Proteomic Alterations of HDL in Youth with Type 1 Diabetes: Outstanding Research at the Symposium

At the 2019 MedStar Health-Georgetown University Research Symposium, three abstracts were recognized as outstanding abstracts from among all of our submissions. These research studies were the three highest scored out of the over 450 submissions to the Research Symposium by the Scientific Review committee and exemplifies the caliber of work presented by the MedStar-Georgetown research community.

“Proteomic Alterations of HDL in Youth with Type 1 Diabetes and their Associations with Glycemic Control: A Case-Control Study” presented a cross-sectional case-control study, comparing the high-density lipoprotein (HDL) cholesterol proteomes of youth with type 1 diabetes and healthy controls. It sought to evaluate the influence of glycemic control on HDL protein composition.

Led by Jenny (Evgenia) Gourgari, MD, the research team included Junfeng Ma, PhD; Martin Playford, PhD; Nehal Mehta, MD; Radoslav Goldman, PhD; Alan Remaley, MD, PhD; and Scott Gordon. This research was presented in the basic/translational science category.

Patients with type 1 diabetes typically have normal or even elevated plasma HDL cholesterol concentrations. However, HDL protein composition can be altered without a change in cholesterol content. Alteration of the HDL proteome can result in dysfunctional HDL particles which reduced the ability of the body to protect against cardiovascular disease.

Blood samples were obtained from 26 patients with type 1 diabetes and 13 healthy controls. HDL was isolated from plasma by size-exclusion chromatography and further purified using a lipid binding resin. The HDL proteome was analyzed by mass spectrometry using label-free SWATH peptide quantification.

The samples were analyzed and 78 HDL-bound proteins were measured. The results showed that youth with type 1 diabetes had significantly increased amounts of complement factor H related protein compared to the healthy controls. When patients were analyzed based on glucose control, several trends emerged. Some proteins were altered in type 1 diabetes and not influenced by glycemic control, while others were partially or completely corrected with optimal glucose control. Some proteins including complement component C3  and albumin were significantly different only in type 1 diabetes patients with optimal glucose control, suggesting a possible effect of exogenous insulin.

The research concluded that youth with type 1 diabetes have proteomic alterations of their HDL compared to healthy controls, despite a similar concentration of HDL cholesterol. The influence of these compositional changes on HDL function are not yet known.

The authors suggested that future efforts should focus on investigating further the role of these HDL associated proteins in regards to HDL function and their role in cardiovascular disease risk in patients with type 1 diabetes. 

Congratulations to the research team for their outstanding research! You can read about the other winners here and here.






Multi-Modal Sepsis Performance Improvement Initiative: Outstanding Research at the Symposium

At the 2019 MedStar Health-Georgetown University Research Symposium, three abstracts were recognized as outstanding abstracts from among all of our submissions. These research studies were the three highest scored out of the over 450 submissions to the Research Symposium by the Scientific Review committee and exemplifies the caliber of work presented by the MedStar-Georgetown research community.

"Multi-Modal Sepsis Performance Improvement Initiative Improves Early and Appropriate Treatment, Reduces Sepsis-Related Readmissions, and Reduces Overall Mortality" analyzed patient outcomes before and after implementation of the Centers for Medicare and Medicaid Services (CMS) SEP-1 Core Measure. The SEP-1 Core Measure mandates that hospitals implement quality improvement initiatives to improve sepsis outcomes. The team looked at data before and after the implementation of the multi-modal sepsis performance initiative launched in 2016 at MedStar Washington Hospital Center (MWHC).

Led by Seife Yohannes, MD, the research team included Sean Huang, PhD, Andrea Ryan, and Muhtadi Alnababteh.

The multi-modal sepsis performance initiative at MWHC had multiple components as part of the process, including:

  • a hospital-wide educational campaign about sepsis
  • 24-7 electronic warning system (EWS) of patients at risk for sepsis
  • a rapid response nursing team that monitors the EWS and implements bundled treatments
  • 24-7 mid-level provider team that evaluates patients identified by the EWS
  • quality improvement initiatives in sepsis documentation and coding.

The study used coding data for over 4,00 patients with a diagnosis of sepsis as reported to CMS. The study compared patient outcomes six months before the launch of the initiative and 13 months after full implementation.

The study found that based on an average of 2000 sepsis cases at our hospital, this amounted to 90 lives saved per year. Post-intervention, hospital length of stay was reduced by 1.8 days and re-admission rate was reduced by 1.6%.

