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1.
J Child Adolesc Psychopharmacol ; 31(7): 464-474, 2021 09.
Article in English | MEDLINE | ID: covidwho-1429159

ABSTRACT

Objectives: To describe the development of a protocol and practical tool for the safe delivery of telemental health (TMH) services to the home. The COVID-19 pandemic forced providers to rapidly transition their outpatient practices to home-based TMH (HB-TMH) without existing protocols or tools to guide them. This experience underscored the need for a standardized privacy and safety tool as HB-TMH is expected to continue as a resource during future crises as well as to become a component of the routine mental health care landscape. Methods: The authors represent a subset of the Child and Adolescent Psychiatry Telemental Health Consortium. They met weekly through videoconferencing to review published safety standards of care, existing TMH guidelines for clinic-based and home-based services, and their own institutional protocols. They agreed on three domains foundational to the delivery of HB-TMH: environmental safety, clinical safety, and disposition planning. Through multiple iterations, they agreed upon a final Privacy and Safety Protocol for HB-TMH. The protocol was then operationalized into the Privacy and Safety Assessment Tool (PSA Tool) based on two keystone medical safety constructs: the World Health Organization (WHO) Surgical Safety Checklist/Time-Out and the Checklist Manifesto. Results: The PSA Tool comprised four modules: (1) Screening for Safety for HB-TMH; (2) Assessment for Safety During the HB-TMH Initial Visit; (3) End of the Initial Visit and Disposition Planning; and (4) the TMH Time-Out and Reassessment during subsequent visits. A sample workflow guides implementation. Conclusions: The Privacy and Safety Protocol and PSA Tool aim to prepare providers for the private and safe delivery of HB-TMH. Its modular format can be adapted to each site's resources. Going forward, the PSA Tool should help to facilitate the integration of HB-TMH into the routine mental health care landscape.


Subject(s)
Adolescent Health Services/organization & administration , COVID-19 , Child Health Services/organization & administration , Clinical Protocols/standards , Home Care Services , Mental Health Services/organization & administration , Patient Safety , Privacy , Telemedicine , Adolescent , COVID-19/epidemiology , COVID-19/prevention & control , Child , Computer Communication Networks/standards , Delivery of Health Care/methods , Delivery of Health Care/organization & administration , Home Care Services/ethics , Home Care Services/standards , Home Care Services/trends , Humans , SARS-CoV-2 , Telemedicine/ethics , Telemedicine/methods , United States
2.
Actas Dermosifiliogr (Engl Ed) ; 112(2): 127-133, 2021 Feb.
Article in English, Spanish | MEDLINE | ID: covidwho-1384814

ABSTRACT

Teledermatology is now fully incorporated into our clinical practice. However, after reviewing current legislation on the ethical aspects of teledermatology (data confidentiality, quality of care, patient autonomy, and privacy) as well as insurance and professional responsibility, we observed that a specific regulatory framework is still lacking and related legal aspects are still at a preliminary stage of development. Safeguarding confidentiality and patient autonomy and ensuring secure storage and transfer of data are essential aspects of telemedicine. One of the main topics of debate has been the responsibilities of the physicians involved in the process, with the concept of designating a single responsible clinician emerging as a determining factor in the allocation of responsibility in this setting. A specific legal and regulatory framework must be put in place to ensure the safe practice of teledermatology for medical professionals and their patients.


Subject(s)
Confidentiality , Dermatology , Telemedicine , COVID-19/epidemiology , Computer Security/ethics , Computer Security/legislation & jurisprudence , Confidentiality/ethics , Confidentiality/legislation & jurisprudence , Dermatology/ethics , Dermatology/legislation & jurisprudence , Emergencies , European Union , Humans , Informed Consent/legislation & jurisprudence , Insurance, Liability/legislation & jurisprudence , Pandemics , Personal Autonomy , SARS-CoV-2 , Spain , Telemedicine/ethics , Telemedicine/legislation & jurisprudence
3.
J Am Geriatr Soc ; 69(10): 2759-2765, 2021 10.
Article in English | MEDLINE | ID: covidwho-1365085

