Current Search: Medical care -- Quality control (x)
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- Title
- Prognostic COPD healthcare management system.
- Creator
- Jain, Piyush, Agarwal, Ankur, Florida Atlantic University, College of Engineering and Computer Science, Department of Computer and Electrical Engineering and Computer Science
- Abstract/Description
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Hospital readmission rates are considered to be an important indicator of quality of care because they may be a consequence of actions of commission or omission made during the initial hospitalization of the patient, or as a consequence of poorly managed transition of the patient back into the community. The negative impact on patient quality of life and huge burden on healthcare system have made reducing hospital readmissions a central goal of healthcare delivery and payment reform efforts....
Show moreHospital readmission rates are considered to be an important indicator of quality of care because they may be a consequence of actions of commission or omission made during the initial hospitalization of the patient, or as a consequence of poorly managed transition of the patient back into the community. The negative impact on patient quality of life and huge burden on healthcare system have made reducing hospital readmissions a central goal of healthcare delivery and payment reform efforts. In this project, we will focus on COPD (Chronic Obstructive Pulmonary Disease) which is one of the leading causes of disability and mortality worldwide. This project will design and develop a prognostic COPD healthcare management system which is a sustainable clinical decision-support system to reduce the number of readmissions by identifying those patients who need preventive interventions to reduce the probability of being readmitted. Based on patient’s clinical records and discharge summary, our system would be able to determine the readmission risk profile of patients treated for COPD. Suitable interventions could then be initiated with the objective of providing quality and timely care that helps prevent avoidable readmission.
Show less - Date Issued
- 2014
- PURL
- http://purl.flvc.org/fau/fd/FA00004125, http://purl.flvc.org/fau/fd/FA00004125
- Subject Headings
- Integrated delivery of health care, Lungs -- Diseases, Obstructive -- Treatment, Medical care -- Quality control
- Format
- Document (PDF)
- Title
- The bureaucratic system: A positive or negative effect on nursing home quality of care?.
- Creator
- Lipsman, Lisa A., Florida Atlantic University, Evans, Arthur S.
- Abstract/Description
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Over the last fifty years quality of care has been a consistent problem in nursing home facilities. The federal government implemented a bureaucratic system as an attempt to improve this standard. This thesis traces the emergence of this system in nursing homes and illustrates its failure to solve the problem. George Ritzer's four-point McDonaldization model of bureaucracy is applied to argue that the bureaucratic system for governing nursing homes has a negative effect on the quality of care...
Show moreOver the last fifty years quality of care has been a consistent problem in nursing home facilities. The federal government implemented a bureaucratic system as an attempt to improve this standard. This thesis traces the emergence of this system in nursing homes and illustrates its failure to solve the problem. George Ritzer's four-point McDonaldization model of bureaucracy is applied to argue that the bureaucratic system for governing nursing homes has a negative effect on the quality of care. Although this hypothesis has proven to be accurate, additional factors were consistently cited as having detrimental effects on resident care. These include issues such as insufficient pay and lack of training/education for CNAs. Moreover, human greed and societal views of the elderly appear to be the true root of the problem.
Show less - Date Issued
- 2004
- PURL
- http://purl.flvc.org/fcla/dt/13148
- Subject Headings
- Long-term care of the sick--Quality control, Nursing home care--Quality control, Outcome assessment (Medical care), Long-term care facilities--Standards
- Format
- Document (PDF)
- Title
- A Clinical Decision Support System for the Identification of Potential Hospital Readmission Patients.
- Creator
- Baechle, Christopher, Agarwal, Ankur, Florida Atlantic University, College of Engineering and Computer Science, Department of Computer and Electrical Engineering and Computer Science
- Abstract/Description
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Recent federal legislation has incentivized hospitals to focus on quality of patient care. A primary metric of care quality is patient readmissions. Many methods exist to statistically identify patients most likely to require hospital readmission. Correct identification of high-risk patients allows hospitals to intelligently utilize limited resources in mitigating hospital readmissions. However, these methods have seen little practical adoption in the clinical setting. This research attempts...
