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2.
BMJ Lead ; 6(2): 104-109, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-36170529

RESUMO

BACKGROUND: Crisis plans for healthcare organisations most often focus on operational needs including staffing, supplies and physical plant needs. Less attention is focused on how leaders can support and encourage individual clinical team members to conduct themselves as professionals during a crisis. METHODS: This qualitative study analysed observations from 79 leaders at 160 hospitals that participate in two national professionalism programmes who shared their observations in focus group discussions about what they believed were the essential elements of leading and addressing professional accountability during a crisis. RESULTS: Analysis of focus group responses identified six leadership practices adopted by healthcare organisations, which were felt to be essential for organisations to navigate the crisis successfully. Unique aspects of maintaining professionalism during each phase of the pandemic were identified and described. CONCLUSIONS: Leaders need a plan to support an organiation's pursuit of professionalism during a crisis. Leaders participating in this study identified practices that should be carefully woven into efforts to support the ongoing safety and quality of the care delivered by healthcare organisations before, during and after a crisis. The lessons learnt from the COVID-19 pandemic may be useful during subsequent crises and challenges that a healthcare organisation might experience.


Assuntos
COVID-19 , Pandemias , COVID-19/epidemiologia , Hospitais , Humanos , Liderança , Profissionalismo
3.
Inf Serv Use ; 42(1): 29-38, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35600126

RESUMO

The Integrated Academic/Advanced Information Systems (IAIMS) program began in 1983 and was based on a study by the Association of American Medical Colleges (AAMC). Donald A.B. Lindberg M.D. was a member of the AAMC Advisory Committee. The U.S. National Library of Medicine (NLM) grants for IAIMS were initiated in 1984 the same year Dr. Lindberg became Director of the NLM. This chapter presents an overview of IAIMS and its progression through three stages with Dr. Lindberg's leadership.

4.
Stud Health Technol Inform ; 288: 32-42, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-35102826

RESUMO

The Integrated Academic/Advanced Information Systems (IAIMS) program began in 1983 and was based on a study by the Association of American Medical Colleges (AAMC). Donald A.B. Lindberg M.D. was a member of the AAMC Advisory Committee. The U.S. National Library of Medicine (NLM) grants for IAIMS were initiated in 1984 the same year Dr. Lindberg became Director of the NLM. This chapter presents an overview of IAIMS and its progression through three stages with Dr. Lindberg's leadership.


Assuntos
Centros Médicos Acadêmicos , Sistemas Integrados e Avançados de Gestão da Informação , Sistemas de Informação , National Library of Medicine (U.S.) , Estados Unidos
5.
J Am Med Inform Assoc ; 28(7): 1543-1547, 2021 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-33893511

RESUMO

OBJECTIVE: Successful technological implementations frequently involve individuals who serve as mediators between end users, management, and technology developers. The goal for this project was to evaluate the structure and activities of such mediators in a large-scale electronic health record implementation. MATERIALS AND METHODS: Field notes from observations taken during implementation beginning in November 2017 were analyzed qualitatively using a thematic analysis framework to examine the relationship between specific types of mediators and the type and level of support to end users. RESULTS: We found that support personnel possessing both contextual knowledge of the institution's workflow and training in the new technology were the most successful in mediation of adoption and use. Those that lacked context of either technology or institutional workflow often displayed barriers in communication, trust, and active problem solving. CONCLUSIONS: These findings suggest that institutional investment in technology training and explicit programs to foster skills in mediation, including roles for professionals with career development opportunities, prior to implementation can be beneficial in easing the pain of system transition.


