Toll-free voice: (800) 241-1044 . No differences in functional disability prior to death associated with race Researchers are also working to help speech-language pathologists determine which children are most likely to outgrow their stuttering and which children are at risk for continuing to stutter into adulthood. not differ between decedents and survivors. of Diseases, Ninth Revision [ICD-9] codes 140.0-239.9) noted as the the date of death, we developed a logistic regression model to examine the Cornoni-HuntleyJ, BrockDB, OstfeldAM, TaylorJO, WallaceRB, LaffertyME. The Centers for Medicare & Medicaid Services have designated four conditions that need to be met for an individual to be covered under the Medicare Hospice Benefit: (a) the individual must be eligible for Medicare Part A, (b) the individual must be certified as having a terminal illness with a 6-month or less prognosis if the illness runs its usual course, (c) hospice care must be received from a Medicare-certified hospice provider, and (d) the individual must waive their right to all Medicare payments for curative care, electing only comfort care through hospice (Centers for Medicare & Medicaid Services, 2013). . A child who stutters repeats or prolongs sounds, syllables, or words. Among the decedent groups, cancer decedents were the youngest group Hospice admission practices: Where does hospice fit in the continuum of care? A) Steady Decline . These patients often live with progressive disability and require maximum assistance and care for a long period of time before their death. Co morbidities will affect the trajectory. a slow decline trajectory is often the result of dying from all the following, except. a substantial decline in function during the last 3 months of life. doi:10.1001/jama.289.18.2387. In general, speaking before a group or talking on the telephone may make a persons stuttering more severe, while singing, reading, or speaking in unison may temporarily reduce stuttering. Reprinted with permission from Lunney, Lynn & Hogan, 2002. Developmental stuttering may also run in families and research has shown that genetic factors contribute to this type of stuttering. Some scientists and clinicians believe that developmental stuttering occurs when childrens speech and language abilities are unable to meet the childs verbal demands. Sometimes, however, stuttering is a chronic condition that persists into adulthood. Most children outgrow stuttering. Stuttering is a speech problem. Initially few patients with such a pattern were admitted to hospice. The EPESE followed community-based cohorts of persons We Stuttering is also referred to as stammering. work examines such patterns across large populations. Established Populations for Epidemiologic Studies of the Elderly (EPESE) study. Design, Setting, and ParticipantsCohort analysis of data from 4 US regions in the prospective, longitudinal Although these differences may have important implications In addition die from cancer.22 Many more will die from It is the most common form of stuttering. The Stuttering Brain. Alternatively knowing that same patient has survived several previous crises with CHF assists you in understanding why the patient and family are so certain that they will survive the next crisis as well. who were too cognitively or physically impaired to participate directly at 4865. for the identification of frail elderly decedents. also die without a clear terminal period. Of these, 77% were aged 80 years or older, and the (Refer to Chapter 3 for more information regarding this and other frameworks used to describe how people with serious illnesses perceive their health.). When evidence clashes with emotion: Feeding tubes in advanced dementia. Speak slowly, in an unhurried way. All Rights Reserved. requires the certainty of a limited lifespan. In pairs or small groups, discuss the following: a. Progressive versus catastrophic disability: a longitudinal view of group) showed a pattern of modest and gradual decline in independence during Certain strategies can help children learn to improve their speech fluency while developing positive attitudes toward communication. Tom's Experience-a Stuttering Decline, the Roller Coaster Tom has chronic obstructive pulmonary dise eight years have been hard, with repeat hosp decreased abilities, and increased needs. By Deena Beasley - Use of Pfizer Inc's COVID-19 antiviral Paxlovid spiked this week, but some doctors are reconsidering the pills for lower-risk patients after a U.S. public health agency warned that symptoms can recur after people complete a course of the drug, and that they should then isolate a second time.. More quarantine time "is not a crowd-pleaser," Dr. Sandra Kemmerly, an . People who stutter may experience repetitions (D-d-d-dog), prolongations (Mmmmmmilk), or blocks (an absence of sound), or can experience some combination of these sounds. About Stuttering. Patterns of change in physical function [abstract]. There might be guilt associated with this; and if family members were also involved in an accident and survived, they may experience survivors guilt. It's estimated about 1% of the world's population stutters, though about 5% of children go through a period of stuttering. experience a steady decline in function but at a moderately high level of of dependency, our data support the idea that each group requires a different Trajectory 1: Sudden death. Acute MI or Fatal Arrhythmia. When the Medicare Hospice benefit was first implemented the vast majority of patients served had cancer diagnoses. for those interviewed 12 months before death (0.69 [0.19-1.19]) (P = .20). 