Achieving and sustaining change for improvement

Wednesday, January 25, 2012: 6:00 PM-8:00 PM
Gracia Ballroom (The Cosmopolitan)
Thursday, January 26, 2012: 12:30 PM-2:30 PM
Gracia Ballroom (The Cosmopolitan)
1
From Paper to Progress: Quality Management's Role in Faciliating Unit Based Change
Ellen M Rice, Ph.D., MPH, RN, CPHQ, Meritus Medical Center
2
  
Twenty Four Months and Running VAP Free
Jennifer Jesske, BSN, BA, RN, CCRN, EMT, Highland Hospital of Rochester; Diane H. Martin, BSN, RN, CCRN, Highland Hospital of Rochester; Sharon Nersinger, MS, RN, Highland Hospital of Rochester

Handout (233.7 kB)

3
  
Reducing central line associated blood stream infection in medical intensive care: leadership and standardization
Jennifer Ghidini, MSN, BSN, BA, RN, FNP, Yale-New Haven Hospital; Carrie Guttman, MSN, BA, BSN, Yale-New Haven Hospital; Monica Gasperini, BSN, RN, Yale-New Haven Hospital; Andrea Giordano, MSN, BSN, RN, Yale-New Haven Hospital; Rachel Southard, BSN, RN, Yale-New Haven Hospital; Carolyn Picci, BSN, RN, Yale-New Haven Hospital; Amy Bennett, BA, AS, RN, CCRN, Yale-New Haven Hospital; Dawn Cooper, RN, MS, CCNS, CCRN, Yale New Haven Hospital

Handout (290.7 kB)

5
We are the champions: engaging clinical nurses in innovative strategies for sustained CAUTI reduction
Bridget Major-Joynes, MSN, RN, Hospital of the University of Pennsylvania; Kathryn L. Green, MSN, RN, ACNS-BC, Hospital of the University of Pennsylvania
6
Reducing Blood Culture Contamination in the ER: No Bad Blood Between US
Barbara Klausing, MHA, BSN, RN, BC-CV, Baylor Medical Center at Irving; Ellen Nyquist, BSN, RN, Baylor Medical Center at Irving; Bella Pepito, BSN, RN, CEN, Baylor Medical Center at Irving; Cherl Phillips, BSN, RN, CEN, Baylor Medical Center at Irving; Becky Martin, MLS, (ASCP), Baylor Medical Center at Irving
7
  
Discharge Information, Does it Really Start on Admission?
Susan Steele-Moses, DNS, APRN, CNS, AOCN, Our Lady of the Lake; Dana Ydarraga, MSN, RN, Our Lady of the Lake; Charla Johnson, MSN, RN, ONC, Our Lady of the Lake; Tana Clark, BSN, RN, Our Lady of the Lake

Handout (1.4 MB)

8
How to Involve and Energize the Bedside Nurse to Care and Feel Empowered to Make a Difference in Prevention of HAPU
Vicky V. Overby, MSN, BSN, RN, CMSRN, Rex Healthcare; Ann Woodruff, BSN, RN, CWOCN, Rex Healthcare
9
  
Enhancing the CLABSI Bundle for Optimal Patient Outcomes
Eleanor Fitzpatrick, MSN, RN, CCRN, Thomas Jefferson University Hospital; Patricia Worthington, MSN, RN, CNSC, Thomas Jefferson University Hospital; Karen A. Gilbert, MSN, RN, CNSC, CRNP, Thomas Jefferson University Hospital; Niels D. Martin, MD, FACS, Thomas Jefferson University Hospital; Kiersten Rosenberg, BSN, RN, Thomas Jefferson University Hospital

Handout (419.2 kB)

10
  
Taking STEPS to IMPROVE the PATIENT EXPERIENCE
Erica L. Szczepkowski, MSN/MBA/HCM, RN, Naples Community Healthcare System; Sherry Arnes, RN, NCH Healthcare System

Handout (69.6 kB)

11
Sustained Reduction of Restraint Usage in a Veterans' hospital: A successful philosophical change
Salena Wright-Brown, MSN, BSN, APN, Veterans Health Care System of the Ozarks
12
  
Transforming the Rapid Response Process
Christina M Consolo, BSN, RN, CCRN, Providence Holy Cross Medical Center

Handout (110.2 kB)

