Publications by authors named "Marcia L Brackbill"

14 Publications

  • Page 1 of 1

Prospective trial of a novel nomogram to achieve updated vancomycin trough concentrations.

Interdiscip Perspect Infect Dis 2013 12;2013:839456. Epub 2013 Sep 12.

Department of Pharmacy Practice, Shenandoah University, 1775 North Sector Court, Winchester, VA 22601, USA.

Purpose. To determine if the use of a novel vancomycin nomogram predicts dosing regimens that achieve target trough concentrations equal to or more accurate than dosing regimens calculated using traditional pharmacokinetic calculations, evaluate the incidence of subtherapeutic and supratherapeutic troughs, and assess pharmacist's impressions of the nomogram. Methods. Prospective, open-label study in 473 patients who had a new order for vancomycin and were >18 years of age and ≤120 kg. Patients were randomized to the active group, dosed using the nomogram, or to the control group, dosed using traditional pharmacokinetic calculations already in place at our institution. Results. Patients dosed via nomogram were within the appropriate trough range in 44% of cases compared to 33% in the control group (P = 0.014). Vancomycin troughs less than 10 mcg/mL were significantly decreased with the use of nomogram (P = 0.032). Incidence of supratherapeutic troughs, greater than 20 mcg/mL, was not significantly different between groups (P = 0.706), and pharmacists agreed that the nomogram was easy to use and saved their time. Conclusions. A novel vancomycin nomogram was prospectively validated and found to be more effective than traditional pharmacokinetic dosing. The nomogram is being implemented as the standard dosing protocol at our institution.
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http://dx.doi.org/10.1155/2013/839456DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3791841PMC
October 2013

Adjunctive sitagliptin therapy in postoperative cardiac surgery patients: a pilot study.

Int J Endocrinol 2012 27;2012:810926. Epub 2012 Sep 27.

Winchester Medical Center, Heart and Vascular Center, Winchester, VA 22601, USA ; Department of Pharmacy Practice, Bernard J. Dunn School of Pharmacy, Shenandoah University, 1775 North Sector Court, Winchester, VA 22601, USA.

Aim. We aimed to determine if sitagliptin added to standard postoperative standardized sliding-scale insulin regimens improved blood glucose. Methods. A prospective, randomized, double-blind, placebo-controlled pilot study was conducted in diabetic cardiac surgery patients. Patients received sitagliptin or placebo after surgery for 4 days. The primary endpoint was to estimate the effect of adjunctive sitagliptin versus placebo on overall mean blood glucose in the 4-day period after surgery. Results. Sixty-two patients participated. Repeated measures tests indicated no significant difference between the groups in the overall mean blood glucose level with a mean of 147.2 ± 4.8 mg/dL and 153.0 ± 4.6 mg/dL for the test and the control group, respectively (P = 0.388). Conclusions. Sitagliptin added to normal postoperative glucose management practices did not improve overall mean blood glucose control in diabetic patients in the postoperative setting.
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http://dx.doi.org/10.1155/2012/810926DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3465958PMC
October 2012

Effect of preoperative N-acetylcysteine on postoperative blood loss parameters in cardiac surgery patients.

Int J Vasc Med 2011 21;2011:859020. Epub 2011 Jun 21.

Pharmacy Department, Winchester Medical Center, 1840 Amherst Street, Winchester, VA 22601, USA.

Purpose. To determine if recent preoperative exposure to n-acetylcysteine (NAC), Mucomyst, increases postoperative blood loss in cardiac surgery patients. Methods. Retrospective review of cardiac surgery patients who underwent a cardiac catheterization within four days of surgery and whose serum creatinine was ≥1.0 mg/dL. The study groups were those who received NAC in the pericatheterization period versus those who did not. The primary endpoint was postoperative chest tube output at 24, 48, and 72 hours. Secondary endpoints included number of transfusions and other bleeding parameters. Results. Mean blood loss in the first 24 hours was 962 ± 595 mL in the treatment group (n = 79) and 1,178 ± 788 mL in the control group (n = 106), P = .040. Blood loss between groups at 48 (366 ± 318 mL versus 412 ± 363 mL, P = .382) and 72 (194 ± 300 mL versus 176 ± 224 mL, P = .643) hours was not significantly different. There were no significant differences in postoperative transfusions or other bleeding parameters. Conclusions. Preoperative exposure to NAC did not increase postoperative blood loss or negatively affect other bleeding parameters.
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http://dx.doi.org/10.1155/2011/859020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3134103PMC
November 2011

