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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_422"
                     title="Nurses Often Silent About Workplace Violence (CME/CE)"
                     score="0.012"
                     href="http://www.medpagetoday.com/HospitalBasedMedicine/WorkForce/tb/18335?impressionId=1265820001279"
                     
      The physical and verbal abuse nurses face on the job often goes unreported, according to an Australian survey.&lt;br&gt;
&lt;br&gt;Over the prior year, 52% of nurses in one community hospital said they had been physically assaulted and 69% reported being threatened with violence, according to Rose Chapman, PhD, of the University of Western Australia in Perth, and colleagues.&lt;br&gt;
&lt;br&gt;Verbal abuse was almost universal, being reported by 92% of respondents, the researchers wrote in the February issue of the &lt;em&gt;Journal of Clinical Nursing&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;However, only half mentioned the incidents to senior staff or co-workers, and just 16% filed an official report.&lt;br&gt;
&lt;br&gt;&quot;The reasons for not reporting are many and may include lack of time and management support and the belief that being attacked is &apos;just part of the job,&apos;&quot; they wrote.&lt;br&gt;
&lt;br&gt;The same is true in the U.S., where assaults and under-reporting appear just as common as suggested in the Australian survey, commented Kathleen M. McPhaul, PhD, RN, MPH, of the University of Maryland School of Nursing in Baltimore, who has been involved in such research in the U.S.&lt;br&gt;
&lt;br&gt;A culture change would likely be needed to make a real difference for nurses, Chapman&apos;s group suggested.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;Hospitals would have to ensure that nurses have necessary support, education, encouragement, and time to complete official reports. Nurses who report abuse should get positive feedback from all levels of nursing, they said.&lt;/p&gt;
&lt;p&gt;&quot;If administrators and governments are serious in their intention to reduce workplace violence and provide staff with safe work environments, they should be seen to act on all reported [incidents],&quot; which is rare today, Chapman&apos;s group wrote.&lt;/p&gt;
&lt;p&gt;However, currently there&apos;s no strong lever or incentive to address this kind of workplace abuse since hospitals focus mainly on patient safety as part of accreditation, and national and state workplace safety organizations have little mechanism for monitoring such incidents, McPhaul noted.&lt;/p&gt;
&lt;p&gt;The researchers&apos; survey was intended to reach all 332 nurses working at one nontertiary hospital across all departments  --  emergency, medical, surgical, maternity, pediatric, and mental health.&lt;/p&gt;
&lt;p&gt;The 113 nurses who responded were mainly women in their early 40s who worked part time.&lt;/p&gt;
&lt;p&gt;Among them, about three-quarters reported at least one incident of workplace violence over the preceding 12 months  --  25% said it occurred weekly, 27% said monthly, and for 25% it was rarer, at once every six months. &lt;ul&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Fully 30% of the nurses said they had been involved in an episode involving a weapon  --  often hospital equipment and more rarely a knife or gun.&lt;/p&gt;
&lt;p&gt;The number of total incidents was lowest among nurse midwives, with a mean of 1.67 per year.&lt;/p&gt;
&lt;p&gt;Not surprisingly, the rate was highest among emergency department and mental health staff, who reported an average of 46.43 and 40.39 episodes over 12 months.&lt;/p&gt;
&lt;p&gt;One reason behind the high risk in these two departments may be the &quot;shift to a community-based approach to mental health care and a reduction in mental health beds&quot; such that the same psychiatric patients that assault mental health department nurses are mainstreamed to the emergency department as their point of entry to the hospital, the researchers said.&lt;/p&gt;
&lt;p&gt;However, more years of experience or higher educational qualification didn&apos;t appear to protect nurses. Senior nurse unit managers and clinical nurse specialists actually reported more physical assaults than less senior nurses.&lt;/p&gt;
&lt;p&gt;Age and gender didn&apos;t predict occurrence or type of incident either.&lt;/p&gt;
&lt;p&gt;When nurses did report workplace violence or verbal abuse, it was most often to their immediate manager (29%), other senior nursing staff (14.5%), or to their friends and colleagues (6%).&lt;/p&gt;
&lt;p&gt;Overall, 30% of nurses who responded to the survey gave as their reason for not reporting that workplace violence happens all the time and is simply part of the job.&lt;/p&gt;
