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Álvarez-Dobaño JM, Rodríguez-García C, Atienza G, Toubes ME, Rodríguez-Núñez N, Zamarrón C, Novo-Platas JÁ, Soto-Feijóo R, Landín E, Carreiras-Cuiña M, Martínez-Martínez HJ, Carbajales MC, Otero B, Valdés L. Analysis of the quality of e-Consultations in chronic obstructive pulmonary disease. Respir Med 2024; 222:107514. [PMID: 38171405 DOI: 10.1016/j.rmed.2023.107514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/22/2023] [Accepted: 12/25/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION The quality of e-Consultations in the COPD is unknown. The objectives of this study were (i) to evaluate the quality of referrals; (ii) to define the characteristics of patients referred from Primary Care (PC) to the Unit of Pulmonology; and (iii) to describe differences between accepted and rejected patients. METHODS A retrospective, observational study of e-Consultations requested by PC for suspected COPD throughout 2022. To quantify the quality of the e-Consultations, an arbitrary scale of 12 variables (score 0-10) was created. RESULTS In total, 384 e-Consultations were reviewed, of which 167 (43.5 %) resulted in a face-to-face visit, and 217 (56.5 %) were rejected. No differences were observed between the two types of patients, except for confirmations of diagnostic suspicion of COPD [significantly higher in accepted patients (p = 0.042)]; physical examination data of rejected patients (more data provided; p = 0.015); and lung function (significantly better in rejected patients). The mean quality of referrals was acceptable (5.6 ± 2.1 score): 121 (31.3 %) had insufficient quality; 118 (30.5 %) acceptable; 75 (19.4 %) good, and 30 (7.8 %) excellent. Quality was low in half of the variables analyzed (6/12); acceptable in 3, and good in another 3. The capacity of resolution of referrals was good (one e-Consultation) in 199 requests (66.1 %); deficient (two e-Consultations) in 72 (23.9 %), and poor (≥3 e-Consultations) in 30 (10 %). Overdiagnosis was 40.2 % (86/214 e-Consultations). The risk could be classified in 247 patients (64.3 %; 135 low-risk; 90 high-risk). CONCLUSIONS When adequate information is provided, e-Consultations help identify different levels of severity. However, the quality and capacity of resolution of referrals were suboptimal, with a high percentage of overdiagnoses.
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Affiliation(s)
- José M Álvarez-Dobaño
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Spain.
| | - Carlota Rodríguez-García
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Spain.
| | - Gerardo Atienza
- Unidad de Calidad y Seguridad Del Paciente, Subdirección de Calidad, Gerencia Área Sanitaria de Santiago de Compostela y Barbanza, Spain.
| | - María E Toubes
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain.
| | - Nuria Rodríguez-Núñez
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain.
| | - Carlos Zamarrón
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain.
| | - José Ángel Novo-Platas
- Servicio de Control y Gestión, Gerencia Área Sanitaria de Santiago de Compostela y Barbanza, Spain.
| | - Roi Soto-Feijóo
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain.
| | - Elisa Landín
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain.
| | - María Carreiras-Cuiña
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain.
| | | | | | | | - Luis Valdés
- Servicio de Neumología, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Santiago de Compostela, Spain.
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2
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Álvarez-Dobaño JM, Toubes M, Novo-Platas JÁ, Reyes-Santías F, Atienza G, Portela M, Rábade C, Lourido T, Casal A, Rodríguez-García C, Riveiro V, Abelleira R, Ricoy J, Rodríguez-Núñez N, Zamarrón C, Calle F, Gude F, Valdés L. Cost-Effectiveness of a New Outpatient Pulmonology Care Model Based on Physician-to-Physician Electronic Consultation. Can Respir J 2022; 2022:2423272. [PMID: 36353446 PMCID: PMC9640234 DOI: 10.1155/2022/2423272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/30/2022] [Accepted: 10/20/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction This study assesses the impact of an electronic physician-to-physician consultation program on the waiting list and the costs of a Pulmonology Unit. Materials and Methods A prepost intervention study was conducted after a new ambulatory pulmonary care protocol was implemented and the capacity of the unit was adopted. In the new model, physicians at all levels of healthcare send electronic consultations to specialists. Results In the preintervention year (2019), the Unit of Pulmonology attended 7,055 consultations (466 e-consultations and 6,589 first face-to-face visits), which decreased to 6,157 (3,934 e-consultations and 2,223 first face-to-face visits; 12.7% reduction) in the postintervention year (all were e-consultations). The mean wait time for the first appointment was 25.7 days in 2019 versus 3.2 days in 2021 (p < 0.001). In total, 43.5% of cases were solved via physician-to-physiciane-consultation. A total of 2,223 patients needed a face-to-face visit, with a mean wait time of 7.5 days. The mean of patients in the waiting listing decreased from 450.8 in 2019 to 44.8 in 2021 (90% reduction). The annual time devoted to e-consultations and first face-to-face visits following an e-consultation diminished significantly after the intervention (1,724 hours versus 2,312.8; 25.4% reduction). Each query solved via e-consultation represented a saving of €652.8, resulting in a total annual saving of €827,062. Conclusions Physician-to-physiciane-consultations reduce waiting times, improve access of complex patients to specialty care, and ensure that cases are managed at the appropriate level. E-consultation reduces costs, which benefits both, society and the healthcare system.