Regression analysis showed age, admission through the emergency department, and severity of illness as independent risk factors for increased mortality. Adjusted for these risk factors, the incidence of severe sepsis and septicemia was reduced by 5.3% and 6.9% in the post-intervention period, while the incidence of simple sepsis increased by 12%.

The study concluded that the “multi-modal sepsis performance improvement initiative improved quality of care and patient outcomes.”

Congratulations to the research team for their outstanding research! You can read about the other winners here and here.

Recognizing Outstanding Resident and Fellow Research at the 2019 Research Symposium

On Thursday, May 30, approximately 1000 investigators, educators, innovators, and associates came together at the MedStar Health-Georgetown University Research Symposium. This event also served as the system-wide Resident Research Day, bringing residents and fellows from all of MedStar Health’s graduate medical education training programs.

Of the over 200 resident and fellow abstract submissions, top honors were award to several in each PGY-level. Six of the top scoring residents and fellows presented their research in the White Flint Amphitheatre, with the presentations live-streamed to the main ballroom. Moderated by Carlo S. Tornatore, MD, 2019 Symposium Vice Chair, the selected residents presented their research to a packed room.

In the category of health services research, Chisom Ikeji (MedStar Good Samaritan Hospital) gave an oral presentation for the research submission “Patient and Prescriber Perspectives on Proton Pump Inhibitor (PPI) Use and Deprescribing in Older Adults”. The purpose of this study was to evaluate the inappropriate use of Proton Pump Inhibitors among older adults in a geriatric ambulatory care setting and to explore the attitudes, beliefs, and concerns of patients regarding PPI therapy. The research team was Chisom Ikeji, Nicole Brandt, Anne Williams, and George Hennawi.

In the category of medical education, Kelly Sutter (MedStar Georgetown University Hospital) was highlighted for the research submission “Fellows in the Operating Room: Understanding the Effect on Resident Operative Experience”. This study sought to better understand the impact of fellows on the operative experience of surgical residents and compare resident educational experience in the operating room based on fellow presence. The research team was Kelly Sutter, Jason Crossley, Eshetu Tefera, Dori Abel, and Shimae Fitzgibbons.

In the category of Basic Science, Robert Ball (Firefighters’ Burn and Surgical Research Laboratory, MedStar Health Research Institute) gave an oral presentation for the research submission “Investigation of Metabolomic Alterations After Burn Injury in a Murine Model”. The purpose of this study was to examine the longitudinal effects of burn injury on the metabolome in a mouse model and identify potential targets for therapeutic intervention. The research team was Robert Ball, Abdulnaser Alkhalil, Gaurav Garg, Anna Day, Raina Kumar, Rasha Hammamieh, Lauren Moffatt and Jeffery Shupp.

Also, in the category of Basic Science, David Weiner (MedStar Union Memorial Hospital) presented “Gender Specific Biomechanical Evaluation of Forty-Four Human Cadaveric Lumbopelvic Spines - Emphasis on the Kinematic Differences in Sacroiliac Joint Range of Motion.” The objective of this study was to quantify and compare the multidirectional flexibility properties of the sacroiliac region based on gender specificity, with and without lumbosacral instrumentation. The research team was David Weiner, Daina Brooks, Jessica Hawken, P. Justin Tortolani and Bryan Cunningham.

In the category of Health Services Research, Michael Yang (MedStar Georgetown University Hospital) gave an oral presentation for the research submission “Continue to Monitor? Reducing Inappropriate Telemetry Use with Multidisciplinary Rounds.” The study aimed to characterize current telemetry practices and to reduce inappropriate telemetry use with a quality improvement intervention based in multidisciplinary rounds (MDR). The research team was Michael Yang, Patrick Miller, Travis Lane, Patrick Cheney, Ravi Masson, Bryan Stone and Alex Montero.

In the category of Combined Surgical Specialities, Michele Zerah (MedStar Washington Hospital Center) gave an oral presentation for the research submission “Intra-Operative Tissue Expansion (IOTE) using 16-Gauge Hollow Bore Needles and Towel Clamps in Mohs Surgery.” The study presented a technique to complement existing reconstructive methods and provide a surgical alternative to facilitate simple closure. The research team was Michele Magnino, Rachel Maiman and Eric Finzi.

