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Academic literature on the topic 'Lahey Clinic Medical Center'

Author: Grafiati

Published: 4 June 2021

Last updated: 7 February 2022

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Journal articles on the topic "Lahey Clinic Medical Center"

1

Cohen, Michael S., Robert S. Hanley, Teodora Kurteva, Robin Ruthazer, Mark L. Silverman, Andrea Sorcini, Karim Hamawy, Robert A. Roth, Ingolf Tuerk, and John A. Libertino. "Comparing the Gleason Prostate Biopsy and Gleason Prostatectomy Grading System: The Lahey Clinic Medical Center Experience and an International Meta-Analysis." European Urology 54, no. 2 (August 2008): 371–81. http://dx.doi.org/10.1016/j.eururo.2008.03.049.

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Archambault, Ashley Joan, Charles F. Arkin, Tim Skelton, Gyorgy Abel, and John Gawoski. "The Fall of the Erythrocyte Sedimentation Rate." Blood 118, no. 21 (November 18, 2011): 4774. http://dx.doi.org/10.1182/blood.v118.21.4774.4774.

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Abstract Abstract 4774 The Fall of the Erythrocyte Sedimentation Rate, Ashley J. Archambault, MLS(ASCP), Gyorgy Abel, MD, PhD, John Gawoski, MD, Tim Skelton, MD, PhD, Charles Arkin, MD, Department of Laboratory Medicine, Lahey Clinic Medical Center, Burlington MA The Erythrocyte Sedimentation Rate (ESR) is widely used to indicate the presence of active inflammation, particularly in rheumatic and infectious disorders. It has long been a mainstay in diagnostic protocols, as well as being a standard in the work-up of temporal arteritis. However, despite its entrenchment in the minds of many physicians, an increasing number of medical professionals believe that the ESR should be eliminated since its results are often misleading and too nonspecific. Moreover other indicators of inflammation such as the C-reactive protein (CRP) and fibrinogen are now readily available to provide more reliable information. The ESR is also costly, labor intensive, and hazardous to laboratory personnel. Based on the above, Lahey Clinic Medical Center eliminated ESR testing in April of 2010. To accomplish this, an initial informational campaign was launched among the Lahey Clinic medical staff. Literature was distributed and face-to-face meetings were conducted with the most frequent users of the test. Details of the ESR's limitations and the suitability of its replacement by the CRP were emphasized. To strengthen the contention that ESRs are not essential to our institution, two in-house studies were performed: Study 1 reviewed 6 months of patient data from 2008 in order to evaluate cases where the CRP was negative and the ESR was positive. Study 2 used multiple regression analysis to show that ESR values could be calculated from, and presumably replaced by, other clinical data. Study 1: The table below shows that among 4,858 paired ESR/CRP results collected over 6 months there were 17 cases with markedly elevated ESRs (> 50) and normal CRPs (≤5). There were 5,944 unpaired ESRs for this period. Chart reviews of the 17 cases showed that the ESR provided no additional clinical value and, of note, 4 of the 17 patients did have elevated CRPs in the course of their illness. In Study 2, multiple regression analysis of 155 specimens identified 4 independent correlates of the ESR among 8 variables studied: Fibrinogen, Globulin, Hematocrit and Age (collective r2 = 0.85). The scatter plot in the figure displays the relation of the observed to the calculated ESRs.Table:Results of 4858 Paired CRP/ESR Tests over 6 Months in 2008ESRCRP≤20>20 ≤50>50TOTAL≤51830304172151>5 ≤10818326561200>104466144471507TOTAL309412445204858 In late 2009 a memo went out to our physicians giving three months notice of the ESR's discontinuation and recommending use of the CRP in its place. During this period, reminders of the approaching deadline were appended to all ESR results. For the Departments of Rheumatology and Infectious Diseases, an additional three months were granted during which time calculated ESR, fibrinogen, globulin, and hematocrit values were reported for every ESR ordered. In comparison to Study 1, the same six month period in 2011 shows a fall of 10,802 ESRs, a gain of 5,669 CRPs, and a drop in utilization of about 5,000 tests or 10,000 per year. These numbers suggest that CRPs replaced the unpaired ESRs and the utilization drop was due primarily to deletion of ESRs from paired orders. Over sixteen months of post ESR testing, the laboratory received only four inquiries from the medical staff: a complaint that a CRP did not automatically replace an ESR order; a request for supportive literature; and two requests for ESR values that were needed to satisfy standard treatment protocols. The latter were provided with calculated ESRs. In summary, ESR elimination occurred smoothly and with minimal incident. Sixteen months of experience have yielded no negative clinical effects but have produced the perceived benefits of utilization reduction, more available technologist time, less bio-hazard exposure, and elimination of an obsolete test. Disclosures: No relevant conflicts of interest to declare.

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Scattoni, Vincenzo. "Editorial Comment on: Comparing the Gleason Prostate Biopsy and Gleason Prostatectomy Grading System: The Lahey Clinic Medical Center Experience and an International Meta-Analysis." European Urology 54, no. 2 (August 2008): 379. http://dx.doi.org/10.1016/j.eururo.2008.03.050.

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Montironi, Rodolfo, Liang Cheng, and Antonio Lòpez Beltran. "Editorial Comment on: Comparing the Gleason Prostate Biopsy and Gleason Prostatectomy Grading System: The Lahey Clinic Medical Center Experience and an International Meta-analysis." European Urology 54, no. 2 (August 2008): 380–81. http://dx.doi.org/10.1016/j.eururo.2008.03.051.

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Danilov, Alexey V., Olga Danilova, Andreas Klein, Jennifer Brown, Arthur P. Rabinowitz, Kenneth B. Miller, and Brigitte T. Huber. "ZAP-70 Disrupts Dipeptidyl Peptidase 2 (DPP2)-Regulated Quiescence in Chronic Lymphocytic Leukemia (CLL)." Blood 114, no. 22 (November 20, 2009): 1251. http://dx.doi.org/10.1182/blood.v114.22.1251.1251.