Assuntos
Informática Médica , Registros Eletrônicos de Saúde , Humanos , Fluxo de Trabalho
6.
J Am Med Inform Assoc ; 28(6): 1168-1177, 2021 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-33576432

RESUMO

OBJECTIVE: The characteristics of clinician activities while interacting with electronic health record (EHR) systems can influence the time spent in EHRs and workload. This study aims to characterize EHR activities as tasks and define novel, data-driven metrics. MATERIALS AND METHODS: We leveraged unsupervised learning approaches to learn tasks from sequences of events in EHR audit logs. We developed metrics characterizing the prevalence of unique events and event repetition and applied them to categorize tasks into 4 complexity profiles. Between these profiles, Mann-Whitney U tests were applied to measure the differences in performance time, event type, and clinician prevalence, or the number of unique clinicians who were observed performing these tasks. In addition, we apply process mining frameworks paired with clinical annotations to support the validity of a sample of our identified tasks. We apply our approaches to learn tasks performed by nurses in the Vanderbilt University Medical Center neonatal intensive care unit. RESULTS: We examined EHR audit logs generated by 33 neonatal intensive care unit nurses resulting in 57 234 sessions and 81 tasks. Our results indicated significant differences in performance time for each observed task complexity profile. There were no significant differences in clinician prevalence or in the frequency of viewing and modifying event types between tasks of different complexities. We presented a sample of expert-reviewed, annotated task workflows supporting the interpretation of their clinical meaningfulness. CONCLUSIONS: The use of the audit log provides an opportunity to assist hospitals in further investigating clinician activities to optimize EHR workflows.


Assuntos
Registros Eletrônicos de Saúde , Aprendizado de Máquina não Supervisionado , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Fluxo de Trabalho , Carga de Trabalho
7.
JAMIA Open ; 3(2): 269-280, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32734168

RESUMO

OBJECTIVES: Healthcare organizations need to rapidly adapt to new technology, policy changes, evolving payment strategies, and other environmental changes. We report on the development and application of a structured methodology to support technology and process improvement in healthcare organizations, Systematic Iterative Organizational Diagnostics (SIOD). SIOD was designed to evaluate clinical work practices, diagnose technology and workflow issues, and recommend potential solutions. MATERIALS AND METHODS: SIOD consists of five stages: (1) Background Scan, (2) Engagement Building, (3) Data Acquisition, (4) Data Analysis, and (5) Reporting and Debriefing. Our team applied the SIOD approach in two ambulatory clinics and an integrated ambulatory care center and used SIOD components during an evaluation of a large-scale health information technology transition. RESULTS: During the initial SIOD application in two ambulatory clinics, five major analysis themes were identified, grounded in the data: putting patients first, reducing the chaos, matching space to function, technology making work harder, and staffing is more than numbers. Additional themes were identified based on SIOD application to a multidisciplinary clinical center. The team also developed contextually grounded recommendations to address issues identified through applying SIOD. DISCUSSION: The SIOD methodology fills a problem identification gap in existing process improvement systems through an emphasis on issue discovery, holistic clinic functionality, and inclusion of diverse perspectives. SIOD can diagnose issues where approaches as Lean, Six Sigma, and other organizational interventions can be applied. CONCLUSION: The complex structure of work and technology in healthcare requires specialized diagnostic strategies to identify and resolve issues, and SIOD fills this need.

8.
Stud Health Technol Inform ; 264: 1318-1322, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438139

RESUMO

In 2017, a US academic medical center switched to a commercial EHR system using the "specialist training the specialist" model, which combines peer-to-peer training, classroom based training, and web-based training. We conducted semi-structured interviews with physicians at multiple training levels to investigate the impact of this EHR switch and to explore the training experience of physicians and their perception of the training quality pre and post Go-Live. Our team used Grounded Theory methodology to classify the interview information. Themes that emerged from the interviews included stress and anxiety, the desire for more realistic training environments tailored to specialty needs, and concerns about the duration of time between training and implementation. In future implementations, we recommend more data-rich test patients and the demonstration of real-world workflows during training.


Assuntos
Medicina , Médicos , Centros Médicos Acadêmicos , Registros Eletrônicos de Saúde , Humanos , Fluxo de Trabalho
9.
Methods Inf Med ; 56(S 01): e20-e29, 2017 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-28144678

RESUMO

This article is part of a For-Discussion-Section of Methods of Information in Medicine about the paper "Representation of People's Decisions in Health Information Systems: A Complementary Approach for Understanding Health Care Systems and Population Health" written by Fernan Gonzalez Bernaldo de Quiros, Adriana Ruth Dawidowski, and Silvana Figar. It is introduced by an editorial. This article contains the combined commentaries invited to independently comment on the paper of de Quiros, Dawidowski, and Figar. In subsequent issues the discussion can continue through letters to the editor.


