1
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Cohen JB, Bress AP. Quantifying antihypertensive effects of GLP-1 agonists. Eur Heart J 2024; 45:4135-4137. [PMID: 39217501 DOI: 10.1093/eurheartj/ehae520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Affiliation(s)
- Jordana B Cohen
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, 831 Blockley, Philadelphia, PA 19104, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Adam P Bress
- Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
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2
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Jia H, Su W, Zhang J, Wei Z, Tsikwa P, Wang Y. Risk factors for urinary tract infection in elderly patients with type 2 diabetes: A protocol for systematic review and meta-analysis. PLoS One 2024; 19:e0310903. [PMID: 39325710 PMCID: PMC11426445 DOI: 10.1371/journal.pone.0310903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 09/08/2024] [Indexed: 09/28/2024] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) is a frequent chronic condition among the elderly, which increasing their susceptibility to infection. Urinary tract infection (UTI) is one of the most prevalent infections among older people with T2DM. However, the association between geriatric T2DM and the risk of UTI has not been thoroughly researched and is still contentious. Consequently, this protocol describes a systematic review to pinpoint the primary risk factors for UTI among elderly T2DM. Our goal is to improve recommendations for the creation of targeted treatment interventions by examining risk factors for UTI in elderly individuals with T2DM. METHODS AND ANALYSIS We will search 4 English literature databases (PubMed, Embase, Web of Science, and Cochrane Library) and 3 major Chinese databases (CNKI, WanFang, and VIP) from the establishment of the database to June 20, 2024. Systematic evaluation and meta-analysis will be conducted on cohort and case-control studies exploring the occurrence and risk determinants of UTI in individuals diagnosed with T2DM. The main focus will be on identifying the risk factors for UTI in elderly diabetic patients. Two researchers will independently review articles, collect data, and evaluate the quality and potential bias of study inclusion. We will use RevMan V.5.4 software to analyze the data. The quality of the included studies will be assessed using the Newcastle-Ottawa scale. In addition, the GRADE (Grade of Recommendations, Assessment, Development, Evaluation) method will be used to examine the quality of evidence for each exposure and outcome of interest. DISCUSSION This study aims to illuminate the various risk factors associated with UTI in older patients diagnosed with T2DM. By this thorough investigation, we hope to provide a more comprehensive reference for medical professionals and researchers, thereby supporting the implementation of effective preventive strategies against UTI and improving overall nursing outcomes for this specific patient population. TRAIL REGISTRATION PROSPERO (CRD42024559129).
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Affiliation(s)
- Hairong Jia
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Wenhao Su
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jiaqi Zhang
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Zhaoyang Wei
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Pepertual Tsikwa
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yanru Wang
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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3
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Su J, Xu J, Hu S, Ye H, Xie L, Ouyang S. Advances in small-molecule insulin secretagogues for diabetes treatment. Biomed Pharmacother 2024; 178:117179. [PMID: 39059347 DOI: 10.1016/j.biopha.2024.117179] [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: 05/30/2024] [Revised: 07/16/2024] [Accepted: 07/22/2024] [Indexed: 07/28/2024] Open
Abstract
Diabetes, a metabolic disease caused by abnormally high levels of blood glucose, has a high prevalence rate worldwide and causes a series of complications, including coronary heart disease, stroke, peripheral vascular disease, end-stage renal disease, and retinopathy. Small-molecule compounds have been developed as drugs for the treatment of diabetes because of their oral advantages. Insulin secretagogues are a class of small-molecule drugs used to treat diabetes, and include sulfonylureas, non-sulfonylureas, glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase 4 inhibitors, and other novel small-molecule insulin secretagogues. However, many small-molecule compounds cause different side effects, posing huge challenges to drug monotherapy and drug selection. Therefore, the use of different small-molecule drugs must be improved. This article reviews the mechanism, advantages, limitations, and potential risks of small-molecule insulin secretagogues to provide future research directions on small-molecule drugs for the treatment of diabetes.
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Affiliation(s)
- Jingqian Su
- Key Laboratory of Microbial Pathogenesis and Interventions of Fujian Province University, Key Laboratory of Innate Immune Biology of Fujian Province, Biomedical Research Center of South China, Key Laboratory of OptoElectronic Science and Technology for Medicine of the Ministry of Education, College of Life Sciences, Fujian Normal University, Fuzhou 350117, China.