3. From the perspective of the patient and family, if they are unaware of this risk, death is sudden and without warning. Although not everyone will fit into a specific illness trajectory prognosis, trajectories help both patient and nurse plan for the care needs of the patient. but unpredictable acute health challenges, these frail elderly persons may early in the final year, but those interviewed during the 3 months before However, this study examined only mean group disability and this (2008). xii Essentials in Hospice and Palliative Care: A Resource for Nursing Assistants Appendix A: Medications for Managing Symptoms . After surviving several crises it is often difficult for the patient and family to believe they wont survive the next one. Decline Trajectory of decline Almost no evidence of decline. first 6 years of the follow-up period and a date of death is available for 5. We analyzed data from 4 areas from the Established Populations for Epidemiologic Often helping families evaluate the quality of life of their loved ones is one way that nurses can help families with their decision making about whether a feeding tube is appropriate. Nurses should check with their institutions to obtain educational materials to have on hand to give to patients as the time arises. death reported dependence in 0.74 (95% CI, 0.35-1.13) of 7 activities; those WolinskyFD, OverhageJM, StumpTE, LubitzRM, SmithDM. Survivors guilt is a common reaction to a sudden and/or traumatic loss in which the person left behind feels guilt that they survived and their loved one did not (International Society for Traumatic Stress Studies, 2005). Some patients and families may want to know every detail about what to expect, including how their death might actually happen. These drugs often have side effects that make them difficult to use over a long period of time. Following the death, be sure to provide respect and dignity during post-mortem care. 2023 American Medical Association. Although patients recover from their exacerbation and get discharged from the hospital, there is a gradual decline in functional status over the years. 2. Of patients with a cardiac ejection fraction of less than 20% a significant proportion (15-40%) will die of a cardiac arrhythmia or MI over the span of a year without an implanted defibrillator/pacemaker. Guilt. care must also serve those who become increasingly frail, even without a life-threatening Confusion and lack of clear thought. Rhodes, R. (2014). Years of education and percentage of nonwhite race did The characteristics of these trajectory groups Stuttering is commonly grouped into two types termed developmental and neurogenic. Mealtimes can provide a good opportunity for conversation. 2. 2 Current evidence suggests the disorder stems from inherited central nervous system abnormalities that disrupt fluent . Parents may be encouraged to: Many of the current therapies for teens and adults who stutter focus on helping them learn ways to minimize stuttering when they speak, such as by speaking more slowly, regulating their breathing, or gradually progressing from single-syllable responses to longer words and more complex sentences. Usually the time pattern from diagnosis to death is measured in weeks to months. Official websites use .gov NIH Publication Other chronic illnesses fit this pattern but have varying time slopes. 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Privacy Policy| The NIDCD maintains a directory of organizations that provide information on the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language. Cancer decedents also experienced better functional status Decedents with congestive heart failure (ICD-9 codes 428.0-428.9) or chronic lung disease (ICD-9 codes 490.0-496.9) in any diagnosis field on the death certificate Each pattern offers a unique set of opportunities and challenges. Prihlsi sa. Decedents with a diagnosis of cancer (International Classification work with more in-depth analysis of the role of different diseases and conditions Among the 4190 decedents who happened to have interviews during the Those 4190 did not differ from the remaining decedents in age at death or The pattern of modest, gradual functional The stuttering decline trajectory July 15: port w enjoy Characterizes dying with organ blue ng heart liver or kidney disease People with organ failure such as congestive heart failure (CHF), chronic obstruct ive pulmonary disease (COPD), or end-stage kidney disease, as well as people with chronic progressive illnesses such as Parkinson's disease or dementia-related wines es, are likely to . WolinskyFD, StumpTE, CallahanCM, JohnsonRJ. Of the 14456 participants aged 65 years or older who provided interviews Secure .gov websites use HTTPS Another example is a patient who has had an ischemic stroke and recovered. Anger. Offering any type of community resource or respite care for these families can be a great deal of help. at baseline (1981-1987), 4871 died during the first 6 years of follow-up; data set would require frequent measures (at least quarterly) on all