Assuntos
Tomada de Decisão Clínica/métodos , Tomada de Decisões/fisiologia , Sistemas de Apoio a Decisões Clínicas/organização & administração , Técnicas de Apoio para a Decisão , Registros Eletrônicos de Saúde/organização & administração , Sistemas de Informação em Saúde/organização & administração , Aceitação pelo Paciente de Cuidados de Saúde , Humanos , Modelos Organizacionais
10.
J Am Med Inform Assoc ; 24(e1): e111-e120, 2017 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-27570217

RESUMO

OBJECTIVE: The goal of this investigation was to determine whether automated approaches can learn patient-oriented care teams via utilization of an electronic medical record (EMR) system. MATERIALS AND METHODS: To perform this investigation, we designed a data-mining framework that relies on a combination of latent topic modeling and network analysis to infer patterns of collaborative teams. We applied the framework to the EMR utilization records of over 10 000 employees and 17 000 inpatients at a large academic medical center during a 4-month window in 2010. Next, we conducted an extrinsic evaluation of the patterns to determine the plausibility of the inferred care teams via surveys with knowledgeable experts. Finally, we conducted an intrinsic evaluation to contextualize each team in terms of collaboration strength (via a cluster coefficient) and clinical credibility (via associations between teams and patient comorbidities). RESULTS: The framework discovered 34 collaborative care teams, 27 (79.4%) of which were confirmed as administratively plausible. Of those, 26 teams depicted strong collaborations, with a cluster coefficient > 0.5. There were 119 diagnostic conditions associated with 34 care teams. Additionally, to provide clarity on how the survey respondents arrived at their determinations, we worked with several oncologists to develop an illustrative example of how a certain team functions in cancer care. DISCUSSION: Inferred collaborative teams are plausible; translating such patterns into optimized collaborative care will require administrative review and integration with management practices. CONCLUSIONS: EMR utilization records can be mined for collaborative care patterns in large complex medical centers.


Assuntos
Mineração de Dados , Registros Eletrônicos de Saúde/estatística & dados numéricos , Equipe de Assistência ao Paciente , Comportamento Cooperativo , Humanos , Relações Interprofissionais , Assistência Centrada no Paciente
12.
Int J Med Inform ; 83(7): 495-506, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24845147

RESUMO

OBJECTIVE: Models of healthcare organizations (HCOs) are often defined up front by a select few administrative officials and managers. However, given the size and complexity of modern healthcare systems, this practice does not scale easily. The goal of this work is to investigate the extent to which organizational relationships can be automatically learned from utilization patterns of electronic health record (EHR) systems. METHOD: We designed an online survey to solicit the perspectives of employees of a large academic medical center. We surveyed employees from two administrative areas: (1) Coding & Charge Entry and (2) Medical Information Services and two clinical areas: (3) Anesthesiology and (4) Psychiatry. To test our hypotheses we selected two administrative units that have work-related responsibilities with electronic records; however, for the clinical areas we selected two disciplines with very different patient responsibilities and whose accesses and people who accessed were similar. We provided each group of employees with questions regarding the chance of interaction between areas in the medical center in the form of association rules (e.g., Given someone from Coding & Charge Entry accessed a patient's record, what is the chance that someone from Medical Information Services access the same record?). We compared the respondent predictions with the rules learned from actual EHR utilization using linear-mixed effects regression models. RESULTS: The findings from our survey confirm that medical center employees can distinguish between association rules of high and non-high likelihood when their own area is involved. Moreover, they can make such distinctions between for any HCO area in this survey. It was further observed that, with respect to highly likely interactions, respondents from certain areas were significantly better than other respondents at making such distinctions and certain areas' associations were more distinguishable than others. CONCLUSIONS: These results illustrate that EHR utilization patterns may be consistent with the expectations of HCO employees. Our findings show that certain areas in the HCO are easier than others for employees to assess, which suggests that automated learning strategies may yield more accurate models of healthcare organizations than those based on the perspectives of a select few individuals.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Registros Eletrônicos de Saúde/estatística & dados numéricos , Pessoal de Saúde , Equipe de Assistência ao Paciente/organização & administração , Integração de Sistemas , Humanos , Cultura Organizacional
13.
AMIA Annu Symp Proc ; 2014: 1940-9, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25954467