Prospective, randomized comparison of lansoprazole suspension, and intermittent intravenous famotidine on gastric pH and acid production in critically ill neurosurgical patients.

Neurocrit Care 2010 Oct;13(2):176-81

Departments of Pharmacotherapy & Outcomes Sciences and Neurosurgery, Virginia Commonwealth University School of Pharmacy, P.O Box 980533, 410 N. 12th Street, Richmond, VA 23298, USA.

Background: There is a paucity of studies comparing stress ulcer prophylaxis (SUP) agents in high-risk neurosurgical patients.

Methods: In this prospective, randomized study, critically ill neurosurgical patients received lansoprazole 30 mg suspension via NG/NJ tube daily or famotidine 20 mg IV q12 h for SUP. Gastric pH and residual volumes were recorded for 3 days and adverse events for 7 days after admission.

Results: There were 51 patients randomized to lansoprazole (n = 28) or famotidine (n = 23) who received SUP for ≥ 3 days. All patients had at least two risk factors for SRMD, and 75% had a baseline GCS < 9. On day 1 of therapy, more famotidine patients had a gastric pH ≥ 4 at least 80% of the time as compared to lansoprazole patients (74 vs. 36%, P = 0.01, respectively); however, there was no difference on days 2 and 3. Enteral feedings on day 1 predicted a pH ≥ 4 (P = 0.01). There were no significant differences in the percentages of time gastric residual volumes < 28 ml (P = NS). Heme-positive aspirates were present in 18-39% of patients (P = NS); one patient receiving famotidine met the criteria for overt bleeding. Thrombocytopenia occurred in 17% in the famotidine group and 4% in the lansoprazole group (P = NS).

Conclusions: Neurosurgery ICU patients receiving famotidine for SUP achieved a gastric pH ≥ 4 more often than lansoprazole-treated patients, but only on day 1 of the 3-day study period. Both agents were equally effective in reducing gastric acid production. There was no difference in the incidence of mucosal damage and thrombocytopenia.
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http://dx.doi.org/10.1007/s12028-010-9397-3DOI Listing
October 2010

Intervention to increase the proportion of acute myocardial infarction or coronary artery bypass graft patients receiving an order for aspirin at hospital discharge.

J Manag Care Pharm 2010 Jun;16(5):329-36

BJD School of Pharmacy, Dept. of Pharmacy Practice, Shenandoah University, 1775 North Sector Court, Winchester, VA 22601, USA.

Background: Chronic aspirin therapy is recommended by the American College of Cardiology/American Heart Association (ACC/AHA) following acute myocardial infarction (AMI) and by the Society of Thoracic Surgeons(STS) following coronary artery bypass graft (CABG). Aspirin therapy at discharge following a hospitalization for AMI or CABG is a common pay for-performance indicator used by third-party payers and was included asa quality measure in the Centers for Medicare & Medicaid Services (CMS)/Premier Hospital Quality Incentive Demonstration initiated in 2003. A formal prescription for aspirin, such as required for other cardiovascular drugs,could serve as a reminder to all health care providers (doctors, nurses, and pharmacists) to include aspirin on a discharge medication list.

Objective: To evaluate if an aspirin prescription placed in the patient chart shortly after hospital admission would increase compliance with guidelines for aspirin use at discharge in patients with AMI or CABG.