| | - Jingran Xu
- Key Laboratory of Microbial Pathogenesis and Interventions of Fujian Province University, Key Laboratory of Innate Immune Biology of Fujian Province, Biomedical Research Center of South China, Key Laboratory of OptoElectronic Science and Technology for Medicine of the Ministry of Education, College of Life Sciences, Fujian Normal University, Fuzhou 350117, China
| | - Shan Hu
- Key Laboratory of Microbial Pathogenesis and Interventions of Fujian Province University, Key Laboratory of Innate Immune Biology of Fujian Province, Biomedical Research Center of South China, Key Laboratory of OptoElectronic Science and Technology for Medicine of the Ministry of Education, College of Life Sciences, Fujian Normal University, Fuzhou 350117, China
| | - Hui Ye
- Key Laboratory of Microbial Pathogenesis and Interventions of Fujian Province University, Key Laboratory of Innate Immune Biology of Fujian Province, Biomedical Research Center of South China, Key Laboratory of OptoElectronic Science and Technology for Medicine of the Ministry of Education, College of Life Sciences, Fujian Normal University, Fuzhou 350117, China
| | - Lian Xie
- Key Laboratory of Microbial Pathogenesis and Interventions of Fujian Province University, Key Laboratory of Innate Immune Biology of Fujian Province, Biomedical Research Center of South China, Key Laboratory of OptoElectronic Science and Technology for Medicine of the Ministry of Education, College of Life Sciences, Fujian Normal University, Fuzhou 350117, China
| | - Songying Ouyang
- Key Laboratory of Microbial Pathogenesis and Interventions of Fujian Province University, Key Laboratory of Innate Immune Biology of Fujian Province, Biomedical Research Center of South China, Key Laboratory of OptoElectronic Science and Technology for Medicine of the Ministry of Education, College of Life Sciences, Fujian Normal University, Fuzhou 350117, China.
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4
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Biondi-Zoccai G, Frati G, Peruzzi M, Booz GW. Empagliflozin: Primus Inter Pares Among Sodium-Glucose Cotransporter-2 Inhibitors? J Cardiovasc Pharmacol 2024; 84:271-275. [PMID: 39027982 DOI: 10.1097/fjc.0000000000001605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/17/2024] [Indexed: 07/20/2024]
Abstract
ABSTRACT Sodium/glucose cotransporter-2 (SGLT2) inhibitors are a novel class of antidiabetic medications which have proved capable of providing breakthrough cardiovascular (CV) benefits in a variety of clinical scenarios, including patients with heart failure or obesity, irrespective of diabetic status. Several SGLT2 inhibitors are available, but the most prominent ones are canagliflozin, dapagliflozin, and empagliflozin. Several studies have focused on empagliflozin and its effects on the risk of heart failure incidence and recurrences. Most recently, empagliflozin has been recently tested in patients with recent myocardial infarction in the EMPAgliflozin on Hospitalization for Heart Failure and Mortality in Patients With aCuTe Myocardial Infarction randomized trial, with apparently ambiguous findings. The present viewpoint succinctly illustrates the main features of SGLT2 inhibitors as a pharmacologic class, their ever expanding role as a CV medication, and the comparative effectiveness of different individual SGLT2 inhibitors, explicitly commenting on the recent data on empagliflozin in patients with acute myocardial infarction. The reader will find in this article a poignant perspective on this novel avenue for CV prevention and treatment, which greatly expands the management armamentarium of CV practitioners. Indeed, we make the case that SGLT2 inhibitors have a clearly favorable class effect, with differences between individual agents mainly suitable for personalization of care and minimization of side effects.
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Affiliation(s)
- Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- IRCCS NEUROMED, Pozzilli, Italy
| | - Mariangela Peruzzi
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University, Rome, Italy ; and
| | - George W Booz
- Department of Pharmacology and Toxicology, School of Medicine, University of Mississippi Medical Center, Jackson, MS
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5
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Dubin I, Glick Y, Schattner A. Sodium-glucose cotransporter 2 inhibitors and emphysematous cystitis. Postgrad Med J 2024:qgae099. [PMID: 39140618 DOI: 10.1093/postmj/qgae099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/16/2024] [Accepted: 07/28/2024] [Indexed: 08/15/2024]
Affiliation(s)
- Ina Dubin
- Departments of Medicine, Laniado University Hospital, Sanz Medical Center, Netanya 4244916, Israel
- The Adelson Medical School, Ariel University, Ariel 40700, Israel
| | - Yair Glick
- The Adelson Medical School, Ariel University, Ariel 40700, Israel
- Departments of Imaging, Laniado University Hospital, Sanz Medical Center, Netanya 4244916, Israel
| | - Ami Schattner
- Departments of Medicine, Laniado University Hospital, Sanz Medical Center, Netanya 4244916, Israel
- The Adelson Medical School, Ariel University, Ariel 40700, Israel
- The Faculty of Medicine, Hebrew University and Hadassah Medical School, Jerusalem, 91120, Israel
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Laine C, Moyer DV, Qaseem A. Newer Pharmacologic Treatments for Type 2 Diabetes. Ann Intern Med 2024; 177:968-969. [PMID: 38801779 DOI: 10.7326/annals-24-00698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Affiliation(s)
| | - Darilyn V Moyer
- Executive Vice President and Chief Executive Officer, American College of Physicians
| | - Amir Qaseem
- Chief Science Officer, American College of Physicians
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James MT, McBrien KA. In patients with the kidney-dysfunction triad, facilitated evidence-based care did not reduce hospitalizations at 1 y. Ann Intern Med 2024; 177:JC78. [PMID: 38950400 DOI: 10.7326/annals-24-00651-jc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/03/2024] Open
Abstract
SOURCE CITATION Vazquez MA, Oliver G, Amarasingham R, et al; ICD-Pieces Study Group. Pragmatic trial of hospitalization rate in chronic kidney disease. N Engl J Med. 2024;390:1196-1206. 38598574.