Show moreRecent federal legislation has incentivized hospitals to focus on quality of patient care. A primary metric of care quality is patient readmissions. Many methods exist to statistically identify patients most likely to require hospital readmission. Correct identification of high-risk patients allows hospitals to intelligently utilize limited resources in mitigating hospital readmissions. However, these methods have seen little practical adoption in the clinical setting. This research attempts to identify the many open research questions that have impeded widespread adoption of predictive hospital readmission systems. Current systems often rely on structured data extracted from health records systems. This data can be expensive and time consuming to extract. Unstructured clinical notes are agnostic to the underlying records system and would decouple the predictive analytics system from the underlying records system. However, additional concerns in clinical natural language processing must be addressed before such a system can be implemented. Current systems often perform poorly using standard statistical measures. Misclassification cost of patient readmissions has yet to be addressed and there currently exists a gap between current readmission system evaluation metrics and those most appropriate in the clinical setting. Additionally, data availability for localized model creation has yet to be addressed by the research community. Large research hospitals may have sufficient data to build models, but many others do not. Simply combining data from many hospitals often results in a model which performs worse than using data from a single hospital. Current systems often produce a binary readmission classification. However, patients are often readmitted for differing reasons than index admission. There exists little research into predicting primary cause of readmission. Furthermore, co-occurring evidence discovery of clinical terms with primary diagnosis has seen only simplistic methods applied. This research addresses these concerns to increase adoption of predictive hospital readmission systems.
Show less - Date Issued
- 2017
- PURL
- http://purl.flvc.org/fau/fd/FA00004880, http://purl.flvc.org/fau/fd/FA00004880
- Subject Headings
- Health services administration--Management., Medical care--Quality control--Statistical methods., Medical care--Quality control--Data processing., Medical care--Decision making., Evidence-based medicine., Outcome assessment (Medical care)
- Format
- Document (PDF)
- Title
- How do home and community based services change long-term care?.
- Creator
- Perez, Enrique M., College for Design and Social Inquiry, School of Public Administration
- Abstract/Description
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The relationship between Public Administration and the people is one that requires legitimacy and compromise in order to solve complex problems. Individuals with intellectual and developmental disabilities (IDD) and their families during the last fifty years have put forth an agenda that calls for the advancement of rights for the disabled and more integration into the larger society. In this arena, government, with post civil rights legislation like the 1990 Americans with Disabilities Act ...
Show moreThe relationship between Public Administration and the people is one that requires legitimacy and compromise in order to solve complex problems. Individuals with intellectual and developmental disabilities (IDD) and their families during the last fifty years have put forth an agenda that calls for the advancement of rights for the disabled and more integration into the larger society. In this arena, government, with post civil rights legislation like the 1990 Americans with Disabilities Act (ADA), plays a huge role in promoting social awareness and bringing down barriers of stigmatization, understanding, and access. This struggle is fought on many fronts. A significant part of the effort focuses on moving the locus of long-term care of the disabled, including the IDD population, from an institutional setting to the least restrictive setting that will foster social ties and integration. Since the early 1980s as part of this effort to deinstitutionalize the disabled, legislation at both the federal and state level has supported and incentivized the creation of Home and Community Based Service (HCBS) programs. HCBS waivers, as they are typically called, are also promoted as a means of containing government expenditures for long-term care. However, the effectiveness of these waivers is poorly understood. The critical questions being - Do HCBS waivers promote and create an environment that increases awareness of the needs of IDD individuals? Do the programs help reduce stigmatization, promote understanding, and increase access to services and activities that foster social interaction? Or, do HCBS waivers create a new "iron cage" where the intellectually or developmentally disabled are once again relegated to existing as second class citizens? In this research, programs are mapped and then evaluated to paint a better picture of how HCBS waivers change long-term care., This research combines qualitative and quantitative approaches to triangulate on these phenoamea as a means to investigate when and how HCBS waiver programs facilitate, promote, or stifle the social integration of those with IDD. How does social integration manifest itself in the quality long-term care of those who often cannot take care of themselves?
Show less - Date Issued
- 2011
- PURL
- http://purl.flvc.org/FAU/3318667
- Subject Headings
- Long-term care of the sick, Medical care, Quality control, Sociology of disabiltiy, Heath care rationing, Outcome assessment (Medical care), Community health services
- Format
- Document (PDF)
- Title
- Personal health record system and integration techniques with various electronic medical record systems.
