Publications by authors named "Dean A Seehusen"

127 Publications

Practical Clinical Topics, Digging Deeper into COVID-19, Social Determinants of Health, and Equity.

J Am Board Fam Med 2021 Sep-Oct;34(5):883-885

As a discipline, we continue to learn lessons from Coronavirus disease 2019 (COVID-19)-lessons for practice, systems, and patient care. This issue also includes articles focused on 2 other topics that attract increasing attention by family physicians. First, articles describe how the social determinants of health impact health and how family physicians can overcome those obstacles with their patients. Patients want assistance from health systems for 1 specific need related to social determinants of their health. Second, we see increasing evidence about opioid prescriptions in primary care. Multiple clinical articles are pertinent to family medicine, such as different implications of an elevated sedimentation rate compared with C-reactive protein, practice facilitation, adolescent vaccination, family physician accuracy with potentially malignant skin lesions, and more.
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http://dx.doi.org/10.3122/jabfm.2021.05.210303DOI Listing
September 2021

Diagnosis and Initial Management of Acute Colonic Diverticulitis.

Am Fam Physician 2021 08;104(2):195-197

Medical College of Georgia, Augusta University, Augusta, GA, USA.

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August 2021

Family Medicine Research on Health Equity, Addiction, and Eating Breakfast-Just for Starters.

J Am Board Fam Med 2021 Jul-Aug;34(4):675-677

As usual, this issue of the journal delivers reports on a broad range of topics that can inform clinical practice. Several articles address equity, or the lack thereof, in health care. This includes research on the social determinants of health and how family medicine can contribute to redressing inequity. Another set of articles report on the ongoing wave of substance abuse. Additional training in addiction medicine for family physicians is 1 strategy for the United States to address this crisis. One of the most intriguing articles looks at the relationship between eating breakfast, amount of dietary fiber intake, and mortality. Several articles discuss ongoing changes or changes to family medicine on the horizon. Readers will find some well-written clinical reviews and an in-depth review of international practice-based research networks. Lastly, 2 great reads will remind readers how it feels to practice family medicine.
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http://dx.doi.org/10.3122/jabfm.2021.04.210199DOI Listing
July 2021

Family Medicine Residents' Experience During Early Phases of the COVID-19 Pandemic.

PRiMER 2021 14;5:18. Epub 2021 Jun 14.

American Board of Family Medicine, Lexington, KY.

Background And Objectives: Residents have been thrust onto the front lines of the US medical response to COVID-19. This study aimed to quantify and describe the experiences of family medicine residents nationally during the early phases of the pandemic. Specific areas of interest included training received and the residents' personal sense of safety. The purpose of this study was to look for differences among residents based on geographic location.

Method: This May 2020 survey was conducted by the Council of Academic Family Medicine Educational Research Alliance (CERA) of a random sample of 5,000 resident members of the American Academy of Family Physicians (AAFP).

Results: The overall response rate for the survey was 5.66% (283/5,000). More than 40% of residents reported having felt in moderate to significant personal danger during the COVID-19 pandemic. Fewer than 20% had been tested for COVID-19 themselves. Among all respondents, 176 (65.7%) of the residents had provided direct patient care for COVID-19-positive patients. Most had been trained on personal protective equipment and the medical aspects of COVID-19, but 16.2% reported no training on how to care for COVID-19 patients. Minority residents, and residents in larger urban areas were less likely to receive timely training.

Conclusions: The COVID-19 pandemic has had a major impact on family medicine residents' medical education and their sense of safety. Regional variations in residents' educational experiences during the pandemic exist. Training prior to COVID-19 exposure was not universal. In our sample, minority residents were less likely to receive timely training than White residents.
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http://dx.doi.org/10.22454/PRiMER.2021.909862DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284493PMC
June 2021

COVID-19 Pandemic Practices, Payment Models, and Publication Successes: Family Medicine Studies a Variety of Primary Care Questions.

