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Mondor E, Barnabe J, Laguan EMR, Malic C. Virtual burn care - Friend or foe? A systematic review. Burns 2024:S0305-4179(24)00047-0. [PMID: 38490837 DOI: 10.1016/j.burns.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 01/16/2024] [Accepted: 02/21/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION Evidence on the impact of virtual care for patients with burn injuries is variable. This review aims to evaluate its use in remote assessment, rounding, and follow-up through outcomes of efficacy, usability, costs, satisfaction, clinical outcomes, impacts on triage and other benefits/drawbacks. METHODS A PRISMA-compliant qualitative systematic review (PROSPERO CRD42021267787) was conducted in four databases and the grey literature for primary research published between 01/01/2010 and 12/31/2020. Study quality was appraised using three established tools. Evidence was graded by the Oxford classification. RESULTS The search provided 481 studies, of which 37 were included. Most studies (n = 30, 81%) were Oxford Level 4 (low-level descriptive/observational) designs and had low appraised risk-of-bias (n = 20, 54%). Most applications were for the acute phase (n = 26, 70%). High patient compliance, enhanced specialist access, and new educational/networking opportunities were beneficial. Concerns pertained to IT/connection, virtual communication barriers, privacy/data-security and logistical/language considerations. Low-to-moderate-level (Oxford Grade C) evidence supported virtual burn care's cost-effectiveness, ability to improve patient assessment and triage, and efficiency/effectiveness for remote routine follow-up. CONCLUSION We find growing evidence that virtual burn care has a place in acute-phase specialist assistance and routine outpatient follow-up. Low-to-moderate-level evidence supports its effectiveness, cost-effectiveness, usability, satisfactoriness, and capacity to improve triage.
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Affiliation(s)
- Eli Mondor
- Carleton University, Department of Health Sciences, 1125 Colonel By Drive, Ottawa, Ontario K1S 5B6, Canada.
| | - Jaymie Barnabe
- Carleton University, Department of Health Sciences, 1125 Colonel By Drive, Ottawa, Ontario K1S 5B6, Canada
| | | | - Claudia Malic
- Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8L1, Canada.
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Hayavi-Haghighi MH, Alipour J. Applications, opportunities, and challenges in using Telehealth for burn injury management: A systematic review. Burns 2023; 49:1237-1248. [PMID: 37537108 DOI: 10.1016/j.burns.2023.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 05/18/2023] [Accepted: 07/04/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Burns are global public health devastating and life-threatening injuries. Telehealth can be an appropriate answer for the effective utilization of health care resources, prevention referrals and reduce socio-economic burden of burns injuries. Thus, this study aimed to systematically evaluate the applications, opportunities, and challenges of using telehealth in burn injuries management. METHODS A structured search was conducted according to PRISMA statement guidelines in the Web of Science, PubMed, Scopus, and Science Direct as well as the Google Scholar for studies published until June 28, 2022. Of the total 2301 yielded studies, 36 articles were included in the final review. Quality appraisal was done according to the Mixed Methods Appraisal Tool (MMAT) version 2018. Thematic analysis was applied for data analysis. RESULTS Patient triage, transfer, and referral (38.9%) follow-up (22%), care (22%), consultation (9%), education (3%), and rehabilitation (3%) were the most prevalent application of telehealth, respectively. Our findings identified 72 unique concepts, eight initial themes, and two clinical and administrative final themes for opportunities of using telehealth in burn injury management. Furthermore, we identified 27 unique concepts, three initial themes, and two clinical and administrative final themes for remaining challenges. CONCLUSIONS Despite providing pivotal opportunities such as improving burn injury diagnosis and quality of care, increasing patient and provider satisfaction, and cost containment using telehealth in burn injuries management, the concept faces challenges such as the impossibility of the physical examination of patients and technological difficulties. Our findings provide valuable information for policymakers and decision-makers infield of burn injuries and effective planning for using telehealth technology.
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Affiliation(s)
- Mohammad Hosein Hayavi-Haghighi
- Department of Health Information Technology, Faculty of Paramedicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Jahanpour Alipour
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
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Mid-Term Follow-Up Study of Children Undergoing Autologous Skin Transplantation for Burns. Life (Basel) 2023; 13:life13030762. [PMID: 36983917 PMCID: PMC10053383 DOI: 10.3390/life13030762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/28/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023] Open
Abstract
Deep partial and full-thickness burns require surgical treatment with autologous skin grafts after necrectomy, which is the generally accepted way to achieve permanent wound coverage. This study sought to examine the grafted and donor areas of children who underwent autologous skin transplantation, using two assessment scales to determine the severity of the scarring and the cosmetic outcome during long-term follow-up. At the Surgical Unit of the Department of Paediatrics of the University of Pécs, between 1 January 2015 and 31 December 2019, children who had been admitted consecutively and received autologous skin transplantation were analyzed. Twenty patients met the inclusion criteria in this retrospective cohort study. The authors assessed the results using the Patient and Observer Scar Assessment Scale (POSAS) and the Vancouver Scar Scale (VSS). There was a significant difference in how parents and examiners perceived the children’s scars. In the evaluation of the observer scale, the most critical variables for the area of skin grafted were relief and thickness. Besides color, relief was the worst clinical characteristic on the patient scale. However, when medical professionals evaluated the donor site, significantly better results were obtained compared to the transplanted area (average observer scale score: 1.4 and 2.35, p = 0.001; VSS: 0.85 vs. 2.60, p < 0.001), yet it was similar to the graft site in the parents’ opinion (Patient Scale: 2.95 and 4.45, p = 0.181).