- Creator
- Ved, Vishesh., College of Engineering and Computer Science, Department of Computer and Electrical Engineering and Computer Science
- Abstract/Description
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In order to improve the quality of care, there is urgent need to involve patients in their own healthcare. So to make patient centered health care system Personal Health Records are proposed as viable solution. This research discusses the importance of a Patient Centric Health Record system. Such systems can empower patients to participate in improving health care quality. It would also provide an economically viable solution to the need for better healthcare without escalating costs by...
Show moreIn order to improve the quality of care, there is urgent need to involve patients in their own healthcare. So to make patient centered health care system Personal Health Records are proposed as viable solution. This research discusses the importance of a Patient Centric Health Record system. Such systems can empower patients to participate in improving health care quality. It would also provide an economically viable solution to the need for better healthcare without escalating costs by avoiding duplication. The proposed system is Web-based; therefore it has high accessibility and availability. The cloud computing based architecture is used which will allow consumers to address the challenge of sharing medical data. PHR would provide a complete and accurate summary of the health and medical history of an individual by gathering data from many sources. This would make information accessible online to anyone who has the necessary electronic credentials to view the information.
Show less - Date Issued
- 2010
- PURL
- http://purl.flvc.org/FAU/1930491
- Subject Headings
- Medical records, Data processing, Management, Medical informatics, Information storage and retrieval systems, Medical care, Medical care, Quality control, Personal information management
- Format
- Document (PDF)
- Title
- Identifying descriptions of quality nursing care shared by nurse and patient in the acute care hospital environment.
- Creator
- Grimley, Karen A., Tappen, Ruth M., Florida Atlantic University, Christine E. Lynn College of Nursing
- Abstract/Description
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Nursing care is considered a primary predictor of patient assessment of the overall hospital experience. Yet, quality nursing care remains difficult to define. Limited research about nurse or patient perspectives on what constitutes quality nursing care in hospital settings prevents the identification of a shared description or insight into their possible interrelationship. Research about nurse and patient descriptions is needed to establish behaviors, attributes, and activities associated...
Show moreNursing care is considered a primary predictor of patient assessment of the overall hospital experience. Yet, quality nursing care remains difficult to define. Limited research about nurse or patient perspectives on what constitutes quality nursing care in hospital settings prevents the identification of a shared description or insight into their possible interrelationship. Research about nurse and patient descriptions is needed to establish behaviors, attributes, and activities associated with quality nursing care to improve the health and well-being of hospitalized patients.
Show less - Date Issued
- 2015
- PURL
- http://purl.flvc.org/fau/fd/FA00004375
- Subject Headings
- Nursing--Philosophy, Nurse and patient, Medical care--Quality control, Intensive care nursing--Quality control, Outcome assessment--Medical care, Total quality management, Evidence-based nursing.
- Format
- Document (PDF)
- Title
- The impact of satisfaction with care and empowerment on glycemic control among older African American adults with diabetes.
- Creator
- Johnson, Bridgette M., Christine E. Lynn College of Nursing
- Abstract/Description
-
atisfaction with diabetes care, perceived feelings of empowerment to participate in self-care management, and glycemic control in a sample of older African American men and women with diabetes. A descriptive correlational quantitative design was used. The participants in this study were 73 men and women of African descent who were at least 50 years, English speaking, and diagnosed with diabetes for at least one year. The participants were asked to complete three survey instruments: the...