ABSTRACT

Telecommunication assisted forensic assessments of capacity and mistreatment by geriatricians with expertise in elder abuse and self-neglect are helping to meet the demand for such forensic services for Adult Protective Services (APS) clients in remote and underserved areas of Texas. The use of synchronous audiovisual assisted interviews instead of in-person interviews with clients to provide capacity assessments has become more important with the arrival of the COVID-19 pandemic. There is growing interest in establishing similar programs in other states using geriatrician faculty from medical schools to serve the clients of their state Adult Protective Services agencies. The arrangement between APS and the geriatricians at McGovern Medical School in Houston, Texas is novel. The structure of the arrangement is important for the success of the program. Legal, ethical, and practical considerations are discussed in this article, including approaches to the Health Insurance Portability and Accountability Act, physician liability, state law, and resource limitations. It is hoped that sharing how one such collaboration has addressed these important issues will suggest approaches for the structuring of similar programs.


Subject(s)
COVID-19 , Elder Abuse , Forensic Medicine , Geriatric Assessment/methods , Telemedicine , Aged , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control/methods , Elder Abuse/diagnosis , Elder Abuse/ethics , Elder Abuse/legislation & jurisprudence , Elder Abuse/prevention & control , Forensic Medicine/ethics , Forensic Medicine/legislation & jurisprudence , Forensic Medicine/methods , Humans , Organizational Innovation , Program Evaluation , SARS-CoV-2 , Telecommunications/organization & administration , Telemedicine/ethics , Telemedicine/legislation & jurisprudence , Telemedicine/methods , United States/epidemiology , Vulnerable Populations
5.
J Anal Psychol ; 66(3): 484-505, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1299068

ABSTRACT

Given the contemporary situation of many analysts in the world now being forced to work online due to the effects of the COVID-19 pandemic, it is important to review the working online issue. Substantial debate over previous years has questioned whether a genuine analytic process can unfold through online work. This debate is reviewed with the conclusion that such a process is not necessarily precluded. Research outcomes are then reviewed to highlight those things that can facilitate positive outcomes when working online. These cover the 'online disinhibition effect', the therapeutic alliance, particular ways of using the screen, focussing on trauma, the importance of self-awareness, knowing the predictors of mental health, certain potential positives of isolation/quarantine and psychotherapy interventions that may be currently needed. Final recommendations and suggestions are then presented as in the diagnosis issue, professional development and guidelines to do with practical and ethical considerations.


Subject(s)
COVID-19 , Physical Distancing , Psychoanalytic Therapy , Telecommunications , Telemedicine , Therapeutic Alliance , Humans , Psychoanalytic Therapy/ethics , Psychoanalytic Therapy/standards , Telecommunications/ethics , Telecommunications/standards , Telemedicine/ethics , Telemedicine/standards
6.
Rev Clin Esp (Barc) ; 221(7): 408-410, 2021.
Article in English | MEDLINE | ID: covidwho-1233597

ABSTRACT

The health emergency in Spain caused by COVID-19 was of such a magnitude that on March 14, 2020, a state of alarm was declared that lasted for more than three months. This ongoing pandemic has affected a vast number of people. Among the measures taken to reduce the risk of contagion, visits to health centers have been reduced and virtual consultations have increased. Once the pandemic ends, it will be necessary to consider whether telemedicine should be limited to periods of health crises or whether it could become a new way of practicing medicine. Telemedicine lacks specific regulations and has loopholes that leave physicians with a considerable degree of insecurity. This article analyzes the limits, precautions, and legal standards of the use of telemedicine.


Subject(s)
COVID-19 , Telemedicine/ethics , Telemedicine/legislation & jurisprudence , Forecasting , Humans , Spain
7.
Clin Obstet Gynecol ; 64(2): 392-397, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1203758

ABSTRACT

While telemedicine had been utilized in varying ways over the last several years, it has dramatically accelerated in the era of the COVID-19 pandemic. In this article we describe the privacy issues, in relation to the barriers to care for health care providers and barriers to the obstetric patient, licensing and payments for telehealth services, technological issues and language barriers. While there may be barriers to the use of telehealth services this type of care is feasible and the barriers are surmountable.