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Abstract Abstract 1251 Poster Board I-273 CLL is a common hematologic malignancy with heterogeneous outcomes. Overexpression of ZAP-70 and unmutated B-cell receptor (BCR) heavy chain gene (IgVH) confer an adverse prognosis. While it is accepted that ZAP-70 augments BCR signaling in CLL B-cells, it remains unclear how ZAP-70 contributes to disease propagation. Peripheral blood CLL B-cells accumulate in G0. We have previously shown that CLL B-cells express DPP2, a serine protease involved in maintenance of quiescence of resting but not activated lymphocytes. We identified two subsets of CLL: sensitive CLL (S-CLL), where CLL B-cells undergo apoptosis upon inhibition of DPP2, and resistant CLL (R-CLL), where inhibition of DPP2 does not cause cell death. Here we sought to validate our preliminary observation and establish the role of ZAP-70 and BCR signaling in resistance to apoptosis in CLL. The patient cohort included 152 subjects with B-CLL from the Hematology clinics at Tufts Medical Center, Dana-Farber Cancer Institute (both in Boston, MA), and the Lahey Clinic (Burlington, MA). IgVH mutational status, ZAP-70 expression and history of treatment were analyzed. CLL B-cells were isolated from peripheral blood with standard Ficoll-Hypaque technique. Cells were treated with ValboroPro (VbP, Point Therapeutics), a non-specific inhibitor of DPPs, or AX8819 (ActivX), a DPP2-specific inhibitor. To interfere with ZAP-70, cells were treated with 17-Allylaminodemethoxygeldanamycin (17-AAG, Calbiochem), an inhibitor of hsp90, a protein involved in stabilization of ZAP-70. For apoptosis analysis cells were stained with propidium iodide and Annexin V at 16 h of incubation and assayed by flow cytometry. A CBA assay was used to measure tyrosine-phosphorylated p72Syk and ZAP-70. Expression of p27 and p130 proteins was assessed by western blot analysis. Of 152 CLL patients 99 were males (65.1%). Median age was 63 years. Median follow up was 6 years. When the study samples were obtained, 107 patients (70.4%) were untreated. In apoptosis assays, 97 (63.8%) samples were categorized as S-CLL and 55 (36.2%) as R-CLL. The small molecule inhibitor data correlated with DPP2 anti-sense experiments. Patients with R-CLL were more likely to receive treatment of their disease and had a shorter treatment-free interval from disease diagnosis compared with S-CLL (HR=4.79, 95% CI, 4.7 to 15.2; p<0.0001). In the R-CLL subgroup, B-CLL cells also exhibited unmutated IgVH and expressed high level of ZAP-70 (p<0.001). R-CLL B-cells exhibited higher level of p72Syk phosphorylation compared with S-CLL (p<0.05), suggesting that those cells are partially activated. Meanwhile, S-CLL B-cells had high p27 and p130 protein level, characteristic of a quiescent state. ZAP-70 was phosphorylated at a similar level between the two subsets, consistent with earlier observations that ZAP-70 does not depend on its phosphorylation to enhance BCR signaling. Upon inhibition of DPP2, S-CLL B-cells became activated as evidenced by dramatic phosphorylation of p72Syk. Concomitantly, p27 and p130 protein levels decreased indicating inappropriate cell cycle entry. Co-inhibition of DPP2 and hsp90 in R-CLL B-cells increased apoptosis by a mean of 8.1%, indicating that their survival is dependent on ZAP-70. CLL can be categorized into two prognostic groups based on the susceptibility of B-cells to DPP2 inhibition-induced apoptosis. Resistance to apoptosis correlates with unmutated IgVH and high ZAP-70 and is associated with an unfavorable disease course. The distinction between the two subsets of CLL stems from the aberration in the quiescence program. While S-CLL B-cells rest in true G0, R-CLL B-cells are partially activated due to ZAP-70 co-stimulatory signal and escape apoptosis. Destabilization of ZAP-70 reverses the resistant phenotype. DPP2 inhibition alone or with concomitant inhibition of ZAP-70 warrants investigation as a therapeutic modality in CLL. Disclosures No relevant conflicts of interest to declare.

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Morley, T. P. "Kenneth Edwin Livingston M.D., D.A.B.N., F.A.C.S., F.R.C.S. (C) (1914 – 1984)." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 12, no. 1 (February 1985): 76. http://dx.doi.org/10.1017/s0317167100046655.

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Kenneth Livingston was born in 1914 in Pendleton, Oregon. He attended Stanford University and obtained his BA in 1936. His medical student days were spent at Harvard where he graduated MD in 1939.His neurosurgical education began in 1942 at Strong Memorial Hospital, Rochester, N.Y.; then, after two years at the U.S. Naval Hospital in Oakland, California, he was appointed to the Attending Staff at the Lahey Clinic in Boston from 1946-1948. He returned to Oregon as Assistant Clinical Professor of Neurosurgery at the University of Oregon Medical School in 1948.

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Al Badi, Khalid Suidan. "Operation Management: Empirical Case Study (Al Buraimi Medical Clinic—Private Clinic)." Journal of Business Theory and Practice 3, no. 1 (March 6, 2015): 18. http://dx.doi.org/10.22158/jbtp.v3n1p18.

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<p><em>This case is about a “walk in” clinic called Al Buraimi Medical Clinic (BMC) which treats non-acute illnesses. BMC’s philosophy states “first come, first served”. It serves about 15,000 citizens. This is the only medical center in the region that provides some of the advanced services including a world-class rehabilitation center, regional burn center, high-risk maternity program and trauma center. This case describes how a process could affect the effectiveness and efficiency of a service. It’s vital to understand how process works as it helps to ensure the competitiveness of the company. A process according to Chase, Jacobs and Aquilano (2006), process is any part of the company that turns inputs into outputs which is of a more value to the company than the original inputs. In this case, nurses, MD, specialized equipments combined with another input, the patient is transformed through proper treatment and medical care into a healthy patient. Therefore, the healthy patient is an outcome of the process.</em><em> </em></p>

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Dorcely, Brenda, Michael Bergman, Craig Tenner, Karin Katz, Ram Jagannathan, and Elizabeth Pirraglia. "Manhattan Veterans Affairs Medical Center Diabetes Prevention Clinic." Clinical Diabetes 38, no. 3 (February 28, 2020): 291–94. http://dx.doi.org/10.2337/cd19-0085.