J Am Board Fam Med 2021 May-Jun;34(3):459-461

This issue provides inspiring reports of family medicine during the Coronavirus disease 2019 (COVID-19) pandemic and the provision of just-in-time COVID-19 information for clinicians. Conversely, burnout - yes or no? The issue includes information that suggests the negative effects of social determinants are related to America's system of paying for medical care. The announcement of the availability of an on-line archive of the official first journal of family medicine gives us the chance to acclaim Dr. Geyman, who started the and was the first editor of this journal. And, as usual, there is more!
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http://dx.doi.org/10.3122/jabfm.2021.03.210099DOI Listing
July 2021

Keeping Patients at the Center of Family Medicine Scholarship.

J Am Board Fam Med 2021 Mar-Apr;34(2):249-250

In addition to the collection of veterans' health articles, this edition of the journal contains a wide range of family medicine research reports, commentaries, clinical reviews, and scholarly observations. These articles clearly exemplify a key strength of family medicine scholarship: the focus is on our patients. Two articles look at modern care of patients with venous thromboembolic disease-the first on acute management and the second on long-term care. Two other articles explore the role of pharmacists in an interdisciplinary team. A clever use of big databases provides a thought-provoking answer about the long-term health of patients with methicillin-resistant Three articles give us possible glimpses into the future of family medicine, exploring a potential payment reform model, suggesting an alternative approach to cancer screening guideline development, and considering how family physicians remain relevant in the technology-laden medical world of tomorrow.
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http://dx.doi.org/10.3122/jabfm.2021.02.210013DOI Listing
September 2021

Coaching, Mentoring, and Sponsoring as Career Development Tools.

Fam Med 2021 Mar;53(3):175-180

University of Michigan Department of Family Medicine and Institute for Healthcare Policy and Innovation, Ann Arbor, MI.

Background And Objectives: Coaching, mentoring, and sponsoring are tools academic leaders can utilize to develop junior faculty. Each tool has a unique goal, time frame and method. It has been suggested that sponsoring may be a particularly useful tool for furthering the careers of women in medicine. Our primary aim was to understand to what extent one group of academic leaders-family medicine department chairs-have benefited from each tool in their own career development and how often they use each to develop others. A secondary aim was to compare women's experiences with sponsorship to their male colleagues.

Methods: We surveyed all US family medicine department chairs electronically about their experiences with coaching, mentoring, and sponsoring. We collected data from August 2019 to October 2019.

Results: One hundred five of 193 family medicine department chairs responded to our survey (54.4% response rate). Most indicated that mentoring played a significant role in their career development, with fewer reporting coaching and sponsorship played significant roles. More reported frequent use of mentoring to develop faculty compared to coaching or sponsoring. Training in mentoring and sponsoring was associated with increased use, but coaching was not. No gender difference was found in this study population.

Conclusions: Chairs have less experience with coaching and sponsoring than mentoring. Personal experience being coached, mentored, or sponsored was associated with increased use of these tools. Formal training may increase use of mentoring and sponsoring. Contrary to our hypothesis, female chairs' experience with sponsoring was similar to their male peers.
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http://dx.doi.org/10.22454/FamMed.2021.341047DOI Listing
March 2021

Advancing Research Methods for Common Problems in Family Medicine and Family Medicine Practice Management.

J Am Board Fam Med 2021 Jan-Feb;34(1):1-3

Several research groups from multiple institutions provide structure and methods to improve research for family medicine. Colon cancer research includes which common screening test for colon cancer most often results in completed colonoscopy. Authors explore how some cardiovascular preventive medications are overused while others are underused. Three research papers specifically advance improvements for practice management, 3 articles address diabetes, 3 others cover family physicians caring for specific populations (pregnant women, children, and those with sports-related issues). There are practical research articles on practice management and others on common clinical problems. This issue also includes a clinical review on acute sensorineural hearing loss and human papilloma virus immunization guidelines that can cause confusion.
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http://dx.doi.org/10.3122/jabfm.2021.01.200584DOI Listing
August 2021

Must-Read Family Medicine Research-Glucosamine/Chondroitin Supplements and Mortality, Telomere Length and the Doctor-Patient Relationship, Reducing Opioid Use, and More.