13
Quality counts: Illuminating the Value of Nursing though a Healthy Working Environment
Fiona a Winterbottom, MSN, BSN, APRN, ACNS, BC, CCRN, Ochsner.org; Anita Campbell, MSN, CCRN, Ochsner.org
14
Effect of an Educational Intervention on Hospital Acquired Urinary Tract Infection Rates
Sharon L. Smith, DNP, MBA, RN, CNL, CMSRN, NE-BC, Flagler Hospital, Inc.
15
  
Improving the Culture of Safety with a Patient Safety Corps
Angela (Angie) S King, BSN, RN, CPHQ, CPHRM, St. Francis Hospital

Handout (1.9 MB)

16
  
It Takes A Village: Reducing Patient Falls in the Hospital Setting
Jean S Blankenship, MSN, PHCNS-BC, CDE, Martha Jefferson Hospital; Rebecca Owen, MSN, RN, NE-BC, Martha Jefferson Hospital; Abby Denby, BSN, RN, CWON, Martha Jefferson Hospital

Handout (651.1 kB)

17
Innovative Strategies to Decrease Cervical Collar Related Pressure Ulcers
Christine M Marsiello, MSN, RN-BC, CCRN, Winthrop-University Hospital; Kim Marshall, BSN, RN, Winthrop-University Hospital; Jeanmarie Moorehead, MA, RN, Winthrop-University Hospital; Yvette Ahamed, AAS, RN, Winthrop-University Hospital; Silvana Justiniano, MS, RN, CCRN, Winthrop-University Hospital; John McNelis, MD, FACS, FCCM, MHCM, Winthrop-University Hospital
18
  
Round, Round, Don't Let your Patient Down: A Falls Prevention Project
Holli D Roberts, MSN, RN, Baptist Hospital East; Nicole Seraphine, MS, BSN, RN, Baptist Hospital East

Handout (494.1 kB)

19
  
Getting to Zero: Implementation of a Nurse Directed Neonatal Peripherally Inserted Central Catheter (PICC) Team
Kim Cooley, MSN, BSN, RN, NNP-BC, CNS, Emory University Hospital Midtown; Valerie Croft, ADN, RNC-NIC, Emory University Hospital Midtown

Handout (1.2 MB)

20
  
21
Virtual Wound Assessment: Avoiding Delays in Appropriate Treatment for Pressure Ulcers/Wounds
Sharon Codi-Turcotte, MSNc, BSN, RN-BC, CWS, Hallmark Health System
22
A Fresh Look at Restraint Use in the ICU
Amber D. Clayton, MBA, BSN, RN, Unviersity of Texas Medical Branch; Charles Machner, BSN, RN, CCRN, University of Texas Medical Branch at Galveston
23
  
Turning Evidence Based Research into Evidence Based Practice in Pressure Ulcer Prevention
Marsha J Duffy, BSN, RN, CNRN, Morristown Medical Center

Handout (60.5 kB)

24
  
Rising to the Surface: A Successful 3 Year Journey
Christina Rose, MSN, BSN, RN, CCRN, CNRN, Denver Health Medical Center; Phil Pettigrew, MBA, Denver Health Medical Center

Handout (875.7 kB)

25
  
Reducing Pressure Ulcer Prevalence in the ICU: An Evidence Based Practice Change
Paula Munch, MSN, RN, CCRN, Scottsdale Healthcare; Carol Siciliano Klein, BSN, RN, Scottsdale Healthcare; Christina VanLandschoot, BSN, RN, CCRN, Scottsdale Healthcare; Michele Fiore, MSN, RN, Scottsdale Healthcare; Melanie Brewer, DNSc, MS, BSN, RN, FNP, Scottsdale Healthcare

Handout (5.3 MB)

26
The New Five Ps: Process, Partnerships, and Passion for Pressure ulcer Prevention
Annamarie DeRoberts, MSHA, BSN, RN, Main Line Health; Kathleen Boyle, BSN, CWOCN, Main Line Health-Bryn Mawr Hospital; DeSales Foster, MSN, CWOCN, CRNP, GNP-BC, Main Line Health-Riddle Memorial Hospital; Kathleen McLaughlin, MSN, RN, CWOCN, Main Line Health-Paoli Hospital; Karen Yohn-Williams, RN, CWON, Main Line Health-Lankneau Medical Center
27
  