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Hansen, Moritz. "Maine Medical Center Cancer Institute's Prostate Cancer Clinic." Oncology Issues 24, no. 5 (September 2009): 24–32. http://dx.doi.org/10.1080/10463356.2009.11883452.

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Yurko, L. C., C. P. Brandt, T. L. Coffee, and C. J. Yowler. "Medical Center Utilization of an Outpatient Burn Clinic." Journal of Burn Care & Rehabilitation 23 (March 2002): S108. http://dx.doi.org/10.1097/00004630-200203002-00131.

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Dissertations / Theses on the topic "Lahey Clinic Medical Center"

1

Wilsey, Katherine Lambos. "Why Patients Miss Appointments at an Integrated Primary Care Clinic." Antioch University / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1595879483897791.

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Asomaning, Margaret. "Impact of a Wellness Clinic Visit on Cardiovascular Risk Biomarkers in Employees of a VA Medical Center." Scholar Commons, 2011. http://scholarcommons.usf.edu/etd/3713.

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Background: Worksite screening programs are increasingly being provided by employers as a means to reduce cardiovascular risk in employees. A screening program that consists of fasting serum analysis of glucose plus a lipid panel is offered yearly to employees at the VA medical center in Tampa. A retrospective study was conducted to determine if a wellness clinic exposure resulted in significant changes in employees' markers of cardiovascular risk. Methods: Computerized records were used to follow serial outcomes for glucose, triglycerides, HDL cholesterol, and LDL cholesterol in employees whose screening results showed abnormal levels of one or more of these markers. An intervention group with 66 subjects received a wellness clinic visit including a health risk assessment and education for lifestyle change, and a reference group with 109 subjects received only serum analysis. Outcomes at repeat screening were compared for the two groups. Results: Both groups showed improvement in cardiovascular risk. In the intervention group there was significant intra-subject improvement from baseline for all markers except glucose. For triglycerides and LDL cholesterol there was a significantly greater proportion of subjects who improved in the intervention group. In addition, the improvement for triglycerides was significantly better in the intervention group. Conclusions: This investigation confirms the value of a worksite wellness program in reducing cardiovascular risk in the population studied. A differential impact of age and gender was seen for glucose and triglycerides and indicates that such modifiers should be considered through covariate analysis in assessing wellness program effectiveness. Increasing levels of employee wellness participation to targets identified in this study and adding a health risk assessment for everyone screened will help to identify the specific benefits of the face to face wellness counseling intervention.

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Bills, Randy K. "Aligning salary expense and workload output In a complex military medical system /." Thesis, Monterey, Calif. : Springfield, Va. : Naval Postgraduate School ; Available from National Technical Information Service, 2004. http://library.nps.navy.mil/uhtbin/hyperion/04Jun%5FBills.pdf.

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Summerer-Moustaki, Margarita [Verfasser], and Uwe [Akademischer Betreuer] Hasbargen. "Conservative medical vs. surgical therapy management of high risk pregnancies, complicated by large uterine fibroids : a single German university center experience at the University Clinic Großhadern from 1996-2007 / Margarita Summerer-Moustaki ; Betreuer: Uwe Hasbargen." München : Universitätsbibliothek der Ludwig-Maximilians-Universität, 2018. http://d-nb.info/1163949000/34.

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Lucas, D. Pulane. "Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital." VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/2996.

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Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs.

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Hsu, Yu-Ting, and 許毓廷. "Instructional Hospital Clinic Physicians’ Perceptionsto the Medical Instructional Resources Center Services:An Example of a Medical Center." Thesis, 2007. http://ndltd.ncl.edu.tw/handle/7246ht.

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碩士
銘傳大學
教育研究所碩士在職專班
95
The purposes of this study were to find out the differences of the clinic physicians’ expectations and the perceptions before and after to be served by the Medical Instructional Resources Center (MIRC) as well as the service frequencies asked by these physicians. In order to reach the purposes, this study used survey method. Questionnaires were sending to 410 physicians of a medical center located in northern Taiwan. The usable questionnaires were 347. The rate of return was 84.63%. The collected data from the questionnaires were analyzed by descriptive statistics, paired t-test, one way ANOVA and t-test. The results and findings from the data analysis were: 1.The clinic physicians’ practical experience to the total functions of the service quality of the MIRC reached the standard of “sometimes matched.” 2.The clinic physicians’ practical experience to the total feelings of the service quality of the MIRC reached the standard of “matched.” 3.Different demographic clinic physicians’ practical experience to the total functions of the service quality of the MIRC had significant differences. The difference was that the resident perception referred to the functions of the services quality was higher than that of chief resident. 4.Different demographic clinic physicians’ practical experience to the total feelings of the service quality of the MIRC had significant differences. The differences were: * The resident felt the services quality was higher than that of chief resident. * The physicians served from 0 to 5 years and above 10 years felt the services quality were higher than those of 6 to 10 years. 5.The clinic physicians’ practical experience to the total functions and the total feelings of the service quality of the MIRC were revealed that the expectations were higher than the perceptions before and after to be served by the MIRC. 6.The Medical Illustration Room had the highest service frequency requested by the clinic physicians. 7.Different demographic clinic physicians’ had significant differences of the requesting services frequencies from different supporting organizations of the MIRC. The differences were: *The resident had higher requesting services frequencies than that of attending physician. * The physicians served from 0 to 5 years and above 10 years had higher requesting services frequencies than those of 6 to 10 years.

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Jiang, Shiang-Huei, and 江香慧. "Effectiveness of Smoking Cessation Clinic among Inpatients in a Medical Center." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/90369247923885661304.

