20 0 obj << << Report on Quality and Safety 2013 Measure Number Measure Name 2012 Rate Perinatal Care Composite 57.6% PC-01 Elective Delivery 8.2% PC-02 Cesarean Section* 26.3% /Tabs /W 16 0 obj Ensuring that patients always receive the core measure recommended treatments requires a well-coordinated effort throughout hospital departments. endobj Terms of Use, Patient-Centered Specialty Practice (PCSP), Credentials Verification Organization (CVO), Managed Behavioral Healthcare Organization (MBHO), Health Information Technology Prevalidation Programs, Virtual Seminars, Webinars and On-demand Training, Advertising and Marketing Your NCQA Status, HEDIS Electronic Clinical Data Systems (ECDS) Reporting, CDC Review to Action. 10 0 obj Importantly, this metric also serves as a balancing measure for other maternal mea-sures such as NTSV (Nulliparous, Term, Singleton, Vertex) cesarean rates and early elective delivery rates. Disclaimer of Warranties and Liabilities. Sample Size: A hospitals performance on some of the core measures is /PDFDocEncoding 37 0 R /BS 48 0 R >> The endorsed measures include those previously endorsed by NQF and newly submitted measures for initial endorsement. endstream endobj 307 0 obj <>stream Center for Academic Medicine, Neonatology, MC 5660, 453 Quarry Road, Palo Alto, CA 94304, CA-PAMR Pregnancy-Associated Mortality Surveillance System Committee, Unexpected Complications in Term Newborns, <1500g Infant Not Delivered at Appropriate Level, COVID-19 Resources for Maternal and Infant Health, Mother & Baby Substance Exposure Initiative Toolkit, OB Hemorrhage Task Force and Update Task Force, Hypertensive Disorders of Pregnancy Toolkit, Hypertensive Disorders of Pregnancy Task Force, Maternal Sepsis Task Force Advisory Group, Support Vaginal Birth and Reduce Primary Cesareans Toolkit, Supporting Vaginal Birth and Reducing Primary Cesarean Delivery Taskforce, Toolkit to Support Vaginal Birth and Reduce Primary Cesareans, Medical School Office Building, 1265 Welch Road, MS 5415, Stanford, CA 94305 USA. section measure. The a diagnosis of galactosemia /Border [0 0 0] Applications are available at the American Medical Association Web site, www.ama- assn.org/go/cpt. Data shows that the majority of newborns with gestational age 37 weeks or more have a birth weight 3000 grams or more. (2018). Lower numbers are better. We looked at how we could improve administration of ACS after 34 weeks. ANA has developed high-impact patient safety measures, with more than two decades of evidence that higher staffing levels are associated with lower rates of patient death and harm. Using the monthly sampling table for the Mother population, the sample size required is 20% of this sub-population or 80 cases for the month. The following indicator sets are considered appropriate and useful for public reports as well: >> By not making a selection you will be agreeing to the use of our cookies. NQF# 0480 Exclusive Breast Milk Feeding, also in electronic measure as 0480e (now managed by The Joint Commission as PC-05). Professor Jean Yang is an applied statistician with expertise in statistical bioinformatics. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period. calendar year numbers publicly available on the Centers for Medicare and Copyright 2023 National Committee for Quality Assurance. /Author () HVYk@~?SqKCB gc@QuVG+q;l\cKwWkEPf`VYg(}8|r%,U|y%KRST@yA,L Wu'MA\kt$c&/B The American Medical Association reserves all rights to approve any license with any Federal agency. They provide a snapshot of how health is influenced by where we live, learn, work, and play. where Reference Date is the date on which you are trying to determine gestational age. /RI 41 0 R reporting by state Medicaid and CHIP agencies. It is now time to emphasize health and development in middle childhood and adolescence--developmental phases that are critical to health in adulthood and the next generation. The effort to make hospitals' sepsis care public follows the introduction of CMS's hospital reporting on Core Measure SEP-1: Early Management Bundle, Severe Sepsis/Septic Shockin its Inpatient Quality Reporting program, which began in October 2015. Any party may request reconsideration of any of the 14 endorsed quality measures listed below by submitting an appeal no later than May 3 (to submit an appeal, go to the NQF Measure Database). No national benchmarking systems existed for gathering or comparing institutional data. 3 0 obj Custom Analytic Interactive Reporting Network, Discuss the Perinatal Care (PC) measures updates, Describe the Perinatal Care (PC) measures, key data elements and recent revisions to the measures, Identify some of the resources available for improving perinatal care. /Rect [45 47.2192001343 154.7259979248 35.9873008728] This core set contains several measures NQF endorsed at the facility or health plan level as noted below; core set users should ensure adequate measure denominator size based on their patient population. What are the national benchmarks for the PC measures? Response: Please note that electronic clinical quality measures are not sampled. /ZaDb 39 0 R The Joint Commission reserves the right to change the content of the information as appropriate.. >> She was awarded the 2015 Moran Medal in statistics from the Australian Academy of Science in recognition of her work on developing methods for molecular data arising in cutting edge biomedical research. /Type /Catalog /Border [0 0 0] QDM v5.5 standards update: Added 'relevantDatetime' attribute to QDM datatypes. 39 weeks of gestation. The ongoing evaluation and updating of endorsed measures ensures the currency and relevance of NQFs perinatal care portfolio. Poster Presentation Purpose for the Program In 2010, the Joint Commission developed perinatal core measures. Lower quality care during pregnancy, childbirth, and the postpartum period can lead to unnecessary complications in women and newborns and wasted resources from overused procedures, prolonged hospital stays, and costly neonatal intensive care unit admissions, said Carol Sakala, PhD, MSPH, director of programs at Childbirth Connection and co-chair of the Perinatal and Reproductive Health Endorsement Maintenance Steering Committee. Background . Inpatient hospitalizations for newborns who were with any of the following conditions: admitted to the Neonatal Intensive Care Unit (NICU), transferred to an acute care facility, or other health care facility, a length of stay greater than 120 days that ends during the measurement period, Inpatient hospitalizations for newborns who were fed breast milk only since birth, Improvement noted as an increase in the rate. This measure is the overall rate of newborns The Joint Commission and the Centers for Medicare and Medicaid Services periodically redefine the core measures based on the latest evidence and nationwide hospital performance. The best practice included using high levels of cholesterol-lowering medications to treat stroke patients. endobj With improved outcomes, the other metrics of success can fall into alignment, with improvement in one area leading to improvement in others. Locomotion is impacted differently according to the perinatal brain injury model: Meta-analysis of preclinical studies with implications for cerebral palsy. /A 45 0 R These perinatal measures are a welcome addition to the NQF portfolio, said Laura Riley, MD, medical director of labor and delivery at Massachusetts General Hospital and co-chair of the Perinatal and Reproductive Health Endorsement Maintenance Steering Committee. provide labor and delivery care. Use of this measure set for quality improvement and public reporting will help strengthen maternal and newborn health and the value of our considerable investment in maternity care.. Johns Hopkins Medicine also established a reporting system to track core measure compliance on each unit. Note: District of Columbia state average not available for the cesarean Learn about the development and implementation of standardized performance measures. Find evidence-based sources on preventing infections in clinical settings. /TrimBox [0 0 612 792] Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this Agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. /IF 42 0 R The measures were originally developed for quality improvement, pay-for-performance, and public health monitoring. In addition to accreditation, certification, and verification, we provide tools and resources for health care professionals that can help make a difference in the delivery of care. /TP 1 With more than four million births in the United States each year, perinatal measures are needed to ensure the health and well-being of new mothers and newborns, said Janet Corrigan, PhD, MBA, president and CEO of NQF. 19 0 obj endobj Hopkins Medicine. This measures the percentage of patients who had an early elective Value set Parenteral Nutrition (2.16.840.1.113883.3.117.1.7.1.38): Deleted 1 SNOMED CT code (304055007) based on terminology update. The core measure work groups allowed hospitals to share best practices and lessons learned and improve internal processes to increase core measure compliance. Because cesarean sections are not /TrimBox [0 0 612 792] Patients may benefit from discussing with their healthcare provider the disruptions COVID-19 may have caused on quality and safety of care. In its 2020review process, the National Quality Forum endorsed 15Perinatal and Women's