Prevention of VAP in the Yale New Haven Children's Hospital PICU
Shannon Pinto, BSN, RN, Yale New Haven Hospital; Jessica Williams RN, BSN, RN, CCRN, Yale New Haven Hospital; Kim Trotta, BSN, RN, CCRN, Yale New Haven Hospital; Susan Reynolds RN, MAHSM, BSN, RN, Yale New Haven Hospital; Edward Vincent S Faustino, MD, Yale University School of Medicine

Handout (239.5 kB)

29
  
Reducing Patient Falls Using a Video Monitoring System at a Inpatient Pediatric Unit
Sharon Guerra, RN, BSN, MSN, University of New Mexico Hospitals

Handout (492.3 kB)

30
  
Telling the Story of the Human Experience in Healthcare
Beth M Nease, MSN, RN, NE-BC, Bon Secours Memorial Regional Medical Center; Jewel Claiborne, MHA, CPHQ, Bon Secours Memorial Regional Medical Center

Handout (2.4 MB)

31
Collaboration Between Two Hospital Departments to Improve Care of the Septic Patient
Rebecca L Pontius, RN, CCRN, PinnacleHealth System; Crystal Miller, ADN, RN, CCRN, PinnacleHealth System
32
  
Getting there is good; staying there is better
Kathleen Hill, MSN, RN, CCNS-CSC, Cleveland Clinic

Handout (107.3 kB)

33
The Implementation of a Pediatric Pressure Ulcer Prevention Tool Promoting Directed Interventions and Alleviating Risk
Marsi L Appleby, RN, BSN, Loyola University Health System; Judy K McHugh, MSN, BSN, RN, Loyola University Health System; Melinda M Mars, BSN, RN, Loyola Medicine; Ewa Hofstad, BSN, RN, CPN, Loyola University Medical Center; Jenny Y Wang, MD, Loyola University Medical Center; Cinthia M. La Porte, BSN, RN, Ronald McDonald Children's Hospital of Loyola University Medical Center; Renee B Niznik, RN, BSN, Loyola Medical Center; Samantha T Sage, RN, Loyola medical center
34
The Case for Professional Certification
Diane M Hanley, MSN, RN-BC, EJD, Hallmark Health System
35
  
Improving Patient Outcomes Utilizing a Primary Nursing Care Delivery Model
Kimberly Hummel, BSN, RN, Hahnemann University Hospital; Stephanie Conners, MBA, BSN, RN, NEA-BC, Hahnemann University Hospital; Melissa J. Fox, RN, Hahnemann University Hospital

Handout (330.3 kB)

36
  
A NDNQI quality improvement project: Decreasing HAPU through nursing rounds
Alyson Dare Kelleher, BSN, RN, CCRN, University of Colorado Hospital; Amanda Moorer, BSN, RN, CCRN, University of Colorado Hospital

Handout (168.5 kB)

37
  
INTEGRATING NURSING PEER REVIEW INTO A UNIT SHARED GOVERNANCE MODEL
Mary Brann, DNP, RN, Chamberlain College of Nursing

Handout (940.9 kB)

38
  
Nurse Driven Mobility Protocol Implementation on a Medical Telemetry Unit
Kimberly Pepmiller, BSN, RN, North Colorado Medical Center, Banner Health, Greeley, Colorado; Julie Roth-Carter, MS, CNS, BSN, RN, McKee Medical Center, Banner Health, Loveland, Colorado; Cara Bruntz, BSN, RN, North Colorado Medical Center, Banner Health, Greeley, Colorado

Handout (857.2 kB)

39
Nursing Sensitive Outcomes Teams: Driving Home the Link Between Shared Governance, Process Reliability & Patient Safety
Cindy Kling, MSN, CNS, CCNS, CCRN, CPN, Arnold Palmer Hospital for Children; Dawn Bradley, ASN, Arnold Palmer Hospital for Children; Amber Degrenier, BSN, CCRN, Arnold Palmer Hospital for Children
40
Using the Practice Environment Scale to Inform Strategic Decisions
Kathryn C MacDavitt, DNSc, RN, NEA-BC, Kennedy Health System; Martin Manno, PhD, (c), MSN, RN, ACNS, -, BC, CEN, Kennedy Health System; Linda A Carrick, PhD, RN, NEA-BC, Kennedy Health System
41
  