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碩士
國防醫學院
公共衛生學研究所
103
Introduction: Smoking has been identified as a risk factor for many diseases and death. The Health Promotion Administration has participated in the ENSH-Global Network for Tobacco Free Healthcare Services in 2011, and March 1, 2012, it implemented the “second generation smoking cessation pilot program” in order to expand access to the smoking cessation treatment to a large target group. However, there very little literature which evaluates the effectiveness of smoking cessation programs for inpatients. Objective: The aim of this study was to evaluate the effectiveness of referrals to smoking cessation clinic, and to assess factors influencing the success of quitting among inpatients. Methods: A quasi-experimental study was conducted at a medical center in the north of Taiwan. Inpatients who were willing to quit during July through November in 2014 assigned themselves to either the group attending the smoking cessation clinic (intervention group) or the group quitting on their own (control group). Demographic factors, attempts to quit, motivation to quit, and nicotine dependence were collected via questionnaires. Follow-up assessments were conducted at 1 week, 1, 3, and 6 months postdischarge by telephone. Results: The 7-day point prevalence abstinence of intervention group at 1 week, 1, 3, and 6 months was 43.5%, 31.8%, 35.0% and 35.0%; that of the control group was 50.0%, 47.8%, 36.6% and 29.3% respectively. The continuous abstinence of intervention group at 1, 3, and 6 months was 27.3%, 25.0% and 25.0%; the control group’s was 47.8%, 34.1% and 24.4% respectively. In multivariate logistic regression analysis, the main factors influencing abstinence are self-efficacy, number of hours worked per week, years of smoking, and educational level. Conclusion: The continuous and 7-day point prevalence abstinence did not differ between the intervention group and control group in the 6-month follow-up. However, nicotine dependence at 6 months was significantly lower when compared to the baseline.

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Hsu, Hsueh-Min, and 許學旻. "A Physician’s Communicative Strategies in an Ophthalmological Clinic in a Medical Center." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/35b4p8.

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碩士
國立臺灣大學
健康行為與社區科學研究所
106
This study investigates face-to-face doctor-patient communication and aims to provide a different viewpoint of doctor-patient relationships. It illustrates doctor-patient communication as a negotiated and co-constructed process between the doctor, patients, and patients’ companions. Due to their power asymmetry, the participants use different verbal strategies to achieve their communicative goals. Through examining the consultations, we hope to demonstrate the doctor-patient relationships in Taiwan and to find a way to improve doctor-patient communication. Armstrong (1984) pointed out that the patient’s view and their subjectivity should be the focus of medical practice and social science research. Researches related to doctor-patient communication have incredibly increased in the past few decades in the West. Medical education and system in Taiwan have also adapted accordingly. Studies have shown that communication between doctors and patients is influenced by their institutional power asymmetry. In Taiwan, one consultation is relatively short so it needs effort and skills to achieve good communication under the time pressure. How can doctors exchange information, diagnose correctly, answer patient’s questions and relieve their concerns, give medical recommendations, and decide medical treatments with the patients becomes very important. In this study, we analyze qualitatively through Discourse Analysis to show how the doctor, the patients, and their companions co-construct communication during their negotiations. This research is conducted in an eye clinic in a medical center in Northern Taiwan. There are in total 68 patients (28 males and 40 females), and 23 companions (6 wives, 5 husband, 9 daughters, 1 son, and 1 female friend) in this study. The doctor uses at least 13 kinds of verbal communication skills to negotiate with the participants. These communication strategies can be categorized into three parts: (1) providing information, (2) treatment decision-making, and (3) other verbal communication strategies. The frequency of other verbal communication strategies takes up 57% of all the verbal strategies. The strategies in treatment decision-making phase are 26%. In the stage of providing information, the frequency is 16%. The goal of this study is to show how an experienced doctor uses different verbal communication strategies when facing different kinds of patients and for different communicative purposes. Through the analysis of the consultations and under our unique cultural and social background, the study provides a different perspective for us to understand the importance of doctor-patient communication and to create more equal and harmonious doctor-patient relationships in Taiwan.

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Ferreira, Simão Pedro Grilo. "Relatório de Estágio Estágio em Coordenação de Estudos Clínicos na CUF Academic Research Medical Center." Master's thesis, 2021. http://hdl.handle.net/10362/115618.

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Resumo O Estágio Curricular foi realizado na Unidade de Coordenação de Estudos Clínicos do Hospital CUF Descobertas e Hospital CUF Infante Santo (uma das áreas de ação da CUF Academic Research Center). Este estágio visou desempenhar tarefas de Coordenação de estudos clínicos ao nível dos Ensaios Clínicos, Estudos Observacionais, Projetos da Iniciativa do Investigador e projetos promovidos pela Indústria Farmacêutica durante um período de 9 meses, correspondente a 1 no letivo. A realização do estágio teve como objetivo consolidar os conteúdos teóricos adquiridos durante a formação académica e assim obter a experiência necessária para entrar no mercado de trabalho com a maior brevidade possível. O estágio decorreu em três áreas: Ensaios clínicos, Estudos Observacionais e Projetos de Iniciativa do Investigador (PIMs). A área dos Ensaios Clínicos foi a de maior preponderância neste estágio e as funções desempenhadas centram-se em atividades relacionadas com a verificação das qualificações do centro e condução dos estudos: ativação dos centros, gestão de recursos, preparação e acompanhamento de visitas (Monitores, Promotores, Participantes), revisão financeira dos custos dos diversos estudos e enceramento dos centros. Durante esta experiência pude constatar a polivalência existente dentro de uma unidade de investigação clinica e a relevância que uma estrutura bem delineada, aliada a um ambiente laboral favorável, motivam no exercício de atividade de investigação clínica.

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Liang, Fu-Jie, and 梁富傑. "Evaluation of the effectiveness of Preoperative Anesthesia Consultation Clinic: an experience of surgical patients in a medical center." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/45076047279600973623.