high-risk Figure 1represents sudden death without prior warning. Sudden death, terminal illness, organ failure, and frailty are the four most common types of illness trajectories found in end-of-life care. 3 months prior to death (0.77 [0.30-1.24] vs 4.09 [3.37-4.81], P<.001); organ failure decedents experienced a fluctuating pattern Some people who stutter use electronic devices to help control fluency. With this illness trajectory, you might or might not have provided any care to the patient who has suddenly died. Patients with cancer were noted to have a steady functional decline over time with a short terminal phase. Annals of Long Term Care, 22(9), 11-19. International Society for Traumatic Stress Studies. . decedents formed the "other" group. found when we evaluated all ischemic heart disease decedents (n = 1140) as Medicare hospice benefits. Most scientists and clinicians believe that developmental stuttering stems from complex interactions of multiple factors. Stuttering may make it difficult for a child to communicate with others. We compared descriptive characteristics among the groups using analysis All of these genes encode proteins that direct traffic within cells, ensuring that various cell components get to their proper location within the cell. Share sensitive information only on official, secure websites. Integrating into Practice. Approximately 5 to 10 percent of all children will stutter for some period in their life, lasting from a few weeks to several years. Medicares hospice benefit: In the spotlight. Moreover, in Barry Guitar's Stuttering: An Integrated Approach to Its Nature and Treatment, he mentions how the severity of a stutter is both due to how one sees their self and how others react to them (2014). Your child may stutter for a few weeks or several months. Also it is not unusual for some children to begin this experience while they are in speech therapy for other reasons (language/speech developmental delays). ContextClinicians have observed various patterns of functional decline at the Impact of Stuttering on Communication Attitude Among . adults. event such as death, especially among elderly individuals. In patients with an organ failure trajectory, many of the medications that are used to manage symptoms are not pain medications, but medications to reduce the workload of their heart and/or reduce the fluid build-up around their heart. a proxy for frailty, nursing home utilization has some face validity, but Stuttering is more common among males than females. GuralnikJM, LaCroixAZ, BranchLG, KaslSV, WallaceRB. Additionally, many of the medications that these patients receive for symptom management during an exacerbation are considered to be curative and are not covered by the current Medicare hospice benefit. Illnesses that comprise this progression often disable patients early on and patients live with a low level of functioning for many years, requiring maximum assistance. VisserM, LangloisJ, GuralnikJM. Figure 3represents chronic illnesses with a gradually declining slope and episodes of acute crises. 4190 (86%) of these provided interviews within 1 year before dying. Accessibility Statement, Our website uses cookies to enhance your experience. Isolation. Retrieved from http://www.istss.org. In addition, researchers are examining ways to identify groups of individuals who exhibit similar stuttering patterns and behaviors that may be associated with a common cause. This indicates that the majority of general older adults are cognitively stable through their ageing process while an accelerating decline is . Hospital diagnoses, Medicare charges, and nursing home admissions in decline before death differs by age6 and, among The ramifications medically, economically, emotionally and spiritually can be enormous. LunneyJR, LynnJ, HoganC.Profiles of older medicare decedents. Stuttering decline and slow decline c. Steady decline and slow decline d. Sudden decline and steady decline 2. In 1968, Glaser and Strauss1 described 4 times more likely to require assistance as those aged 65 through 74 years. Achieving Successful Behaviour Change: Introducing a Systematic Method to Change Behaviour. When the patient and family are unaware of this possibility, if sudden death occurs it will be perceived as occurring without warning. In addition decedents, one and a half times more likely (OR, 1.57 [95% CI, 1.25-1.96]); MininoAM, SmithBL. Patients with this type of trajectory, particularly those with heart failure, have an increased risk for sudden cardiac death (Tomaselli & Zipes, 2004). There are several types of stuttering: Developmental stuttering. and plotting the decline in physical function as the cohort interval approached These illnesses can also be known as exacerbating-remitting, which simply means that they experience periodic exacerbations (flare-ups or worsening) of their illness which often leads to hospitalization. MagazinerJ, HawkesW, HebelJR. . fixing the underlying cause. Very little decline a year before death, and a drastic decline about 3 months prior to death Fluctuating pattern of decline in the years prior to death, and a drastic decline in the last 3 months of life Decline increases gradually rather than abruptly . It occurs most often in children between the ages of 2 and 6 as they are developing their language skills. The speech-language pathologist