Passing the Baton: Effective hand-off at the bedside
Melanie Conforti, MSN, BSN, RN, Presbyterian Orthopaedic Hospital; Maria M Bard, BSN, RN, Novant Health

Handout (501.1 kB)

42
Strategies to Dramatically Reduce Hospital/Unit Acquired Pressure Ulcers
Misty D Watts, MSN, RN, Northeast Baptist Hospital
43
ABC'Skin
Cynthia A Walker, BSN, RN, CWON, Johns Hopkins Bayview Medical Center; Rachel N Moseley, BSN, RN, CWCN, CWON, Johns Hopkins Bayview Medical Center
44
  
Falls reduction: An Innovative Approach
Jeffrey Williams, MSN, RN, CCRN, CCNS, UT Southwestern Medical Center; James Lester, ADN, RN, UT Southwestern Medical Center

Handout (362.0 kB)

45
  
Solving the Puzzle Pieces: A Facility Commitment to Reduce Hospital Acquired Pressure Ulcers
Holli D Roberts, MSN, RN, Baptist Hospital East; Beth Fangman, MSN, RN, CWOCN, Baptist Hospital East; Lisa Brooking, BSN, RN, Baptist Hospital East

Handout (738.0 kB)

46
No One Falls: Impact of a Comprehensive Interdisciplinary Falls Prevention Program
Mary L Sylwestrak, MS, APN, RN, Advocate Good Shepherd Hospital; Linda Serafin, RN, Advocate Good Shepherd Hospital; Roseanne Niese, MBA, BSN, RN, Advocate Good Shepherd Hospital
47
From ‘Uh-Oh' to ‘Oh-Yeah!': A Nurse Driven Urinary Catheter Removal Protocol
Bonnie Kosman, MSN, RN, NE-BC, NHA, Lehigh Valley Health Network1; Nancy DiRico, MSN, RN, CMSRN, Lehigh Valley Health Network1; Alyssa S Campbell, BSN, RN, Lehigh Valley Health Network
48
  
Getting Sustainable Quality Outcomes by Conducting Daily Rounding
Diane F McGraw, MSN, BSN, RN, CNS-CH, CPHQ, CCM, Methodist Sugar Land Hospital; Janet Leatherwood, MSN, BSN, RN, Methodist Sugar Land Hospital

Handout (8.5 kB)

49
  
S.T.A.R. Trek: The Journey to reduce HAPU...going where we have not gone before!
Beverly Folkedahl, BSN, RN, CWON, University of Iowa Hospitals and Clinics; Barbara J Hannon, MSN, RN, CPHQ, University of Iowa Hospitals and Clinics; Patricia Pezzella, BSN, RN, CWON, University of Iowa Hospitals and Clinics; Anne Smith, MSN, RN-BC, University of Iowa Hospitals and Clinics

Handout (4.3 MB)

50
Tools Used to Tackle Falls
Diane DePaul, MBA, BSN, RN, NE-BC, Advocate Lutheran General Hospital
51
Nurses' Physical Restraint Knowledge, Attitudes, and Practices: The Impact of a Restraint Reduction Education Program
Brenda A. Lawrence, MSA, BSN, RN, Detroit Receiving Hospital; Pamela Mayes, MSN, RN, BC, Detroit Receiving Hospital
52
  
Parenteral Nutrition Associated CLABSI in the Era of Bundles
Karen Gilbert, MSN, RN, CNSC, CRNP, Thomas Jefferson University Hospital; Patricia Worthington, MSN, RN, CNSC, Thomas Jefferson University Hospital; Leslie Schechter, PharmD, Thomas Jefferson University Hospital; Carmen Cornaglia, BSN, RN, CIC, Thomas Jefferson University Hospital

Handout (617.5 kB)

54
  
Elements of Innovative Strategies: Advocate Trinity Hospital
Diana K Dudick, RN, BSN, Advocate Trinity Hospital

Handout (478.6 kB)

55
  
Breaking Free From Knots: An Evidence-Based Approach To Physical Restraint Reduction
Norlissa Cooper, BSN, RN, San Francisco General Hospital; Sasha Cuttler, PhD, MSN, BSN, RN, San Francisco General Hospital

Handout (74.5 kB)