 

Congratulations to the Following Residents and Fellows for Receiving the Highest Abstract Scores

PGY 1 to 3

  1. Kelly Sutter (MGUH/MWHC, General Surgery): Fellows in the Operating Room: Understanding the Effect on Resident Operative Experience
  2. Angela Hsu (MGUH, Internal Medicine): Triage Surveys are a Safe and Efficient Method to Streamline Utilization of Direct Access Endoscopy
  3. Michael Yang (MGUH, Internal Medicine): Continue to Monitor? Reducing Inappropriate Telemetry Use with Multidisciplinary Rounds
  4. Afroditi Boulougoura (MGUH, Internal Medicine): A phase 1, a Randomized, Controlled Clinical Trial of CC-11050, a novel PDE4 inhibitor, in Human Immunodeficiency Virus-1-Infected Adults with Suppressed Plasma Viremia on Antiretroviral Therapy
  5. Chisom Ikeji (MUMH, Internal Medicine): Patient and Prescriber Perspectives on Proton Pump Inhibitor (PPI) Use and Deprescribing in Older Adults

PGY 4 and above

  1. Michele Zerah (MWHC, Med/Derm): Intra-Operative Tissue Expansion (IOTE) using 16-Gauge Hollow Bore Needles and Towel Clamps in Mohs Surgery
  2. David Weiner (MUMH, Orthopedics): Gender-Specific Biomechanical Evaluation of Forty-Four Human Cadaveric Lumbopelvic Spines - Emphasis on the Kinematic Differences in Sacroiliac Joint Range of Motion
  3. Arash Hassantoufighi (MWHC, Rheumatology): Efficacy and Safety of Anakinra in Congestive Heart Failure Patients, including LVAD, with Acute Gouty Arthritis: Retrospective Study of 36 Patients at an Academic Medical Center

Research Fellows

  1. Robert Ball (MWHC, Burn): Investigation of Metabolomic Alterations After Burn Injury in a Murine Model
  2. Alexandre Kajita (MWHC, Cardiology): Quantitative Flow Ratio (QFR)
    Inter- and Intra-Observer Reproducibility Assessed at Baseline and After 1 Week
  3. Yuichi Ozaki (MWHC, Cardiology): Comparison of Quantitative Flow Ratio Value of Left Anterior Descending and Circumflex Coronary Artery in Patients With Takotsubo Syndrome

Recognition of Top Case Reports

  • Acute Encephalopathy from Human Metapneumovirus Fatima Hafizi; Francois Gregoire (PGY1-3; MedStar Harbor Hospital)
  • Acute Hepatitis Associated with Garcinia Cambogia: An Herbal Weight Loss Supplement Muhammad Yousaf; Seyed Hodanazari; Charmian Sittambalam (PGY1-3; MedStar Health Internal Medicine)
  • Combined Spontaneous Bacterial Peritonitis and Left Sided Spontaneous Bacterial Empyema in Cirrhotic Patient Maria Rivera; Nooshin Mirkheshti; Nargiz Muganlinskaya (PGY1-3; MedStar Health)
  • Delayed Brain MRI Abnormalities in Fat Embolism Syndrome in Hemoglobin SC Disease Shahla Moghbel (PGY4 and above; MedStar Georgetown University Hospital)
  • Green Coffee Extract: An Unusual Cause of Drug Induced Liver Injury Rajus Chopra; Avinash Sharma; Emil Oweis (PGY1-3; MedStar Washington Hospital Center)
  • Hematochezia? Consider Histoplasmosis Cory Higley; Nuval Cherian; Joshua Steinberg; Joseph Jennings; James Lewis (PGY1-3; MedStar Georgetown University Hospital)
  • High Frequency Oscillations (HFOs) as a Unique Pattern of EEG in a Patient with Anti-NMDA Receptor Encephalitis Douglas Mayson; Carlo Tornatore; Gholam Motamedi (PGY1-3; MedStar Georgetown University Hospital
  • A New Approach to Navicular-Medial Cuneiform Fusions in the Setting of Adult Acquired Flat foot: A New Role for Pre-shaped Allograft Bone Systems Nam Tran; Deepal Dalal; Andrew Falco; Kristy Golden (PGY1-3; MedStar Washington Hospital Center)
  • Nephrotic Syndrome in a Patient with Diabetes: Things Are Not Always as They Seem Harshal Shah; Ping Li (PGY4 and above; MedStar Georgetown University Hospital)




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Mobilizing a Million Hearts: Outstanding Research at the Symposium

At the 2019 MedStar Health-Georgetown University Research Symposium, three abstracts were recognized as outstanding abstracts from among all of our submissions. These research studies were the three highest scored out of the over 450 submissions to the Research Symposium by the Scientific Review committee and exemplifies the caliber of work presented by the MedStar-Georgetown research community.