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Affiliation(s)
- Matthew T James
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada (M.T.J., K.A.M.)
| | - Kerry A McBrien
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada (M.T.J., K.A.M.)
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Qaseem A, Obley AJ, Shamliyan T, Hicks LA, Harrod CS, Crandall CJ, Balk EM, Cooney TG, Cross JT, Fitterman N, Lin JS, Maroto M, Miller MC, Shekelle P, Tice JA, Tufte JE, Etxeandia-Ikobaltzeta I, Yost J. Newer Pharmacologic Treatments in Adults With Type 2 Diabetes: A Clinical Guideline From the American College of Physicians. Ann Intern Med 2024; 177:658-666. [PMID: 38639546 DOI: 10.7326/m23-2788] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Abstract
DESCRIPTION The American College of Physicians (ACP) developed this clinical guideline to update recommendations on newer pharmacologic treatments of type 2 diabetes. This clinical guideline is based on the best available evidence for effectiveness, comparative benefits and harms, consideration of patients' values and preferences, and costs. METHODS This clinical guideline is based on a systematic review of the effectiveness and harms of newer pharmacologic treatments of type 2 diabetes, including glucagon-like peptide-1 (GLP-1) agonists, a GLP-1 agonist and glucose-dependent insulinotropic polypeptide agonist, sodium-glucose cotransporter-2 (SGLT-2) inhibitors, dipeptidyl peptidase-4 (DPP-4) inhibitors, and long-acting insulins, used either as monotherapy or in combination with other medications. The Clinical Guidelines Committee prioritized the following outcomes, which were evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach: all-cause mortality, major adverse cardiovascular events, myocardial infarction, stroke, hospitalization for congestive heart failure, progression of chronic kidney disease, serious adverse events, and severe hypoglycemia. Weight loss, as measured by percentage of participants who achieved at least 10% total body weight loss, was a prioritized outcome, but data were insufficient for network meta-analysis and were not rated with GRADE. AUDIENCE AND PATIENT POPULATION The audience for this clinical guideline is physicians and other clinicians. The population is nonpregnant adults with type 2 diabetes. RECOMMENDATION 1 ACP recommends adding a sodium-glucose cotransporter-2 (SGLT-2) inhibitor or glucagon-like peptide-1 (GLP-1) agonist to metformin and lifestyle modifications in adults with type 2 diabetes and inadequate glycemic control (strong recommendation; high-certainty evidence). • Use an SGLT-2 inhibitor to reduce the risk for all-cause mortality, major adverse cardiovascular events, progression of chronic kidney disease, and hospitalization due to congestive heart failure. • Use a GLP-1 agonist to reduce the risk for all-cause mortality, major adverse cardiovascular events, and stroke. RECOMMENDATION 2 ACP recommends against adding a dipeptidyl peptidase-4 (DPP-4) inhibitor to metformin and lifestyle modifications in adults with type 2 diabetes and inadequate glycemic control to reduce morbidity and all-cause mortality (strong recommendation; high-certainty evidence).
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Affiliation(s)
- Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania (A.Q., T.S., C.H.S.)
| | - Adam J Obley
- Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (A.J.O.)
| | - Tatyana Shamliyan
- American College of Physicians, Philadelphia, Pennsylvania (A.Q., T.S., C.H.S.)
| | - Lauri A Hicks
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.A.H.)
| | - Curtis S Harrod
- American College of Physicians, Philadelphia, Pennsylvania (A.Q., T.S., C.H.S.)
| | - Carolyn J Crandall
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California (C.J.C.)