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Affiliation(s)
- José Manuel Álvarez-Dobaño
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Malena Toubes
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - José Ángel Novo-Platas
- Servicio de Control de Gestión, Área Sanitaria de Santiago de Compostela y Barbanza, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | | | - Gerardo Atienza
- Unidad de Calidad y Seguridad del Paciente, Subdirección de Calidad, Gerencia Área Sanitaria de Santiago de Compostela y Barbanza, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Manuel Portela
- Subdirección de Prestación Farmacéutica Formación Docencia Innovación e Investigación, Gerencia Área Sanitaria de Santiago de Compostela y Barbanza, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Carlos Rábade
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Tamara Lourido
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Ana Casal
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Carlota Rodríguez-García
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Vanessa Riveiro
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Romina Abelleira
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Jorge Ricoy
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Nuria Rodríguez-Núñez
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Carlos Zamarrón
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Felipe Calle
- Subdirección de Processos Asistenciales Sin Ingresso, Gerencia Área Sanitaria de Santiago de Compostela y Barbanza, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Francisco Gude
- Unidad de Epidemiología Clínica, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Luis Valdés
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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Álvarez-Dobaño JM, Atienza G, Zamarrón C, Toubes ME, Ferreiro L, Riveiro V, Casal A, Suárez-Antelo J, Rodríguez-Núñez N, Lama-López A, Rábade-Castedo C, Rodríguez-García C, Lourido-Cebreiro T, Ricoy J, Abelleira R, Golpe A, Pais B, González-Barcala FJ, Valdés L. Health outcomes: Towards the accreditation of respiratory medicine departments. Arch Bronconeumol 2021; 57:637-647. [PMID: 35702904 DOI: 10.1016/j.arbr.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/13/2021] [Indexed: 06/15/2023]
Abstract
National health systems must ensure compliance with conditions such as equity, efficiency, quality, and transparency. Since it is the right of society to know the health outcomes of its healthcare system, our aim was to develop a proposal for the accreditation of respiratory medicine departments in terms of care, teaching, and research, measuring health outcomes using quality of care indicators. The management tools proposed in this article should be implemented to improve outcomes and help us achieve our objectives. Promoting accreditation can serve as a stimulus to improve clinical management and enable professionals to take on greater leadership roles and take action to improve outcomes in patient care.
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Affiliation(s)
- José Manuel Álvarez-Dobaño
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain; Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Gerardo Atienza
- Unidad de Calidad y Seguridad del Paciente, Subdirección de Calidad, Área Sanitaria de Santiago de Compostela y Barbanza, Santiago de Compostela, Spain
| | - Carlos Zamarrón
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - María Elena Toubes
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Lucía Ferreiro
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain.
| | - Vanessa Riveiro
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Ana Casal
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Juan Suárez-Antelo
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Nuria Rodríguez-Núñez
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Adriana Lama-López
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Carlos Rábade-Castedo
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Carlota Rodríguez-García
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Tamara Lourido-Cebreiro
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Jorge Ricoy
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Romina Abelleira
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Antonio Golpe
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain; Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Beatriz Pais
- Unidad de Calidad y Seguridad del Paciente, Subdirección de Calidad, Área Sanitaria de Santiago de Compostela y Barbanza, Santiago de Compostela, Spain
| | - Francisco Javier González-Barcala
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain; Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
| | - Luis Valdés
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain; Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain
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4
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Álvarez-Dobaño JM, Atienza G, Zamarrón C, Toubes ME, Ferreiro L, Riveiro V, Casal A, Suárez-Antelo J, Rodríguez-Núñez N, Lama-López A, Rábade-Castedo C, Rodríguez-García C, Lourido-Cebreiro T, Ricoy J, Abelleira R, Golpe A, Pais B, González-Barcala FJ, Valdés L. Health Outcomes: Towards the Accreditation of Respiratory Medicine Departments. Arch Bronconeumol 2021; 57:S0300-2896(21)00029-6. [PMID: 33678474 DOI: 10.1016/j.arbres.2021.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/04/2021] [Accepted: 01/13/2021] [Indexed: 11/22/2022]
Abstract
National health systems must ensure compliance with conditions such as equity, efficiency, quality, and transparency. Since it is the right of society to know the health outcomes of its healthcare system, our aim was to develop a proposal for the accreditation of respiratory medicine departments in terms of care, teaching, and research, measuring health outcomes using quality of care indicators. The management tools proposed in this article should be implemented to improve outcomes and help us achieve our objectives. Promoting accreditation can serve as a stimulus to improve clinical management and enable professionals to take on greater leadership roles and take action to improve outcomes in patient care.