Show moreatisfaction with diabetes care, perceived feelings of empowerment to participate in self-care management, and glycemic control in a sample of older African American men and women with diabetes. A descriptive correlational quantitative design was used. The participants in this study were 73 men and women of African descent who were at least 50 years, English speaking, and diagnosed with diabetes for at least one year. The participants were asked to complete three survey instruments: the Patient Satisfaction Questionnaire-18 (PSQ-18), which measured how satisfied the participants were with their medical care; the Diabetes Empowerment Scale-Short Form (DES-SF), which measured attitudes towards diabetes and self-management of diabetes; and a demographic form, which collected data on the demographics of each participant. The most recent hemoglobin A1c (HbA1c) of each participant was obtained from the medical records. The correlations between HbA1c, DES, and the PSQ-18 subscales were exam ined. The study data indicated all correlations were statistically significant and negative with one exception. There was no correlation between HbA1c and time spent, a satisfaction subscale. Approximately half the participants were high school graduates, married, and reported being born in the Caribbean. Most had primary care physicians, but less than half reported attending a diabetes education program. The average BMI was 33.0. The findings of this study indicated older African adults who reported higher satisfaction with the care provided by their health care provider reported feeling more empowered to participate in diabetes self-care and reported lower HbA1c levels, suggesting better glycemic control (R2 = .39; P=<.001)., The implications of this study are that feeling empowered to participate in diabetes self-care management may result in improved glycemic control. Positive diabetes outcomes have been linked in the literature with persons feeling empowered to participate in diabetes self-care. The significance of the findings from this study is that given the relationship between empowerment and glycemic control, nurses should support the empowerment model of diabetes teaching. Diabetes education should provide written materials that are culturally sensitive for African American elders.
Show less - Date Issued
- 2012
- PURL
- http://purl.flvc.org/FAU/3342114
- Subject Headings
- Outcome assessment (Medical care), Nursing, Quality control, Medical economics, Patient satisfaction, Evaluation, African Americans, Health and hygiene, Sociological aspects
- Format
- Document (PDF)
- Title
- A web-based automated classification system for nursing language based on nursing theory.
- Creator
- Dass, Subhomoy D., College of Engineering and Computer Science, Department of Computer and Electrical Engineering and Computer Science
- Abstract/Description
-
Health care systems consist of various individuals and organizations that aim to meet the health care needs of people and provide a complete and responsive health care solution. One of the important aspects of a health care delivery system is nursing. The use of technology is a vital aspect for delivering an optimum and complete nursing care to individuals; and also for improving the quality and delivery mechanism of nursing care. The model proposed in this thesis for Nursing Knowledge...
Show moreHealth care systems consist of various individuals and organizations that aim to meet the health care needs of people and provide a complete and responsive health care solution. One of the important aspects of a health care delivery system is nursing. The use of technology is a vital aspect for delivering an optimum and complete nursing care to individuals; and also for improving the quality and delivery mechanism of nursing care. The model proposed in this thesis for Nursing Knowledge Management System is a novel knowledge-based decision support system for nurses to capture and manage nursing practice, and further, to monitor nursing care quality, as well as to test aspects of an electronic health record for recording and reporting nursing practice. As a part of a collaborative research of the Christine E. Lynn College of Nursing and the Department of Computer Science, a prototype toolset was developed to capture and manage nursing practice in order to improve the quality of care. This thesis focuses on implementing a web based SOA solution for Automated Classification of Nursing Care Categories, based on the knowledge gained from the prototype for nursing care practice.
Show less - Date Issued
- 2011
- PURL
- http://purl.flvc.org/FAU/3332184
- Subject Headings
- Nursing, Quality control, Outcome asssessment (Medical care), Nursing assessment, Digital techiques, Nursing, Computer-assisted instruction, Nursing informatics
- Format
- Document (PDF)
- Title
- A Systematic Review and Quantitative Meta-Analysis of the Accuracy of Visual Inspection for Cervical Cancer Screening: Does Provider Type or Training Matter?.
- Creator
- Driscoll, Susan D., Tappen, Ruth M., Florida Atlantic University, Christine E. Lynn College of Nursing
- Abstract/Description
-
Background: A global cervical cancer health disparity persists despite the demonstrated success of primary and secondary preventive strategies, such as cervical visual inspection (VI). Cervical cancer is the leading cause of cancer incidence and death for women in many low resource areas. The greatest risk is for those who are unable or unwilling to access screening. Barriers include healthcare personnel shortages, cost, transportation, and mistrust of healthcare providers and systems. Using...
