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Multiple sclerosis is associated with higher comorbidity and healthcare resource use: a population-based, case-control study in a western Mediterranean region.

Eur J Neurol 2021 Jul 22. Epub 2021 Jul 22.

Servei de Neurología-Neuroimmunología, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Hospital Universitari, Barcelona, Spain.

Background: Comorbidities are common in multiple sclerosis (MS), and have been associated with worse outcomes and increased healthcare resource usage. We studied the frequency of comorbidities and adverse health behaviors (AHB) in MS patients in the Mediterranean region of Catalonia.

Methods: Population-based, case-control study using primary healthcare information covering 80% of Catalonia's population. Read More

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Is Telemedicine the Preferred Visit Modality in Patients with Type 1 Diabetes?

Exp Clin Endocrinol Diabetes 2021 Jul 22. Epub 2021 Jul 22.

Department of Endocrinology, Diabetes and Metabolic Disease, Kaplan Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, 7661041, Israel.

Background: The COVID-19 pandemic limits access to diabetes clinics. Remote communication by phone calls and WhatsApp messages became available in the past years. However, the current need to avoid face-to-face meetings necessitates further expansion of telemedicine services. Read More

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Insourcing and scaling a telemedicine solution in under 2 weeks: Lessons for the digital transformation of health care.

Healthc (Amst) 2021 Jul 19;9(3):100568. Epub 2021 Jul 19.

University of Pennsylvania Health System, Penn Medicine Center for Health Care Innovation, 3400 Civic Center Blvd, 14(th) Floor South Pavilion, Philadelphia, PA, 19104, USA; University of Pennsylvania Health System, Office of the Chief Medical Information Officer, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA; University of Pennsylvania Health System, Cardiology, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA. Electronic address:

The Covid-19 pandemic required rapid scale of telemedicine as well as other digital workflows to maintain access to care while reducing infection risk. Both patients and clinicians who hadn't used telemedicine before were suddenly faced with a multi-step setup process to log into a virtual meeting. Unlike in-person examination rooms, locking a virtual meeting room was more error-prone and posed a risk of multiple patients joining the same online session. Read More

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A French survey on the lockdown consequences of COVID-19 pandemic in Parkinson's disease. The ERCOPARK study.

Parkinsonism Relat Disord 2021 Jul 13;89:128-133. Epub 2021 Jul 13.

Service de Neurologie, Centre Hospitalier Universitaire, Toulouse, France; France CHU de Toulouse, Université de Toulouse-Toulouse 3, INSERM, UMR1214 Toulouse NeuroImaging Centre "TONIC," Center of Excellence in Neurodegeneration (CoEN), NeuroToul, Centre Expert Parkinson de Toulouse, Centre d'Investigation Clinique CIC1436, NS-Park/FCRIN Network, Services de Neurologie et de Pharmacologie Clinique, UMR 1048 Institute for Cardiovascular Diseases, Toulouse, France.

Background: In 2020 the coronavirus disease 19 (COVID-19) pandemic imposed a total and sudden lockdown. We aimed to investigate the consequences of the first COVID-19 lockdown (mid-March - mid-April 2020) on motor and non-motor symptoms (NMS) in a cohort of French people with Parkinson's disease (PwP).

Methods: PwP were enrolled either by an on-line survey sent from the national France Parkinson association (FP) to reach the French community of PwP or as part of outpatients' telemedicine visits followed by an hospital-based Parkinson Expert Center (PEC). Read More

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Metformin use and risk of asthma exacerbation among asthma patients with glycemic dysfunction.

J Allergy Clin Immunol Pract 2021 Jul 19. Epub 2021 Jul 19.

Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore Maryland. Electronic address:

Background: Diabetes is associated with worse asthma morbidity. Metformin, which treats diabetes, may have a role among patients with asthma and glycemic dysfunction.

Objective: To determine the association between metformin use and asthma exacerbations among patients with diabetes. Read More

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Effect of Early Feeding on Intestinal Permeability and Inflammation Markers in Infants with Genetic Susceptibility to Type 1 Diabetes: A Randomized Clinical Trial.

J Pediatr 2021 Jul 19. Epub 2021 Jul 19.

Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland; Department of Pediatrics, Tampere University Hospital, Tampere, Finland. Electronic address:

Objectives: To assess whether weaning to an extensively hydrolyzed formula (EHF) decreases gut permeability and/or markers of intestinal inflammation in infants with HLA-conferred diabetes susceptibility, when compared with conventional formula.

Study Design: By analyzing 1468 expecting biological parent pairs for HLA-conferred susceptibility for type 1 diabetes, 465 couples (32%) potentially eligible for the study were identified. After further parental consent, 332 babies to be born were randomized at 35 gestational week. Read More

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Point-of-Care Virtual Radiology Consultations in Primary Care: A Feasibility Study of a New Model for Patient-Centered Care in Radiology.

J Am Coll Radiol 2021 Jul 19. Epub 2021 Jul 19.

Department of Radiology, University of Washington School of Medicine, Seattle, Washington.

Background: The goal of this study is to assess the value of point-of-care virtual consultations in radiology.

Methods: We conducted an institutional review board-approved feasibility study of video-based radiology consultations in an internal medicine primary care clinic at a quaternary academic medical center. The study included 3 primary care providers (PCPs) and enrolled 43 patients. Read More

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The Association of Service Use and Other Client Factors With the Time to Transition From Home Care to Facility-Based Care.

J Am Med Dir Assoc 2021 Jul 19. Epub 2021 Jul 19.

Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.

Objectives: People are living longer with complex health needs and wish to remain in their homes as their care needs change. We examined which client factors (sociodemographic, health service use, health, and function) influenced older persons' (≥65 years) time to transition from home living to assisted living (AL) or long-term care (LTC) facilities.

Design: Retrospective cohort study. Read More

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Inhaled corticosteroid prescriptions in the ED for recurrent asthma using IT clinical decision support: Revisit after cessation of an incentive program.

J Asthma 2021 Jul 22:1-9. Epub 2021 Jul 22.

Statistics Department, Phoenix Children's Hospital, Phoenix, AZ, USA.

The objective of this study was to assess whether inhaled corticosteroid (ICS) prescription rates for patients with poorly controlled asthma presenting to the emergency department (ED) remained high with a clinical support system in place, after a financial incentive program ended. This study is the second phase of a previous study done at our institution. The first phase demonstrated that the introduction of an electronic alert system advising providers to prescribe ICS to patients with poorly controlled asthma, along with a financial incentive, increased ICS prescription rates from 2% to 77%. Read More

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Individualized Glaucoma Change Detection Using Deep Learning Auto Encoder-Based Regions of Interest.

Transl Vis Sci Technol 2021 Jul;10(8):19

Hamilton Glaucoma Center, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, CA, USA.

Purpose: To compare change over time in eye-specific optical coherence tomography (OCT) retinal nerve fiber layer (RNFL)-based region-of-interest (ROI) maps developed using unsupervised deep-learning auto-encoders (DL-AE) to circumpapillary RNFL (cpRNFL) thickness for the detection of glaucomatous progression.

Methods: Forty-four progressing glaucoma eyes (by stereophotograph assessment), 189 nonprogressing glaucoma eyes (by stereophotograph assessment), and 109 healthy eyes were followed for ≥3 years with ≥4 visits using OCT. The San Diego Automated Layer Segmentation Algorithm was used to automatically segment the RNFL layer from raw three-dimensional OCT images. Read More

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Heat-Related Emergency Department Visits During the Northwestern Heat Wave - United States, June 2021.

MMWR Morb Mortal Wkly Rep 2021 Jul 23;70(29):1020-1021. Epub 2021 Jul 23.

Record high temperatures are occurring more frequently in the United States, and climate change is causing heat waves to become more intense (1), directly impacting human health, including heat-related illnesses and deaths. On average, approximately 700 heat-related deaths occur in the United States each year (2). In the northwestern United States, increasing temperatures are projected to cause significant adverse health effects in the coming years (3). Read More

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Agreement and variability of subjective refraction, autorefraction, and wavefront aberrometry in pseudophakic patients.

J Cataract Refract Surg 2021 Aug;47(8):1056-1063

From the VIROS-Vienna Institute for Research in Ocular Surgery, a Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria.