The purpose of “Mobilizing a Million Hearts: Process Mapping of Cardiac Risk Assessment and Discussion” is an effort to optimize current cardiac risk calculators that are being used to predict patient 10-year risk. The work sought to identify individuals at high risk for atherosclerotic cardiovascular disease (ASCVD) who would benefit the most from cardiac risk management.

The research team was led by Ronald Romero Barrientos, with funding through the Office of the National Coordinator for Health Information Technology. This research was presented in the health services research category at the MedStar-Georgetown Research Symposium.

The research team analyzed physician workflow to better understand the current state and needs of physicians when using cardiac risk calculators. The overall goal is to optimize an ASCVD risk tool that implements a comprehensive method of communicating cardiovascular risk that is fully integrated into clinician workflow.

The study included a total of 17 clinician interviews that were conducted among cardiologists (n=6), primary care physicians (n=7), and care navigators (n=4). Also, 30 hours of clinical observations were conducted. During data analysis, common trends across 34 visits were identified and developed a general process outline for the sequence of events during patient visits. Six out of the total 34 visits were process mapped to confirm this general trend and highlight individual differences. These process maps illustrated that ASCVD risk discussion manifested itself during these patient visits as either a physician-initiated probe into patient lifestyle, physician education of risk factor management, or physician and patient discussion revolving around medication management.

The research collaborators were Lucy Stein, Laura Schubel, Mark Townsend, Kevin Chaney, and Kristen Miller. These researchers from MedStar Health Research Institute, MedStar National Center for Human Factors in Healthcare, MedStar National Rehabilitation Hospital, and the MedStar Institute for Innovation found that the results of the research revealed implications for both technical design and optimization of the risk calculator. Application of this workflow analysis process will be used in future endeavours to optimize and integrate clinical decision support tools directly into clinician workflow.

Congratulations to the research team for their outstanding research! You can read about the other winners here and here.






Eighth International Conference on Clinical Trials—July 19-20, 2019

The 8th International Conference on Clinical Trials is scheduled to be held July 19-20, 2019 in Atlanta, GA. The Conference brings together Academicians, Researchers, Doctors, Principle Investigators, Clinical research sites, CROs, CMOs, Investors, and senior executives from Biotech, Biopharma, Biomedical, Medical devices and Pharmaceutical industries around the globe to discuss, reflect on and develop their ideas. It offers many opportunities for professional contact and development and is a great networking event.

This conference includes world-renowned Keynote speakers, Speakers, Poster presentations, Symposiums, Workshops, Wide range of Exhibitions and Career development programs.

July 19-20, 2019
Atlanta, GA

Holiday Inn & Suites Atlanta Airport North
1380 Virginia Avenue
Atlanta, GA 30344

Learn More Here

May Peer-Reviewed Publications from MedStar Health

Congratulations to all MedStar researchers who had articles published in April 2018. The selected articles and link to PubMed provided below represent the body of work completed by MedStar Health investigators, physicians, and associates and published in peer-reviewed journals last month. The list is compiled from PubMed for any author using “MedStar” in the author affiliation. Congratulations to this month’s authors. We look forward to seeing your future research.

View the full list of publications on PubMed.gov here.

 Selected research:

  1. Safety of Thyroid Surgery in the Elderly: A Propensity Score Matched Cohort Study
    Journal of Surgical Research, 2019. DOI: 10.1016/j.jss.2019.04.012
    Papoian V, Marji FP, Rosen JE, Carroll NM, Felger EA.

  2. Cardiovascular Emergencies in Pregnancy
    Emergency Medicine Clinics of North America, 2019. DOI: 1016/j.emc.2019.01.010
    Borhart J, Palmer J.

  3. Reproducibility of Semi-automated Three-dimensional Volumetric Analysis using Cardiac Computed Tomography in Patients With Left Ventricular Assist Device
    Cardiovascular Revascularization Medicine, 2019. DOI: 10.1016/j.carrev.2019.01.024
    Gill GS, Weissman G, Meirovich YF, Medvedofsky D, Mohammed SF, Waksman R, Garcia-Garcia HM.