Health measures, of which CMQCC was the developer of three: NQF# 0716 Unexpected Complications in Term Newborns (currently used by The Joint Commission as PC-06) The database collects and evaluates unit-specific nurse-sensitive data from hospitals in the United States." Source: National Database of Nursing Quality Indicators Measures Patient falls License to use CPT for any use not authorized herein must be obtained through the American Medical Association, Intellectual Property Services, AMA Plaza, 330 North Wabash Avenue, Suite 39300, Chicago, Illinois 60611-5885. You can also ask your health care provider how you can prepare for surgery or other procedures to reduce your risk of complications. Perinatal Care measures focuses on achieving integrated, coordinated, patient-centered care for clinically uncomplicated pregnancies and births. /Thumb 30 0 R Perinatal Quality Collaboratives (PQCs) are state or multistate networks of teams working to improve the quality of care for mothers and babies. /Subject () Stakeholder CommentsGeneral and Measure-Specific. Report from nine maternal mortality review committees. A. We do not share your information with third parties. transferred to an acute care facility, or other health care facility a0,eJl-sxbuH6@T;4XpI _lLvzs_[6`,0^G@. /Type /Annot Submitting all the initial patient population provides a more precise estimate of the performance rate for the measures. Specific steps for each condition vary, but examples include providing preventative medication to patients at risk for developing blood clots or determining rehabilitation needs for a stroke patient. As a stroke compliance specialist, Meta Phillips, R.N., advocates for a personal touch when reviewing patient charts to help improve processes and patient care. /Encoding 11 0 R The study was carried out with the following aims: 1) to assess the quality of perinatal care (PC) by measuring the frequencies of the five PC indicators developed by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and comparing results with . >> endobj This will be reported as the percentage of infants with unexpected newborn . /Subtype /Link Learn about the priorities that drive us and how we are helping propel health care forward. In cases where there is conflicting data, use the document recording the birth weight closest to the time of delivery. Strikethrough text highlighted in red indicates information changed from the previous version. V AQ"]_tRIRo;Ioda`Y$a'qj fNxh1Yb8MVfuzf|Fugzt=nI"-jckBxUKqK4wKCZ[>Lf7p6q-?!Bc^YQADSJI_,KY-sqh9=1 ,DY jRb|]&JA ;{J%jc 9c$;)Z %hU#!FT6n9RrlZW~/i~4kId5h_`ASPBAbP0a 2hKU%.UlO22j+ bd-hWJ =QJewl=b&x~f00PM?D!rK!p4-t=UK$9'9}Q S]:tIGX4VmpZPv>$2k!%mA = f^/)No@ $;L6kP2@ u #%xg This Agreement will terminate upon notice if you violate its terms. /A 47 0 R The Joint Commissions Advanced Perinatal Care Certification requires the use of this set of standardized performance measures in order to meet the performance measurement requirements for certification. American Academy of Pediatrics, American College of Obstetricians and Gynecologists. << by Purpose. These processes are proven to reduce complications and lead to better patient outcomes. CMQCC has developed four quality measures that are used by government and quality review agencies such as the Joint Commission and the Leapfrog Group to help measure maternity care performance. We would urge patients to consider more recent performance in combination with historical performance. You acknowledge that the American Medical Association (AMA) holds all copyright, trademark and other rights in CPT. Note however that the calculation may yield a non-whole number and gestational age should be rounded off to the nearest completed week. Added text to indicate whether the measure is patient-based or episode-based. The measures address a wide range of care concerns, including childbirth, pregnancy and post-partum care, and newborn care. Obstet Gynecol, 131:140-150. The following sample size tables for each option automatically build in the number of cases needed to obtain the required sample sizes. Using the quarterly sampling table for the Exclusive Breast Milk Feeding measure, the sample size is less than the minimum required quarterly sample size, so 100% of this sub-population or all 25 cases are sampled. Custom Analytic Interactive Reporting Network. Using the quarterly sampling table for for the Exclusive Breast Milk Feeding measure, the sample size required is 20% of this sub-population or 70 cases for the quarter . Figures do not account for changes in the underlying measure that could break trending. 