&lt;p&gt;Even among those who did make a report of some sort, half said they thought hospital management failed to act on it.&lt;/p&gt;
&lt;p&gt;In fact, when the researchers audited hospital records, they found that 42 official incident reports had been filed by nurses over the prior one year period, nearly always involving injuries.&lt;/p&gt;
&lt;p&gt;In 95% of the cases, the only action taken by the hospital was making staff in the area aware of the incident. No other actions had been documented.&lt;/p&gt;
&lt;p&gt;The researchers cautioned that the voluntary nature and limited scope of the study may have limited generalizability, although the occurrence of violence against nurses is likely similar across developed countries.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The researchers provided no information on conflicts of interest.&lt;/p&gt;&lt;p&gt;McPhaul reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_228"
                     title="Nurses Should Have a Bigger Leadership Role in Healthcare"
                     score="-0.002"
                     href="http://www.medpagetoday.com/PracticeManagement/StaffingScheduling/tb/18080?impressionId=1265820001279"
                     
      &lt;p&gt;Opinion leaders across a wide variety of groups think nurses should have more influence in health policy, planning, and management, according to a new Gallup survey.&lt;/p&gt;
&lt;p&gt;Although nurses are viewed as being the most valued source of health information behind physicians, survey respondents rank them as the least likely of healthcare stakeholders  --  including patients  --  to have a great deal of influence in healthcare reform over the next 10 years.&lt;/p&gt;
&lt;p&gt;This despite the fact that among the 1,504 thought leaders in academia, insurance, health services, government, industry, and the corporate world polled, 51% said nurses are very important in reducing medical errors and improving patient safety, and 50% said they are very influential in improving the quality of patient care.&lt;/p&gt;
&lt;p&gt;The major barriers to increased nurse influence, nearly 70% of respondents said, are perceptions that they are lower on the totem pole than physicians when it comes to decision-making and revenue generation.&lt;/p&gt;
&lt;p&gt;When asked what could be done to ensure that nurses take on more leadership responsibility, the first priority, respondents said, was that they make their voices heard  --  56% had said that nursing lacks a single voice in speaking on national issues. More than half of respondents also noted that there was a lack of opportunities for nurses to advance into leadership positions.&lt;/p&gt;
&lt;p&gt;The survey, conducted by Gallup for the Robert Wood Johnson Foundation, examined professional views of nursing, nursing leadership, the future of the industry, and potential barriers to leadership roles for nurses among various healthcare-related groups. It included responses from opinion leaders in academia (276), health services (253), government (253), industry (253), insurance (237), and the corporate world (232).&lt;/p&gt;
&lt;p&gt;Nine out of 10 said nurses should have more influence in increasing the quality of care and reducing medical errors.&lt;/p&gt;
&lt;p&gt;About 85% said they wanted nurses to have more influence in promoting wellness and preventive care, improving efficiency and cost, coordinating care through the healthcare system, and adjusting care to meet an aging population.&lt;/p&gt;
&lt;p&gt;Additionally, 72% thought increased nurse influence would help the healthcare system adapt to the growing change in ethnic, racial, and cultural diversity in patient populations.&lt;/p&gt;
&lt;p&gt;The opinion leaders were also asked whether they feel there is a nursing shortage in the U.S. Just over 80% said Yes and of those, only 2% said it was not a serious problem.&lt;/p&gt;
&lt;p&gt;To blame for the shortage? Respondents cited a stressful/poor work environment (44% see that as a very important reason), not enough openings in nursing schools (40%), and too many nurses leaving the profession (37%). Only 22% cited low pay as very instrumental in causing the shortage.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20090101_19_1279"
                     title="Cardiology Consults Less Likely From Community Health Centers"
                     score="-0.005"
                     href="http://www.medpagetoday.com/PracticeManagement/PracticeManagement/tb/13922?impressionId=1265820001279"
                     
      SAN FRANCISCO, April 27 -- Community health centers refer patients with heart problems to cardiology specialists less often than hospital-based primary care practices do, a new study shows.
