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Sperry JD, Loeb A, Smith MJ, Brighton TB, Ehret JA, Fermo JD, Gentili ME, Lancaster JW, Mazur JN, Spezzano K, Szwak JA. Retrospective, multicenter analysis of the safety and effectiveness of direct oral anticoagulants for the treatment of venous thromboembolism in obesity. J Thromb Thrombolysis 2024; 57:603-612. [PMID: 38409303 DOI: 10.1007/s11239-024-02955-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Direct oral anticoagulants (DOACs) are the preferred treatment for venous thromboembolism (VTE). However, DOAC use in patients with a BMI greater than 40 kg/m2 has not been well studied despite the growing prevalence of obesity, and current literature is often underpowered. METHODS This multicenter, retrospective, observational study evaluated patients 18 years and older who received DOACs for acute VTE treatment. Patients receiving DOACs for recurrent VTE or for failure of another agent were excluded. The primary efficacy outcome was recurrent VTE and the primary safety outcome was major bleeding within 12 months (or one month after stopping anticoagulation therapy). A propensity score analysis was performed to balance patient characteristics and evaluate the primary endpoints by BMI group. Time-to-event outcomes were analyzed using weighted Kaplan-Meier curves. RESULTS There were 165 patients with a BMI of at least 40 kg/m2 and 320 patients with a BMI less than 40 kg/m2. The majority received apixaban (373, 77%). Recurrent VTE occurred in 5 (3.0%) and 13 (4.1%) of patients in the higher and lower BMI groups, respectively (adjusted OR: 0.66; 95% CI: 0.16-2.69). Major bleeding occurred in 5 (3.0%) and 15 (4.7%) of patients in the higher and lower BMI groups, respectively (adjusted OR: 1.19; 95% CI: 0.36-3.92). CONCLUSION There was no significant difference in VTE recurrence or major bleeding related to BMI among patients treated with DOACs. This study showed that DOACs may be a safe and effective VTE treatment option in patients with obesity.
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Affiliation(s)
- Jeffrey D Sperry
- UC Health Memorial Hospital, Department of Pharmacy, Colorado Springs, CO, USA
| | - Aletha Loeb
- Department of Pharmacy, University of California, Davis, Sacramento, CA, USA
| | - Melissa J Smith
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tessa B Brighton
- Department of Pharmacy, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Julie A Ehret
- Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA
| | - Joli D Fermo
- Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA
| | - Morgan E Gentili
- Department of Pharmacy Services, Beth Israel Lahey Health, Burlington, MA, USA
| | - Jason W Lancaster
- School of Pharmacy and Pharmaceutical Sciences, Northeastern University, Boston, MA, USA
| | - Jennifer N Mazur
- Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA
| | - Katherine Spezzano
- Department of Pharmacy, University of Kentucky HealthCare, Lexington, KY, USA
| | - Jennifer A Szwak
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, USA.