17 0 obj It is acceptable to calculate Gestational Age using the American College of Obstetricians and Gynecologists ReVITALize guidelines, which define Gestational Age as calculated using the best obstetrical Estimated Due Date (EDD) based on the formula: Gestational Age= (280-(EDD-Reference Date))/7. << /Resources 29 0 R /N /NextPage Using the quarterly sampling table for the Mother population, the sample size required is 301 cases for the quarter. 306 0 obj <>stream /CreationDate () /I 40 0 R /Type /Action The PC measure set is unique in that there are two distinct Initial Patient Populations within the measure set, mothers and newborns. The measure is reported as an overall rate which includes all newborns that were exclusively fed breast milk during the entire hospitalization. /Border [0 0 0] Symptoms from MRSA infections often take a few days to develop. Mothers The population of the PC-Mother measures (PC-01, and 02) are identified using 4 data elements: Admission Date Birthdate Discharge Date The Perinatal and Women's Health Standing Committee oversees NQF's perinatal and women's health measures. /Subtype /Link A hospital's PC-Newborn Population size is 600 cases during the second quarter. PPO corresponds to PPO and EPO within Quality Compass. The responsibility for the content of this product is with The Joint Commission, and no endorsement by the AMA is intended or implied. PC-05. /Type /Annot These four measures are harmonized with the National Quality Forum (NQF) and Joint Commission perinatal quality measures. National and state averages for This measure compares the number of MRSA-positive blood samples collected 4 or more days after the patient entered the hospital to a national benchmark. 13 0 obj Connected /N 40 0 R The AMA is a third party beneficiary to this Agreement. 14 0 obj /Subtype /Link The measure maintenance process is guided by expertise and advice provided by the Perinatal Care Measure Maintenance Technical Advisory Panel. View them by specific areas by clicking here. /Contents 33 0 R Short Name. >> /BS 50 0 R /Type /Pages You, your employees and agents are authorized to use CPT only as contained in The Joint Commission performance measures solely for your own personal use in directly participating in healthcare programs administered by The Joint Commission. lz;2[&EPI:+O/A@Fg0{NlAYIS*yIQ6Hfw}I5wMo}#F>juLt!aj-?}a)4g]xo/3sst7o6vso^u|;?=MGmnNgw;{~Kom6:Lc|:;Ow7y}dCy2W79{/]-we33'Wa7i-b| =LNq3d4N'9k{n,~35LWe.cCAX)&I]Ie\E'ZQ+T5.0N=iw]2c3>EZq>-7iNp.~:-Ao>W4e1p0ZTifYg:<6'(>ji{{%6sW L8O;SB&Z:hL:0Mv{(CQE9PCQE9P:`7R8Px&v`i`#fq(bq(>T8%,q`|&f0TAi%Y%y%E%eJ4+H_I4%XelY-o{MlF.I]Rif]lCtcbFSLq|I;%m;*:LQj9o`gKK05o$3;#7 h/?neC%1_}\=wIZn!B4$.Rr\}=O|ikS4@ 9_aMimyT{f7\sB^E@Uo6[Xq2oQr4;w"uFWXr.dK=<. Hospitals with CB rates at 15-20% have infant outcomes that are just as good and better maternal outcomes (Gould et al., 2004). >> /Parent 4 0 R >> **National Goal Benchmark Source: The United States Department of Health Moved the criteria of length of stay (LOS), diagnosis of galactosemia and subject to parenteral nutrition from initial population to denominator exclusions. This version of the eCQM uses QDM version 5.5. Note: Hospitals are encouraged to utilize a data source that reduces unnecessary medical record review e.g., using vital records, delivery logs or clinical information systems as a data source. Washington, DC the National Quality Forum (NQF) Board of Directors has approved for endorsement 14 quality measures on perinatal care. The organizations quality and safety performance may have been impacted by the COVID-19 pandemic. /Producer () The new perinatal core measures were ready for hospitals to use in the fall of 2009, and data collection began in April 2010. A hospital may choose to use vital records to identify the PC-Mother Initial Patient Population as given in the Population section earlier. Description. Using the quarterly sampling table for the Mother population, the sample size required is 20% of this sub-population or 300 cases for the quarter. The Inpatient Web-based Measure, Elective Delivery, documents the number of patients with elective vaginal deliveries or elective Cesarean sections at greater than or equal to (>=) 37 and less than (<) 39 . PC-05 Exclusive breast milk feeding during the newborn's entire hospitalization. Recently, the National Quality Forum, a consensus-based body that endorses quality measure, endorsed 24 measures related to maternity care. The Perinatal Center Database A Quality and Utilization Benchmark The Perinatal Center Database (PCDB) has become one of the largest repositories for hospital-based perinatal data in the country. /Subtype /XML The core measure processes are proven standards of care that reduce complications and lead to better patient outcomes. Chart Abstracted Measures for Certification. /Border [0 0 0] Birth