              &lt;p&gt; 
              &lt;p&gt;But researchers stopped short of recommending that community practices use specialists more often. That&apos;s because they&apos;re not sure whether the disparity is the result of underuse in the community or overuse of specialists by hospital-based practices.
              &lt;p&gt; 
              &lt;p&gt;In a retrospective cohort study, coronary artery disease patients treated in community centers were 21% less likely to get an initial cardiology consultation, while those with heart failure were 23% less likely to get a referral than those seen at hospital-based primary care practices.
              &lt;p&gt; 
              &lt;p&gt;Likewise, patients with hospital-based primary care were 20% more likely to get follow-up cardiology consultations (&lt;em&gt;P&lt;/em&gt;&lt;0.001), Nakela L. Cook, M.D., M.P.H., of the National Heart, Lung, and Blood Institute, and colleagues reported.
              &lt;p&gt; 
              &lt;p&gt;&quot;Disparities in access to specialists may contribute to lower quality of care and poorer outcomes among certain populations,&quot; they wrote in the May 12 issue of &lt;em&gt;Circulation: Journal of the American Heart Association&lt;/em&gt;.
              &lt;p&gt; 
              &lt;p&gt;They said further research is needed to determine whether the differences represent underuse in the community or overuse in hospital-based practices. &quot;There are potential disadvantages of increased consultation, including cost, difficult care coordination, and increased testing and procedure use,&quot; they noted.
              &lt;p&gt; 
              &lt;p&gt;Even so, researchers suggested their findings might help explain some disparities in cardiovascular outcomes, noting that community health centers serve a large proportion of racial and ethnic minorities who either are uninsured or have Medicaid.
              &lt;p&gt; 
              &lt;p&gt;Disparities in access to cardiovascular procedures are well documented, but access to the specialists who may act as gatekeepers for these procedures is less well studied, they said.
              &lt;p&gt; 
              &lt;p&gt;Their retrospective cohort study included 9,761 patients receiving primary care for coronary artery disease or congestive heart failure at practices affiliated with two academic medical centers in Massachusetts.
              &lt;p&gt; 
              &lt;p&gt;Over the five year period from 2000 through 2005, 79.6% of coronary artery disease patients and 90.3% of those with heart failure got at least one cardiology consultation.
              &lt;p&gt; 
              &lt;p&gt;This rate was higher than they expected based on earlier studies, but the researchers speculated that results may reflect the primary care practices&apos; affiliation with academic hospitals, the researchers noted.
              &lt;p&gt; 
              &lt;p&gt;Patients at the community-based primary care practices were less likely to be referred to cardiac specialists, as were women in all treatment settings.
              &lt;p&gt; 
              &lt;p&gt;Even after adjustment for age, insurance status, disease severity, comorbid diseases, and clustering by primary physician, these findings included:
              &lt;p&gt; 
              &lt;ul&gt;
                &lt;li&gt;Female coronary artery disease patients were 11% less likely to get cardiology consultations than men (hazard ratio 0.89, 95% confidence interval 0.85 to 0.93).
                &lt;li&gt;Female heart failure patients were 7% less likely to get a cardiology consultation (HR 0.93, 95% CI 0.87 to 0.99).
                &lt;li&gt;Coronary artery disease patients treated at community health centers were 21% less likely to get a cardiology consult than those hospital-based clinics (HR 0.79, 95% CI 0.74 to 0.84).
                &lt;li&gt;Community health center patients with heart failure were 23% less likely to get a consultation (HR 0.77, 95% CI 0.71 to 0.84).