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碩士
國防醫學院
公共衛生學研究所
99
Abstract Background: Patients before surgery, according to flow arrangement anesthesiologist to ward implementation of the Preoperative Anesthetic Visiting(PAV), but found some of the patients physical condition was not suitable for surgical anesthesia and post-implementation, such a result would lead to increase length of stay, thereby increasing health care utilization. In addition, the hospital established Preoperative Anesthesia Consultation Clinic (PACC) in order to be able to distribute medical resources more efficiently and ongoing maintenance of quality of care under the implementation of TW-DRG (Taiwan Diagnosis Related Groups) system. And it hopes that this new way can substitute the existing PAV mode. Objectives: The aim of this study was to investigate whether Preoperative Anesthesia Consultation Clinic affects preoperative outcomes in terms of medical utilization, indicators of quality, patient’s satisfaction, emotional expression, and ideological concerns about anesthesia in surgical patients. Methods: This study design was a cross-sectional study. All subjects were surgical patients and were recruited from 3 different specialty divisions (General surgery, Urological surgery, and Orthopedics surgery) in a medical center. In order to explore the effectiveness of PACC, the data were collected from questionnaire survey and computerized database of hospital. Data analysis was performed using the SPSS 18.0 and using chi-square test, Student’s t-test, ANOVA analysis, and multiple linear regression test. Results: Out of 344 surgical patients, 142 were received PACC, and 202 were received PAV. Our results indicated that the patients of PACC had a significantly smaller amount of laboratory fees than did those of PAV (P value=0.037), but there was no significant difference in anesthesia fees (P value =0.192). Furthermore, the patients of PACC had a significantly higher performance of emotional expression, the feeling of trust, and health education than did those of PAV (P value<0.001), but there was no significant difference in the score of anxiety (P value=0.458). Conclusions: This study demonstrated that the implementation of PACC helped to reduce the laboratory fees, improved the feelings of trust, provided better perception of health education, and obtained the higher score of the patient’s satisfaction. Keywords: TW-DRG, Preoperative Anesthesia Consultation Clinic, Preoperative Anesthetic Visiting

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Books on the topic "Lahey Clinic Medical Center"

1

Managing change, changing medicine: Park Nicollet 75 years. Minneapolis: Park Nicollet Press, 1996.

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Field hearing on improving patient safety and quality care at the Dayton VA Medical Center: Hearing before the Committee on Veterans' Affairs, United States Senate, One Hundred Twelfth Congress, first session, April 26, 2011. Washington: U.S. G.P.O., 2011.

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Boston Office of the Mayor. Back-of-the-hill townhouses at the lahey site. 1986.

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Burns, David L. 100 Q&A About Gastro-Esophageal Reflux Disease (GERD): A Lahey Clinic Guide (100 Questions & Answers about . . .). Jones and Bartlett Publishers, Inc., 2007.

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Associates, Ellenzweig. Joslin diabetes center, research and clinic facility expansion: project notification form. 1990.

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Associates, Ellenzweig. Joslin diabetes center, research and clinic facility expansion, draft and final project impact report. 1991.

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Dodge, Mary Mapes, and Gilbert Geis. Stealing Dreams: A Fertility Clinic Scandal. Northeastern University Press, 2003.

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Models that work: Award-winning strategies : the Los Angeles Free Clinic Hollywood Center : peer outreach and access for high-risk youth. [Bethesda, MD] (4350 East West Highway, Bethesda 20814): [U.S. Dept. of Health and Human Services, Health Resources & Services Administration, Bureau of Primary Health Care, 1997.

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Fye, W. Bruce. Patient Care and Clinical Research in the 1920s. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199982356.003.0004.

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The Mayo Clinic, recognized as a world center for comprehensive diagnosis and surgical therapy by World War I, became known for its research programs during the 1920s. Laboratories of experimental biochemistry and experimental surgery had already been established. In 1920 Will Mayo hired internist-pharmacologist Leonard Rowntree to build a hospital-based program of clinical research in Rochester, Minnesota. Rowntree assembled a group of internist-investigators that complemented internist Henry Plummer’s team of medical diagnosticians. Much of the research undertaken at Mayo focused on common clinical problems. The institution was among the first to study insulin therapy for diabetes. Steady growth of the multispecialty group practice led to the construction of a twenty-floor outpatient building that opened in 1928. In it, internist-diagnosticians were clustered in sections that reflected their interests in subspecialties, such as cardiology, gastroenterology, or hematology.

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Kleespies, Phillip M., ed. The Oxford Handbook of Behavioral Emergencies and Crises. Oxford University Press, 2014. http://dx.doi.org/10.1093/oxfordhb/9780199352722.001.0001.

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The Oxford Handbook of Behavioral Emergencies and Crisesincludes the most up-to-date and valuable research on the evaluation and management of arguably the most challenging patients faced by mental health practitioners—that is, individuals who are at high risk of suicide or other-directed violence or of becoming the victims of interpersonal violence. The outcome with such cases can be serious injury or death, and there can be negative consequences for the patient, and also for the patient’s family and friends, for the clinician, and for the clinic or medical center. This book presents a framework for learning the skills to assess and work competently with these patients. The book has sections dealing with such critical incidents in children, adolescents, adults, and the elderly. There are sections to aid clinicians with conditions that need to be distinguished from behavioral emergencies; on treating patients or clients who have ongoing chronic risk of harming themselves or others; and on legal and ethical risk management as well as psychological risk management for the clinician in the event of a negative outcome. The book examines interrelated aspects of the major behavioral emergencies; for example, the degree to which interpersonal victimization may lead an individual to later suicidal or violent behavior; or the degree to which suicidal individuals and violent individuals may share certain cognitive characteristics. It also presents a method for reducing the clinician’s stress and acquiring skill in working with high-risk people.

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Book chapters on the topic "Lahey Clinic Medical Center"

1

Jiang, Shan, and Sofija Kaljevic. "Hennepin County Medical Center Whittier Clinic Methods." In Hennepin County Medical Center Whittier Clinic. Landscape Architecture Foundation, 2017. http://dx.doi.org/10.31353/cs1201.

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Control, Glycemic. "Predictors of Glycemic Control in a Multiethnic Public Clinic Population." In Bulletin of Medical and Clinical Research, 50–61. IOR INTERNATIONAL PRESS, 2020. http://dx.doi.org/10.34256/br2016.