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Gallegos PJ, Hoffmaster BS, Howard ML, Lancaster JW, Pluckrose D, Smith BA, Tallian K, Van Matre ET, Scott JD. Remote experiential education: A silver lining from the
COVID
‐19 pandemic. J Am Coll Clin Pharm 2021. [DOI: 10.1002/jac5.1572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Lancaster JW, McAuliffe L, O'Gara E, Cornelio C, Hum J, Kim Y, Phung A, She K, Lei Y, Balaguera H, Liesching T. Impact of antibiotic choice on readmission in adults experiencing an acute COPD exacerbation. Am J Health Syst Pharm 2020; 78:S26-S32. [PMID: 32995869 DOI: 10.1093/ajhp/zxaa317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The impact of antibiotic therapy in managing acute chronic obstructive pulmonary disease (COPD) exacerbations requiring hospitalization remains unclear. We conducted a study to assess the impact of antibiotic therapy on the rate of 30-day readmission after discharge from a hospital stay for an acute COPD exacerbation. Additional study outcomes analyzed included the effects of antibiotic therapy on hospital length of stay, in-hospital mortality, 90-day and 12-month readmission rates, and time to next COPD exacerbation. METHODS The study was an institutional review board-approved, retrospective, observational review of adult patients at a tertiary academic medical center. The medical records of patients 18 years of age or older who were hospitalized for an acute COPD exacerbation between January 2008 and December 2014 were evaluated. Included patients were stratified by receipt of guideline-appropriate, guideline-inappropriate, or no antibiotic therapy. Nonparametric data were analyzed using the Kruskal-Wallis test (nonparametric) and categorical data via χ 2 test, respectively. RESULTS Three hundred twenty-five subjects were included; there were no significant differences in baseline characteristics in the 3 study groups. Sixty-eight percent of patients (n = 223) received antibiotics. The percentage of patients readmitted within 30 days did not differ between cohorts: 11.9% (appropriate therapy) vs 13.2% (nonappropriate therapy) vs 12.2% (no antibiotics) (P = 0.95 for all comparisons). Additionally, no detectable differences in 90-day or 12-month readmission rate, length of hospital day, or in-hospital mortality were found. However, a trend toward increased time to next COPD exacerbation was noted in those receiving antibiotics vs no antibiotics (352 days vs 192 days, P = 0.07). CONCLUSION Treatment of COPD exacerbations with antibiotics did not impact readmission rates, length of hospital stay, in-hospital mortality, or time to next exacerbation. More investigation is warranted to assess the effect of antibiotics on time to next exacerbation, as well as comparative effectiveness between antibiotic classes.
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Affiliation(s)
- Jason W Lancaster
- School of Pharmacy, Northeastern University, Boston, MA.,Department of Pharmacy, Lahey Hospital & Medical Center, Burlington, MA
| | - Laura McAuliffe
- Department of Pharmacy, Lahey Hospital & Medical Center, Burlington, MA
| | - Elizabeth O'Gara
- Department of Pharmacy, Lahey Hospital & Medical Center, Burlington, MA
| | | | - Jennifer Hum
- School of Pharmacy, Northeastern University, Boston, MA
| | - Yestle Kim
- School of Pharmacy, Northeastern University, Boston, MA
| | - Ann Phung
- School of Pharmacy, Northeastern University, Boston, MA
| | - Kevin She
- School of Pharmacy, Northeastern University, Boston, MA
| | - Yuxiu Lei
- Department of Pulmonary & Critical Care Medicine, Lahey Hospital & Medical Center, Burlington, MA
| | - Henri Balaguera
- Department of Hospital Medicine, Lahey Hospital & Medical Center, Burlington, MA
| | - Timothy Liesching
- Department of Pulmonary & Critical Care Medicine, Lahey Hospital & Medical Center, Burlington, MA
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Abstract
The incidence of Neisseria gonorrhoeae infections in the United States has grown over the past decade. The most recent data provided by the Centers for Disease Control and Prevention (CDC) indicate that reported cases have increased by almost 10% over the last 5 years. In conjunction with this rise, the presence of multidrug-resistant strains of N. gonorrhoeae has also emerged. The 2015 CDC guidelines recommend dual therapy with intramuscular ceftriaxone and oral azithromycin as first-line treatment, although components of this regimen are met with a high level of resistance. Although ceftriaxone resistance has not yet been reported in the United States, it is only a matter of time before such isolates are detected, thus ushering in a new era of difficult-to-manage uncomplicated gonococcal infection. The potential public health crisis and patient-associated sequelae (e.g., pelvic inflammatory disease, epididymitis, and human immunodeficiency virus infection) linked with untreatable gonorrhea are cause for great concern. To try to stem this tide, a number of new agents targeted against N. gonorrhoeae are being investigated in clinical trials. In this article, we review the various agents, both currently available and under clinical investigation, and provide recommendations for the management of gonococcal infections.