              &lt;/ul&gt;
              &lt;p&gt; 
              &lt;p&gt;Follow-up consultations for both coronary artery disease and heart failure patients were also less frequent among women (14.9% and 14.8% fewer, respectively, both &lt;em&gt;P&lt;/em&gt;&lt;0.001) and those seen at community-based primary care practices (20.7% and 19.2% fewer, respectively, both &lt;em&gt;P&lt;/em&gt;&lt;0.001). 
              &lt;p&gt; 
              &lt;p&gt;These disparities appeared to have an impact on healthcare quality as measured against quality-of-care indicators in national guidelines or standards.
              &lt;p&gt; 
              &lt;p&gt;Performance scores were consistently better for patients who saw a specialist compared with those who did not (mean score 69.7% versus 60.4% at year one up to 71.8% versus 58.8% at year six, &lt;em&gt;P&lt;/em&gt;&lt;0.001 from repeated-measures regression). 
              &lt;p&gt; 
              &lt;p&gt;Surprisingly, access to cardiology specialists was better for Medicare and Medicaid recipients than for the privately insured, and at least as good for racial and ethnic minorities as for whites. 
              &lt;p&gt; 
              &lt;p&gt;However, the overall quality of care for Medicare/Medicaid and minority patients was poorer overall than for privately insured patients and whites over time (all &lt;em&gt;P&lt;/em&gt;&lt;0.01). 
              &lt;p&gt; 
              &lt;p&gt;Women, likewise, had lower healthcare performance scores than men (&lt;em&gt;P&lt;/em&gt;&lt;0.01), but consultation with a cardiology specialist narrowed the gap in quality of care (&lt;em&gt;P&lt;/em&gt;&lt;0.001).
              &lt;p&gt; 
              &lt;p&gt;The researchers cautioned that the study lacked pharmaceutical data for assessing this aspect of quality of care and that residual confounding may have limited the findings.
              &lt;p&gt; 
              &lt;p&gt;The authors also suggested that disparities in referral to specialists are likely to be even greater in the general medical community than in this report because the practices in the study were affiliated with academic centers.
              &lt;p&gt; 
              &lt;p&gt; 
              &lt;p&gt;&quot;Collaborative efforts by policy makers, health system administrators, and physicians are needed to improve equity in access to cardiovascular specialists, especially for women and patients at community health centers,&quot; they concluded.
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;The Agency for Healthcare Research and Quality partially funded the study.
              &lt;p&gt; 
              &lt;p&gt;One of the researchers reported consulting for WellPoint.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
       
    </recommendedItem>
    <recommendedItem id="20090101_19_1834"
                     title="ADA: Wal-Mart, Mail-Order Pharmacies Top Affordable Drug List"
                     score="-0.006"
                     href="http://www.medpagetoday.com/MeetingCoverage/ADA/tb/14611?impressionId=1265820001279"
                     
      NEW ORLEANS, June 9 -- Diabetes patients who shop for the best prices on prescription drugs at mail-order retailers and big-box discounters may save thousands of dollars a year, researchers found.
              &lt;br&gt; 
              &lt;br&gt;In an analysis of pricing data obtained from state attorneys general, Medco by Mail and Wal-Mart were the least expensive, while neighborhood and chain pharmacies generally charged the most, Clifton M. Jackness, M.D., and Ronald Tamler, M.D., Ph.D., both of the Mount Sinai School of Medicine in New York, N.Y., reported.
              &lt;br&gt; 
              &lt;br&gt;&quot;Being an informed consumer is clearly beneficial,&quot; they said here at the American Diabetes Association meeting.
              &lt;br&gt; 
              &lt;br&gt;The total monthly out-of-pocket price for all 10 drugs most commonly prescribed to diabetes patients for any indication ranged from a low of $428.35 with Medco to a high of $641.90 with Rite Aid. 
              &lt;br&gt; 
              &lt;br&gt;The researchers speculated that lower costs may improve adherence, and thus outcomes, since nearly one in five adults with diabetes reports cutting back on their prescriptions because of cost.
              &lt;p&gt; 
              &lt;p&gt;However, there is often a tradeoff for lower prices, commented R. Paul Robertson, M.D., ADA&apos;s president of medicine and science.