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To assess correlates of glycemic control in a multiethnic federally qualified health center population. Deidentifed data from a federally qualified health center were examined for patients in diabetes treatment. New variables were created to assess illness burden. Bivariate testing was done to assess treatment compliance by language group. Multinomial regression models assessed three outcomes: uncontrolled, controlled and well controlled glycated hemoglobin (Hba1c). The conceptual framework for this study was Andersen’s Health Care Utilization Model. The sample was 1,581 patients. The average was 56. Eighty Five percent of the patients had well controlled or controlled Hba1c. Mandarin speakers were the most likely to have Hba1c controlled despite having the highest average age. Immigrant English speakers had worse glycemic control then their monolingual counterparts. All Asian subgroups had better glycemic control than Hispanics and African Americans. In the final model, the correlates of glycemic control were illness burden, time spent with a provider and health promoting activities. English speaking Hispanics and African Americans continue to have worse glycemic control regardless of having access to care.

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Control, Glycemic. "Predictors of Glycemic Control in a Multiethnic Public Clinic Population." In Bulletin of Medical and Clinical Research, 50–61. IOR INTERNATIONAL PRESS, 2020. http://dx.doi.org/10.34256/br2016.

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To assess correlates of glycemic control in a multiethnic federally qualified health center population. Deidentifed data from a federally qualified health center were examined for patients in diabetes treatment. New variables were created to assess illness burden. Bivariate testing was done to assess treatment compliance by language group. Multinomial regression models assessed three outcomes: uncontrolled, controlled and well controlled glycated hemoglobin (Hba1c). The conceptual framework for this study was Andersen’s Health Care Utilization Model. The sample was 1,581 patients. The average was 56. Eighty Five percent of the patients had well controlled or controlled Hba1c. Mandarin speakers were the most likely to have Hba1c controlled despite having the highest average age. Immigrant English speakers had worse glycemic control then their monolingual counterparts. All Asian subgroups had better glycemic control than Hispanics and African Americans. In the final model, the correlates of glycemic control were illness burden, time spent with a provider and health promoting activities. English speaking Hispanics and African Americans continue to have worse glycemic control regardless of having access to care.

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Ojabo, A. O., O. Audu, A. G. Adesiyun, S. K. Hembah-Hilekaan, T. Z. Swende, Sulayman-Umar Hajaratu, M. T. Maanongun, and P. O. Eka. "Analysing the Determinants of Male Coital Difficulties among Attendees of the Gynae Clinic at a Tertiary Health Center in North-Central Nigeria." In Current Topics in Medicine and Medical Research Vol. 13, 162–66. Book Publisher International (a part of SCIENCEDOMAIN International), 2021. http://dx.doi.org/10.9734/bpi/ctmmr/v13/5667d.

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Fein, Elizabeth. "The Division of a Syndrome." In Living on the Spectrum, 166–88. NYU Press, 2020. http://dx.doi.org/10.18574/nyu/9781479864355.003.0007.

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This chapter provides an ethnographic case study of divided medicalization—the process through which multivalent, identitarian conditions get produced and then reduced to fit within a preexisting, disease-oriented clinical paradigm. The chapter is a clinical ethnography of a clinic located within a university medical center in an East Coast city, serving children diagnosed with Asperger’s syndrome. As medical categorizations and classifications expanded beyond the borders of the body to examine and remedy disorders of social life in the world, the staff shifted their own practice, exploring interventions that were playful and social, determined by pleasures as well as pathologies, and driven by the goal of expanding relationships rather than containing contagion. These interventions, however, crossed and complicated the clinic's carefully maintained boundaries between the inside and the outside of both the building and the body. In the end, the elements of autism that least fit within the existing medical paradigm were not incorporated into that paradigm but instead came to be extruded from it. Interpersonal, aesthetic, and identitarian elements of the condition were at first invited into but then gradually banished from the clinic, leaving behind an incomplete representation of complex social phenomena as diseases to be eliminated from individuals.

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Scano, Alessandro, Marco Caimmi, Andrea Chiavenna, Matteo Malosio, and Lorenzo Molinari Tosatti. "A Kinect-Based Biomechanical Assessment of Neurological Patients' Motor Performances for Domestic Rehabilitation." In Advances in Medical Technologies and Clinical Practice, 252–79. IGI Global, 2016. http://dx.doi.org/10.4018/978-1-4666-9740-9.ch013.

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Stroke is one of the main causes of disability in Western countries. Damaged brain areas are not able to provide the fine-tuned muscular control typical of human upper-limbs, resulting in many symptoms that affect consistently patients' daily-life activities. Neurological rehabilitation is a multifactorial process that aims at partially restoring the functional properties of the impaired limbs, taking advantage of neuroplasticity, i.e. the capability of re-aggregating neural networks in order to repair and substitute the damaged neural circuits. Recently, many virtual reality-based, robotic and exoskeleton approaches have been developed to exploit neuroplasticity and help conventional therapies in clinic. The effectiveness of such methods is only partly demonstrated. Patients' performances and clinical courses are assessed via a variety of complex and expensive sensors and time-consuming techniques: motion capture systems, EMG, EEG, MRI, interaction forces with the devices, clinical scales. Evidences show that benefits are proportional to treatment duration and intensity. Clinics can provide intensive assistance just for a limited amount of time. Thus, in order to preserve the benefits and increase them in time, the rehabilitative process should be continued at home. Simplicity, easiness of use, affordability, reliability and capability of storing logs of the rehabilitative sessions are the most important requirements in developing devices to allow and facilitate domestic rehabilitation. Tracking systems are the primary sources of information to assess patients' motor performances. While expensive and sophisticated techniques can investigate neuroplasticity, neural activation (fMRI) and muscle stimulation patterns (EMG), the kinematic assessment is fundamental to provide basic but essential quantitative evaluations as range of motion, motor control quality and measurements of motion abilities. Microsoft Kinect and Kinect One are programmable and affordable tracking sensors enabling the measurement of the positions of human articular centers. They are widely used in rehabilitation, mainly for interacting with virtual environments and videogames, or training motor primitives and single joints. In this paper, the authors propose a novel use of the Kinect and Kinect One sensors in a medical protocol specifically developed to assess the motor control quality of neurologically impaired people. It is based on the evaluation of clinically meaningful synthetic performance indexes, derived from previously developed experiences in upper-limb robotic treatments. The protocol provides evaluations taking into account kinematics (articular clinical angles, velocities, accelerations), dynamics (shoulder torque and shoulder effort index), motor and postural control quantities (normalized jerk of the wrist, coefficient of periodicity, center of mass displacement). The Kinect-based platform performance evaluation was off-line compared with the measurements obtained with a marker-based motion tracking system during the execution of reaching tasks against gravity. Preliminary results based on the Kinect sensor suggest its efficacy in clustering healthy subjects and patients according to their motor performances, despite the less sensibility in respect to the marker-based system used for comparison. A software library to evaluate motor performances has been developed by the authors, implemented in different programming languages and is available for on-line use during training/evaluation sessions (Figure 1). The Kinect sensor coupled with the developed computational library is proposed as an assessment technology during domestic rehabilitation therapies with on-line feedback, enabled by an application featuring tracking, graphical representation and data logging. An experimental campaign is under development on post-stroke patients with the Kinect-One sensor. Preliminary results on patients with different residual functioning and level of impairment indicate the capability of the whole system in discriminating motor performances.