Purpose: To evaluate the comparability and variability of subjective refraction (SR), autorefraction (AR), and wavefront aberrometry (WA) in pseudophakic patients.

Setting: Hanusch Hospital, Vienna, Austria.

Design: Prospective study. Read More

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Assessing Orthopedic Patient Preferences for Mandated Virtual Care During the COVID-19 Pandemic and Elective Virtual Care in Non-Pandemic Circumstances.

Orthopedics 2021 Jul-Aug;44(4):e471-e476. Epub 2021 Jul 1.

The purpose of this study was to compare orthopedic patient preferences for mandated virtual care during the coronavirus disease 2019 (COVID-19) pandemic and elective virtual care during non-pandemic circumstances. An orthopedic virtual care questionnaire was administered to adult orthopedic patients undergoing their first orthopedic virtual visit between March 15, 2020, and May 18, 2020. The questionnaire had 13 items rated on a 1-to-5 Likert scale ("strongly agree" to "strongly disagree"). Read More

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Differences in Patient and Physician Perceptions of Urgency for Musculoskeletal Conditions During the COVID-19 Pandemic.

Orthopedics 2021 Jul-Aug;44(4):e534-e538. Epub 2021 Jul 1.

In 2020, the coronavirus disease 2019 (COVID-19) pandemic limited musculoskeletal care to urgent or "nonelective" office visits and procedures. No guidelines exist to inform patients or physicians what meets these criteria. The purpose of this multi-institutional study was to describe the differences in perceptions of urgency for musculoskeletal complaints between patients and providers during the COVID-19 pandemic. Read More

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Risks for Recurrent Vulvovaginal Candidiasis Caused by Non-Albicans Versus .

J Womens Health (Larchmt) 2021 Jul 22. Epub 2021 Jul 22.

Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA.

Vulvovaginal candidiasis (VVC) is the second most common vulvovaginitis (VV). About 20% of women will experience recurrent infections in their lifetime with non- (NAC) species being one of the causative agents. Although studies have looked at risk factors for recurrent VVC they are limited in scope. Read More

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Outpatient Practice Reactivation in an Integrated Community Practice During the COVID-19 Pandemic.

Telemed J E Health 2021 Jul 22. Epub 2021 Jul 22.

Department of Management Engineering and Consulting, Mayo Clinic, Rochester, Minnesota, USA.

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Clinicians' and nurses' documentation practices in palliative and hospice care.

Int J Palliat Nurs 2021 Jul;27(5):227-234

Professor; Consultant Palliative Care Advocate and Physician; Founder Hospice Africa; Director of Policy Hospice Africa, Uganda.

Background: Health workers are likely to document patients' care inaccurately, especially when using new and revised case tools, and this could negatively impact patient care.

Aim: To assess nurses' and clinicians' documentation practices when using a new patients' continuation case sheet (PCCS) and explore nurses' and clinicians' experiences regarding the documentation of patients' information in the new PCCS. The purpose of introducing the PCCS was to improve the continuity of care for patients attending clinics at which they were unlikely to consistently see the same clinician or nurse. Read More

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US Trends in Opioid Access Among Patients With Poor Prognosis Cancer Near the End-of-Life.

J Clin Oncol 2021 Jul 22:JCO2100476. Epub 2021 Jul 22.

Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.

Purpose: Heightened regulations have decreased opioid prescribing across the United States, yet little is known about trends in opioid access among patients dying of cancer.

Methods: Among 270,632 Medicare fee-for-service decedents with poor prognosis cancers, we used part D data to examine trends from 2007 to 2017 in opioid prescription fills and opioid potency (morphine milligram equivalents per day [MMED]) near the end-of-life (EOL), defined as the 30 days before death or hospice enrollment. We used administrative claims to evaluate trends in pain-related emergency department (ED) visits near EOL. Read More

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Direct and Indirect Costs of Influenza-Like Illness Treated with and Without Oseltamivir in 15 European Countries: A Descriptive Analysis Alongside the Randomised Controlled ALICE Trial.

Clin Drug Investig 2021 Jul 22. Epub 2021 Jul 22.

Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium.