weight 3000 grams or more is a proxy to capture term newborns without gestational age recorded in EHR system. >> If a hospital uses this method to identify the initial patient population, then the hospital is encouraged to submit all the records of the initial population rather than using sampling to identify the cases for submission. The goal of prenatal care is the birth of a healthy child with minimal risk for the mother. Data show that the majority of newborns with gestational age 37 weeks or more have a birth weight 3000 grams or more. The patients in each measure are processed independently. As we said above, if you decide to submit these traditionally chart-abstracted measures . /Length 54 0 R Learn more about the communities and organizations we serve. Masks are required inside all of our care facilities. 736. Core member of the Edinburgh Imaging research capability. CMS9v9. While a number of these measures are voluntarily reported as part of << One of the five core measures includes exclusive breastmilk feeding. Quality metric meeting national benchmarks. Using the quarterly sampling table for the Mother population, the sample size required 75 cases for the quarter. This measure tracks the number of term singleton newborns Date: 09/15/2021 Duration: 1.5 Hours Participants will be able to verbalize changes and updates to Joint Commission Maternal core measures, PC-02 and PC-06 standards, reporting and documentation. You will be prompted to log in to your NCQA account. >> This measure is a part of a set of five nationally implemented measures that address perinatal care (PC-01: Elective Delivery, PC-02: Cesarean Birth, PC-03: Antenatal Steroids, PC-04: Health Care-Associated Bloodstream Infections in Newborns). All rights reserved. /F 4 6 0 obj stream The measures address a wide range of care concerns, including childbirth, pregnancy and post-partum care, and newborn care. endstream endobj 308 0 obj <>stream These were the first nursing-sensitive measures developed by ANA, and were prioritized by the Measures Application Partnership (MAP) . Using the quarterly sampling table for the Exclusive Breast Milk Feeding measure, the sample size required 27 cases for the quarter. the American Academy of Pediatrics have in place a standard This product includes CPT which is commercial technical data, which was developed exclusively at private expense by the American Medical Association, 330 North Wabash Avenue, Chicago, Illinois 60611. Electronic Clinical Quality Measures (eCQMs) for Accreditation, Chart Abstracted Measures for Accreditation, Electronic Clinical Quality Measures (eCQMs) for Certification. a length of stay greater than 120 days that ends during the measurement period 15 0 obj Core measures are national standards of care and treatment processes for common conditions. subject to parenteral nutrition, Inpatient hospitalizations for newborns who were with any of the following conditions: Due to exclusions and contraindications, hospitals selecting sample cases MUST submit AT LEAST the minimum required sample size. This Core Set, which consists of 7 measures from CMS's Child Core Set and 4 measures from the Adult Core Set, will be used by CMS to measure and evaluate progress toward improvement of maternal and perinatal health in Medicaid and CHIP. 'RelevantDatetime' indicates when the action occurred whereas 'authorDatetime' indicates when the action was recorded. (h6}qA%Zb60 Using the monthly sampling table for the Exclusive Breast Milk Feeding measure, the sample size required 9 cases for the month. This field is for validation purposes and should be left unchanged. The Joint Commission tracks compliance with core measures and each year recognizes the top performing hospitals for key quality metrics. /Rect [80 323.2290039062 136.4620056152 307.7850036621] Conducted research in perinatal and ageing brains within a multi-disciplinary team: Designed imaging analysis pipelines to further understanding of connectivity and information processing in the brain, and the mechanisms by which these change due to normal development and disease. Participants will be able to verbalize changes and updates to Joint Commission Maternal core measures, PC-02 and PC-06 standards, reporting and documentation. RRKd*k2 O! Get more information about cookies and how you can refuse them by clicking on the learn more button below. For you, the electronic versions of the same measures are ePC-01, ePC-02, ePC-05 and ePC-06. Find out about the current National Patient Safety Goals (NPSGs) for specific programs. A hospital's PC-Newborn Population size is 350 cases during the second quarter. A technical advisory panel (TAP) comprising experts in the perinatal care field was convened