J Am Board Fam Med 2020 Nov-Dec;33(6):823-826

This issue of the contains some exceptional research articles. A few are truly "must-reads," including a fascinating look at the relationship between having a usual source of care and telomere length. Glucosamine/chrondroitin supplementation seems to be helpful for more than just arthritis pain. There is a very practical advice on keeping patients discharged from the emergency department out of the hospital and on reducing patient requests for inappropriate antibiotics. This issue also features 5 articles addressing how family physicians can combat the opioid epidemic. Three articles highlight research on diabetes and another 3 on breast cancer. Payment reform, dermoscopy, and telemedicine are among many other topics covered.
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http://dx.doi.org/10.3122/jabfm.2020.06.200513DOI Listing
August 2021

Practical Family Medicine: After-Hours Video Telehealth, Office Procedures, Polyp Follow-up in Older Patients, Terminology for Domestic Violence Intervention.

J Am Board Fam Med 2020 Sep-Oct;33(5):641-642

This issue primarily contains practice-based research reports. For a commentary on these articles, see Tapp. also has a call for submissions and accepted pre-print articles specifically on COVID at our Web site, www.jabfm.org These online COVID-related articles will be collated into a future print issue. This issue also has additional articles, encompassing a range of issues, as is common for .
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http://dx.doi.org/10.3122/jabfm.2020.05.200387DOI Listing
July 2021

Diabetes ROADMAP: Teaching Guideline Use, Communication, and Documentation When Delivering the Diagnosis of Diabetes.

MedEdPORTAL 2020 09 11;16:10959. Epub 2020 Sep 11.

Professor of Family Medicine, Military Primary Care Research Network, Uniformed Services University of the Health Sciences, and Nellis Air Force Base Family Medicine Residency.

Introduction: Most interventions to date regarding breaking bad news focus on late-stage disease or disclosing a cancer diagnosis. Little attention has been given to delivery of chronic metabolic disease diagnoses such as prediabetes/type 2 diabetes.

Methods: Informed by the American Diabetes Association standards of care and formative research conducted by our research team, we developed this curriculum through the six-step approach to curriculum development. The curriculum consists of a 2- or 3-hour intervention that teaches medical decision-making, interpersonal communication, and clinical documentation in the context of prediabetes and type 2 diabetes followed by role-play and clinical practice.

Results: Across three cohorts, 53 clinicians completed the curriculum. Across the three iterations, learners rated the curricular intervention as worthwhile and delivered at an appropriate level. In a community hospital setting, learners scored significantly higher on a knowledge check than did a control group of six clinicians ( < .001). Learners in the community hospital also indicated high response efficacy and self-efficacy. At the academic medical center, simulated patients indicated high measures on the Diabetes Health Threat Communication Questionnaire.

Discussion: The moment of diagnosis presents a key opportunity to affect patients' perceptions of the disease. This curriculum guides clinicians in making the most of diagnosis delivery. Pairing of qualitative, patient-centered research alongside the iterative curriculum design process allows the curriculum to be adaptable and scalable to multiple settings and learner types.
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http://dx.doi.org/10.15766/mep_2374-8265.10959DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7485911PMC
September 2020

Toward a model of shared meaningful diagnosis.

Patient Educ Couns 2021 01 26;104(1):143-148. Epub 2020 Jul 26.

Uniformed Services University of the Health Sciences, Bethesda, MD, United States.

Objectives: The purpose was to explain the process of diabetes-related diagnosis that prompts patient action (behavior change or treatment adherence). A secondary purpose was to identify barriers/gaps that prevent those outcomes.