Background And Objective: Influenza-like illness (ILI) leads to a substantial disease burden every winter in Europe; however, oseltamivir is not frequently prescribed to ILI patients in the primary-care setting. An open-label, multi-country, multi-season, randomised controlled trial investigated the effectiveness of oseltamivir for treating ILI in 15 European countries. We aimed to evaluate whether patients presenting with ILI in primary care and being managed with the addition of oseltamivir to usual care had lower average direct and indirect costs compared to patients with usual care alone. Read More

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Impact of the COVID-19 pandemic on emergency medical resources : An observational multicenter study including all hospitals in a major urban center of the Rhein-Ruhr metropolitan region.

Anaesthesist 2021 Jul 22. Epub 2021 Jul 22.

Klinikdirektion, Kliniken Maria Hilf GmbH Mönchengladbach, Akademisches Lehrkrankenhaus der RWTH Aachen, Aachen, Germany.

Background: With the coronavirus disease 2019 (COVID-19) outbreak hospitals prepared for increasing numbers of patients without knowing how patient populations were evolving and what resources would be required. The present study aimed to analyze the impact of the local COVID-19 pandemic on emergency resources of all hospitals in a major urban center (Mönchengladbach) in Germany.

Methods: This observational multicenter study involved all acute care hospitals (n = 4). Read More

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Evaluation of a Clinical Decision Support Strategy to Increase Seasonal Influenza Vaccination Among Hospitalized Children Before Inpatient Discharge.

JAMA Netw Open 2021 Jul 1;4(7):e2117809. Epub 2021 Jul 1.

Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.

Importance: Hospitalized children are at increased risk of influenza-related complications, yet influenza vaccine coverage remains low among this group. Evidence-based strategies about vaccination of vulnerable children during all health care visits are especially important during the COVID-19 pandemic.

Objective: To design and evaluate a clinical decision support (CDS) strategy to increase the proportion of eligible hospitalized children who receive a seasonal influenza vaccine prior to inpatient discharge. Read More

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Decline in the Incidence of Neonatal Sepsis in Rural Gadchiroli, India During the Twenty-one Years (1998-2019) Following the Home-based Neonatal Care Field-trial.

Pediatr Infect Dis J 2021 Jul 20. Epub 2021 Jul 20.

From the Society for Education, Action and Research in Community Health (SEARCH), Gadchiroli, Maharashtra, India Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada.

Background: Sepsis is a leading cause of neonatal mortality globally. The home-based neonatal care (HBNC) field trial (1995-1998) in rural Gadchiroli demonstrated a reduction in the incidence of neonatal sepsis. The current study examines the trend of neonatal sepsis during the twenty-one years (1998-2019) following the trial's completion. Read More

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Effects of Exercise Structure and Modality on Physiological and Perceptual Responses to Exercise.

J Strength Cond Res 2021 Jul 20. Epub 2021 Jul 20.

School of Physical Education and Sports Science, National and Kapodistrian University of Athens, Athens, Greece; and Department of Kinesiology, California State University-San Marcos, San Marcos, California.

Abstract: Bogdanis, GC, Mallios, VJ, Katsikas, C, Fouseki, T, Holman, I, Smith, C, and Astorino, TA. Effects of exercise structure and modality on physiological and perceptual responses to exercise. J Strength Cond Res XX(X): 000-000, 2021-This study examined the effect of exercise mode and intensity on physiological and perceptual responses to exercise. Read More

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The Impact of Disease Activity on 5 year Outcomes in patients undergoing treatment for Neovascular Age Related Macular Degeneration.

Retina 2021 Jul 16. Epub 2021 Jul 16.

Singapore Eye Research Institute, Singapore National Eye Centre, Singapore Duke-NUS Medical School, National University of Singapore The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, NSW, Australia Marsden Eye Specialists, Sydney, NSW, Australia Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Perth, WA, Australia University Hospital Zurich and University of Zurich, Zurich, Switzerland.

Purpose: To assess the impact of disease activity on clinical outcomes in a "real-world" cohort with neovascular age related macular degeneration (nAMD) over 5 years.