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Scano, Alessandro, Marco Caimmi, Andrea Chiavenna, Matteo Malosio, and Lorenzo Molinari Tosatti. "A Kinect-Based Biomechanical Assessment of Neurological Patients' Motor Performances for Domestic Rehabilitation." In Robotic Systems, 811–37. IGI Global, 2020. http://dx.doi.org/10.4018/978-1-7998-1754-3.ch042.

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Stroke is one of the main causes of disability in Western countries. Damaged brain areas are not able to provide the fine-tuned muscular control typical of human upper-limbs, resulting in many symptoms that affect consistently patients' daily-life activities. Neurological rehabilitation is a multifactorial process that aims at partially restoring the functional properties of the impaired limbs, taking advantage of neuroplasticity, i.e. the capability of re-aggregating neural networks in order to repair and substitute the damaged neural circuits. Recently, many virtual reality-based, robotic and exoskeleton approaches have been developed to exploit neuroplasticity and help conventional therapies in clinic. The effectiveness of such methods is only partly demonstrated. Patients' performances and clinical courses are assessed via a variety of complex and expensive sensors and time-consuming techniques: motion capture systems, EMG, EEG, MRI, interaction forces with the devices, clinical scales. Evidences show that benefits are proportional to treatment duration and intensity. Clinics can provide intensive assistance just for a limited amount of time. Thus, in order to preserve the benefits and increase them in time, the rehabilitative process should be continued at home. Simplicity, easiness of use, affordability, reliability and capability of storing logs of the rehabilitative sessions are the most important requirements in developing devices to allow and facilitate domestic rehabilitation. Tracking systems are the primary sources of information to assess patients' motor performances. While expensive and sophisticated techniques can investigate neuroplasticity, neural activation (fMRI) and muscle stimulation patterns (EMG), the kinematic assessment is fundamental to provide basic but essential quantitative evaluations as range of motion, motor control quality and measurements of motion abilities. Microsoft Kinect and Kinect One are programmable and affordable tracking sensors enabling the measurement of the positions of human articular centers. They are widely used in rehabilitation, mainly for interacting with virtual environments and videogames, or training motor primitives and single joints. In this paper, the authors propose a novel use of the Kinect and Kinect One sensors in a medical protocol specifically developed to assess the motor control quality of neurologically impaired people. It is based on the evaluation of clinically meaningful synthetic performance indexes, derived from previously developed experiences in upper-limb robotic treatments. The protocol provides evaluations taking into account kinematics (articular clinical angles, velocities, accelerations), dynamics (shoulder torque and shoulder effort index), motor and postural control quantities (normalized jerk of the wrist, coefficient of periodicity, center of mass displacement). The Kinect-based platform performance evaluation was off-line compared with the measurements obtained with a marker-based motion tracking system during the execution of reaching tasks against gravity. Preliminary results based on the Kinect sensor suggest its efficacy in clustering healthy subjects and patients according to their motor performances, despite the less sensibility in respect to the marker-based system used for comparison. A software library to evaluate motor performances has been developed by the authors, implemented in different programming languages and is available for on-line use during training/evaluation sessions (Figure 1). The Kinect sensor coupled with the developed computational library is proposed as an assessment technology during domestic rehabilitation therapies with on-line feedback, enabled by an application featuring tracking, graphical representation and data logging. An experimental campaign is under development on post-stroke patients with the Kinect-One sensor. Preliminary results on patients with different residual functioning and level of impairment indicate the capability of the whole system in discriminating motor performances.

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Conference papers on the topic "Lahey Clinic Medical Center"

1

Wahyudin, M., Munsi Lampe, and Nurhadelia Nurhadelia. "Family Doctor Clinic: Organizational Culture Study at Wirahusada Medical Center in Makassar City." In Proceedings of the 4th International Conference on Accounting, Management, and Economics, ICAME 2019, 25 October 2019, Makassar, Indonesia. EAI, 2020. http://dx.doi.org/10.4108/eai.25-10-2019.2295313.

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Haneda, Kiyofumi, Toshio Kajima, Tadashi Koyama, Hiroyuki Muranaka, Hirofumi Dojo, and Yasuhiko Aratani. "Development of quantitative security optimization approach for the picture archives and carrying system between a clinic and a rehabilitation center." In Medical Imaging 2002, edited by Eliot L. Siegel and H. K. Huang. SPIE, 2002. http://dx.doi.org/10.1117/12.467036.