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Affiliation(s)
- Jason W Lancaster
- School of Pharmacy, Northeastern University, Boston, Massachusetts.,Department of Pharmacy, Lahey Hospital & Medical Center, Burlington, Massachusetts
| | - Monica V Mahoney
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Sana Mandal
- School of Pharmacy, Northeastern University, Boston, Massachusetts
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Hirsch EB, Raux BR, Lancaster JW, Mann RL, Leonard SN. Surface microbiology of the iPad tablet computer and the potential to serve as a fomite in both inpatient practice settings as well as outside of the hospital environment. PLoS One 2014; 9:e111250. [PMID: 25360719 PMCID: PMC4216077 DOI: 10.1371/journal.pone.0111250] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 09/26/2014] [Indexed: 11/30/2022] Open
Abstract
Background The use of tablet computers and other touch screen technology within the healthcare system has rapidly expanded. It has been reported that these devices can harbor pathogens in hospitals; however, much less is known about what pathogens they can harbor when used outside the hospital environment compared to hospital practice. Methods Thirty iPads belonging to faculty with a variety of practice settings were sampled to determine the presence and quantity of clinically-relevant organisms. Flocked nylon swabs and neutralizer solution were used to sample the surface of each iPad. Samples were then plated on a variety of selective agars for presence and quantity of selected pathogens. In addition, faculty members were surveyed to classify the physical location of their practice settings and usage patterns. Continuous variables were compared via an unpaired Student's t test with two-tailed distribution; categorical variables were compared with the Fisher's exact test. Results Of the iPads sampled, 16 belonged to faculty practicing within a hospital and 14 belonged to a faculty member practicing outside a hospital. More faculty within the hospital group used their iPads at their practice sites (78.6% vs. 31.3%; p = 0.014) and within patient care areas (71.4% vs. 18.8%; p = 0.009) than the non-hospital group. There were no differences in the presence, absence, or quantity of, any of the pathogens selectively isolated between groups. Problematic nosocomial pathogens such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and P. aeruginosa were isolated from both hospital and non-hospital faculty iPads. Conclusions Gram positive and Gram negative organisms were recovered from the surfaces of iPads regardless of practice setting; these included problematic multidrug-resistant pathogens like MRSA, VRE, and Pseudomonas aeruginosa. Healthcare personnel in all settings should be aware of the potential for tablet computers to serve as a nidus for microorganism transmission.
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Affiliation(s)
- Elizabeth B. Hirsch
- Northeastern University, Bouvé College of Health Sciences, School of Pharmacy, Boston, Massachusetts, United States of America
| | - Brian R. Raux
- Northeastern University, Bouvé College of Health Sciences, School of Pharmacy, Boston, Massachusetts, United States of America
| | - Jason W. Lancaster
- Northeastern University, Bouvé College of Health Sciences, School of Pharmacy, Boston, Massachusetts, United States of America
| | - Rachael L. Mann
- Northeastern University, Bouvé College of Health Sciences, School of Pharmacy, Boston, Massachusetts, United States of America
| | - Steven N. Leonard
- Northeastern University, Bouvé College of Health Sciences, School of Pharmacy, Boston, Massachusetts, United States of America
- * E-mail:
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Lancaster JW, Stein SM, MacLean LG, Van Amburgh J, Persky AM. Faculty development program models to advance teaching and learning within health science programs. Am J Pharm Educ 2014; 78:99. [PMID: 24954939 PMCID: PMC4064499 DOI: 10.5688/ajpe78599] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 04/17/2014] [Indexed: 05/11/2023]
Abstract
Within health science programs there has been a call for more faculty development, particularly for teaching and learning. The primary objectives of this review were to describe the current landscape for faculty development programs for teaching and learning and make recommendations for the implementation of new faculty development programs. A thorough search of the pertinent health science databases was conducted, including the Education Resource Information Center (ERIC), MEDLINE, and EMBASE, and faculty development books and relevant information found were reviewed in order to provide recommendations for best practices. Faculty development for teaching and learning comes in a variety of forms, from individuals charged to initiate activities to committees and centers. Faculty development has been effective in improving faculty perceptions on the value of teaching, increasing motivation and enthusiasm for teaching, increasing knowledge and behaviors, and disseminating skills. Several models exist that can be implemented to support faculty teaching development. Institutions need to make informed decisions about which plan could be most successfully implemented in their college or school.