Methods: Using a grounded theory approach, we explored diagnosis from the patient's perspective and through the lens of the electronic health record (EHR). A thematic analysis was conducted on interview and EHR data from 28 patients, using the constant comparative method.

Results: The emerging model of shared meaningful diagnosis included four stages: stimulus to screen, medical decision making, medical information transfer, and patient sensemaking. Barriers to a meaningful diagnosis emerged in clinical documentation, clinician communication, and patient sensemaking.

Conclusions: This study expands current understanding of "diagnosis," suggesting additional stages between diagnostic labeling and disease management. The additional stages of medical information transfer and patient sensemaking are critical steps to a shared meaningful diagnosis that could enable teamwork among the patient and healthcare team.

Practice Implications: To sustain meaningful diagnosis for the patient, clinicians should document what language they used to explain the diagnosis to the patient so that subsequent clinicians can use similar language. Clinicians who work as a team should unify their approach to discussing prediabetes.
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http://dx.doi.org/10.1016/j.pec.2020.07.016DOI Listing
January 2021

Fetal Fibronectin Testing in Threatened Preterm Labor.

Am Fam Physician 2020 08;102(3):145-146

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August 2020

Medications, Medicating, and Medicated-When, Where, and How-Opioids and Others.

J Am Board Fam Med 2020 Jul-Aug;33(4):489-490

Medication therapy emerged as a theme for this issue-from many perspectives and for different conditions. We have several articles on opioids, including for pain/noncancer pain; use by older drivers and their reported driving; and the advantages of family medicine treatment sites. A related article explores chronic widespread pain and concurrent low back pain. In addition, this issue covers the gamut of prescribing inappropriate medications for older individuals and prescribing antibiotics when a CT scan of the abdomen would not have found an indication for such treatment. Other included topics include social complexity and impact on primary care physician income.
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http://dx.doi.org/10.3122/jabfm.2020.04.200227DOI Listing
August 2021

A Clarion Call to Our Family Medicine Colleagues.

Fam Med 2020 06;52(7):471-473

Department of Family Medicine, F. Edward H├ębert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.

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http://dx.doi.org/10.22454/FamMed.2020.806737DOI Listing
June 2020

Well-Being, New Technologies, and Clinical Evidence for Family Physicians.

J Am Board Fam Med 2020 May-Jun;33(3):347-349

This special issue contains several articles on well-being. Not surprisingly, many of these articles are specifically about burnout. The evidence shows differences in the rates of burnout between men and women family physicians as well as their responses. Clinical team structure and organizational change also contribute to burnout. What about the electronic medical record? We are also reminded that burnout is an international issue. There are also several articles on how technology is changing the way family physicians practice. Two articles report on issues regarding screening for frequently seen clinical entities, specifically breast cancer and alcohol misuse. There are also articles looking at the cost of medical assistant turnover in practices, the impact of continuity with a provider on the retention of patients in clinical trials, and much more of interest to family physicians.
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http://dx.doi.org/10.3122/jabfm.2020.03.200105DOI Listing
July 2021

Turning Points as Opportunities to Partner with Patients Living with type 2 Diabetes or Prediabetes.

J Am Board Fam Med 2020 Mar-Apr;33(2):211-219

From the Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD (CJWL); College of Journalism & Communications, UF Health Cancer Center, UF Health Center for Arts in Medicine, University of Florida, Gainesville, FL (CLF); Henry M. Jackson Foundation, Military Primary Care Research Network, Uniformed Services University of the Health Sciences, Department of Family Medicine, Bethesda, MD (LAC, JTJ); Department of Family Medicine, Augusta University, Augusta, GA (DAS); Department of Family Medicine, Nellis Family Medicine Residency, Mike O'Callaghan Military Medical Center, Las Vegas, NV (PFC).