RESUMO

Acute coronary syndrome (ACS) accounts for 1.36 million hospitalizations and billions of dollars in costs in the United States alone. A major challenge to diagnosing and treating patients with suspected ACS is the significant symptom overlap between patients with and without ACS. There is a high cost to over- and under-treatment. Guidelines recommend early risk stratification of patients, but many tools lack sufficient accuracy for use in clinical practice. Prognostic indices often misrepresent clinical populations and rely on curated data. We used random forest and elastic net on 20,078 deidentified records with significant missing and noisy values to develop models that outperform existing ACS risk prediction tools. We found that the random forest (AUC = 0.848) significantly outperformed elastic net (AUC=0.818), ridge regression (AUC = 0.810), and the TIMI (AUC = 0.745) and GRACE (AUC = 0.623) scores. Our findings show that random forest applied to noisy and sparse data can perform on par with previously developed scoring metrics.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Algoritmos , Inteligência Artificial , Medição de Risco/métodos , Área Sob a Curva , Erros de Diagnóstico/prevenção & controle , Humanos , Modelos Logísticos , Prognóstico , Curva ROC
14.
J Biomed Inform ; 46(6): 970-6, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23583424

RESUMO

A new model of health care is emerging in which individuals can take charge of their health by connecting to online communities and social networks for personalized support and collective knowledge. Web 2.0 technologies expand the traditional notion of online support groups into a broad and evolving range of informational, emotional, as well as community-based concepts of support. In order to apply these technologies to patient-centered care, it is necessary to incorporate more inclusive conceptual frameworks of social support and community-based research methodologies. This paper introduces a conceptualization of online social support, reviews current challenges in online support research, and outlines six recommendations for the design, evaluation, and implementation of social support in online communities, networks, and groups. The six recommendations are illustrated by CanConnect, an online community for cancer survivors in middle Tennessee. These recommendations address the interdependencies between online and real-world support and emphasize an inclusive framework of interpersonal and community-based support. The applications of these six recommendations are illustrated through a discussion of online support for cancer survivors.


Assuntos
Guias como Assunto , Sistemas On-Line , Apoio Social , Humanos , Neoplasias/fisiopatologia , Neoplasias/psicologia
15.
JMIR Med Inform ; 1(1): e3, 2013 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-25600166

RESUMO

BACKGROUND: The fragmented nature of health care delivery in the United States leads to fragmented health information and impedes patient care continuity and safety. Technologies to support interorganizational health information exchange (HIE) are becoming more available. Understanding how HIE technology changes health care delivery and affects people and organizations is crucial to long-term successful implementation. OBJECTIVE: Our study investigated the impacts of HIE technology on organizations, health care providers, and patients through a new, context-aware perspective, the Regional Health Information Ecology. METHODS: We conducted more than 180 hours of direct observation, informal interviews during observation, and 9 formal semi-structured interviews. Data collection focused on workflow and information flow among health care team members and patients and on health care provider use of HIE technology. RESULTS: We structured the data analysis around five primary information ecology components: system, locality, diversity, keystone species, and coevolution. Our study identified three main roles, or keystone species, involved in HIE: information consumers, information exchange facilitators, and information repositories. The HIE technology impacted patient care by allowing providers direct access to health information, reducing time to obtain health information, and increasing provider awareness of patient interactions with the health care system. Developing the infrastructure needed to support HIE technology also improved connections among information technology support groups at different health care organizations. Despite the potential of this type of technology to improve continuity of patient care, HIE technology adoption by health care providers was limited. CONCLUSIONS: To successfully build a HIE network, organizations had to shift perspectives from an ownership view of health data to a continuity of care perspective. To successfully integrate external health information into clinical work practices, health care providers had to move toward understanding potential contributions of external health information. Our study provides a foundation for future context-aware development and implementation of HIE technology. Integrating concepts from the Regional Health Information Ecology into design and implementation may lead to wider diffusion and adoption of HIE technology into clinical work.