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Affiliation(s)
| | - Susan M. Stein
- School of Pharmacy, Pacific University, Hillsboro, Oregon
| | | | | | - Adam M. Persky
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Lancaster JW, Douglass MA, Gonyeau MJ, Wong A, Woolley AB, Divall MV. Providers' perceptions of student pharmacists on inpatient general medicine practice experiences. Am J Pharm Educ 2013; 77:26. [PMID: 23519602 PMCID: PMC3602850 DOI: 10.5688/ajpe77226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 10/16/2012] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To assess health care providers' perceptions of student pharmacists involved as members of a general medicine team. METHODS A brief, anonymous, online survey instrument was distributed to 134 health care providers at 4 major medical centers in Massachusetts who interacted with Northeastern University student pharmacists during inpatient general medicine advanced pharmacy practice experiences beginning in March 2011. The survey instrument assessed health care provider perception of student pharmacists' involvement, preparedness, clinical skills, and therapeutic recommendations. RESULTS Of the 79 providers who responded, 96.2% reported that student pharmacists were prepared for medical rounds and 87.3% reported that student pharmacists were active participants in patient care. Also, 94.9% and 98.7% of providers indicated that student pharmacist recommendations were appropriate and accurate, respectively. The majority (61.8%) of providers believed that student pharmacist involvement on internal medicine teams was beneficial. CONCLUSIONS Provider perceptions regarding student pharmacist participation on general medicine practice experiences were mostly positive.
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Affiliation(s)
- Jason W Lancaster
- Department of Pharmacy Practice, Northeastern University, Boston, MA 02115, USA.
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Matthews SJ, Lancaster JW. Telaprevir: a hepatitis C NS3/4A protease inhibitor. Clin Ther 2012; 34:1857-82. [PMID: 22951253 DOI: 10.1016/j.clinthera.2012.07.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 07/30/2012] [Accepted: 08/01/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Telaprevir is a hepatitis C NS3/4A protease inhibitor approved by the US Food and Drug Administration as part of combination therapy for the management of chronic hepatitis C virus (HCV) genotype 1 infection. OBJECTIVE The article reviews published literature on telaprevir, including its chemistry, mechanism of action, resistance, pharmacodynamic and pharmacokinetic properties, drug interactions, therapeutic efficacy, HIV/HCV coinfection, pharmacogenomics, adverse events, pharmacoeconomics, and dosing and administration. METHODS English-language literature was included. Searches of MEDLINE and BIOSIS databases from 1975 through January 2012 were performed. Emphasis was placed on reference citations involving clinical trials, randomized controlled trials, and research in humans. Additional publications were found by searching the reference lists of identified articles and reviewing abstracts from recent scientific meetings. Search terms included, but were not limited to, telaprevir, VX-950, hepatitis C virus genotype 1, resistance, pharmacology, pharmacokinetics, pharmacodynamics, drug interactions, pharmacogenomics, adverse events, and therapeutic use. RESULTS Review of the databases revealed 471 publications/abstracts on this subject. Of these, 85 were chosen based on the review criteria. Two Phase III studies investigated the efficacy and tolerability of telaprevir administered for 12 weeks (T12) when used with peginterferon alfa and ribavirin (PR) in treatment-naive subjects. The ADVANCE study reported that patients who had an extended rapid virologic response (eRVR; an undetectable HCV RNA level at both 4 and 12 weeks of treatment) with triple therapy could be treated with PR for a total of 24 weeks (T12PR24 group) versus standard PR treatment for 48 weeks (PR48 group [control]). The proportions of patients who achieved sustained virologic response (SVR; undetectable HCV RNA concentration at 24 weeks after the completion of therapy) in the T12PR24 and PR48 groups were 89% and 44%, respectively. The ILLUMINATE study reported T12PR24 was noninferior to T12PR48 in patients with an eRVR to combination therapy. In the REALIZE study, patients with a history of relapse responded well to T12PR48 compared with PR48 (SVR, 83% vs 24%). Telaprevir is a substrate/inhibitor of cytochrome P450 (CYP3A4) and a substrate/inhibitor of P-glycoprotein and poses an important risk for drug interactions. Adverse drug events (ADEs) reported most commonly with triple therapy compared with the T or PR regimen alone were rash, pruritus, nausea, diarrhea, and anemia. The serious AEs most commonly reported during T + PR therapy were anemia, rash, and pruritus. Two reports concluded that T combined with PR was not cost-effective due to the high cost of telaprevir. One study reported that the combination of T + PR would be cost-effective if the treatment rate of HCV genotype 1 infected patients reached 50%. CONCLUSION Including telaprevir as part of triple therapy for the management of chronic HCV genotype 1 infection significantly increases the likelihood of achieving an SVR over standard dual drug therapy (PR) in both treatment-naive and -experienced patients. However, due to the high cost, the use of triple therapy with telaprevir will likely be limited to patient groups known to respond poorly to dual therapy.