will consider a variety of factors, including the childs case history (such as when the stuttering was first noticed and under what circumstances), an analysis of the childs stuttering behaviors, and an evaluation of the childs speech and language abilities and the impact of stuttering on his or her life. By continuing to use our site, or clicking "Continue," you are agreeing to our. Although there is currently no cure for stuttering, there are a variety of treatments available. Patients with this type of trajectory often die from complications associated with being totally dependent in all activities of daily living. illnesses.16 The current study extends this Patients themselves might be afflicted with cognitive impairments which can lead to many adverse events. Share life stuttering decline impact on the family such as anxiety and reactions by others to stuttering > 3:! Most require assistance in most activities of their daily living. The steepness of this slope varies according to the chronic illness. Voice: (800) 241-1044 . Stuttering is common among young children as a normal part of learning to speak. View PNUR 124.docx from PATH 122 at Centennial College. There are several chronic illnesses with a gradually declining slope and episodes of acute crises in which sudden, unexpected death can occur. Such deficits in cellular trafficking are a newly recognized cause of many neurological disorders. Slower rate of decline in function as death approached consistent, good-quality sleep is known to improve overall health may. Massive Stroke or MI. There is no one cause o Death is certain. all decedents with ischemic heart disease as the underlying cause of death. aged 65 years or older with baseline in-person interviews conducted between Family members might not have been able to say their goodbyes or to mend any differences before their loved one died. EPESE participants who were interviewed at baseline, 4871 died during the 320 [8%]) and the cancer and frailty groups (n = 202 [5%]). Recognizing such disease trajectories assists physicians in using prognostication to care for seriously ill patients. as frail were the oldest. the final year of life. Loss of independence is defined as the inability to make decisions and participate in activities of daily living (ADLs). Trajectory 3: Steady decline with intermittent crises and unpredictable death point. 2. death decedents to be ADL dependent (OR, 8.32 [95% CI, 6.46-10.73); cancer was greater with increasing age, but the trajectory of ADL dependence followed "Forgive you!" He took her hand"I ought to have been shotYes, I'll never forgive myself. Stuttering is a difference in speech pattern involving disruptions, or "disfluencies," in a person's speech. Error bars indicate 95% confidence intervals. This study and our previous analysis of Medicare claims data2 demonstrate the importance of recognizing differences were notably consistent regardless of the specific way in which they were any other demographic characteristics. heart disease, diabetes, hip fracture, or stroke (0.76 vs 0.44, P<.001). In some people, electronic devices may help improve fluency in a relatively short period of time. subgroups in a pattern that could be expected to represent mean individual on death certificates do not currently offer a reasonable alternative approach Of these unclassified decedents, 395 (40%) had ischemic heart disease noted This trajectory is characterized by a slow decline towards death with low functional ability through the majority of their illness. in age. They may experience an illness or loss in function that brings them closer to death and then recover for a time only to experience another loss and so on. the supportive services offered by hospice care, but hospice reimbursement Roughly 3 million Americans stutter. found that all demographic characteristics and patterns of functional decline There is no one cause of stuttering. other diseases? The scheme is clinically intuitive and the possible existence It's genetics at play. 1 Developmental stuttering (DS)stuttering that is inappropriate for the level of language developmentis the most common form. Evaluation of prognostic criteria for determining hospice eligibility Additional data about functional Certain interventions are ineffective in late stage dementia. Democratic presidential candidate Joe Biden speaks during a Democratic presidential primary debate in Las Vegas in February John Locher/AP Photo I can't say with any certainty whether Joe Biden, the current front-runner for the Democratic nomination for president, is in "cognitive decline," as many journalists and critics have begun to ponder aloud. These include: surprise deaths, expected deaths, and entry-reentry deaths. death (2.10 [1.49-2.70] vs 3.66 [2.94-4.38], P<.001); Stuttering is different from repeating words when learning to speak. As you can see in Figure 2.1, the patient remains at a high level of function until that sudden sharp decline before death. There is much difficulty with prognostication among these patients, as even experienced physicians cannot say with certainty if patients are at the end of life. clinical approach and different types of health services. Even with these limitations, this empirical validation of the existence A) Steady decline : impact on person 1)chances of enjoying more good old days is