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Fougère B, Morley JE, Arai H, Bauer JM, Bernabei R, Cherubini A, Dong B, Martin FC, Flicker L, Merchant RA, Rodriguez Mañas L, Woo J, Vellas B. RETRACTED ARTICLE: Precision Medicine: The Future Management of Geriatric Conditions. J Nutr Health Aging 2023; 27:1292-1295. [PMID: 38242610 DOI: 10.1007/s12603-018-1045-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Bertrand Fougère
- Tours University Hospital - Division of Geriatric medicine, Bretonneau Hospital, Building B1A Level 4, 2, boulevard Tonnellé, 37044, Tours cedex 9, France; Inserm UMR1027, Toulouse University III Paul Sabatier, Toulouse, France; Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA.
| | - J E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - H Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - J M Bauer
- Center for Geriatric Medicine, University of Heidelberg, Heidelberg, Germany
| | - R Bernabei
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of Sacred Heart, Rome, Italy
| | - A Cherubini
- Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS-INRCA), Ancona, Italy
| | - B Dong
- Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - F C Martin
- Division of Health and Social Care Research, Kings College, London, UK
| | - L Flicker
- Geriatric Medicine, University of Western Australia, Perth, Australia
| | - R A Merchant
- Division of Geriatric Medicine, National University Hospital, Singapore, Singapore
| | | | - J Woo
- Chinese University of Hong Kong, Hong Kong, China
| | - B Vellas
- Inserm UMR1027, Toulouse University III Paul Sabatier, Toulouse, France; Gérontopôle, Toulouse University Hospital, Toulouse, France
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Deniau N, Natali JP. [The role of private geriatricians in the health care system (2/2): comprehensive qualitative analysis using semi-structured interviews]. SOINS. GERONTOLOGIE 2023; 28:26-32. [PMID: 36870760 DOI: 10.1016/j.sger.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Private geriatricians report heterogeneous practices, while the specialty as a whole is questioning its model. We conducted semi-structured interviews to understand how private geriatricians viewed their role in the health care system. They report a certain homogeneity in their conception of their role, which corresponds to that of geriatricians as a whole: there seems to be a professional identity for geriatrics.
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Affiliation(s)
- Nicolas Deniau
- Université de Versailles Saint-Quentin-en-Yvelines, 55 avenue de Paris, 78035 Versailles, France; UFR Simone-Veil-Santé, 2 avenue de la Source-de-la-Bièvre, 78180 Montigny-le-Bretonneux, France
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Deniau N, Natali JP. [Role of private geriatricians in the health care system (1/2): quantitative descriptive analysis by questionnaire]. SOINS. GERONTOLOGIE 2023; 28:17-25. [PMID: 36870759 DOI: 10.1016/j.sger.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Private practice geriatrics is a little known practice modality. We conducted a questionnaire survey to try to describe the role of private geriatricians in the health care system. Although few in number, private geriatricians report very different practices, including their conception of their role. This is the first monograph on the activity of private geriatricians, and the results have motivated us to propose a comprehensive analysis of this role.
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Affiliation(s)
- Nicolas Deniau
- Université de Versailles Saint-Quentin-en-Yvelines, UFR Simone Veil-Santé, 2 avenue de la Source-de-la-Bièvre, 78180 Montigny-le-Bretonneux, France
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Sun H, Zweig Y, Perskin M, Chodosh J, Blachman NL. Hospital volunteers: An innovative pipeline to increase the geriatrics workforce. GERONTOLOGY & GERIATRICS EDUCATION 2022; 43:564-570. [PMID: 34229562 DOI: 10.1080/02701960.2021.1946045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Objectives: There is an urgent need to expand the geriatrics workforce. By providing volunteers meaningful experiences with older adults, we hoped to stimulate interest in geriatrics.Design: Electronic mixed methods survey of volunteers from April 2018-October 2019Setting: Academic medical centerParticipants: 32 volunteersMeasurements: We conducted a mixed methods survey of volunteers to understand their experiences in the program, in part using a Likert scale. Two coders independently compared themes to ensure consensus.Results: Thirty-six percent (n = 32) completed surveys; 69% (n = 22) were women; most (59%) were first in their family to work in healthcare, and 81% (n = 26) had prior healthcare experience. Volunteers found patients to be engaging, and recognized that older adults need attention. Almost half (47%, n = 15) expressed interest in working with older adults before starting the program, which increased to 63% (n = 20) after the program. Most volunteers (n = 30, 94%) answered 'definitely yes' or 'probably yes' for feeling appreciated by patients, and 88% (n = 28) felt appreciated by patients' families.Conclusion: A volunteer program pairing companions with older age inpatients increased interest and appreciation for older adults. While additional research should examine whether such experiences influence career choices, this intervention proposes an innovative pipeline to increase the geriatrics workforce.