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García-Díaz A, Vilardell-Roig L, Novillo-Ortiz D, Gacto-Sánchez P, Pereyra-Rodríguez JJ, Saigí-Rubió F. Utility of Telehealth Platforms Applied to Burns Management: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3161. [PMID: 36833860 PMCID: PMC9968161 DOI: 10.3390/ijerph20043161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/02/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
The financial burden of burn injuries has a considerable impact on patients and healthcare systems. Information and Communication Technologies (ICTs) have demonstrated their utility in the improvement of clinical practice and healthcare systems. Because referral centres for burn injuries cover large geographic areas, many specialists must find new strategies, including telehealth tools for patient evaluation, teleconsultation, and remote monitoring. This systematic review was performed according to PRISMA guidelines. PubMed, Cochrane, Medline, IBECS, and LILACS were the search engines used. Systematic reviews, meta-analyses, clinical trials, and observational studies were included in the study search. The protocol was registered in PROSPERO with the number CRD42022361137. In total, 37 of 185 studies queried for this study were eligible for the systematic review. Thirty studies were comparative observational studies, six were systematic reviews, and one was a randomised clinical trial. Studies suggest that telehealth allows better perception of triage, more accurate estimation of the TBSA, and resuscitation measures in the management of acute burns. In addition, some studies assess that TH tools are equivalent to face-to-face outpatient visits and cost-efficient because of transport savings and unnecessary referrals. However, more studies are required to provide significant evidence. However, the implementation of telehealth should be specifically adapted to each territory.
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Affiliation(s)
- Antonio García-Díaz
- Plastic Surgery and Major Burns Service, Virgen del Rocío University Hospital, 41013 Seville, Spain
| | - Lluís Vilardell-Roig
- Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), 08018 Barcelona, Spain
| | - David Novillo-Ortiz
- Division of Country Health Policies and Systems, Regional Office for Europe, World Health Organization, 2100 Copenhagen, Denmark
| | | | - José Juan Pereyra-Rodríguez
- Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), 08018 Barcelona, Spain
- Dermatology Service, Virgen del Rocío University Hospital, 41013 Seville, Spain
| | - Francesc Saigí-Rubió
- Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), 08018 Barcelona, Spain
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Parajuli R, Bohara D, KC M, Shanmuganathan S, Mistry SK, Yadav UN. Challenges and opportunities for implementing digital health interventions in Nepal: A rapid review. Front Digit Health 2022; 4:861019. [PMID: 36120714 PMCID: PMC9480345 DOI: 10.3389/fdgth.2022.861019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background In recent times, digital technologies in health care have been well recognized in Nepal. It is crucial to understand what is works well and areas that need improvements in the digital health ecosystem. This rapid review was carried out to provide an overview of Nepal's challenges and opportunities for implementing digital health interventions. Methods This study is reported according to PRISMA guidelines and used telehealth, telemedicine, e-health, mobile health, digital health, implementation, opportunities, challenges and Nepal as key search terms to identify primary studies published between 1 January 2010 and 30 December 2021 in four databases, namely PubMed, Google Scholar, Scopus, and CINAHL. Initially, identified studies were screened against predetermined selection criteria, and data were extracted, and the findings were narratively synthesized. Result The review identified various challenges, opportunities, and benefits of implementing digital health initiatives in Nepal. The most expressed challenge was inadequate technical facilities (lack of electricity and internet) and rugged geographical distribution, which makes transportation difficult in hilly and mountain areas. Shortage of skilled workforce and supportive policies were also notable challenges documented. Meanwhile, major opportunities identified were education and training of the students and health practitioners and increasing awareness among the general population. Conclusion This review identified various factors associated with the successful implementation of digital health initiatives in Nepal. Our findings may guide the formulation of digital health policy and interventions to improve mass health outcomes using digital health services.