Subject(s)
Communication Barriers , Health Services Accessibility , Obstetrics , Privacy , Telemedicine , Female , Health Insurance Portability and Accountability Act , Health Services Accessibility/ethics , Health Services Accessibility/legislation & jurisprudence , Health Services Accessibility/organization & administration , Humans , Internet , Licensure , Obstetrics/ethics , Obstetrics/legislation & jurisprudence , Obstetrics/methods , Obstetrics/organization & administration , Pregnancy , Privacy/legislation & jurisprudence , Technology , Telemedicine/ethics , Telemedicine/legislation & jurisprudence , Telemedicine/methods , Telemedicine/organization & administration , United States
8.
Ann Clin Psychiatry ; 33(2): e8-e12, 2021 05.
Article in English | MEDLINE | ID: covidwho-1194815

ABSTRACT

BACKGROUND: In representative cases of Munchausen by internet (MBI), an individual (or "poser") goes online to falsely report or exaggerate illnesses or life crises. The principal goal, as in factitious disorder imposed on self or another, is to garner emotional satisfaction. We provide the first evidence that MBI can target a specific type of health care provider-in this case, birthing doulas. METHODS: We describe 5 cases in which individuals have utilized social media platforms to report factitious perinatal illnesses and crises, including neonatal death, in real time. Current health headlines, such as those involving the COVID-19 pandemic, can be relevant to the ruses. Posers can engage in deceptions with several health care professionals concurrently or serially, and may portray multiple people ("sock puppets") at the same time. RESULTS: MBI has consequences that can be highly disruptive. In the cases highlighted in this report, many hours of support were given to individuals who had fabricated their pregnancies, infants, and perinatal complications. The doulas experienced feelings ranging from resignation to anger and betrayal. CONCLUSIONS: Health care professionals of all types who offer services online should be vigilant to the risks of potential MBI.


Subject(s)
COVID-19 , Deception , Doulas , Factitious Disorders , Internet Use , Malingering , Munchausen Syndrome , Telemedicine , Adult , COVID-19/psychology , Communication , Doulas/ethics , Doulas/psychology , Emotional Abuse , Factitious Disorders/diagnosis , Factitious Disorders/psychology , Female , Help-Seeking Behavior , Humans , Munchausen Syndrome/diagnosis , Munchausen Syndrome/epidemiology , Munchausen Syndrome/psychology , Perinatal Care , Telemedicine/ethics , Telemedicine/methods
9.
J Med Internet Res ; 23(3): e25698, 2021 03 30.
Article in English | MEDLINE | ID: covidwho-1158315

ABSTRACT

BACKGROUND: As the use of technology to deliver health services is increasing rapidly and has further intensified during the COVID-19 pandemic, these initiatives may fail if ethical impacts are not fully identified and acted upon by practitioners. Ignoring the ethical impacts of information and communication technology health service delivery creates an unintended risk for patients and can lead to reduced effectiveness, noncompliance, and harm, undermining the best intentions of governments and clinicians. OBJECTIVE: Our aim was to explore how ethical considerations or impacts may be different, greater, or more variable in information and communication technology methods versus face-to-face health care delivery models, and how they may be applied in practice. METHODS: We undertook a systemic literature review to provide a critical overview of existing research into the incorporation of ethical principles into telehealth practice. Six databases were searched between March 2016 to May 2016 and again in December 2020 to provide the benefit of currency. A combination of broad terms ("ethics," "ethical," "health," and "care") with the restrictive terms of "telehealth" and "telemedicine" was used in keyword searches. Thematic analysis and synthesis of each paper was conducted, aligned to the framework developed by Beauchamp and Childress. RESULTS: From the 49 papers reviewed, authors identified or discussed the following ethical principles in relation to telehealth practice: autonomy (69% of authors, 34/49), professional-patient relationship (53% of authors, 26/49), nonmaleficence (41% of authors, 20/49), beneficence (39%, of authors, 19/49), and justice (39% of authors, 19/49). CONCLUSIONS: Although a small number of studies identified ethical issues associated with telehealth practice and discussed their potential impact on service quality and effectiveness, there is limited research on how ethical principles are incorporated into clinical practice. Several studies proposed frameworks, codes of conduct, or guidelines, but there was little discussion or evidence of how these recommendations are being used to improve ethical telehealth practice.