Show moreBackground: A global cervical cancer health disparity persists despite the demonstrated success of primary and secondary preventive strategies, such as cervical visual inspection (VI). Cervical cancer is the leading cause of cancer incidence and death for women in many low resource areas. The greatest risk is for those who are unable or unwilling to access screening. Barriers include healthcare personnel shortages, cost, transportation, and mistrust of healthcare providers and systems. Using community health workers (CHWs) may overcome these barriers, increase facilitators, and improve participation in screening for women in remote areas with limited access to clinical resources. Aim: To determine whether the accuracy of VI performed by CHWs was comparable to VI by physicians or nurses and to consider the affect components of provider training had on VI accuracy. Methods: A systematic review and quantitative meta-analysis of published literature reporting on VI accuracy, provider type, and training was conducted. Strict inclusion/exclusion criteria, study quality, and publication bias assessments improved rigor and bivariate linear mixed modeling (BLMM) was used to determine the affect of predictors on accuracy. Unconditional and conditional BLMMs, controlling for VI technique, provider type, community, clinical setting, HIV status, and gynecological symptoms were considered. Results: Provider type was a significant predictor of sensitivity (p=.048) in the unconditional VI model. VI performed by CHWs was 15% more sensitive than physicians (p=.014). Provider type was not a significant predictor of accuracy in any other models. Didactic and mentored hours predicted sensitivity in both BLMMs. Quality assurance and use of a training manual predicted specificity in unconditional BLMMs, but was not significant in conditional models. Number of training days, with ≤5 being optimal, predicted sensitivity in both BLMMs and specificity in the unconditional model. Conclusion: Study results suggest that community based cervical cancer screening with VI conducted by CHWs can be as, if not more, accurate than VI performed by licensed providers. Locally based screening programs could increase access to screening for women in remote areas. Collaborative partnerships in “pragmatic solidarity” between healthcare systems, CHWs, and the community could promote participation in screening resulting in decreased cervical cancer incidence and mortality.
Show less - Date Issued
- 2016
- PURL
- http://purl.flvc.org/fau/fd/FA00004755
- Subject Headings
- Women--Health and hygiene., Cervix uteri--Cancer--Diagnosis., Cervix uteri--Cancer--Prevention., Medical screening., Medical care--Quality control., Community health services.
- Format
- Document (PDF)
- Title
- Text Mining and Topic Modeling for Social and Medical Decision Support.
- Creator
- Hurtado, Jose Luis, Zhu, Xingquan, Florida Atlantic University, College of Engineering and Computer Science, Department of Computer and Electrical Engineering and Computer Science
- Abstract/Description
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Effective decision support plays vital roles in people's daily life, as well as for professional practitioners such as health care providers. Without correct information and timely derived knowledge, a decision is often suboptimal and may result in signi cant nancial loss or compromises of the performance. In this dissertation, we study text mining and topic modeling and propose to use text mining methods, in combination with topic models, to discover knowledge from texts popularly available...
Show moreEffective decision support plays vital roles in people's daily life, as well as for professional practitioners such as health care providers. Without correct information and timely derived knowledge, a decision is often suboptimal and may result in signi cant nancial loss or compromises of the performance. In this dissertation, we study text mining and topic modeling and propose to use text mining methods, in combination with topic models, to discover knowledge from texts popularly available from a wide variety of sources, such as research publications, news, medical diagnose notes, and further employ discovered knowledge to assist social and medical decision support. Examples of such decisions include hospital patient readmission prediction, which is a national initiative for health care cost reduction, academic research topics discovery and trend modeling, and social preference modeling for friend recommendation in social networks etc. To carry out text mining, our research, in Chapter 3, first emphasizes on single document analyzing to investigate textual stylometric features for user pro ling and recognition. Our research confirms that by using properly designed features, it is possible to identify the authors who wrote the article, using a number of sample articles written by the author as the training data. This study serves as the base to assert that text mining is a powerful tool for capturing knowledge in texts for better decision making. In the Chapter 4, we advance our research from single documents to documents with interdependency relationships, and propose to model and predict citation relationship between documents. Given a collection of documents with known linkage relationships, our research will discover e ective features to train prediction models, and predict the likelihood of two documents involving a citation relationships. This study will help accurately model social network linkage relationships, and can be used to assist e ective decision making for friend recommendation in social networking, and reference recommendation in scienti c writing etc. In the Chapter 5, we advance a topic discovery and trend prediction principle to discover meaningful topics from a set of data collection, and further model the evolution trend of the topic. By proposing techniques to discover topics from text, and using temporal correlation between trend for prediction, our techniques can be used to summarize a large collection of documents as meaningful topics, and further forecast the popularity of the topic in a near future. This study can help design systems to discover popular topics in social media, and further assist resource planning and scheduling based on the discovered topics and the their evolution trend. In the Chapter 6, we employ both text mining and topic modeling to the medical domain for effective decision making. The goal is to discover knowledge from medical notes to predict the risk of a patient being re-admitted in a near future. Our research emphasizes on the challenge that re-admitted patients are only a small portion of the patient population, although they bring signficant financial loss. As a result, the datasets are highly imbalanced which often result in poor accuracy for decision making. Our research will propose to use latent topic modeling to carryout localized sampling, and combine models trained from multiple copies of sampled data for accurate prediction. This study can be directly used to assist hospital re-admission assessment for early warning and decision support. The text mining and topic modeling techniques investigated in the dissertation can be applied to many other domains, involving texts and social relationships, towards pattern and knowledge based e ective decision making.