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Affiliation(s)
- H Sun
- Section of Geriatrics, Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Y Zweig
- Division of Geriatric Medicine and Palliative Care, NYU Langone Health, New York, New York, USA
| | - M Perskin
- Division of Geriatric Medicine and Palliative Care, NYU Langone Health, New York, New York, USA
| | - J Chodosh
- Division of Geriatric Medicine and Palliative Care, NYU Langone Health, New York, New York, USA
| | - N L Blachman
- Division of Geriatric Medicine and Palliative Care, NYU Langone Health, New York, New York, USA
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Merchant RA, Ho VWT, Chen MZ, Wong BLL, Lim Z, Chan YH, Ling N, Ng SE, Santosa A, Murphy D, Vathsala A. Outcomes of Care by Geriatricians and Non-geriatricians in an Academic Hospital. Front Med (Lausanne) 2022; 9:908100. [PMID: 35733862 PMCID: PMC9208654 DOI: 10.3389/fmed.2022.908100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/09/2022] [Indexed: 12/19/2022] Open
Abstract
Introduction While hospitalist and internist inpatient care models dominate the landscape in many countries, geriatricians and internists are at the frontlines managing hospitalized older adults in countries such as Singapore and the United Kingdom. The primary aim of this study was to determine outcomes for older patients cared for by geriatricians compared with non-geriatrician-led care teams. Materials and Methods A retrospective cohort study of 1,486 Internal Medicine patients aged ≥75 years admitted between April and September 2021 was conducted. They were either under geriatrician or non-geriatrician (internists or specialty physicians) care. Data on demographics, primary diagnosis, comorbidities, mortality, readmission rate, Hospital Frailty Risk Score (HFRS), Age-adjusted Charlson Comorbidity Index, Length of Stay (LOS), and cost of hospital stay were obtained from the hospital database and analyzed. Results The mean age of patients was 84.0 ± 6.3 years, 860 (57.9%) females, 1,183 (79.6%) of Chinese ethnicity, and 902 (60.7%) under the care of geriatricians. Patients under geriatrician were significantly older and had a higher prevalence of frailty, dementia, and stroke, whereas patients under non-geriatrician had a higher prevalence of diabetes and hypertension. Delirium as the primary diagnosis was significantly higher among patients under geriatrician care. Geriatrician-led care model was associated with shorter LOS, lower cost, similar inpatient mortality, and 30-day readmission rates. LOS and cost were lower for patients under geriatrician care regardless of frailty status but significant only for low and intermediate frailty groups. Geriatrician-led care was associated with significantly lower extended hospital stay (OR 0.73; 95% CI 0.56–0.95) and extended cost (OR 0.69; 95% CI 0.54–0.95). Conclusion Geriatrician-led care model showed shorter LOS, lower cost, and was associated with lower odds of extended LOS and cost.
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Affiliation(s)
- Reshma Aziz Merchant
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- *Correspondence: Reshma Aziz Merchant,
| | - Vanda Wen Teng Ho
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Matthew Zhixuan Chen
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Beatrix Ling Ling Wong
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Zhiying Lim
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Natalie Ling
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Shu Ee Ng
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Amelia Santosa
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Diarmuid Murphy
- Value Driven Outcomes Office, National University Health System, Singapore, Singapore
| | - Anantharaman Vathsala
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Nephrology, Department of Medicine, National University Hospital, Singapore, Singapore
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Saif-Ur-Rahman KM, Onishi J, Mamun R, Suenaga H, Chiang C, Hirakawa Y. Job satisfaction among physicians providing health care to the elderly in Japan: a qualitative study. Psychogeriatrics 2021; 21:311-316. [PMID: 33598980 DOI: 10.1111/psyg.12668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/22/2020] [Accepted: 02/01/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Physicians' job satisfaction plays an important role in service delivery. Japan is a country with a higher number of elderly people and their medical care is a crucial issue. To date, no study has been conducted on the job satisfaction of geriatricians serving the elderly in Japan. This study aims to explore the job satisfaction and motivation of physicians providing health care to the elderly working at different hospitals in Japan. METHODS In-depth interview of 23 geriatric physicians was conducted and data were coded and analysed. Qualitative content analysis was conducted to identify the response themes. RESULTS Three major themes emerged from the analysis and they are: satisfaction as a primary care provider, career development, and suitable communication with patients. Geriatric physicians enjoy their work with inter-professional collaboration and are satisfied to provide primary health care to elderly people. Geriatrics is a very promising career to them and they enjoy the communication and empathetic doctor-patient relationship in their service. CONCLUSIONS Japanese physicians providing health care to the elderly are enjoying their work due to a suitable environment, multi-professional collaboration, work-life balance, and patient-doctor relationship.