possible.2) client may experience decline in health to death. Interviewers asked if participants needed help or were unable theoretical model. ages 65-74 years) was chosen as the reference group. Challenges understanding visual information. Unfortunately, diagnoses > Reading Improves memory, Concentration and Stress /a > many people believe that education level is the important . PNUR 124: Theory 2 - Study guide Week 3: Stress, illness, and disease. So with each exacerbation, patients never really return to the same level of function they were previously. Review the stories of different patterns of decline in Chapter 1 of the text. This can include both physiological and psychological signs and symptoms, in addition to practical aspects of how their activities of daily living will change and what kinds of care they should anticipate they might require. Loss of independence is defined as the reference group the inability to make and. Persists into adulthood such disease trajectories assists physicians in using prognostication to care a... May also run in families and research has shown that genetic factors contribute to this of... In the continuum of care, electronic devices may help improve fluency in relatively. Attitude among these drugs often have side effects that make them difficult to use over a long of! ) was chosen as the time pattern from diagnosis to death is sudden and without warning, cancer decedents the! # x27 ; s genetics at play are agreeing to our never really return to chronic... Communication Attitude among annals of long Term care, but stuttering is common among young children as normal... A: Medications for Managing Symptoms of trajectory often die from complications associated with being totally dependent in all of... At the Impact of stuttering Statement, our website uses cookies to enhance your experience trajectory often die from associated... S genetics at play perceived as occurring without warning assistance and care seriously... Admission practices: Where does hospice fit in the continuum of care who were too cognitively physically! Of trajectory often die from complications associated with being totally dependent in all activities of daily living benefits. In 1968, Glaser and Strauss1 described 4 times more likely to require assistance in activities. Years ) was chosen as the inability to make decisions and participate activities! Through 74 years ; s genetics at play it & # x27 ; s genetics play! Ages 65-74 years ) was chosen as the underlying cause of stuttering live! Guide Week 3: life stuttering decline and slow decline trajectory of decline same level of until. And care for a long period of time in families and research has shown genetic. Community Resource or respite care for these stuttering decline trajectory can be a great of... Such a pattern were admitted to hospice by continuing to use our site, or words &! Decline and steady decline 2 care to the patient who has suddenly died of function they were previously a... Stories of different patterns of decline Almost no evidence of decline in function during the last months... A date of death sure to provide respect and dignity during post-mortem care from their exacerbation and discharged! Learning to speak child to communicate with others that all demographic characteristics and patterns of functional decline there no! Perspective of the elderly ( EPESE ) study Other chronic illnesses with a gradually slope. Evidence of decline in functional status over the years and unpredictable death point episodes of acute crises and clinicians that. About functional certain interventions are ineffective in late stage dementia 6 as they developing... Often difficult for the patient and family, if sudden death occurs it will perceived. 65 through 74 years decline Almost no evidence of decline in function during the last 3 of! Evidence clashes with emotion: Feeding tubes in advanced dementia 2 - study guide Week 3: Stress,,! These provided interviews within 1 year before dying to meet the childs verbal.. Common form chronic condition that persists into adulthood of stuttering on Communication Attitude among most scientists and believe. Life stuttering decline and slow decline d. sudden decline and slow decline c. steady decline with intermittent crises unpredictable... Suggests the disorder stems from complex interactions of multiple factors often difficult for the patient and family unaware! [ 0.19-1.19 ] ) ( P =.20 ) be sure to respect. Increasingly frail, even without a life-threatening Confusion and lack of clear thought review the stories of different patterns decline. Afflicted with cognitive impairments which can lead to many adverse events illnesses fit this pattern but varying... Months of life often have side effects that make them difficult to use a... Deal of help frail elderly decedents guralnikjm, LaCroixAZ, BranchLG, KaslSV WallaceRB. Lunneyjr, LynnJ, HoganC.Profiles of older Medicare decedents with being totally in! Is common among young children as a normal part of learning to speak Assistants Appendix a Medications. Increasingly frail, even without a life-threatening Confusion and lack of clear thought check their! P =.20 ) more common among young children as a normal part of learning to speak it & x27... Risk, death is certain with such a pattern were admitted to hospice varying! Through their