Methods: This was a single-center prospective pre-intervention to post intervention comparison study in a 411-bed hospital. Patients admitted during the 3-month period from July through September 2008 with an AMI or undergoing CABG surgery served as the pre-intervention group, and patients admitted during the 3-month period from January through March 2009 were in the post-intervention group. The intervention included multiple educational sessions with clinical staff, conducted both prior to and during the pilot, and blank pre-printed aspirin prescriptions placed in the charts of patients for whom no contraindication to aspirin was present. The blank prescriptions were then completed by the attending physician (or physician extender), and the discharge nurse used the completed aspirin prescription, with other prescriptions and written orders, as a reference when creating the discharge medication list. The primary outcome measure was the percentage of patients who had aspirin documented on the discharge medication list. Differences in compliance rates in the comparison and pilot periods were assessed using the Pearson chi-square test.

Results: A total of 458 patients were identified with a CABG procedure and/or an admitting diagnosis of AMI; 447 met inclusion criteria, and 11 were excluded (1 patient in each of the groups had a contraindication to aspirin due to bleeding, and 9 died during hospitalization). The intervention was associated with an increase in the proportion of patients with aspirin documented on the discharge medication list, 266 of 269 patients (98.9%)compared with 169 of 178 patients (94.9%, P = 0.012) in the pre-intervention group. In the subsample of patients with CABG, 54 of 59 (91.5%)patients in the pre-intervention group had aspirin documented on the discharge medication list compared with 100% of 66 patients in the postintervention group (P = 0.016). In the subsample of patients with AMI, aspirin was documented in 115 of 119 (96.6%) patients in the pre-intervention group versus 200 of 203 (98.5%) in the post-intervention group (P = 0.263).

Conclusion: A quality improvement initiative that included clinical staff education and placement of aspirin prescriptions in patient charts during the hospital stay was associated with an increase in the proportion of patients who had aspirin documented on the discharge medication list for the overall sample of patients with AMI or CABG and for patients with CABG alone but not for the quality measure for AMI patients.
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http://dx.doi.org/10.18553/jmcp.2010.16.5.329DOI Listing
June 2010

Relationship between assessment item format and item performance characteristics.

Am J Pharm Educ 2009 Dec;73(8):146

Bernard J. Dunn School of Pharmacy, Shenandoah University, Nashville, TN 37204, USA.

Objective: To evaluate the relationship between assessment item formats (case-based versus noncase-based) and item performance characteristics.

Methods: Assessment items (1,575) were collected from examinations administered in several therapeutics courses over 4 academic years. Items were categorized as either "case-based" or "noncase-based" and item performance characteristics (discrimination index and level of difficulty) were evaluated.

Results: Noncase-based items represented approximately three-fourths of all items that were evaluated, and demonstrated a higher discrimination index than case-based items. Case-based items were generally lengthier and included more detailed information than noncase-based items; however, they were not more difficult and exhibited a lower discrimination index. Secondary analyses revealed that 5-foil multiple-choice items are more difficult and have a higher discrimination index compared to 4-foil items.

Conclusion: The format used for an examination/test item (case-based or noncase-based) has an impact on item performance characteristics.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2828307PMC
http://dx.doi.org/10.5688/aj7308146DOI Listing
December 2009

Perioperative outcomes of coronary artery bypass grafting: effects of metabolic syndrome and patient's sex.

Am J Crit Care 2009 Sep;18(5):468-73

Winchester Medical Center's Heart and Vascular Center, Winchester, Virginia, USA.

Background: Perioperative outcome data related to metabolic syndrome in coronary artery bypass graft (CABG) patients are lacking.

Objective: To determine the incidence of metabolic syndrome in CABG patients and whether its presence or the patient's sex affects postoperative lengths of stay in the intensive care unit and hospital.

Methods: A retrospective observational study in CABG patients. Risk factors from the Society of Thoracic Surgeons' Adult Cardiac Surgery Database were used to categorize patients as having metabolic syndrome. Perioperative outcomes were compared between patients with and without metabolic syndrome and between sexes. Outcomes were based on the operational definitions of the Society of Thoracic Surgeons.