56
  
Avoidable Day Text Pager - Collaborative Process: Improving Patient Throughput Utilizing an Avoidable Day Text Pager
Joanne M Boyd, MSN, BSN, RN, UPMC Presbyterian Shadyside Hospital; Kathy Markus, MSN, BSN, RN, CCM, UPMC Presbyterian Shadyside Hospital; Sandra Weinheimer, MSN, BSN, RN, ACM, UPMC Presbyterian Shadyside Hospital

Handout (2.8 MB)

58
Red Zone Medication Safety Initiative in the Cardiac Intensive Care Unit
Jeanne P Ahern, MHA, BSN, CCRN, Children's Hospital Boston
60
  
Quality Breakthrough: Reducing Hospital Acquired Pressure Ulcers to Zero
Ann Asnaashari, MS, RN, CPHQ, CPHRM, HACP, NEA-BC, Memorial Hermann Sugar Land Hospital; Steven J Brockman-Weber, MSN, RN, MS, FACHE, NEA-BC, Memorial Hermann Sugar Land

Handout (547.3 kB)

61
  
The Stakes are High, Reduce the Chance of Falls with these Winning Interventions
Jennifer Richards, PhD, RN, CNRN, Renown Regional Medical Center; Linda M Reuber, RN-BC, MSN, AOCNS, CHTC, Fairview Ridges Hospital

Handout (108.9 kB)

62
  
Reduction of Central Line-Associated Blood Stream Infection Rates in the SICU
Clay Gaspard, MSN, MBA, RN, UT Southwestern Medical Center, University Hospital - Zale Lipshy; Camille Sheldon, RN, CNRN, UT Southwestern Medical Center, University Hospital - Zale Lipshy; Doramarie Arocha, MS, MT(ASCP)SM, UT Southwestern Medical Center Hospitals and Clinics; Shelley Brown-Cleere, RN, BSN, UT Southwestern Medical Center, University Hospital - Zale Lipshy; Wengui Yu, MD, PhD, UT Southwestern Medical Center, University Hospital - Zale Lipshy

Handout (269.6 kB)

63
How implementation of NDNQI has created an environment of change in pressure ulcers rates in a Saudi Arabian Hospital
Alicia M Dunn, MHM, JBICF, MN, BN, RN, King Faisal Specialist Hospital and Research Centre
64
  
Sustaining Low NDNQI Falls Rates in an Inpatient Rehabilitation Unit Using Innovative Falls Prevention Interventions
Vicki R. Haag, DHA, MS, RN, Riverside Medical Center; Barbara A Hamilton, RN, Riverside Medical Center

Handout (2.5 MB)

65
  
From Old School to New: Leveraging functionality of clinical documentation software to transform a classic Nursing tool
Richard J Houck, BSN, RN, UNC Health Care; Becky Dodge, MBA, RN, UNC Health Care

Handout (749.1 kB)

67
  
Evidence based insulin therapy for hospitalized patients
Kelly R Grogan, APRN, FNP-C, MNA, BSN, RN, JC Lincoln Network

Handout (1.5 MB)

68
Leading and Sustaining Change : The Michigan Experience
Michele Adaline, MBA, BSN, RN, CCRN, Northern Michigan Regional Hospital; Gretchen Shrage, MBA, MT, (ASCP)SH, CPHQ, Northern Michigan Regional Hospital; Sam Watson, MBA, MT, (ASCP)SH, Michigan Health and Hopsital Association
69
  
Reducing Catheter Associated -Urinary Tract Infections
Robin Eads, MSN, RN, ACNS-BC, CEN, Franciscan St. Francis Health Centers; Kim Devine, BSN, RN, CMSRN, Franciscan St. Francis Health Centers; Mickelle Sullivan, RN, CBN, Franciscan St. Francis Health Centers

Handout (569.4 kB)

70
  
Nursing Sensitive Measures Scorecard Improves Outcomes
Sharon J Barton, PhD, RN, PCNS-BC, The Children's Hospital of Philadelphia; Patricia D Black, MBA, The Children's Hospital of Philadelphia

Handout (744.3 kB)

71
The implementation of a shared governance model and how it influences decision making in a multicultural setting
Alicia M Dunn, MHM, JBICF, MN, BN, RN, King Faisal Specialist Hospital and Research Centre
72
  