Introduction: Understanding patients' perspectives about their diabetes and what causes those perspectives to shift is critical to building a treatment strategy with the patient and facilitating patient self-management behavior. Key "turning points" can provide crucial opportunities to enact a change in perspective. The goal of this study is to identify "turning points" that have significance to diabetes-related health.

Methods: Research coordinators interviewed 33 patients aged 25 to 65 diagnosed with type 2 diabetes mellitus or prediabetes at medical centers in Augusta, Georgia, and Las Vegas, Nevada. Retrospective interview technique and turning point analysis was employed to plot health or diabetes management changes from diagnosis up to the present day. The constant comparative method was used to conduct a thematic analysis. Axial coding identified properties characterizing each turning point.

Results: Patients reported 5 interrelated turning points occurring at various times after diagnosis: 1) either through patients own research and/or a health care class; 2) including exercising and healthier eating; 3) including events that derailed healthy behavior, motivated health behavior, and removed barriers to enacting healthy behavior; 4) either through holding patients accountable or encouraging them to enact healthy behavior; and 5) such as medication changes or behavior changes critical to disease management.

Discussion: These turning points provide specific moments throughout diabetes care in which family physicians can effectively partner with patients. By prompting, facilitating, or attending to these turning points, family physicians can partner with patients throughout diabetes care.
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http://dx.doi.org/10.3122/jabfm.2020.02.190136DOI Listing
August 2021

Increasing Article Visibility: and Author Responsibilities and Possibilities.

J Am Board Fam Med 2020 Mar-Apr;33(2):168-169

seeks to widely disseminate its peer-reviewed publications, increasing article visibility for the purpose of advancing scientific knowledge. We describe the journal's approach to dissemination and recommend a number of strategies for authors to implement, including press releases and social media. Providing the article's digital object identifier (DOI) is most useful, compared with links that can break, or attaching the article PDF, which will depress reader metrics. All articles are freely accessible online worldwide.
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http://dx.doi.org/10.3122/jabfm.2020.02.200023DOI Listing
August 2021

Many Family Medicine Successful Interventions and Clinical Reviews for Common Illnesses.

J Am Board Fam Med 2020 Mar-Apr;33(2):161-163

Family physician researchers continue to provide assistance to improve family medicine care. Commentaries on social determinants of health lead off this issue. Next, we have several papers on successful interventions by clinicians and/or patients to improve diabetes control, and then other provide information on other practice interventions that make a difference in overall care. Drug advertising continues to mislead. There is costly and nonproductive overuse of specific types of care. Herein is also a Scoping Review of possible indices for determining timely initiation of advance care planning. The issue's clinical reviews on use of transgender care, cervical myelopathy, and inhaled steroids for chronic obstructive pulmonary disease are pertinent, thorough, and timely.
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http://dx.doi.org/10.3122/jabfm.2020.02.200018DOI Listing
August 2021

How patients make sense of a diabetes diagnosis: An application of Weick's model of organizing.

Diabetes Res Clin Pract 2020 Apr 13;162:108117. Epub 2020 Mar 13.

Augusta University, Department of Family Medicine, 1120 15th Street, Augusta, GA, USA.

Aims: To identify communication cycles patients use to make sense of a diabetes diagnosis and barriers patients encounter in their sensemaking process.

Methods: Researchers conducted interviews with 33 participants with type 2 diabetes mellitus or prediabetes at medical centers in Georgia and Nevada. A thematic analysis using the constant comparative method identified communication cycles.

Results: Patients reported engaging three communication cycles to make sense of the diagnosis: (1) interacting with healthcare clinicians; (2) seeking information online; and (3) taking a nutrition/diabetes management class. Patients reported system-level barriers that impact sensemaking: (1) lack of consistent or routine care; and (2) lack of access to resources.