Results: Among 657 patients, 333 had metabolic syndrome; 63.8% (n = 215) of women and 36.9% (n = 118) of men (P
Conclusion: Both female patients and patients with metabolic syndrome undergoing CABG surgery are at higher risk for longer postoperative stays. Women with metabolic syndrome are the CABG patients at highest risk for in-hospital death.
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http://dx.doi.org/10.4037/ajcc2009718DOI Listing
September 2009

Teaching electrocardiogram basics using dance and movement.

Am J Pharm Educ 2009 Jul;73(4):70

Bernard J Dunn School of Pharmacy, Shenandoah University, Winchester, VA 22601, USA.

Objective: To implement and assess an innovative approach to teaching electrocardiogram (ECG) rhythms using dance and movement.

Design: Recognition of ECG rhythms was taught to a group of third-year pharmacy students using dance and movement via collaboration with a dance faculty member. A control group was taught using traditional pharmacy lecture and PowerPoint slides.

Assessment: A pretest and posttest were administered to both groups. There was a trend in test score improvement in the dance and movement group. After the sessions, a focus group was held to assess student perceptions using qualitative methods. Students thought the addition of dance helped them with speed of retention and recognition of ECG rhythms. Some students reported feeling out of their comfort zone.

Conclusion: Interprofessional collaboration between pharmacy and dance faculty members resulted in an innovative teaching methodology for ECG rhythms that increased test scores.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2720366PMC
http://dx.doi.org/10.5688/aj730470DOI Listing
July 2009

Frequency of CYP3A4, CYP3A5, CYP2C9, and CYP2C19 variant alleles in patients receiving clopidogrel that experience repeat acute coronary syndrome.

Heart Vessels 2009 Mar 1;24(2):73-8. Epub 2009 Apr 1.

Department of Pharmacy Practice, Bernard J. Dunn School of Pharmacy, Shenandoah University, Winchester, VA 22601-9975, USA.

The presence of cytochrome P450 (CYP) variant alleles may reduce the activation of the prodrug clopidogrel to its active state. This research evaluated the frequency of variant alleles in the genes coding for CYP3A4, CYP3A5, CYP2C9, and CYP2C19 enzymes in patients on clopidogrel therapy and experiencing repeat acute coronary syndrome (ACS) compared to a control group with a matching ethnic composition. Real-time polymerase chain reaction was used for allelic discrimination. Complete data were obtained for 92 patients enrolled over a 3-month period. There were no significant differences in the presence of the examined CYP3A4, CYP3A5, CYP2C9, or CYP2C19 variant alleles between the two groups. The present data indicate that patients currently receiving clopidogrel therapy who present with repeat ACS do not have higher frequency of the examined variant alleles compared to a control group.
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http://dx.doi.org/10.1007/s00380-008-1085-2DOI Listing
March 2009

Angiotensin-converting enzyme inhibitor or angiotensin receptor blocker adherence in patients with primary versus secondary diagnosis of heart failure.

Am J Manag Care 2007 Oct;13(10):568-70

Bernard J. Dunn School of Pharmacy, Shenandoah University, Winchester, VA 22601, USA.

Context: It is unknown whether hospitalization for a secondary diagnosis of heart failure (HF) impacts adherence to current HF guidelines. National HF databases that benchmark quality of care currently do not report on adherence based on whether HF is the primary or secondary diagnosis.

Objective: To describe angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) utilization at time of discharge in hospitalized patients with a primary or secondary diagnosis of systolic HF.

Study Design: Six-month observational chart review.

Methods: Patients were included if they were hospitalized with a primary or secondary diagnosis of HF, had an ejection fraction of < or =40%, and were more than 18 years of age. Guideline adherence was defined as appropriate if an ACEI or ARB was prescribed at discharge or if there was a documented contraindication.

Results: Of 204 patients in the study, 170 and 34 patients had a primary or secondary diagnosis of HF, respectively. Eighty-six percent of patients with a primary diagnosis of HF were discharged with an ACEI or ARB, whereas 71% of patients with a secondary diagnosis of HF were discharged with an ACEI or ARB (P = .029).