              &lt;p&gt; 
              &lt;p&gt;&quot;Pharmacies, especially local ones, offer more than drugs,&quot; he said. &quot;They offer service and the opportunity to talk to a pharmacist.&quot;
              &lt;p&gt; 
              &lt;p&gt;Giving that up in exchange for a lower bill may be worthwhile for some patients who are on a stable regimen and familiar with their medications, whereas for others it might not, Dr. Robertson noted.
              &lt;p&gt; 
              &lt;p&gt;The researchers tabulated the most common prescriptions filled by diabetes patients under age 65 (a population expected to have at least some out-of-pocket cost associated with their medications) from a medical and pharmaceutical claims database compiled by 91 health insurance plans across the U.S.
              &lt;p&gt; 
              &lt;p&gt;After exclusion of nonchronic medications such as antibiotics, the top medications in order of number of prescriptions were: 
              &lt;p&gt; 
              &lt;ul&gt;
                &lt;li&gt;Metformin
                &lt;li&gt;Atorvastatin (Lipitor)
                &lt;li&gt;Lisinopril (Prinivil, Zestril)
                &lt;li&gt;Rosiglitazone (Avandia), excluded from the analysis because of declining use since the time covered by the database
                &lt;li&gt;Furosemide (Lasix, Furocot)
                &lt;li&gt;Pioglitazone (Actos)
                &lt;li&gt;Simvastatin (Zocor)
                &lt;li&gt;Hydrochlorothiazide (Microzide)
                &lt;li&gt;Insulin glargine (Lantus)
                &lt;li&gt;Amlodipine (Norvasc)
                &lt;li&gt;Atenolol (Tenormin)
              &lt;/ul&gt;
              &lt;p&gt; 
              &lt;p&gt;While this list contained several duplicate classes, such as multiple antihypertensives and two statins, Dr. Jackness noted that diabetes patients take an average of 8.9 medications. The typical patient would be on the majority of drugs on the list, he said.
              &lt;p&gt; 
              &lt;p&gt;The cost of a 30-day supply of each -- assuming no prescription drug coverage by public or private insurance -- was determined from the New York and New Jersey State Attorneys General. 
              &lt;p&gt; 
              &lt;p&gt;These offices maintain publicly-accessible Web sites on current prescription drug prices at the pharmacies in their respective states. The researchers confirmed the prices by direct contact with the pharmacies.
              &lt;p&gt; 
              &lt;p&gt;For some drugs, the price differences between pharmacies were dramatic. 
              &lt;p&gt; 
              &lt;p&gt;Consider metformin, the 10th most popular generic drug prescribed overall in 2008, with 40 million prescriptions written, according to &lt;em&gt;Drug Topics&lt;/em&gt; magazine
              &lt;p&gt; 
              &lt;p&gt;Dr. Jackness and colleagues found that metformin sold for $4.00 in the generic drug discount program at Wal-Mart and Target and for $5.00 at Kmart. But the local neighborhood pharmacies averaged $38.95 and pharmacy chain Rite Aid charged $39.99.
              &lt;p&gt; 
              &lt;p&gt;While stores such as Wal-Mart have heavily marketed their low-cost generic programs, they tended to offer more competitive prices for nongeneric drugs as well.
              &lt;p&gt; 
              &lt;p&gt;And, although the superstores and mail-order pharmacies did not consistently offer lower prices for every medication, none of the local chains or independently-owned pharmacies had the lowest price for any drug on the list. 
              &lt;p&gt; 
              &lt;p&gt;When prices for the 10 drugs most commonly prescribed to diabetes patients were added (excluding rosiglitazone), the monthly totals were:
              &lt;p&gt; 
              &lt;ul&gt;
                &lt;li&gt;$428.35 for Medco by Mail (excluding shipping and handling)
                &lt;li&gt;$432.53 for Wal-Mart
                &lt;li&gt;$483.94 for Kmart
                &lt;li&gt;$501.65 for Drugstore.com (excluding shipping and handling)
                &lt;li&gt;$505.95 for Target
                &lt;li&gt;$584.44 for CVS
                &lt;li&gt;$633.11 for Duane Reade
                &lt;li&gt;$638.31 for Walgreen&apos;s
                &lt;li&gt;$639.20 for local pharmacies
                &lt;li&gt;$641.90 for Rite Aid
              &lt;/ul&gt;
              &lt;p&gt; 
              &lt;p&gt;Unfortunately, this kind of price information is not readily available in most other states, commented Patricia Coon, M.D., of the Billings Clinic in Billings, Mont.