Subject(s)
COVID-19 , Delivery of Health Care , Disease Outbreaks , SARS-CoV-2 , Telemedicine/ethics , Ethics, Medical , Humans
10.
Support Care Cancer ; 29(8): 4195-4198, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1156946

ABSTRACT

Breaking bad news is a mandatory provision in the professional life of nearly every physician. One of its most frequent occasions is the diagnosis of malignancy. Responding to the recipients' emotions is a critical issue in the delivery of unsettling information, and has an impact on the patient's trust in the treating physician, adjustment to illness and ultimately treatment. Since the World Health Organization (WHO) declared COVID-19 a pandemic on March 11, 2020, several measures of social distancing and isolation have been introduced to our clinical setting. In the wake of these restrictions, it is important to reexamine existing communication guidelines to determine their applicability to face-to-face counseling in the context of social distancing, as well as to new communication technologies, such as telemedicine. We address these issues and discuss strategies to convey bad news the most empathetic and comprehensible way possible.


Subject(s)
COVID-19 , Neoplasms/psychology , Physical Distancing , Physician-Patient Relations/ethics , Telemedicine , Truth Disclosure , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Emotional Intelligence , Humans , Neoplasms/diagnosis , Physicians/ethics , Physicians/psychology , Psycho-Oncology/methods , SARS-CoV-2 , Telemedicine/ethics , Telemedicine/methods , Telemedicine/standards
11.
Camb Q Healthc Ethics ; 30(1): 37-41, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1047908

ABSTRACT

The COVID-19 pandemic has necessitated a rapid escalation in the use of telepsychiatry. Herein we revisit some of the ethical issues regarding its use, including patient benefice, distributive justice, privacy, and autonomy. Based on these considerations we would hold that telepsychiatry is a vital aspect of providing psychiatric care, and ethically should be offered as a format for treatment, likely beyond the pandemic period. Investigative and advocacy efforts will need to continue to determine its exact role within psychiatric care, and expand its availability for those most in need.


Subject(s)
COVID-19 , Psychiatry , Telemedicine/ethics , Humans , Personal Autonomy , Privacy , SARS-CoV-2 , Social Justice
13.
Semergen ; 47(2): 122-130, 2021 Mar.
Article in Spanish | MEDLINE | ID: covidwho-997527

ABSTRACT

Public health emergencies, such as the current SARS-CoV-2 coronavirus pandemic, have led to tragic resource constraints that prevent lives from being saved. This has led to tensions in patient-centered care as the backbone of the system in normal conditions and the same care in emergencies originating in the COVID-19. In this review we address some of the healthcare, organizational and ethical problems that this scenario has caused in primary care such as: cancellation of programmed activities; scarce home care and follow-up of elderly, chronically ill and immobilized patients; shortage of PPE and the exposure to risk of healthcare professionals, and finally the problems associated with telemedicine and telephone attention to patients.


Subject(s)
COVID-19/prevention & control , Health Care Rationing/ethics , Health Services Accessibility/ethics , Infection Control/methods , Primary Health Care/ethics , Telemedicine/ethics , COVID-19/epidemiology , Health Care Rationing/methods , Health Care Rationing/organization & administration , Health Services Accessibility/organization & administration , Health Services for the Aged/ethics , Health Services for the Aged/organization & administration , Humans , Infection Control/instrumentation , Infection Control/organization & administration , Pandemics , Personal Protective Equipment/supply & distribution , Primary Health Care/methods , Primary Health Care/organization & administration , Quality of Health Care/ethics , Quality of Health Care/organization & administration , Spain/epidemiology , Telemedicine/methods , Telemedicine/organization & administration
14.
Clin Dermatol ; 39(1): 45-51, 2021.
Article in English | MEDLINE | ID: covidwho-987300

ABSTRACT

Dermatology is a clinical and visual discipline, which makes it the quintessential medical specialty for spot diagnosis and telemedicine. The COVID-19 pandemic has led to an unprecedented worldwide renaissance of teledermatology (TD). It has helped deliver high-quality medical care, while protecting the medical personnel and vulnerable patients from potential infection. Examining a patient from a distance through digital photography has many drawbacks, including lack of physical touch, difficulties in performing full body examinations, and several legal and ethical issues. We summarize have summarized the more common pitfalls and highlight the key aspects of direct patient-to-physician TD. Basic practical advice includes the use of TD for obtaining patient history, examining patient-captured photographs for inflammatory skin disease, and skin cancer screening.