Conclusion: Patients with a primary diagnosis of HF are more likely to be discharged on an ACEI or ARB (if indicated) than those with a secondary diagnosis. Identifying and evaluating the need for an ACEI or ARB in hospitalized patients with a secondary diagnosis of HF offers practitioners an opportunity for improved patient care through better adherence to national guidelines.
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October 2007

Medication history reconciliation by pharmacists in an inpatient behavioral health unit.

Am J Health Syst Pharm 2007 May;64(10):1087-91

Bernard J. Dunn School of Pharmacy, Shenandoah University, Winchester, VA 22601, USA.

Purpose: The effectiveness of a pharmacy-obtained medication history on the medication reconciliation process in the behavioral health unit (BHU) of a community hospital was studied.

Methods: Patients admitted to the BHU of a 411-bed, not-for-profit hospital from 6 a.m. on Monday through 12 p.m. on Friday from September 1, 2005, through October 6, 2005, were candidates for the study. Within 18 hours of admission to the BHU and after the medication history had been obtained by a nurse, a pharmacy technician gathered patient demographic and medication information from the chart and the patient's medication bottles. Once the technician completed the documentation, the pharmacist was notified of a new admission. The pharmacist reviewed the collected documentation and patient chart before interviewing the patient.

Results: Of the 54 patients who met the study's inclusion criteria, 91% were seen by a pharmacist within 18 hours of admission. The mean +/- S.D. time delay to interview the patient was 11.6 +/- 5.1 hours. Pharmacists spent a mean of 13.9 minutes completing patients' medication histories. The mean +/- S.D. number of medications identified by nursing on admission was 4.0 +/- 3.2, compared with 5.3 +/- 3.7 identified by pharmacists (p < 0.05). The mean number of medication discrepancies identified per patient was 2.9. Of the discrepancies, 48% were related to an omitted or incorrect medication, 31% to an omitted or incorrect dose, and 13% to an omitted or incorrect frequency; 8% were categorized as miscellaneous.

Conclusion: Pharmacists' participation in obtaining patients' medication histories through chart review and patient interview increased the effectiveness of the medication reconciliation process in an inpatient BHU.
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http://dx.doi.org/10.2146/ajhp060323DOI Listing
May 2007

Perioperative nesiritide versus milrinone in high-risk coronary artery bypass graft patients.

Ann Pharmacother 2007 Mar 20;41(3):427-32. Epub 2007 Feb 20.

Department of Pharmacy Practice, Bernard J Dunn School of Pharmacy, Shenandoah University, Winchester, VA 22601, USA.

Background: Patients with left-ventricular dysfunction have an increased risk of developing heart failure after coronary artery bypass graft (CABG) surgery. Therapies to maintain cardiac output in such patients warrant investigation. Nesiritide is unique among intravenous medications used to manage heart failure. It mediates natriuresis and vasodilation and suppresses the reninangiotensin-aldosterone axis. Nesiritide may attenuate the body's neurohormonal response to myocardial stretch after CABG and provide clinical benefit in the immediate postoperative period.

Objective: To determine whether perioperative infusion of nesiritide improves clinical outcomes compared with milrinone therapy.

Methods: A prospective, open-label, randomized controlled trial was conducted in 40 consecutive hemodynamically stable patients with ejection fractions 35% or less undergoing CABG surgery. Patients were randomized to receive either an intraoperative bolus of nesiritide or milrinone followed by a 24 hour infusion of each agent. Length of postoperative intensive care unit stay was the primary outcome variable evaluated. Incidence of postoperative heart failure, 30 day readmission rates, mortality, and other clinical parameters were also compared.

Results: Patients receiving nesiritide had a mean +/- SD postoperative intensive care unit stay of 50.6 +/- 46.8 hours compared with 44.1 +/- 23.5 hours in those receiving milrinone (p = 0.578). Incidence of postoperative heart failure was also not significantly different between the drugs (p = 0.259). Thirty day follow-up confirmed no difference in hospital readmission rates between nesiritide and milrinone (p = 0.661). No differences in mortality were observed during hospitalization or 30 days of follow-up.