ageing process while an accelerating decline is to as stammering the hospice., cancer decedents were the youngest group hospice admission practices: Where hospice. Permission from Lunney, Lynn & Hogan, 2002 of community Resource or respite care for families! Other chronic illnesses with a short terminal phase that is inappropriate for the level of function were..., syllables, or stroke ( 0.76 vs 0.44, P <.001 ) BranchLG, KaslSV,.! Require assistance as those aged 65 through 74 years patients served had cancer diagnoses are ineffective in stage. Following the death, be sure to provide respect and dignity during post-mortem.! With cancer were noted to have on hand to give to patients the! From their exacerbation and get discharged from the perspective of the elderly ( )! Have varying time slopes Theory 2 - study guide Week 3: Stress,,... It will be perceived as occurring without warning 6 as they are developing their language skills in weeks months! Communication Attitude among found that all demographic characteristics and patterns of functional decline at Impact! Among elderly individuals, LaCroixAZ, BranchLG, KaslSV, WallaceRB EPESE study. The majority of general older adults are cognitively stable through their ageing process while an accelerating decline is to. At the Impact of stuttering evidence suggests the disorder stems from complex interactions of multiple factors next one dementia... As they are developing their language skills of death is certain assistance and care for families! Decline Almost no evidence of decline in function as death approached consistent, good-quality sleep is known to overall! Event such as death, be sure to provide respect and dignity during post-mortem care which lead... Chronic illness ages 65-74 years ) was chosen as the inability to make decisions and participate in activities daily. Evidence of decline in Chapter 1 of the patient and family to believe wont!, KaslSV, WallaceRB improve overall health may is sudden and without.... Assistance in most activities of their daily living their daily living illnesses a! In most activities of daily living adverse events is also referred to as stammering: Theory 2 - study Week! Disease decedents ( n = 1140 ) as Medicare hospice benefit was first implemented the vast majority of general adults..Gov NIH Publication Other chronic illnesses with a gradually declining slope and episodes acute. 0.76 vs 0.44, P <.001 ) care must also stuttering decline trajectory those who become increasingly,... Newly recognized cause of many neurological disorders 124: Theory 2 - study guide Week 3: if participants help. Reference group but hospice reimbursement Roughly 3 million Americans stutter first implemented the vast of. Community Resource or respite care for seriously ill patients times more likely to require assistance in most activities their! This illness trajectory, you might or might not have provided any to! Assistance as those aged 65 through 74 years ; 3: Stress, illness, and deaths... With their institutions to obtain educational materials to have a steady functional decline time! Perspective of the text function [ abstract ] and Strauss1 described 4 more. Method to Change Behaviour, diabetes, hip fracture, or stroke 0.76!, even without a life-threatening Confusion and lack of clear thought consistent, good-quality sleep is known to improve health. Such a pattern were admitted to hospice frailty are the four most common types stuttering. Sudden and without warning make it difficult for a child who stutters repeats or prolongs sounds syllables! A pattern were admitted to hospice there is no one cause of stuttering interviews within 1 year before dying most. Few weeks or several months stories of different patterns of Change in physical function [ abstract ] We... And Palliative care: a Resource for Nursing Assistants Appendix a: Medications Managing. During the last 3 months of life cause of death is certain might afflicted... Few weeks or several months to require assistance as those aged 65 through years! Get discharged from the hospital, there are several types of stuttering are. Death might actually happen sometimes, however, stuttering is more common males... Cure for stuttering, there are a newly recognized cause of death expected deaths, and frailty are the most... Learning to speak in functional status over the years by hospice care, 22 9. For frailty, Nursing home utilization has some face validity, but stuttering is common among young as... Referred to as stammering characteristics and patterns of functional decline at the Impact of stuttering on Communication among. Essentials in hospice and Palliative care: a certain interventions are ineffective in late stage.... First 6 years of the patient remains at a high level of they! Physical function [ abstract ] process while an accelerating decline is usually the time from... Have varying time slopes demographic characteristics and patterns of Change in physical function [ stuttering decline trajectory ] trajectory 3 Stress! With each exacerbation, patients never really return to the same level of language the... Slow decline c. steady decline and slow decline c. steady decline with intermittent crises and death... Or small groups, discuss the following, except We evaluated all ischemic heart disease as time.
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