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Schousboe JT, Landsteiner A, Drake T, Sultan S, Langsetmo L, Kaka A, Anthony M, Billington CJ, Kalinowski C, Ullman K, Wilt TJ. Cost-Effectiveness of Newer Pharmacologic Treatments in Adults With Type 2 Diabetes: A Systematic Review of Cost-Effectiveness Studies for the American College of Physicians. Ann Intern Med 2024; 177:633-642. [PMID: 38639547 DOI: 10.7326/m23-1492] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND In the United States, costs of antidiabetes medications exceed $327 billion. PURPOSE To systematically review cost-effectiveness analyses (CEAs) of newer antidiabetes medications for type 2 diabetes. DATA SOURCES Bibliographic databases from 1 January 2010 through 13 July 2023, limited to English. STUDY SELECTION Nonindustry-funded CEAs, done from a U.S. perspective that estimated cost per quality-adjusted life-year (QALY) gained for newer antidiabetic medications. Two reviewers screened the literature; disagreements were resolved with a third reviewer. DATA EXTRACTION Cost-effectiveness analyses were reviewed for treatment comparisons, model inputs, and outcomes. Risk of bias (RoB) of the CEAs was assessed using Drummond criteria and certainty of evidence (CoE) was assessed using GRADE (Grading of Recommendations Assessment, Development, and Evaluations). Certainty of evidence was determined using cost per QALY thresholds predetermined by the American College of Physicians Clinical Guidelines Committee; low (>$150 000), intermediate ($50 to $150 000), or high (<$50 000) value per QALY compared with the alternative. DATA SYNTHESIS Nine CEAs were eligible (2 low, 1 high, and 6 some concerns RoB), evaluating glucagon-like peptide-1 agonists (GLP1a), dipeptidyl peptidase-4 inhibitors (DPP4i), sodium-glucose cotransporter-2 inhibitors (SGLT2i), glucose-dependent insulinotropic peptide agonist (GIP/GLP1a), and insulin. Comparators were metformin, sulfonylureas, neutral protamine Hagedorn (NPH) insulin, and others. Compared with metformin, GLP1a and SGLT2i are low value as first-line therapy (high CoE) but may be of intermediate value when added to metformin or background therapy compared with adding nothing (low CoE). Insulin analogues may be similarly effective but more expensive than NPH insulin (low CoE). The GIP/GLP1a value is uncertain (insufficient CoE). LIMITATIONS Cost-effectiveness analyses varied in methodological approach, assumptions, and drug comparisons. Risk of bias and GRADE method for CEAs are not well established. CONCLUSION Glucagon-like peptide-1 agonists and SGLT2i are of low value as first-line therapy but may be of intermediate value when added to metformin or other background therapy compared with adding nothing. Other drugs and comparisons are of low or uncertain value. Results are sensitive to drug effectiveness and cost assumptions. PRIMARY FUNDING SOURCE American College of Physicians. (PROSPERO: CRD42022382315).
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Affiliation(s)
- John T Schousboe
- Park Nicollet Clinic and HealthPartners Institute, Bloomington, and Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota (J.T.S.)
| | | | - Tyler Drake
- Department of Medicine, VA Health Care System, and Department of Medicine, University of Minnesota, Minneapolis, Minnesota (T.D., A.K., C.J.B.)
| | - Shahnaz Sultan
- Department of Medicine, University of Minnesota, and Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, Minnesota (S.S.)
| | - Lisa Langsetmo
- Department of Medicine, University of Minnesota, Center for Care Delivery and Outcomes Research, VA Health Care System, and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota (L.L.)
| | - Anjum Kaka
- Department of Medicine, VA Health Care System, and Department of Medicine, University of Minnesota, Minneapolis, Minnesota (T.D., A.K., C.J.B.)
| | - Maylen Anthony
- Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, Minnesota (M.A., C.K., K.U.)
| | - Charles J Billington
- Department of Medicine, VA Health Care System, and Department of Medicine, University of Minnesota, Minneapolis, Minnesota (T.D., A.K., C.J.B.)
| | - Caleb Kalinowski
- Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, Minnesota (M.A., C.K., K.U.)
| | - Kristen Ullman
- Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, Minnesota (M.A., C.K., K.U.)
| | - Timothy J Wilt
- Division of Health Policy and Management, School of Public Health, and Department of Medicine, University of Minnesota, Department of Medicine and Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, Minnesota (T.J.W.)
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Syed FZ. Pharmacologic Treatments in Adults With Type 2 Diabetes: Cost-Effectiveness and Comorbidity Considerations. Ann Intern Med 2024; 177:680-681. [PMID: 38639544 DOI: 10.7326/m24-0861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Affiliation(s)
- Fatima Z Syed
- Duke University Division of General Internal Medicine, Durham, North Carolina
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