Latest / Morning Medical with Dr. Chow / Massage Gun Safety, Pediatric Obesity, and Cognitive Resilience

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Massage Gun Safety, Pediatric Obesity, and Cognitive Resilience · Morning Medical with Dr. Chow

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  Welcome to "Morning Medical with Doctor Chow," your daily update on the latest in medical and
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  health news from around the globe.
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  I'm your host, Doctor Chi-Ming Chow, a cardiologist based in Toronto, Canada.
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  Today, we're delving into a rather surprising case study involving the use of percussive
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  massage guns and the potential dangers they may pose, especially when misused.
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  The popularity of percussive massage guns has been on the rise, touted for their ability to
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  relieve muscle soreness and tension.
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  However, a recent case study published in BMJ Case Reports highlights a hidden danger
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  associated with these devices.
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  The case involves a young student in his twenties who experienced alarming symptoms in
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  his eyes after using a massage gun.
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  Initially, he reported seeing flashing lights and floaters in his right eye for six days.
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  Notably, he had no prior history of eye disorders or trauma.
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  Upon examination at the Princess Alexandra Eye Pavilion in Edinburgh, Scotland, doctors Niamh
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  O'Connell and Ashraf Khan discovered multiple retinal tears and retinal whitening, known as
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  commotio retinae, in his right eye, along with retinal detachment.
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  His left eye also showed signs of damage, with several small retinal tears present.
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  These findings prompted further questioning, which led to the revelation that the patient
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  had been using a massage gun directly on his eyes for several minutes at a time over a
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  period of three months.
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  The case study authors noted that the unusual location of the retinal detachment, known as
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  superior temporal retinal dialysis, was likely due to the direct application of the massage
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  gun to the eye.
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  This differs from more common blunt trauma injuries, which typically affect other parts of
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  the eye.
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  The patient underwent treatment involving retinal laser therapy to seal off the tears and
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  damaged blood vessels, and barrier laser therapy for the detachment.
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  The authors of the study, O'Connell and Khan, highlighted that while this case is concerning,
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  it is not isolated.
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  They referenced two other cases of significant vision impairment linked to massage gun use and
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  a case of traumatic cataract.
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  Despite their growing popularity, the safety profile of percussive massage guns remains
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  poorly understood, particularly regarding their use near sensitive areas such as the eyes.
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  An important takeaway from this case is the need for awareness and caution when using
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  massage guns.
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  The student in this case was unaware of any warnings against ocular use in the product's
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  instructions, highlighting a potential gap in consumer safety information.
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  As these devices become more common in households, ensuring that users are informed
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  about their proper use and potential risks is crucial to prevent such serious injuries.
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  Let's shift our focus to an important topic in pediatric obesity management.
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  Recently, a systematic review and network meta-analysis published in JAMA Pediatrics has
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  shed light on the significance of combining lifestyle treatments with medications for
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  managing obesity in children and teenagers.
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  This study explored various interventions and their effectiveness in reducing body mass
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  index, also known as BMI, and other obesity-related outcomes.
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  The study found that combining the GLP-1 receptor agonist semaglutide with counseling
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  was particularly effective, resulting in significant reductions in both BMI and BMI z
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  score.
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  However, it is crucial to note that this conclusion was drawn from a single trial with a
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  relatively small number of participants, so the certainty of this evidence is considered
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  moderate.
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  Nonetheless, it points to the potential of semaglutide when paired with counseling.
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  Interestingly, the study also highlighted the effectiveness of lifestyle treatments alone,
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  such as counseling and health behavior and lifestyle treatment, in achieving substantial
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  decreases in BMI and BMI z score compared to no structured weight management plan.
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  This reinforces the idea that lifestyle treatments should form the backbone of any
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  pediatric obesity intervention strategy.
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  The research encompassed 42 randomized trials with a total of 3,835 participants,
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  predominantly from North America.
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  It examined a variety of treatments, including pharmacological interventions like GLP-1
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  receptor agonists—such as liraglutide, semaglutide, dulaglutide, and exenatide—as well
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  as other medications like orlistat, phentermine-topiramate, and metformin.
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  The study found that while pharmacotherapy combined with lifestyle treatments showed the
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  greatest efficacy, lifestyle treatment alone still produced significant results.
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  The authors of the study emphasize the urgent need for effective prevention and intervention
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  strategies, given the increasing prevalence of obesity and its associated health risks, such
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  as type 2 diabetes and cardiovascular disease.
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  They also noted that direct comparisons between different therapies are scarce, which
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  highlights an area for future research.
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  It's important to mention the limitations of the study, as the findings for newer drugs like
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  GLP-1 agonists and phentermine-topiramate were based on a limited number of trials with small
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  sample sizes.
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  Additionally, factors such as the components, duration, and intensity of lifestyle programs
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  varied, potentially influencing the outcomes.
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  Despite these limitations, the study provides valuable insights into the management of
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  pediatric obesity.
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  Today, we're diving into fascinating research on "super movers," a term used to describe
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  adults aged 80 and older who walk as fast as people 30 years younger.
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  This intriguing group appears to show signs of exceptional brain aging, with a lower risk of
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  cognitive impairment compared to their peers.