  4. Left Bundle Branch Block After TAVR: Bubble or Trouble?
    JACC: Cardiovascular Interventions, 2019. DOI: 1016/j.jcin.2019.04.008
    Waksman R, Khan JM.

  5. Leveraging the electronic health record to eliminate hepatitis C: Screening in a large integrated healthcare system
    PLoS One, 2019. DOI: 10.1371/journal.pone.0216459
    Geboy AG, Nichols WL, Fernandez SJ, Desale S, Basch P, Fishbein DA.

First International Conference in Systems Medicine, Systems Thinking, and Systems Science

The First International Conference in Systems Medicine will be held September 11-13, 2019 at Georgetown University Medical Center in Washington, DC. The conference will offer workshops, plenary sessions, panel discussions, oral, and poster presentations, as well as several interactive sessions – highlighting science, academia, business, and public policy. Presentations will showcase the science of systems medicine and how this exciting new field is beginning to change healthcare. The conference aims to create an active engagement between participants, encourage future interdisciplinary research opportunities, create collaboration amongst the international systems thinking stakeholders, and foster networking.

Early bird registration ends on May 31st, 2019. Regular registration is available until September 11, 2019.

September 11-13, 2019
Georgetown University Medical Center in Washington, DC
Register Here
Abstracts submitted by June 15, 2019 may be eligible for registration fee waivers.

Pre-Conference Workshop
There will be a pre-conference workshop on September 11, 2019. Students and Postdocs can register for free.
Check out the Agenda for more information. Space is limited so please hurry!

Travel Stipends
Travels stipends are also available for selected presenters who are traveling within the United States!
Please email  [email protected] to learn more. Information will be provided on the website soon.

Hotel Discounts Available
Click here for discounted rates at the Georgetown University Hotel and Conference Center. Please book ASAP as the number of rooms at discounted rates is limited.




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MedStar Funding Opportunities for MedStar Investigators





At MedStar Health, we are committed to creating an academic healthcare system that fosters and supports research. To support this effort, we are pleased to announce two (2) intramural grant funding opportunities that are now open.

These research funding announcements have been developed to increase collaboration, support new investigators, and enhance the quality of care to our communities. Please refer to the attached requests for proposals (RFPs) for specific submission instructions. Questions about the application process should be directed to [email protected].

2019 Early Stage Investigator – Associate Giving Grant

This grant opportunity is made possible by our annual associate giving campaign. Every dollar given by MedStar associates who select “Research” is directed to this fund and used to support early stage investigators. This funding opportunity prioritizes early stage investigators at MedStar Health to help launch impactful research careers in any discipline or specialty that will advance health and create new knowledge.

We all know the first years as an investigator are important and this grant will provide support to initiate research and conduct pilot studies that can lead to building a robust research activity that will be competitive for external funding. The successful candidate will demonstrate how this seed funding will lead to external grant funding. The proposed budget must not exceed $25,000 in direct costs. There are no indirect costs associated with this grant opportunity. The proposed budget can be used for any study-related expenses necessary to complete the proposed investigation (e.g., salary, supplies, equipment, etc.).

The RFP is available here. The application should be sent to [email protected] as a single PDF file by 11:59 pm on May 13, 2019.

2019 MedStar Diabetes Research Grant

This grant is an opportunity for Investigators interested in diabetes research and is made possible by a generous donation to advance the health of patients living with diabetes through research at MedStar Health. This donation will allow us to support investigators in the field of diabetes research who are interested in developing pilot data that can lead to additional, externally funded studies. These awards are intended to support particularly innovative and transformational ideas that have the potential to have an exceptional impact on diabetes. The successful candidate will demonstrate how this seed funding will lead to external grant funding.

The proposed budget must not exceed $25,000 in direct costs. There are no indirect costs associated with this grant opportunity. The proposed budget can be used for any study-related expenses necessary to complete the proposed investigation (e.g., salary, supplies, equipment, etc.).

The RFP is available here.  The application should be sent to [email protected] as a single PDF file by 11:59 pm on May 13, 2019.

RFA Now Available for Pilot Awards for Clinical Translational Studies through GHUCCTS

Applications are now being accepted for the Pilot Awards for Clinical Translational Studies (PTCS) through GHUCCTS.  Applications Submissions are online at PTCS Applications. The completed application and signed forms (institutional support forms) are due by Monday, April 15th, 2019 at 11:59 pm.