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Affiliation(s)
- K M Saif-Ur-Rahman
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Joji Onishi
- Department of Community Healthcare and Geriatrics, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Razib Mamun
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Haruki Suenaga
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Chifa Chiang
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Yoshihisa Hirakawa
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
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Rogers FB, Morgan ME, Brown CT, Vernon TM, Bresz KE, Cook AD, Malat J, Sohail N, Bradburn EH. Geriatric Trauma Mortality: Does Trauma Center Level Matter? Am Surg 2020; 87:1965-1971. [PMID: 33382347 DOI: 10.1177/0003134820983190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Given their mostly rural/suburban locations, level II trauma centers (TCs) may offer greater exposure to and experience in managing geriatric trauma patients. We hypothesized that geriatric patients would have improved outcomes at level II TCs compared to level I TCs. METHODS The Pennsylvania Trauma Outcome Study (PTOS) database was retrospectively queried from 2003 to 2017 for geriatric (age ≥65 years) trauma patients admitted to level I and II TCs in Pennsylvania. Patient demographics, injury severity, and clinical outcomes were compared to assess differences in care between level I and II TCs. A multivariate logistic regression model assessed the adjusted impact of care at level I vs II TCs on mortality, complications, and functional status at discharge (FSD). The National Trauma Data Bank (NTDB) was retrospectively queried for geriatric (age ≥65 years) trauma admissions to state-accredited level I or level II TCs in 2013. RESULTS 112 648 patients met inclusion criteria. The proportion of geriatric trauma patients across level I and level II TCs were determined to be 29.1% and 36.2% (P <.001), respectively. In adjusted analysis, there was no difference in mortality (adjusted odds ratio [AOR]: 1.13; P = .375), complications (AOR: 1.25; P = .080) or FSD (AOR: 1.09; P = .493) when comparing level I to level II TCs. Adjusted analysis from the NTDB (n = 144 622) also found that mortality was not associated with TC level (AOR: 1.04; P = .182). DISCUSSION Level I and level II TCs had similar rates of mortality, complications, and functional outcomes despite a higher proportion (but lower absolute number) of geriatric patients being admitted to level II TCs. Future consideration for location of centers of excellence in geriatric trauma should include both level I and II TCs.