Show less - Date Issued
- 2016
- PURL
- http://purl.flvc.org/fau/fd/FA00004782, http://purl.flvc.org/fau/fd/FA00004782
- Subject Headings
- Social sciences--Research--Methodology., Data mining., Machine learning., Database searching., Discourse analysis--Data processing., Communication--Network analysis., Medical care--Quality control.
- Format
- Document (PDF)
- Title
- Mechanisms of protection against ischemic damage in the heart.
- Creator
- Moench, Ian, Charles E. Schmidt College of Science, Department of Biological Sciences
- Abstract/Description
-
Heart disease including ischemic heart disease is the highest contributor to death and morbidity in the western world. The studies presented were conducted to determine possible pathways of protection of the heart against ischemia/reperfusion. We employed adenovirus mediated over-expression of Methionine sulfoxide reductase A (MsrA) in primary neonatal rat cardiac myocytes to determine the effect of this enzyme in protecting against hypoxia/reoxygenation. Cells transfected with MsrA encoding...
Show moreHeart disease including ischemic heart disease is the highest contributor to death and morbidity in the western world. The studies presented were conducted to determine possible pathways of protection of the heart against ischemia/reperfusion. We employed adenovirus mediated over-expression of Methionine sulfoxide reductase A (MsrA) in primary neonatal rat cardiac myocytes to determine the effect of this enzyme in protecting against hypoxia/reoxygenation. Cells transfected with MsrA encoding adenovirus and subjected to hypoxia/reoxygenation exhibited a 45% decrease in apoptosis as compared to controls. Likewise total cell death as determined by levels of Lactate Dehydrogenase (LDH) release was dramatically decreased by MsrA overexpression. The initial hypothesis that led to our testing sulindac was based on the fact that the S epimer of sulindac was a substrate for MsrA and that this compound might function as a catalytic anti-oxidant based on a reaction cycle that involved reductio n to sulindac sulfide followed by oxidation back to sulindac. To test this we examined the protective effect of sulindac in hypoxia re-oxygenation in both cardiac myocytes in culture and using a Langendorff model of myocardial ischemia. Using this model of myocardial ischemia we showed that pre-incubation of hearts with sulindac, or the S and R epimers of sulindac resulted in protection against cell death. We present several lines of evidence that the protective effect of sulindac is not dependent on the Msr enzyme system nor does it involve the well established role of sulindac as a Cyclooxygenase (COX) inhibitor. Numerous signaling pathways have been implicated in myocardial protective mechanisms, many of which require fluctuations in ROS levels as initiators or mediators., Sulindac shows very good potential as a preconditioning agent that could induce tissue protection against oxidative damage.Blocking of preconditioning pathways by administration of the PKC blocker chelerythine abrogated the ischemic protection afforded by sulindac. Secondly, an end-effector of preconditioning, inducible nitric oxide synthase (iNOS),was found to be induced by greater than 5 fold after 48 h prior feeding sulindac.
Show less - Date Issued
- 2008
- PURL
- http://purl.flvc.org/FAU/186291
- Subject Headings
- Biochemical markers, Diagnostic use, Cardiovascular system, Diseases, Diagnosis, Heart, Diseases, Molecular aspects, Medical care, Quality control, Coronary heart disease, Prevention, Apoptosis, Myocardial infarction, Prevention
- Format
- Document (PDF)