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Affiliation(s)
- Samuel James Matthews
- Department of Pharmacy Practice, Bouvé College of Health Sciences, School of Pharmacy, Northeastern University, Boston, Massachusetts 02115, USA.
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Lancaster JW, Wong A, Roberts SJ. 'Tech' versus 'talk': a comparison study of two different lecture styles within a Master of Science nurse practitioner course. Nurse Educ Today 2012; 32:e14-e18. [PMID: 22071277 DOI: 10.1016/j.nedt.2011.09.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 09/12/2011] [Accepted: 09/23/2011] [Indexed: 05/31/2023]
Abstract
BACKGROUND Generation Y students have a strong preference for technology that has caused educators to re-evaluate their instructional techniques. Limited published literature exists evaluating the benefits of electronic lecture delivery to students enrolled within nursing degree programs, with no publications to date comparing traditional to blended learning modalities. OBJECTIVES To retrospectively compare student outcomes, including overall course grade and individual examination scores, between two cohorts of students utilizing two distinctly different methods of lecture delivery, traditional and blended. METHODS IRB approval was granted to retrospectively compare student outcomes from fifty-two students enrolled within Northeastern University's Master of Science Nurse Practitioner degree program. A total of 23 students were enrolled in the traditional section taught in 2010 and 29 students were enrolled in the blended section taught in 2011. Student'st-test was used to compare studied outcomes between each section. A p-value of ≤0.05 was considered to be statistically significant. RESULTS The students enrolled within blended course scored statistically significantly higher than their counterparts within the traditional course for three of the four studied outcomes, including overall course score. CONCLUSIONS This study demonstrates that nursing students enrolled within a more technologically advanced course may have improved performance over students enrolled in courses with traditional lecture styles given their generational preferences for learning.
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Affiliation(s)
- Jason W Lancaster
- Bouve College of Health Sciences, School of Pharmacy, Department of Pharmacy Practice, Boston, MA 02115, USA.
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Lancaster JW, Matthews SJ. Fidaxomicin: The Newest Addition to the Armamentarium Against Clostridium difficile Infections. Clin Ther 2012; 34:1-13. [DOI: 10.1016/j.clinthera.2011.12.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 12/06/2011] [Accepted: 12/09/2011] [Indexed: 01/05/2023]
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Lancaster JW, Lawrence KR, Fong JJ, Doron SI, Garpestad E, Nasraway SA, Devlin JW. Impact of an Institution-Specific Hospital-Acquired Pneumonia Protocol on the Appropriateness of Antibiotic Therapy and Patient Outcomes. Pharmacotherapy 2008; 28:852-62. [DOI: 10.1592/phco.28.7.852] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Quillian WW, Quillian WW, Lancaster JW. Non-thrombocytopenic purpura associated with cat-scratch disease. Pediatrics 1974; 53:279-80. [PMID: 4812014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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