              &lt;p&gt; 
              &lt;p&gt;Nevertheless, savvy patients and physicians can find this information locally by doing their homework, Dr. Coon said.
              &lt;p&gt; 
              &lt;p&gt;&quot;They do a lot of shopping from pharmacy to pharmacy to get the lowest price,&quot; said Dr. Coon, who was not involved in the study. &quot;It&apos;s not unusual for patients to be asking to be switched to generics or the generic that&apos;s offered by a Wal-Mart or large brand.&quot;
              &lt;p&gt; 
              &lt;p&gt;Dr. Jackness agreed, noting that even if it&apos;s not posted in a central location, price information is available with a phone call. &quot;People shouldn&apos;t assume a drug is the same price everywhere,&quot; he said.
              &lt;p&gt; 
              &lt;p&gt;In his own New York City practice, Dr. Jackness said he often recommends low-priced local outlets to patients at financial risk. &quot;If we see patients without insurance we tell them to go down to Penn Station and go to Kmart,&quot; he said.
              &lt;p&gt; 
              &lt;p&gt;But realizing the savings from purchasing all medications at a superstore or mail-order company may not be possible for all patients, the researchers noted.
              &lt;p&gt; 
              &lt;p&gt;&quot;The patient must have the physical ability and means of transportation to travel to these stores or order online,&quot; they said.
              &lt;p&gt; 
              &lt;p&gt;They cautioned that the study did not take into consideration insurance coverage, which may limit generalizability.
              &lt;p&gt; 
              &lt;p&gt;But regardless of patients&apos; insurance status, the findings should serve as a wakeup call for physicians to take an active role in ensuring patients are able to obtain their prescribed medications, Drs. Jackness and Tamler concluded.
              &lt;p&gt; 
              &lt;p&gt;If adherence is an issue, physicians should ask patients about the impact of medication costs and suggest cost-lowering strategies, Dr. Robertson agreed.
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;The researchers reported no funding or conflicts of interest.
              &lt;p&gt; 
              &lt;p&gt;Drs. Coon and Robertson reported no conflicts of interest.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
              
    </recommendedItem>
    <recommendedItem id="20090101_19_3705"
                     title="AHA: Cardiologists Face Major Payment Cut But Still Back Reform"
                     score="-0.006"
                     href="http://www.medpagetoday.com/MeetingCoverage/AHA/tb/17019?impressionId=1265820001279"
                     
       &lt;p&gt;ORLANDO -- In this exclusive &lt;em&gt;MedPage Today&lt;/em&gt; InFocus&amp;#8482; video report, the vice president of the American College of Cardiology sounds an alarm about the potentially devastating effects of planned Medicare payment cuts to its cardiologists, but but he says payment concerns are unlikely to weaken the ACC&apos;s longstanding support for healthcare reform.&lt;/p&gt;
&lt;p&gt;David Holmes, MD, of the Mayo Clinic in Rochester, Minn., talked about healthcare reform and the need to keep the ACC&apos;s position on it separate from the College&apos;s current battle with Medicare, which has become the ACC&apos;s top priority.&lt;/p&gt;
&lt;p&gt;The payment problem is especially frustrating because the decision to cut reimbursement to cardiologists was based on bad data, and ACC has been frustrated in its efforts to study those data, Holmes told Peggy Peck, &lt;em&gt;MedPage Today&lt;/em&gt;&apos;s Executive Editor.&lt;/p&gt;

    </recommendedItem>
</recommendedContent>