Methods: Data were obtained from the prospectively-defined Fight Retinal Blindness! registry. Eyes were divided into tertiles based on the proportion of visits where choroidal neovascular lesion was active (low, moderate and high) up until 5 years. Read More

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Modifications of intravitreal injections in response to the COVID-19 pandemic.

J Chin Med Assoc 2021 Jul 20. Epub 2021 Jul 20.

Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.

The Coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented disruption to the normal operation of the healthcare system. On a worldwide scale, hospitals suspended non-urgent surgeries and outpatient visits to downsized clinical loadings to redistribute manpower to counteract the pandemic's impact. So far, there is no evidence-based guideline defining a clear line between urgent and non-urgent indications of intravitreal injections (IVI). Read More

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Effective Treatment Recommendations for Type 2 Diabetes Management Using Reinforcement Learning: Treatment Recommendation Model Development and Validation.

J Med Internet Res 2021 Jul 22;23(7):e27858. Epub 2021 Jul 22.

Ping An Healthcare Technology, Beijing, China.

Background: Type 2 diabetes mellitus (T2DM) and its related complications represent a growing economic burden for many countries and health systems. Diabetes complications can be prevented through better disease control, but there is a large gap between the recommended treatment and the treatment that patients actually receive. The treatment of T2DM can be challenging because of different comprehensive therapeutic targets and individual variability of the patients, leading to the need for precise, personalized treatment. Read More

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Genetic counseling, virtual visits, and equity in the era of COVID-19 and beyond.

J Genet Couns 2021 Jul 21. Epub 2021 Jul 21.

Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA.

Overnight, as a result of the COVID-19 pandemic, telehealth rapidly transitioned from limited application to widespread implementation. The field of genetic counseling was well positioned to make this transition to virtual care since there is generally less of a need for patients to be seen in-person for physical exams or urgent care. Going forward, virtual visits will presumably become a mainstay in the provision of genetic services and it is anticipated that clinics will adopt "hybrid" models with both in-person and virtual visit options. Read More

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[Response to perampanel in a patient with chronic post-hypoxic myoclonus].

Rev Neurol 2021 Aug;73(3):111-113

Hospital Universitario de La Princesa, 28006 Madrid, España.

Introduction: Chronic post-hypoxic myoclonus is a condition in which the predominant clinical picture is myoclonus following hypoxic brain damage, usually due to cardiorespiratory arrest. It is a condition that is usually treated with antiepileptic drugs, in most cases with a modest clinical response.

Case Report: We report the case of a patient who started with jerking movements, compatible with myoclonus in the four limbs and the face the day after recovering from a cardiorespiratory arrest. Read More

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KSI-301: antibody biopolymer conjugate in retinal disorders.

Ther Adv Ophthalmol 2021 Jan-Dec;13:25158414211027708. Epub 2021 Jul 12.

Retina Services, JB Eye Care & Retina Centre, Salem, India.

KSI-301 is a new intravitreal anti-vascular endothelial growth factor (VEGF) antibody biopolymer conjugate under investigation for the treatment of age-related macular degeneration (AMD), diabetic macular oedema (DME) and retinal vein occlusion (RVO). Preclinical and early clinical trials so far have shown promising results in retinal vascular diseases. When using anti-VEGF agents for treatment of retinal disorders, the frequency of injections and follow-up visits has increased the treatment burden, greatly affecting the treatment outcome. Read More

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Nonurgent Patients' Preferences for Emergency Department Versus General Practitioner and Effects of Incentives: A Discrete Choice Experiment.

MDM Policy Pract 2021 Jul-Dec;6(2):23814683211027552. Epub 2021 Jul 9.

Accident & Emergency Department, Changi General Hospital, Singapore.

This study investigates potential of a new financial incentive policy, the GP-referral discount scheme introduced in Singapore, in reducing nonurgent emergency department (ED) visits, and compares it with alternative interventions. A discrete choice experiment (DCE) was designed to elicit patients' preferences for ED and general practitioner (GP) under hypothetical nonurgent medical conditions. Through latent class multinomial logistic regression, choice models were estimated to quantify how patients' choices are influenced by GP-referral discount, other ED/GP attributes (waiting time, test facilities, and payment), patient demographics, and their perception of severity. Read More

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