73
  
Hardwiring a Multi-Factorial Fall Prevention Intervention into Nurses' Work to Reduce Inpatient Falls
Renee F. DiGiovanni, BS, BSN, RN-BC, CCTN, Ochsner Medical Center - New Orleans

Handout (942.0 kB)

74
  
Achieving Sustained Improvement in Reducing Ventilator Associated Pneumonia
Susan Benware, DNP, RN, ANP, BC, CPHQ, VA Medical Center; Rose M Burke, RN, BSN, MHA, VA Medical Center; Mary H Moorefield, BSN, RN, Durham VA Medical Center

Handout (1.8 MB)

75
  
Partnering to Prevent Falls: Utilizing a Multi-Modal , Multi-Disciplinary Approach
Jane Swaim, MS, BSN, St. Elizabeth Healthcare; Benita Utz, MSN, BSN, FNP, NEA-BC, St. Elizabeth Healthcare; Sabrina Long, BS, RN-BC, St. Elizabeth Healthcare; Wendy Bauer, MS, BSN, St. Elizabeth Healthcare; Jeannie Smith, ADN, CPHQ, St. Elizabeth Healthcare

Handout (115.7 kB)

76
TEAMWORK YIELDS PERFECT EVIDENCE BASED CARE IN ACUTE MYOCARDIAL INFARCTION, CONGESTIVE HEART FAILURE AND PNEUMONIA
Debra Schmitt, MSN, RN-BC, Duke Raleigh Hospital; Winnie Walker, RN, Duke Raleigh Hospital
77
  
CLABSI Elimination: It Takes a Team to Reach Zero
Tim Taylor, BSN, RN, Methodist Mansfield Medical Center; Debra Culmer, B.S., CIC, Methodist Mansfield Medical Center; Zakir A Shaikh, MD, MPH, FIDSA, FSHEA, CPE, CMSL, Methodist Health System

Handout (112.3 kB)

78
Improving collegial nurse-physician relations within a new service line
Christie M. Zotter, RN, BSN, CPN, NE-BC, Children's Medical Center Dallas
79
Taking a unit from worst to first: The Saudi Arabian Experience
Brent R Foreman, BHlthSc(N), RN, CEN, King Faisal Specialist Hospital & Research Center
80
  
Implementing a Culture of Safety for Safe Patient Handling
Linda M Stevens, MS, RN-BC, CPHQ, University of Wisconsin Hospital and Clinics

Handout (167.0 kB)

81
  
Sustaining Change in Hospital Acquired Pressure Ulcer Rate
Elaine A Yellen, PhD, MSN, BSN, RN, ACNS, Texas Health Presbyterian Hospital Dallas

Handout (2.0 MB)

82
Achieving Exemplary Practice through Staffing and Scheduling Process Change
Linda H Andrews, MSN, RN, Northwestern Lake Forest Hospital; Kimberly A Nagy, MSN, RN, CNS, NEA-BC, Northwestern Lake Forest Hospital; Beverly W McLaughlin, MS, RN, Northwestern Lake Forest Hospital
83
Fall Reduction : Sustaining the Gain
Kelly M. Briggs, MBA, BSN, RN, CNA-BC, Hackensack University Medical Center
84
Minor Changes—Monumental Impact: Utilizing Direct Care Staff to Improve Critical Care Transport Services
Cheri Hunt, MHA, RN, NEA-BC, Children's Mercy Hospitals and Clinics; Andrew Loehr, MSN, RN, CPNP, Children's Mercy Hospitals and Clinics; Sherry McCool, MHA, RRT-NPS, Children's Mercy Hospitals and Clinics
85
  
Nursing Quality Structure to Improve Nursing Outcomes
Cathaleen Ley, Ph.D, RN, PMHCNS-BC, Anne Arundel Medical Center; Ann Marie L Pessagno, RN, MSA, NEA-BC, Anne Arundel Medical Center

Handout (2.1 MB)

86
  
Preventing Urinary Tract Infections in Rehabilitation Through Effective Nursing Driven Algorithms
Piedad D Angeles, MA, BSN, RN, NE-BC, New York University Medical Center; Millie A Hepburn, PhD(c), RN, ACNS-BC, New York University Hospital Center; Annette Best, BSN, RN, CRRN, NYU Langone Medical Center; Henrietta Adams-Campbell, BSN, CRRN, New York University Langone Medical Center

Handout (4.3 MB)

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