16.
Stud Health Technol Inform ; 172: 45-53, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22910501

RESUMO

The creation of a new public e-health product is no guarantee that it will be used. Developing an implementation strategy is crucial for success. This paper presents a model for both an implementation and an evaluation process. It offers strategies for the multiple phases of an implementation process (foundational concepts, actual implementation, and the on-going use process). It also offers evaluation considerations that parallel each of the implementation phases.


Assuntos
Implementação de Plano de Saúde/métodos , Promoção da Saúde/organização & administração , Internet , Desenvolvimento de Programas/métodos , Avaliação de Programas e Projetos de Saúde/métodos , Saúde Pública , Humanos
17.
J Am Med Inform Assoc ; 19(6): 1043-9, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22634157

RESUMO

OBJECTIVE: Without careful attention to the work of users, implementation of health IT can produce new risks and inefficiencies in care. This paper uses the technology use mediation framework to examine the work of a group of nurses who serve as mediators of the adoption and use of a barcode medication administration (BCMA) system in an inpatient setting. MATERIALS AND METHODS: The study uses ethnographic methods to explore the mediators' work. Data included field notes from observations, documents, and email communications. This variety of sources enabled triangulation of findings between activities observed, discussed in meetings, and reported in emails. RESULTS: Mediation work integrated the BCMA tool with nursing practice, anticipating and solving implementation problems. Three themes of mediation work include: resolving challenges related to coordination, integrating the physical aspects of BCMA into everyday practice, and advocacy work. DISCUSSION: Previous work suggests the following factors impact mediation effectiveness: proximity to the context of use, understanding of users' practices and norms, credibility with users, and knowledge of the technology and users' technical abilities. We describe three additional factors observed in this case: 'influence on system developers,' 'influence on institutional authorities,' and 'understanding the network of organizational relationships that shape the users' work.' CONCLUSION: Institutionally supported clinicians who facilitate adoption and use of health IT systems can improve the safety and effectiveness of implementation through the management of unintended consequences. Additional research on technology use mediation can advance the science of implementation by providing decision-makers with theoretically durable, empirically grounded evidence for designing implementations.


Assuntos
Implementação de Plano de Saúde/organização & administração , Sistemas de Informação Hospitalar , Equipes de Administração Institucional , Sistemas de Medicação no Hospital , Negociação , Recursos Humanos de Enfermagem Hospitalar , Antropologia Cultural , Processamento Eletrônico de Dados , Implementação de Plano de Saúde/métodos , Humanos , Sistemas Multi-Institucionais , Análise e Desempenho de Tarefas , Estados Unidos
18.
J Craniofac Surg ; 23(1): 301-3, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22337430

RESUMO

Evidence-based medicine is a vital process for maintaining and improving quality and value in health care. However, evidence-based practice is most limited by the availability of research and outcomes data. Although randomized controlled trials (RCTs) have been identified by numerous research organizations as the criterion standard for research methodology (eg, "level I evidence"), the execution of well-designed RCTs has proved either challenging or impossible in many surgical fields and with rare disease conditions. In particular, craniofacial and plastic surgery has been noted to be lacking in both the number and quality of RCTs. Many reasons are discussed for this dearth of research including inadequate sample size and challenges in randomization, blinding, and clinical equipoise. Yet, data for outcomes assessment are highly valued by surgeons and by consumers and payers. Therefore, alternative and more practical means for research and data collection must be sought. Observational studies of clinical practice are particularly useful for outcomes assessment despite relegation to a lower tier of evidence (eg, "level II evidence"). Functional databases with well-defined processes for data collection, called medical data registries, are an essential informatics tool to collect and store outcomes data and produce high-quality observational, practice-based research studies. A properly designed and implemented registry can provide surgeons with an abundance of data to perform research and quality improvement projects. In fact, registries may be superior in many ways to RCTs for craniofacial and plastic surgeons both pragmatically and functionally. In this commentary, we discuss the production of such registries in the framework of evidence-based practice and the relevant studies in craniofacial surgery.