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Affiliation(s)
- Rojina Parajuli
- Department of Public Health, Torrens University, Sydney, Australia
| | - Dipak Bohara
- Department of Public Health, Torrens University, Sydney, Australia
| | - Malati KC
- Department of Public Health, Torrens University, Sydney, Australia
| | - Selvanaayagam Shanmuganathan
- Department of Public Health, Torrens University, Sydney, Australia
- Menzies Centre for Health Policy and Economics, The University of Sydney, New South Wales, Sydney, Australia
| | - Sabuj Kanti Mistry
- Centre for Primary Health Care and Equity, Faculty of Medicine,, University of New South Wales, NSW, Sydney, Australia
- Department of Public Health, Daffodil International University, Dhaka, Bangladesh
| | - Uday Narayan Yadav
- Department of Public Health, Torrens University, Sydney, Australia
- Centre for Primary Health Care and Equity, Faculty of Medicine,, University of New South Wales, NSW, Sydney, Australia
- National Centre for Epidemiology and Population Health, The Australian National University, ACT, Canberra, Australia
- Correspondence: Uday N Yadav
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Luan A, Mghase AE, Meyers N, Chang J. Are we curing by cutting? A call for long-term follow up and outcomes research in global surgery interventions - perspective. Int J Surg 2021; 87:105885. [PMID: 33513453 DOI: 10.1016/j.ijsu.2021.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 01/06/2023]
Abstract
Success in global surgery interventions cannot be claimed until consistent long-term follow up is achieved and corresponding outcomes are studied. However, post-operative outcomes remain inconsistently collected and analyzed in the setting of global surgery, with current efforts largely focused on the delivery of surgical care. Barriers in low- and middle-income countries include patient cost and distance, low surgical workforce capacity, poor patient health literacy, lack of affordable technology availability, inconsistent documentation, and structural deficiencies. Here, we suggest that future work can be focused on (1) enhancing systems to facilitate long-term follow up and care, (2) expanding availability and adoption of electronic medical record systems, and (3) collaboration with local surgeons in the development of international cross-organizational registries and standardized quality measures. Long-term collaborations between local healthcare administrators and providers, policymakers, international bodies, nonprofit organizations, patients, and the private sector are necessary to build and sustain processes to achieve reliable long-term follow up and rigorous data collection, with the goal of ultimately ensuring better patient outcomes.
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Affiliation(s)
- Anna Luan
- Department of Surgery, Plastic and Reconstructive Surgery Division, Stanford University School of Medicine, Stanford, CA, USA; ReSurge International, Sunnyvale, CA, USA.
| | - Adelaida E Mghase
- Department of Surgery, Plastic and Reconstructive Surgery Unit, Muhimbili National Hospital, Dar Es Salaam, Tanzania
| | | | - James Chang
- Department of Surgery, Plastic and Reconstructive Surgery Division, Stanford University School of Medicine, Stanford, CA, USA; ReSurge International, Sunnyvale, CA, USA
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Gacto-Sánchez P, Molina-Morales J, Rodríguez-Vela F, Moreno-Conde J, Sendin-Martin M, Parra-Calderon C, Gomez-Cía T, Pereyra-Rodriguez JJ. Diagnostic accuracy of a telemedicine tool for acute burns diagnosis. Burns 2020; 46:1799-1804. [DOI: 10.1016/j.burns.2020.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/21/2020] [Accepted: 05/21/2020] [Indexed: 10/24/2022]
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Deng H, Li-Tsang CW. Measurement of vascularity in the scar: A systematic review. Burns 2019; 45:1253-1265. [DOI: 10.1016/j.burns.2018.10.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 06/28/2018] [Accepted: 10/31/2018] [Indexed: 01/24/2023]
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Hwang CJ, Eftekhari K, Schwarcz RM, Massry GG. The Aesthetic Oculoplastic Surgery Video Teleconference Consult. Aesthet Surg J 2019; 39:714-718. [PMID: 30820528 DOI: 10.1093/asj/sjz058] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Skype video telemedicine consults are gaining popularity to evaluate patients from distant locations. No study has analyzed the utility of this means of patient evaluation in a cosmetic oculoplastic patient population. OBJECTIVES The authors sought to provide an evidence-based analysis of the utility of Skype video consults in a cosmetic oculoplastic surgery patient population with regards to patient demographics, reasons for consult, and procedural conversion rate. METHODS A 1-year retrospective chart review (May 2016 to May 2017) of patients who underwent aesthetic oculoplastic Skype consults from 2 authors' practices was performed. The authors analyzed patient demographics, referral source, chief complaint, location of residence, length of consult, and conversion to face-to-face consultation and intervention. RESULTS Seventy-nine patients (60 women and 19 men) underwent Skype evaluations. Mean age was 49 years. Sixty-four consults (81%) lasted 15 minutes or less. Referral sources included the internet (67%), another physician (19%), self-referral (7.5%), referred by former patients (4%), and social media sites (2.5%). Consultations were obtained for revision (49%), or first-time (30%) eyelid/eyebrow surgery, cosmetic ptosis surgery (6%), laser skin procedures (5%), cosmetic orbital decompression (5%), and lower eyelid fat prolapse (5%). Twenty patients (25%) followed-up with in-person consultation. Sixteen of these patients (80%) had surgical (56%) or nonsurgical (44%) interventions. CONCLUSIONS Skype consults are an efficient, in-office modality to increase patient flow through the office, expand patient base, and generate income. In this report, 25% of Skype contacts followed-up with formal in-person consultations, of which 80% had surgical or nonsurgical interventions.