Conclusion: Results here reinforce the theoretical proposition that receiving a diagnosis is an equivocal process that requires patients to make sense of new information through communication cycles. Patients in this sample repeatedly described communication cycles to interpret this new information rather than relying on assembly rules. Clinicians can promote patient understanding of diabetes and self-management by taking time to explain the diagnosis, maintaining consistent care, providing guidance to online sources, and ensuring patients have access to diabetes education.
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http://dx.doi.org/10.1016/j.diabres.2020.108117DOI Listing
April 2020

Residency Scholarship Within Practice-based Research Networks.

Fam Med 2020 02 10;52(2):91-96. Epub 2020 Jan 10.

Department of Family Medicine, Augusta University, Augusta, GA.

Background And Objectives: Finding scholarship opportunities is a common struggle for family medicine residency programs, especially community-based programs. Participation in practice-based research networks (PBRNs) has been suggested as one option, but little is known about resident engagement in PBRNs. This study explores how PBRNs are currently involving family medicine residency programs and whether there are additional opportunities for engagement.

Methods: We conducted a cross-sectional survey of 126 primary care PBRN directors regarding residency program involvement in PBRN governance and scholarly activity. We used descriptive statistics to characterize our sample and bivariate analyses to assess association between involvement of residency programs in PBRNs and PBRN characteristics.

Results: Most responding PBRNs (N=56, 44.4% response rate) included at least one residency program (80%) and many had residency faculty involved in projects (67.3%), though involvement of residents was less common (52.7%). When involved, residents were part of fewer projects but participated in the full range of research activities. Few PBRNs had deeper engagement with residencies such as written goals specifying their inclusion in projects (23.6%) or residency faculty participation in the PBRN's governing body (45.5%). Most PBRNs not currently involving residents are interested in doing so (73.9%), and half of these have the resources to do this.

Conclusions: Most family medicine and primary care PBRNs have some involvement with residency programs, usually at the faculty level. Building on current PBRN involvement and making connections between local PBRNs and residency programs where none exist represents an excellent opportunity for education and for growing the research capacity of the discipline.
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http://dx.doi.org/10.22454/FamMed.2020.303653DOI Listing
February 2020

New Research on Back Pain, Diet and Diabetes, Advanced Care Planning, and Other Issues Frequently Seen in Family Medicine.

J Am Board Fam Med 2019 Nov-Dec;32(6):759-762

From the United States and Netherlands, we have 2 articles on back pain, with findings that indicate significant treatment differences between the countries, and a high likelihood of persistence. The Inflammatory Diet is now shown to be related to diabetes. Multiple perspectives on palliative care for the homeless. Could pharmacists assist in preventing suicide? There are changes in the practice of family medicine. Social determinants of health substantially influence health and medical care. Moreover, care for patients from deprived communities is under-reimbursed. Patient pre-existing conditions increased after the Affordable Care Act, suggesting that repealing pre-existing condition protections would likely exacerbate disparities in health and health care.
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http://dx.doi.org/10.3122/jabfm.2019.06.190322DOI Listing
September 2020

The Effectiveness of Outpatient Telehealth Consultations.

Am Fam Physician 2019 11;100(9):575-577

The Family Medicine Residency Program, Medical College of Georgia, Augusta, GA, USA.

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November 2019

PURL: Can sleep apnea be accurately diagnosed at home?

J Fam Pract 2019 10;68(8):459-461

Augusta University, GA, USA.

A recent study says Yes, and that it offers advantages: It can be scheduled faster, is less expensive, and is more acceptable to many patients than lab testing.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6791464PMC
October 2019

Author's Reply.

Authors:
Dean A Seehusen

Fam Med 2019 10;51(9):787

Department of Family and Community Medicine, and Department of Graduate Medical Education, Eisenhower Army Medical Center, Fort Gordon, GA.

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http://dx.doi.org/10.22454/FamMed.2019.263288DOI Listing
October 2019

When to Discuss Prostate Cancer Screening with Your Patients.

Am Fam Physician 2019 07;100(2):69-70

Bethesda, MD, USA.

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July 2019
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