Subject(s)
COVID-19/prevention & control , Dermatitis/diagnostic imaging , Dermatology/methods , Skin Neoplasms/diagnostic imaging , Telemedicine/methods , COVID-19/epidemiology , Dermatology/ethics , Dermatology/legislation & jurisprudence , Early Detection of Cancer/methods , Humans , Medical History Taking , Office Visits , Photography/standards , Telemedicine/ethics , Telemedicine/legislation & jurisprudence
15.
Int J Med Inform ; 143: 104239, 2020 11.
Article in English | MEDLINE | ID: covidwho-912242

ABSTRACT

BACKGROUND: Information technologies have been vital during the COVID-19 pandemic. Telehealth and telemedicine services, especially, fulfilled their promise by allowing patients to receive advice and care at a distance, making it safer for all concerned. Over the preceding years, professional societies, governments, and scholars examined ethical, legal, and social issues (ELSI) related to telemedicine and telehealth. Primary concerns evident from reviewing this literature have been quality of care, access, consent, and privacy. OBJECTIVES: To identify and summarize ethical, legal, and social issues related to information technology in healthcare, as exemplified by telehealth and telemedicine. To expand on prior analyses and address gaps illuminated by the COVID-19 experience. To propose future research directions. METHODS: Literature was identified through searches, forward and backward citation chaining, and the author's knowledge of scholars and works in the area. EU and professional organizations' guidelines, and nineteen scholarly papers were examined and categories created to identify ethical, legal, and social issues they addressed. A synthesis matrix was developed to categorize issues addressed by each source. RESULTS: A synthesis matrix was developed and issues categorized as: quality of care, consent and autonomy, access to care and technology, legal and regulatory, clinician responsibilities, patient responsibilities, changed relationships, commercialization, policy, information needs, and evaluation, with subcategories that fleshed out each category. The literature primarily addressed quality of care, access, consent, and privacy. Other identified considerations were little discussed. These and newer concerns include: usability, tailoring services to each patient, curriculum and training, implementation, commercialization, and licensing and liability. The need for interoperability, data availability, cybersecurity, and informatics infrastructure also is more apparent. These issues are applicable to other information technologies in healthcare. CONCLUSIONS: Clinicians and organizations need updated guidelines for ethical use of telemedicine and telehealth care, and decision- and policy-makers need evidence to inform decisions. The variety of newly implemented telemedicine services is an on-going natural experiment presenting an unparalleled opportunity to develop an evidence-based way forward. The paper recommends evaluation using an applied ethics, context-sensitive approach that explores interactions among multiple factors and considerations. It suggests evaluation questions to investigate ethical, social, and legal issues through multi-method, sociotechnical, interpretive and ethnographic, and interactionist evaluation approaches. Such evaluation can help telehealth, and other information technologies, be integrated into healthcare ethically and effectively.


Subject(s)
COVID-19 , Medical Informatics/ethics , Medical Informatics/legislation & jurisprudence , Telemedicine/ethics , Telemedicine/legislation & jurisprudence , Computer Security , Delivery of Health Care/methods , Humans , Pandemics , Privacy , SARS-CoV-2
16.
Int J Clin Pract ; 75(1)2021 Jan.
Article in English | MEDLINE | ID: covidwho-780893