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Affiliation(s)
- Christopher J Hwang
- Department of Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kian Eftekhari
- Department of Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Robert M Schwarcz
- Oculofacial Plastic and Reconstructive Surgery, Ophthalmology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY
| | - Guy G Massry
- Department of Ophthalmology, Division of Oculoplastic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Klingberg A, Sawe HR, Hammar U, Wallis LA, Hasselberg M. m-Health for Burn Injury Consultations in a Low-Resource Setting: An Acceptability Study Among Health Care Providers. Telemed J E Health 2019; 26:395-405. [PMID: 31161967 PMCID: PMC7187966 DOI: 10.1089/tmj.2019.0048] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: The rapid adoption of smartphones, especially in low- and middle-income countries, has opened up novel ways to deliver health care, including diagnosis and management of burns. This study was conducted to measure acceptability and to identify factors that influence health care provider's attitudes toward m-health technology for emergency care of burn patients. Methods: An extended version of the technology acceptance model (TAM) was used to assess the acceptability toward using m-health for burns. A questionnaire was distributed to health professionals at four hospitals in Dar Es Salaam, Tanzania. The questionnaire was based on several validated instruments and has previously been adopted for the sub-Saharan context. It measured constructs, including acceptability, usefulness, ease of use, social influences, and voluntariness. Univariate analysis was used to test our proposed hypotheses, and structural equation modeling was used to test the extended version of TAM. Results: In our proposed test-model based on TAM, we found a significant relationship between compatibility—usefulness and usefulness—attitudes. The univariate analysis further revealed some differences between subgroups. Almost all health professionals in our sample already use smartphones for work purposes and were positive about using smartphones for burn consultations. Despite participants perceiving the application to be easy to use, they suggested that training and ongoing support should be available. Barriers mentioned include access to wireless internet and access to hospital-provided smartphones.
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Affiliation(s)
- Anders Klingberg
- Department of Public Health Sciences, Karolinska Institutet, Widerströmska Huset, Stockholm, Sweden
| | - Hendry Robert Sawe
- Department of Emeregency Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Ulf Hammar
- Department of Medical Sciences, Uppsala University, Epihubben, MCT-Huset, Uppsala, Sweden
| | - Lee Alan Wallis
- Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Bellville, South Africa.,Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Marie Hasselberg
- Department of Public Health Sciences, Karolinska Institutet, Widerströmska Huset, Stockholm, Sweden
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Utility of Mobile Apps for Video Conferencing to Follow Patients at Home After Outpatient Surgery. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2019; 2:e078. [PMID: 30680368 PMCID: PMC6336578 DOI: 10.5435/jaaosglobal-d-18-00078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction: Outpatient surgery has a great opportunity to demonstrate the role of using mobile video conference (VC) postoperatively. Our patients use technology to help decision making in finding physicians. The authors aim to assess patient's perception on the use of mobile apps for VC with the surgeon and/or staff. Methods: Consenting patients completed a questionnaire of 10 questions preoperatively and postoperatively to assess the difference in opinion. Results: Overall, 120 patients completed the questionnaire preoperatively with 58% female population, 71% younger than 65 years, and 67% having a GED/higher education. Fifty-two patients had surgery with 54% female population, and 60% were younger than 65 years. All patients had mobile apps for VC with 55% using WhatsApp, 40% using Facetime, and 5% other. In person, being with a trained educator at the office was the preferred method for learning about surgical procedures. Overall, four patients contacted the surgeon directly preoperatively. After surgery, 8 of 52 patients (15%) used VC to the surgeon directly, and 37 patients used the VC with the team. Conclusion: With advances in new technology, the use of mobile video conferencing adds a new forum for communication with patients. In the outpatient surgical setting, this forum would improve patient-physician relations.
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Brownson EG, Wong J, Cannon C, Thompson CM, Mandell SP, Gibran NS, Muffley L, Pham TN. Combining store-and-forward pictures and videoconferencing for outpatient burn follow-up care. BURNS OPEN 2018. [DOI: 10.1016/j.burnso.2018.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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