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Affiliation(s)
- Frederick B Rogers
- Trauma and Acute Care Surgery, 209639Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Madison E Morgan
- Trauma and Acute Care Surgery, 209639Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Catherine Ting Brown
- Trauma and Acute Care Surgery, 209639Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Tawnya M Vernon
- Trauma and Acute Care Surgery, 209639Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Kellie E Bresz
- Trauma and Acute Care Surgery, 209639Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Alan D Cook
- 12347University of Texas Health Science Center at Tyler, UT Health East Texas, Tyler, TX, USA
| | - Jaclyn Malat
- 6556Pennsylvania College of Osteopathic Medicine Surgical Residency Program, Philadelphia, PA, USA
| | - Neelofer Sohail
- Geriatric Specialists, 209639Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Eric H Bradburn
- Trauma and Acute Care Surgery, 209639Penn Medicine Lancaster General Health, Lancaster, PA, USA
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Merchant RA, Chen MZ, Ng SE, Sandrasageran S, Wong BLL. Letter to the Editor: The Role of a Geriatrician Has Become Even More Important in an Academic Institution during COVID-19. J Nutr Health Aging 2020; 24:681-682. [PMID: 32510123 PMCID: PMC7220849 DOI: 10.1007/s12603-020-1387-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/11/2020] [Indexed: 11/29/2022]
Affiliation(s)
- R A Merchant
- Reshma A Merchant, National University Hospital, Singapore,
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[Geriatrics in Spain 2020: Main challenges]. Rev Esp Geriatr Gerontol 2019; 55:107-113. [PMID: 31882162 DOI: 10.1016/j.regg.2019.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 10/21/2019] [Indexed: 11/24/2022]
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Lakomek HJ, Schulz C. [Characteristics of pharmacotherapy in older patients with rheumatism]. Z Rheumatol 2019; 77:369-378. [PMID: 29691687 DOI: 10.1007/s00393-018-0460-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Due to medical advances and the availability of efficient immunosuppressive therapies, the life-expectancy of people suffering from inflammatory rheumatic diseases is continuously increasing. In Germany, geriatric patients (definition: age older than 70 years combined with geriatric multimorbidity) affected, e. g. by rheumatoid arthritis (RA) frequently receive corticosteroids and less often biologic disease-modifying antirheumatic drugs (bDMARDs) and conventional DMARDs (cDMARDs), which is justified by additionally existing comorbidities and polypharmacy. Using geriatric typical assessments as well as detailed medication regimens the treatment risk of bDMARD and cDMARD administration can be properly evaluated. Current data on biological therapy in older patients with rheumatism support this recommendation. Following the "choosing wisely" initiative of the German Association of Internal Medicine the authors listed 5 positive and 5 negative recommendations concerning the pharmacotherapy of older patients suffering from rheumatism (e. g. RA) as practical guidance towards safer bDMARD and cDMARD treatment for geriatric RA patients.
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Affiliation(s)
- H-J Lakomek
- Klinik für Rheumatologie und Universitätsklinik für Geriatrie, Johannes Wesling Klinikum Minden, Hans-Nolte-Str. 1, 32429, Minden, Deutschland.
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Morley JE, Vellas B. Patient-Centered (P4) Medicine and the Older Person. J Am Med Dir Assoc 2019; 18:455-459. [PMID: 28549701 DOI: 10.1016/j.jamda.2017.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/04/2017] [Indexed: 12/25/2022]
Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO.
| | - Bruno Vellas
- Gérontopôle, CHU Toulouse University Hospital and INSERM U1027, Toulouse, France
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Sanford AM, Berg-Weger M, Lundy J, Morley JE. Editorial: Aging Friendly Health Systems. J Nutr Health Aging 2019; 23:119-121. [PMID: 30697619 DOI: 10.1007/s12603-019-1154-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- A M Sanford
- John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104, USA,
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Affiliation(s)
- B Vellas
- John E. Morley, MB,BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104,
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Martínez-Velilla N, Baztán JJ, Sanchez E, Formiga F. [How to transform the concept of frailty into efficient interventions: Transversality and leadership of geriatrics]. Rev Esp Geriatr Gerontol 2017; 52:297-298. [PMID: 28595964 DOI: 10.1016/j.regg.2017.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 04/10/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Nicolas Martínez-Velilla
- Servicio de Geriatría, Complejo Hospitalario de Navarra, IdiSNa, CIBER de Fragilidad y Envejecimiento Saludable, Pamplona, Navarra, España.
| | - Juan Jose Baztán
- Servicio de Geriatría, Hospital Central Cruz Roja San José y Sta. Adela, SERMAS, Madrid, España
| | - Elisabet Sanchez
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Francesc Formiga
- Unidad de Geriatría, Servicio de Medicina Interna, Hospital Universitario de Bellvitge, Barcelona, España
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Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, School of Medicine, Saint Louis University, St. Louis, Missouri
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Katz B. Comment On: Geriatricians: The Super Specialist. J Am Geriatr Soc 2017. [PMID: 28644510 DOI: 10.1111/jgs.14917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Benny Katz
- Victorian Geriatric Medicine Training Program, Department of Geriatric Medicine, St Vincent's Hospital, Melbourne, Australia
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Callahan CM. Response to John E. Morley about "The Future Role of Geriatrics". J Am Geriatr Soc 2017; 65:869. [PMID: 28177516 DOI: 10.1111/jgs.14701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Christopher M Callahan
- Department of Medicine, Indiana University School of Medicine, Indiana University Center for Aging Research, Indianapolis, Indiana.,Regenstrief Institute, Inc., Indianapolis, Indiana
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