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Affiliation(s)
- José Manuel Álvarez-Dobaño
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, España
| | - Gerardo Atienza
- Unidad de Calidad y Seguridad del Paciente, Subdirección de Calidad, Área Sanitaria de Santiago de Compostela y Barbanza, Santiago de Compostela, España
| | - Carlos Zamarrón
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España
| | - María Elena Toubes
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España
| | - Lucía Ferreiro
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, España.
| | - Vanessa Riveiro
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España
| | - Ana Casal
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España
| | - Juan Suárez-Antelo
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España
| | - Nuria Rodríguez-Núñez
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España
| | - Adriana Lama-López
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España
| | - Carlos Rábade-Castedo
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España
| | - Carlota Rodríguez-García
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España
| | - Tamara Lourido-Cebreiro
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España
| | - Jorge Ricoy
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España
| | - Romina Abelleira
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, España
| | - Antonio Golpe
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, España
| | - Beatriz Pais
- Unidad de Calidad y Seguridad del Paciente, Subdirección de Calidad, Área Sanitaria de Santiago de Compostela y Barbanza, Santiago de Compostela, España
| | - Francisco Javier González-Barcala
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, España
| | - Luis Valdés
- Servicio de Neumología, Complejo Hospitalario Clínico-Universitario de Santiago, Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, España
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Fasano A, Antonini A, Katzenschlager R, Krack P, Odin P, Evans AH, Foltynie T, Volkmann J, Merello M. Management of Advanced Therapies in Parkinson's Disease Patients in Times of Humanitarian Crisis: The COVID-19 Experience. Mov Disord Clin Pract 2020; 7:361-372. [PMID: 32373652 DOI: 10.1002/mdc3.12965] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 12/22/2022] Open
Abstract
Background Although the COVID-19 pandemic is affecting a relatively small proportion of the global population, its effects have already reached everyone. The pandemic has the potential to differentially disadvantage chronically ill patients, including those with Parkinson's disease (PD). The first health care reaction has been to limit access to clinics and neurology wards to preserve fragile patients with PD from being infected. In some regions, the shortage of medical staff has also forced movement disorders neurologists to provide care for patients with COVID-19. Objective To share the experience of various movement disorder neurologists operating in different world regions and provide a common approach to patients with PD, with a focus on those already on advanced therapies, which may serve as guidance in the current pandemic and for emergency situations that we may face in the future. Conclusion Most of us were unprepared to deal with this condition given that in many health care systems, telemedicine has been only marginally available or only limited to email or telephone contacts. In addition, to ensure sufficient access to intensive care unit beds, most elective procedures (including deep brain stimulation or the initiation of infusion therapies) have been postponed. We all hope there will soon be a time when we will return to more regular hospital schedules. However, we should consider this crisis as an opportunity to change our approach and encourage our hospitals and health care systems to facilitate the remote management of chronic neurological patients, including those with advanced PD.
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Affiliation(s)
- Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, University Health Network, Division of Neurology University of Toronto Toronto Ontario Canada.,Krembil Brain Institute Toronto Ontario Canada.,The Center for Advancing Neurotechnological Innovation to Application Toronto Ontario Canada
| | | | - Regina Katzenschlager
- Department of Neurology and Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders Donauspital Vienna Austria
| | - Paul Krack
- Department of Neurology, Center for Parkinson's Disease and Movement Disorders Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences Lund Lund University Lund Sweden
| | - Andrew H Evans
- Department of Neurology the Royal Melbourne Hospital Victoria Australia
| | - Thomas Foltynie
- Department of Clinical & Movement Neurosciences University College London Institute of Neurology, Queen Square London United Kingdom
| | - Jens Volkmann
- Neurologischen Klinik Universitätsklinikum Würzburg Würzburg Germany
| | - Marcelo Merello
- Movement Disorders Section Fleni Buenos Aires Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas Buenos Aires Argentina
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de la Fuente Ballesteros S, García Granja N, Hernández Carrasco M, Hidalgo Benito A, García Álvarez I, García Ramón E. La consulta no presencial como herramienta de mejora de la consulta a demanda en atención primaria. Semergen 2018; 44:458-462. [DOI: 10.1016/j.semerg.2018.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/09/2018] [Accepted: 05/24/2018] [Indexed: 10/28/2022]
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