ABSTRACT

BACKGROUND: At the end of 2019, a novel coronavirus (COVID-19) was identified in China. The high potential of human-to-human transmission led to subsequent COVID-19 global pandemic. Public health strategies including reduced social contact and lockdown have been adopted in many countries. Nonetheless, social distancing and isolation could also represent risk factors for mental disorders, resulting in loneliness, reduced social support and under-detection of mental health needs. Along with this, social distancing determines a relevant obstacle for direct access to psychiatric care services. The pandemic generates the urgent need for integrating technology into innovative models of mental healthcare. AIMS: In this paper, we discuss the potential role of telepsychiatry (TP) and other cutting-edge technologies in the management of mental health assistance. We narratively review the literature to examine the advantages and risks related to the extensive application of these new therapeutic settings, along with the possible limitations and ethical concerns. RESULTS: Telemental health services may be particularly feasible and appropriate for the support of patients, family members and healthcare providers during this COVID-19 pandemic. The integration of TP with other technological innovations (eg, mobile apps, virtual reality, big data and artificial intelligence (AI)) opens up interesting future perspectives for the improvement of mental health assistance. CONCLUSION: Telepsychiatry is a promising and growing way to deliver mental health services but is still underused. The COVID-19 pandemic may serve as an opportunity to introduce and promote, among numerous mental health professionals, the knowledge of the possibilities offered by the digital era.


Subject(s)
COVID-19/psychology , Mental Disorders/therapy , Psychiatry/methods , Psychotherapy/methods , Telemedicine , Artificial Intelligence , Delivery of Health Care/methods , Family/psychology , Health Personnel/psychology , Humans , Mental Disorders/virology , Mental Health Services/ethics , Mobile Applications , Privacy , SARS-CoV-2 , Telemedicine/ethics , Virtual Reality
17.
Actas Dermosifiliogr (Engl Ed) ; 111(10): 815-821, 2020 Dec.
Article in English, Spanish | MEDLINE | ID: covidwho-758464

ABSTRACT

Teledermatology has facilitated specialist care during the crisis caused by the coronavirus disease 2019 pandemic, eliminating unnecessary office visits and the possible exposure of patients or dermatologists. However, teledermatology brings forward certain ethical and medicolegal questions. A medical consultation in which the patient is not physically present is still a medical act, to which all the usual ethical and medicolegal considerations and consequences apply. The patient's right to autonomy and privacy, confidentiality, and data protection must be guaranteed. The patient must agree to remote consultation by giving informed consent, for which a safeguard clause should be included. Well-defined practice guidelines and uniform legislation are required to preserve the highest level of safety for transferred data. Adequate training is also needed to prevent circumstances involving what might be termed «telemalpractice¼.


Subject(s)
COVID-19/epidemiology , Pandemics , SARS-CoV-2 , Telemedicine , Checklist , Confidentiality , Delivery of Health Care/legislation & jurisprudence , Dermatology/ethics , Dermatology/legislation & jurisprudence , Dermatology/methods , Evidence-Based Medicine , Humans , Informed Consent , Malpractice , Patient Acceptance of Health Care , Personal Autonomy , Spain/epidemiology , Telemedicine/ethics , Telemedicine/legislation & jurisprudence , Telemedicine/methods
20.
Br J Sports Med ; 54(19): 1162-1167, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-627549

ABSTRACT

BACKGROUND: The COVID-19 pandemic forces sport and exercise medicine (SEM) physicians to think differently about the clinical care of patients. Many rapidly implement eHealth and telemedicine solutions specific to SEM without guidance on how best to provide these services. AIM: The aim of this paper is to present some guiding principles on how to plan for and perform an SEM consultation remotely (teleSEM) based on a narrative review of the literature. A secondary aim is to develop a generic teleSEM injury template. RESULTS: eHealth and telemedicine are essential solutions to effective remote patient care, also in SEM. This paper provides guidance for wise planning and delivery of teleSEM. It is crucial for SEM physicians, technology providers and organisations to codesign teleSEM services, ideally involving athletes, coaches and other clinicians involved in the clinical care of athletes, and to gradually implement these services with appropriate support and education. CONCLUSION: teleSEM provides solutions for remote athlete clinical care during and after the COVID-19 pandemic. We define two new terms-eSEM and teleSEM and discuss guiding principles on how to plan for and perform SEM consultations remotely (teleSEM). We provide an example of a generic teleSEM injury assessment guide.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Sports Medicine/methods , Telemedicine/methods , COVID-19 , Decision Making, Shared , Electronic Health Records , Humans , Pandemics , Patient Selection , Physical Examination , Practice Guidelines as Topic , Remote Consultation/methods , Remote Consultation/organization & administration , SARS-CoV-2 , Sports Medicine/organization & administration , Telemedicine/ethics , Telemedicine/organization & administration , Terminology as Topic
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