Assuntos
Medicina Baseada em Evidências , Sistema de Registros , Especialidades Cirúrgicas/normas , Cirurgia Plástica/normas , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Pesquisa Participativa Baseada na Comunidade/normas , Bases de Dados como Assunto , Face/cirurgia , Pesquisa sobre Serviços de Saúde/normas , Humanos , Armazenamento e Recuperação da Informação , Informática Médica , Avaliação de Resultados em Cuidados de Saúde , Qualidade da Assistência à Saúde/normas , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Procedimentos de Cirurgia Plástica/normas , Sistema de Registros/classificação , Sistema de Registros/normas , Projetos de Pesquisa/normas , Tamanho da Amostra , Crânio/cirurgia
19.
J Am Med Inform Assoc ; 19(3): 392-400, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22003156

RESUMO

OBJECTIVE: The goal of this study was to develop an in-depth understanding of how a health information exchange (HIE) fits into clinical workflow at multiple clinical sites. MATERIALS AND METHODS: The ethnographic qualitative study was conducted over a 9-month period in six emergency departments (ED) and eight ambulatory clinics in Memphis, Tennessee, USA. Data were collected using direct observation, informal interviews during observation, and formal semi-structured interviews. The authors observed for over 180 h, during which providers used the exchange 130 times. RESULTS: HIE-related workflow was modeled for each ED site and ambulatory clinic group and substantial site-to-site workflow differences were identified. Common patterns in HIE-related workflow were also identified across all sites, leading to the development of two role-based workflow models: nurse based and physician based. The workflow elements framework was applied to the two role-based patterns. An in-depth description was developed of how providers integrated HIE into existing clinical workflow, including prompts for HIE use. DISCUSSION: Workflow differed substantially among sites, but two general role-based HIE usage models were identified. Although providers used HIE to improve continuity of patient care, patient-provider trust played a significant role. Types of information retrieved related to roles, with nurses seeking to retrieve recent hospitalization data and more open-ended usage by nurse practitioners and physicians. User and role-specific customization to accommodate differences in workflow and information needs may increase the adoption and use of HIE. CONCLUSION: Understanding end users' perspectives towards HIE technology is crucial to the long-term success of HIE. By applying qualitative methods, an in-depth understanding of HIE usage was developed.


Assuntos
Registros Eletrônicos de Saúde/estatística & dados numéricos , Disseminação de Informação , Registro Médico Coordenado , Fluxo de Trabalho , Instituições de Assistência Ambulatorial/organização & administração , Continuidade da Assistência ao Paciente , Serviço Hospitalar de Emergência/organização & administração , Humanos , Relações Interinstitucionais , Recursos Humanos de Enfermagem , Médicos , Papel Profissional , Relações Profissional-Paciente , Tennessee , Confiança
20.
NI 2012 (2012) ; 2012: 437, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-24199137

RESUMO

The growth of Internet applications has substantially broadened the potential for its use in global telehealth. This pilot project used the virtual reality world of Second Life for diabetic patients to meet with their nurse practitioners for their maintenance visits. Using avatars and the online patient portal, these scheduled visits were designed to meet the needs of the patients as determined by the results from a questionnaire completed by patients prior to the visit. The virtual visits took place in the replicated building where patients typically receive their care, the Eskind Diabetes Clinic. Orientation sessions to Second Life were made available prior to the actual visit, and additional online resources were made available after the visit was over. Although only seven pilot patients have currently completed visits, data illustrate the positive potential use of this treatment modality for future study.

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