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  The concept of "super movers" was introduced by Doctor Joe Verghese and his colleagues at the
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  Renaissance School of Medicine at Stony Brook University in New York.
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  They examined data from several studies, including the Health and Retirement Study
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  International Network of Studies, the LonGenity study, and the Rush Memory and Aging Project.
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  What they found was that these super movers had about half the risk of cognitive impairment
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  compared to non-super movers over several years of follow-up.
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  One of the key insights from this research is that super movers tend to have a lower burden
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  of disease, healthier lifestyles, and potentially a younger biological age.
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  This suggests that their mobility might reflect a broad resilience across various systems,
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  including the brain, cardiovascular system, and muscles.
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  Essentially, walking speed seems to be a good indicator of overall health and resilience in
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  later life.
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  In the LonGenity study, super movers not only showed slower cognitive decline but also had
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  preserved hippocampal volume in specific subfields of the brain.
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  This is significant because the hippocampus plays a crucial role in memory and cognition.
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  Autopsy data from the Rush Memory and Aging Project further supported these findings,
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  indicating that super movers had better cognition before they passed away and a lower
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  incidence of clinically diagnosed Alzheimer's disease and other dementias.
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  Doctor Verghese pointed out that most aging research focuses on risk factors for cognitive
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  decline, but their study looked at the other end of the spectrum—individuals who age
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  exceptionally well.
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  Understanding how these super movers maintain both mobility and cognition into their later
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  years could help identify factors that promote cognitive resilience.
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  The study also highlighted some limitations.
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  While the definition of super movers was based on gait speed, other measurements like step
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  variability could offer additional insights into the relationship between gait and
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  cognition.
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  Moreover, the Rush cohort had a high prevalence of super movers, which could be due to certain
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  biases, such as participants being more health-conscious and highly educated.
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  Despite these limitations, the research provides valuable insights into how exceptional
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  brain aging occurs and underscores the importance of maintaining mobility as we age.
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  It suggests that a combination of favorable biology, preserved brain health, and lifelong
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  healthy behaviors may contribute to this remarkable aging phenotype.
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  In our final segment today, we're exploring a significant trend in healthcare communication
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  that has emerged over the past few years—the remarkable increase in patient portal
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  messaging.
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  This shift signifies a substantial change in how physicians deliver care, and it's something
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  that both healthcare providers and patients are adjusting to.
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  A national analysis of electronic health record data, as reported by Kristina Fiore from
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  MedPage Today, reveals that patient portal messages have surged dramatically since 2020.
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  Specifically, the number of patient-authored messages increased from just under one message
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  per patient per year in 2020 to two and a half messages per patient per year by 2025.
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  This represents a more than 150% increase, highlighting a new modality in
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  patient-physician communication.
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  This increase in messaging reflects a broader structural change in how care is delivered.
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  As noted by editorialists, health systems now face the challenge of adapting to this new
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  reality.
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  They suggest that healthcare providers should allocate specific time for inbox management
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  within clinicians' schedules to handle the increased volume of messages.
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  The analysis, led by Doctor Michal Mankowski and colleagues at the New York University
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  Grossman School of Medicine, utilized data from Epic Cosmos, examining over two thousand
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  hospitals and more than forty-seven thousand clinics.
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  Their findings show not only the rise in patient messages but also a slight decrease in
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  telephone encounters and a modest increase in office visits over the same period.
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  Interestingly, while telehealth visits surged during the COVID-19 pandemic, they accounted
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  for a smaller fraction of visits by 2025.
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  This suggests that while patient portal messaging has increased, it doesn't fully
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  replace other forms of communication, such as office visits or phone calls.
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  The editorialists, including Doctor Melanie Molina from the University of California San
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  Francisco and Doctor Joseph Ross from Yale School of Medicine, emphasize the operational
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  implications of this shift.
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  They argue that without proper adjustments, there's a risk of increasing clinician
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  workload, potentially leading to burnout.
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  It's crucial for health systems to integrate asynchronous care effectively and ensure that
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  clinicians have the resources needed to manage this communication volume.
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  Doctor Robert Doolan from the University of Colorado Anschutz has studied the impact of
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  portal messaging on primary care and highlighted the importance of scheduling
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  dedicated time for message management.
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  This approach not only improves productivity but also helps mitigate burnout by ensuring
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  that clinicians can manage their workloads more efficiently.
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  Finally, Doctor Yanjun Gao, also from the University of Colorado Anschutz, suggests that
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  while scheduling time for message management is important, additional strategies such as inbox
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  triage and the use of artificial intelligence to draft responses could further ease the
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  burden on physicians.
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  These innovations could help streamline workflows and ensure that patient queries are
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  addressed promptly and effectively.
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  As we wrap up today's episode, it's clear that the rise in patient portal messaging is
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  reshaping the landscape of healthcare communication.
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  It underscores the need for healthcare systems to adapt and evolve, ensuring that clinicians
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  can continue to provide high-quality care without being overwhelmed.
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  Thank you for tuning in to "Morning Medical with Doctor Chow." I hope you found today's
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  topics insightful.
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  Until next time, stay informed and stay healthy.