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Rotolo, S. M., L. K. Flowers, A. Leahy, M. E. Strek, R. Vij, A. O. Adegunsoye, and R. P. Jablonski. "Specialty Pharmacy Role in a Pulmonary Fibrosis Clinic at a Large Academic Medical Center." In American Thoracic Society 2020 International Conference, May 15-20, 2020 - Philadelphia, PA. American Thoracic Society, 2020. http://dx.doi.org/10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a1520.

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Guzman, Leidy, Aliysa Rajwani, and Julie Sherman. "2 Improving efficiency & throughput in the cancer center at tufts medical center for linked clinic and infusion visits." In IHI Scientific Symposium. British Medical Journal Publishing Group, 2020. http://dx.doi.org/10.1136/bmjoq-2020-ihi.2.

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Ingham, JA, DK Cremeans, SL Daugherty, RC Myhand, and WE Sever. "P1-11-09: Effects of a Multidisciplinary Breast Cancer Clinic in an Appalachian Based Medical Center." In Abstracts: Thirty-Fourth Annual CTRC‐AACR San Antonio Breast Cancer Symposium‐‐ Dec 6‐10, 2011; San Antonio, TX. American Association for Cancer Research, 2011. http://dx.doi.org/10.1158/0008-5472.sabcs11-p1-11-09.

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Colon, Fel Angelie. "Extrapulmonary Tuberculosis: 21 Patients at Western Visayas Medical Center DOTS Clinic, Philippines (January 2016 to December 2017)." In ERS International Congress 2018 abstracts. European Respiratory Society, 2018. http://dx.doi.org/10.1183/13993003.congress-2018.pa2754.

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Flower, Kori, Samuel Wurzelmann, Claudia Rojas, Jennifer Dixon, Francisco Sylvester, and Michael J. Steiner. "Using Quality Improvement Methods to Test and Implement Bilingual Patient Navigation in an Academic Medical Center Multi-specialty Pediatric Clinic." In Selection of Abstracts From NCE 2016. American Academy of Pediatrics, 2018. http://dx.doi.org/10.1542/peds.141.1_meetingabstract.178.

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Parsons, Paige, and Linda Nici. "Implementation Of A Pulmonary Risk Reduction Clinic (PRRC) In A Veterans Affairs Medical Center To Target High Readmission Rates In Patients With Chronic Obstructive Pulmonary Disease (COPD)." In American Thoracic Society 2012 International Conference, May 18-23, 2012 • San Francisco, California. American Thoracic Society, 2012. http://dx.doi.org/10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a4873.

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Pettys-Baker, Robert, Crystal Compton, Sophia Utset-Ward, Marc Tompkins, Brad Holschuh, and Lucy E. Dunne. "Design and Development of Valgus-Sensing Leggings." In 2017 Design of Medical Devices Conference. American Society of Mechanical Engineers, 2017. http://dx.doi.org/10.1115/dmd2017-3526.

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Performing exercises, especially cutting and pivoting activities, with poor lower extremity mechanics can lead to severe damage of the knee, such as anterior cruciate ligament (ACL) tears [1]. A common movement pattern observed in at-risk athletes is knee valgus. This term refers to the medial collapse of the knee (when the knees falls inward towards the center of the body). Intervention to prevent knee valgus could reduce the chance of injury for at-risk athletes, or re-injury for those recovering from a knee injury. Currently, in patients with knee injuries, knee valgus is monitored by physical therapists, who observe a patient’s movements visually during exercise. The therapists instruct patients on how to identify valgus and how they might correct it. Visual diagnosis of valgus can be difficult and subjective, thereby allowing the unavoidable presence of human error. In addition, monitoring in real time is only possible when the patient is with a therapist. Several studies have focused on the issue of accurate detection of knee valgus by using a variety of systems such as 2D and 3D motion capture systems to track knee and hip movements, dynamometers, and electromyography [2][3][4]. Although these systems are able to determine knee valgus, they are difficult to use, require expensive equipment, and do not provide real-time feedback outside of the clinic setting. The purpose of this study was to inform the design of a valgus-sensing legging by exploring sensor placement options to maximize the magnitude of the sensor response difference between valgus and non-valgus knee bends.

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Haugeberg, Glenn, Bjørg Tilde Svanes Fevang, Gunnstein Bakland, Erik Rødevand, and Andreas Diamantopoulos. "SAT0146 COMPARING DRUG SURVIVAL FOR BIOSIMILAR SB4 ETANERCEPT IN RHEUMATOID ARTHRITIS BOTH ETANERCEPT NAïVE AND NON-MEDICAL SWITCH PATIENTS WITH ETANERCEPT REFERENCE DRUG IN A NORWEGIAN OUT-PATIENT CLINIC. PRELIMINARY RESULTS FROM A MULTI-CENTER STUDY." In Annual European Congress of Rheumatology, EULAR 2019, Madrid, 12–15 June 2019. BMJ Publishing Group Ltd and European League Against Rheumatism, 2019. http://dx.doi.org/10.1136/annrheumdis-2019-eular.7423.

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Reports on the topic "Lahey Clinic Medical Center"

1

Jiang, Shan, and Sofija Kaljevic. Hennepin County Medical Center Whittier Clinic. Landscape Architecture Foundation, 2017. http://dx.doi.org/10.31353/cs1200.

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Adams, Brent N. Case Study: Preparing the Gastroenterology Clinic at Naval Medical Center San Diego (NMCSD) for T-NEX Implementation. Fort Belvoir, VA: Defense Technical Information Center, April 2004. http://dx.doi.org/10.21236/ada432458.

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Merkie, John F. Computer Simulation: A Methodology to Improve the Efficiency in the Brooke Army Medical Center Family Care Clinic (A Patient Wait Case Study). Fort Belvoir, VA: Defense Technical Information Center, March 2000. http://dx.doi.org/10.21236/ada409614.

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Gall, Daniel W. Coding Accuracy of the Ambulatory Data System: A Study of Coding Accuracy Within the General Internal Medicine Clinic, Walter Reed Army Medical Center. Fort Belvoir, VA: Defense Technical Information Center, April 1998. http://dx.doi.org/10.21236/ada372083.

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