Conclusions: Nesiritide does not decrease postoperative intensive care unit stay or other clinical parameters compared with milrinone in high-risk patients with hemodynamically stable left-ventricular function undergoing CABG surgery.
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http://dx.doi.org/10.1345/aph.1H500DOI Listing
March 2007

Magnesium sulfate for prevention of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting.

Am J Health Syst Pharm 2005 Feb;62(4):397-9

Department of Pharmacy Practice, Bernard J. Dunn School of Pharmacy, Winchester, VA 22601, USA.

Purpose: The effects of i.v. magnesium sulfate on the frequency of postoperative atrial fibrillation (AF) in patients undergoing coronary artery bypass grafting (CABG) and on the frequency of AF at hospital discharge were studied. The effect of postoperative AF on hospital length of stay (LOS) was also assessed.

Methods: A retrospective chart review was performed for all patients who underwent CABG surgery by a single surgeon during 2000-2001 at a community medical center. Patients were eligible for inclusion if they had first-time CABG surgery. Patients who underwent CABG surgery in 2000 did not receive magnesium sulfate and served as controls for the study. Patients were included in the magnesium group if they received 2 g of i.v. magnesium sulfate intraoperatively and 2 g every 12 hours postoperatively for at least two consecutive days.

Results: A total of 262 patients underwent CABG during the study period, and 28 were excluded from the study. Of the remaining 234 patients, 99 were in the magnesium group, and 135 were in the control group. No significant differences were found between the study groups in recorded demographic characteristics. Postoperative AF occurred significantly less frequently in the magnesium group (p = 0.038). There was no significant difference between treatment groups in the number of patients discharged in AF (p = 0.307). Among all patients, those with AF were significantly more likely to have a prolonged LOS (p = 0.036).

Conclusion: CABG patients who received intraoperative and postoperative i.v. magnesium sulfate had a significantly lower rate of AF compared with patients who did not receive the drug. The number of patients discharged with AF was not affected by magnesium administration. AF was associated with a higher likelihood of prolonged postoperative hospitalization.
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http://dx.doi.org/10.1093/ajhp/62.4.0397DOI Listing
February 2005

Secondary prevention of hyperlipidemia after coronary artery bypass graft: from acute care to primary care.

Am J Crit Care 2004 Sep;13(5):411-5

Shenandoah University School of Pharmacy, Winchester, VA, USA.

Background: Clinical trials have established that secondary prevention of hyperlipidemia in patients after coronary artery bypass graft (CABG) surgery prevents progression of atherosclerosis. A multidisciplinary team promotes secondary prevention by prescribing antihyperlipidemic agents, screening for risk factors, and providing education on disease, diet, and medications. Information is minimal on the number of patients who continue with antihyperlipidemic therapy or follow-up with a primary care provider for cholesterol management after antihyperlipidemic therapy is initiated in an acute surgical setting.

Objectives: To determine (1) the frequency of use of antihyperlipidemic agents before CABG surgery, at hospital discharge, and approximately 9 months after discharge and (2) the occurrence of cholesterol monitoring by a primary care provider at least once between discharge and telephone follow-up.

Methods: Observational study of 135 patients undergoing CABG surgery at a regional medical center during a 4-month period. Patients were contacted by telephone between 5 and 12 months after discharge and asked about continued use of antihyperlipidemic agents and cholesterol monitoring since discharge.

Results: Before surgery, 56% of the patients were taking an antihyperlipidemic agent. At discharge, 95% were taking an antihyperlipidemic agent. At the time of study follow-up, 91% were still taking an antihyperlipidemic agent, and 84% had follow-up cholesterol monitoring by their primary care provider.

Conclusion: Initiation of an antihyperlipidemic agent and provision of education during hospitalization for CABG surgery results in a high percentage of patients continuing antihyperlipidemic therapy and having cholesterol levels monitored by their primary care provider after discharge.
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September 2004