in February 2009 to select the replacement set of measures from among those endorsed for national use by the National Quality Forum. << Women and families should use Leapfrog's Hospital Survey results to consider which hospital they'd like to use for their child's delivery. By using this site, you agree to our use of cookies. Connected section who have not previously given birth. endstream measures the percentage of women who had an elective cesarean There are no data that higher rates improve any outcomes, yet the CB rates continue to rise. /Group 34 0 R That's because The Joint Commission's eCQM option only applies to hospitals submitting all four perinatal measures. Our mission is to end preventable morbidity, mortality and racial disparities in California maternity care. /MediaBox [0 0 612 792] >> However, very few hospitals chose to adopt the measures because, the measures were optional. Core Curriculum for Neonatal Intensive Care Nursing - E-Book Lippincott Williams & Wilkins More children born today will survive to adulthood than at any time in history. /Filter /FlateDecode outcomes for a newborn. Its critical that providers have the right measurement tools to help ensure mothers and newborns receive safe, high-quality care.. /Annots [31 0 R 32 0 R 7 0 R] by Data. /Border [0 0 0] This field is for validation purposes and should be left unchanged. Find the exact resources you need to succeed in your accreditation journey. The following are Perinatal Care chart abstracted measures used by The Joint Commission. Using the quarterly sampling table for the Exclusive Breast Milk Feeding measure, the sample size required is 109 cases. Eight or more contacts for antenatal care can reduce perinatal deaths by up to 8 per 1000 births when compared to 4 visits. 8th ed. There are no Perinatal Care eCQMs applicable or available for Certification purposes. * Bei Fragen einfach anrufen oder schreiben: +49 (0)176 248 87 424. betheme google analytics; crave burger calories; pipp program application; chaps advantages and disadvantages Core measure compliance shows how often a hospital provides each recommended treatment for certain medical conditions. The Perinatal Center Database (PCDB) has become one of the largest repositories for hospital-based perinatal data in the country. Find more COVID-19 testing locations on Maryland.gov. The annual rankings measure vital health factors, including high school graduation rates, obesity, smoking, unemployment, access to healthy foods, the quality of air and water, income inequality, and teen births in nearly every county in America. "j9ZV",,-^ UHTXs}? endobj NQF operates under a three-part mission to improve the quality of American healthcare by: 1099 14th Street NW Suite 500Washington DC 20005, 202-783-1300 Main202-783-3434 Faxinfo@qualityforum.org. and Human Services' Healthy People 2020 goal. Updated definitions and functions in the MAT Global Common Functions Library to align with standards changes, CQL Style Guide, and to include one new function related to calculating length of hospital stays with observation stays. This site uses cookies and other tracking technologies to assist with navigation, providing feedback, analyzing your use of our products and services, assisting with our promotional and marketing efforts, and provide content from third parties. /H /N 225 Chapman Street Suite 200 Providence, RI 02905. /BS 44 0 R EMPOWERED having a vaginal delivery. And a CDC survey found that 8 to 19% of women reported having frequent postpartum depressive symptoms. For information concerning how to perform sampling, refer to the Population and Sampling Specifications section in this manual. connection among participants to achieve project goals. Objectives: Discuss the Perinatal Care (PC) measures updates Review PC measure reporting requirements /Type /Annot /AcroForm 2 0 R Measure Set: Perinatal Care (PC) Set Measure ID: PC-05 Performance Measure Name: Exclusive Breast Milk Feeding Description: Exclusive breast milk feeding during the newborn's entire hospitalization The measure is reported as an overall rate which includes all newborns that were exclusively fed breast milk during the entire hospitalization. /Pages 4 0 R Stay up to date with all the latest Joint Commission news, blog posts, webinars, and communications. Quality and Safety Performance During COVID-19, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, Central Line-Associated Bloodstream Infections (CLABSI), Patients Leaving the Pediatric ER Without Being Seen by a Health Care Provider, The Centers for Medicare and Medicaid Services - Recommended Core Measures, AHRQs Guide for Questions to Ask Your Doctor.
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