vaccination and Comprehensive Infection Control Interventions. Geriatrics (Basel) 2021; 6:48. [PMID: 34066781 PMCID: PMC8162358 DOI: 10.3390/geriatrics6020048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 12/24/2022] Open
Abstract
The COVID-19 pandemic identifies the problems of preventing respiratory illnesses in seniors, especially frail multimorbidity seniors in nursing homes and Long-Term Care Facilities (LCTFs). Medline and Embase were searched for nursing homes, long-term care facilities, respiratory tract infections, disease transmission, infection control, mortality, systematic reviews and meta-analyses. For seniors, there is strong evidence to vaccinate against influenza, SARS-CoV-2 and pneumococcal disease, and evidence is awaited for effectiveness against COVID-19 variants and when to revaccinate. There is strong evidence to promptly introduce comprehensive infection control interventions in LCFTs: no admissions from inpatient wards with COVID-19 patients; quarantine and monitor new admissions in single-patient rooms; screen residents, staff and visitors daily for temperature and symptoms; and staff work in only one home. Depending on the vaccination situation and the current risk situation, visiting restrictions and meals in the residents' own rooms may be necessary, and reduce crowding with individual patient rooms. Regional LTCF administrators should closely monitor and provide staff and PPE resources. The CDC COVID-19 tool measures 33 infection control indicators. Hand washing, social distancing, PPE (gowns, gloves, masks, eye protection), enhanced cleaning of rooms and high-touch surfaces need comprehensive implementation while awaiting more studies at low risk of bias. Individual ventilation with HEPA filters for all patient and common rooms and hallways is needed.
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Affiliation(s)
- Roger E Thomas
- Department of Family Medicine, Faculty of Medicine, University of Calgary, Calgary, AB T2M 1M1, Canada
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