Funding Priorities

  • Investigations of environmental determinants of health, particularly those involving clinical and or public health data bases and geospatial mapping, and have potential to point toward solutions through surveillance or policy;
  • Innovative community engagement methods and technologies including research aimed at engaging minority, vulnerable, or other understudied populations;
  • Research that brings together a new type of team;
  • Research that expands a translational research focus across the lifespan including to pediatric and/or geriatric populations;
  • Innovative approaches to the implementation of precision medicine;
  • Engaging individuals with Opioid Use Disorders in research and clinical care while developing effective models of care delivered within medical settings of interest;
  • Research to address health disparities and the significant burden of conditions that disproportionately affect rural, minority, and other underserved populations.

Eligibility

Applicants must have a full-time faculty appointment at one of the GHUCCTS institutions (Howard, Georgetown, DCVA, MedStar, ORNL). Each application should identify a Contact PI that will be responsible for coordinating and submitting the application. Research teams can include collaborators who are not GHUCCTS affiliated.

Funding Opportunity Details

  • Award Amount: up to $40,000 (includes Institutional cost share)
  • Duration: Funds must be spent by March 31st, 2020.
  • A 50% cost-share with the applicant institution is required. (In most cases this has previously been negotiated with the participating institutions.)

Applications Submissions are online at PTCS Applications. The completed application and signed forms (institutional support forms) are due by Monday, April 15th, 2019 at 11:59 pm.

About GHUCCTS

The missions of Georgetown-Howard University Center for Clinical and Translational Science (GHUCCTS) and the national Clinical Translational Science Award (CTSA) programs highlight promotion of interdisciplinary research that translates basic research findings into clinical applications and clinical research into community practice, and improving the process of research. It is also our goal to implement research that will benefit underserved populations, including minorities, people with disabilities, and older adults. Additional priorities recently indicated by the agency that administers CTSAs, the National Center for Advancing Translational Science (NCATS) (see https://ncats.nih.gov/ctsa), further emphasize interaction and collaboration of the 62 CTSA hubs spread throughout the United States (see https//ctsacentral.org).  

March Peer-Reviewed Publications from MedStar Health

Congratulations to all MedStar researchers who had articles published in March 2019. The selected articles and link to PubMed provided below represent the body of work completed by MedStar Health investigators, physicians, and associates and published in peer-reviewed journals last month. The list is compiled from PubMed for any author using “MedStar” in the author affiliation. Congratulations to this month’s authors. We look forward to seeing your future research.

View the full list of publications on PubMed.gov here.

Selected research:

  1. Type 2 Diabetes and Later Cognitive Function in Older American Indians: The Strong Heart Study
    International Journal of Geriatric Psychiatry, DOI: 10.1002/gps.5108
    Cholerton B, Omidpanah A, Verney SP, Nelson LA, Baker LD, Suchy-Dicey A, Longstreth WT Jr, Howard BV, Henderson JA, Montine TJ, Buchwald D.
  2. Effectiveness of Early Laser Treatment in Surgical Scar Minimization: A Systematic Review and Meta-Analysis
    Dermatologic Surgery, 2019. DOI: 1097/DSS.0000000000001887
    Kent RA, Shupp J, Fernandez S, Prindeze N, DeKlotz CMC.
  3. Comparison of Coronary Revascularization Appropriateness for Non-Acute Coronary Syndrome Cases Under 2017 Update vs, the 2012 Appropriate Use Criteria
    Catherization & Cardiovascular Interventions, 2019. DOI: 1002/ccd.27895
    Case BC, Geiser KM, Torguson R, Pichard AD, Satler LF, Waksman R, Ben-Dor I.
  4. We Want To Know: Patient Comfort Speaking up About Breakdowns in Care and Patient Experience
    BMJ Quality & Safety ,2019. DOI: 10.1136/bmjqs-2018-008159
    Fisher KA, Smith KM, Gallagher TH, Huang JC, Borton JC, Mazor KM.
  5. Regionalization of Retroperitoneal Sarcoma Surgery to High-Volume Hospitals: Missed Opportunities for Outcome Improvement
    Journal of Hand Surgery,
    2019. DOI: 10.1200/JOP.18.00349
    Villano AM, Zeymo A, McDermott J, Barrak D, Unger KR, Shara NM, Chan KS, Al-Refaie WB.