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Vigil IM, Sylvia M. Transforming Neurology Care Delivery Through a Population Health Data Strategy. Neurol Clin Pract 2024; 14:e200248. [PMID: 38585437 PMCID: PMC10996910 DOI: 10.1212/cpj.0000000000200248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/08/2023] [Indexed: 04/09/2024]
Abstract
Background With more than 30% of global data originating from health care, deriving usable insights that improve health requires population health analytics. In neurology, data-driven approaches have grown in significance because of digital health records and advanced analytics. A vital aspect of this evolution is adopting a population health data strategy (PHDS). Recent Findings Crafting a tailored PHDS for neurology involves cataloging data points and measures spanning demographics, clinical history, genetics, and social determinants. Neurologic outcomes include mortality rates, functional and cognitive abilities, and imaging results. A robust strategy relies on interoperability, advanced analytics, and transparent AI algorithms. Summary Neurology is embracing data-driven health care. The PHDS synthesizes diverse patient data to provide personalized care. It includes a wide range of outcome measures to address neurologic complexities. Advanced analytics and collaboration among neurologists, data scientists, and business leaders uncover hidden patterns and promote outcome-driven medicine in the 21st century.
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Affiliation(s)
- Ines M Vigil
- Clarify Health Solutions (IMV); and Medical University of South Carolina College of Nursing (MS)
| | - Martha Sylvia
- Clarify Health Solutions (IMV); and Medical University of South Carolina College of Nursing (MS)
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Grange E, Solaro C, Di Giovanni R, Marengo D. The correlation between 9-HPT and patient-reported measures of upper limb function in multiple sclerosis: a systematic review and meta-analysis. J Neurol 2023; 270:4179-4191. [PMID: 37294322 PMCID: PMC10421783 DOI: 10.1007/s00415-023-11801-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/30/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023]
Abstract
Upper limb function is one of the most affected domains in people with multiple sclerosis (PwMS), as self-reported by 50% of patients. Heterogeneous results have been found about the correlation between objective and subjective upper limb function. The aim of the present study is to perform a systematic review and meta-analysis of studies presenting data on the strength of association between the gold standard for 9-Hole Peg Test scores and Patient-Reported Outcome Measures (PROMs) of manual ability. Primary research studies including assessments of 9-Hole Peg Test scores and Patient-Reported Outcome Measures were searched in Scopus, Web of Science, and PubMed. Meta analytical calculations were performed using a random-effects model. We retrieved n = 27 studies including n = 75 distinct effect sizes (N of subjects = 3263). The central tendency analysis showed a strong correlation between 9-HPT scores and PROMs (r = 0.51, 95% CI [0.44, 0.58]). Moderator analysis showed the effect size to be significantly larger in studies with a mean or median EDSS level indicating severe disability. The publication bias hypothesis was not supported; instead, we noted that studies based on larger samples also tend to report stronger effect sizes. Results of the study indicate that the correlation between 9-HPT and PROMs is strong, although the constructs measured by these instrument does not fully overlap. The correlation between 9-HPT and PROMs was stronger in larger studies and when samples include a sizeable subgroup of PwMS with severe disability, pointing out the importance of sample diversity.
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Affiliation(s)
- Erica Grange
- CRRF "Mons. Luigi Novarese", Moncrivello, VC, Italy
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Claudio Solaro
- CRRF "Mons. Luigi Novarese", Moncrivello, VC, Italy
- Neurology Unit, Galliera Hospital, Genoa, Italy
| | | | - Davide Marengo
- Department of Psychology, University of Turin, Turin, Italy.
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van Munster CE, Jessica B, Steinheimer S, Kamm CP, D’Souza M, Diederich M, Dorn J, Walsh L, Dahlke F, Kappos L, Uitdehaag BM. Assessment of Multiple Aspects of Upper Extremity Function Independent From Ambulation in Patients With Multiple Sclerosis. Int J MS Care 2023; 25:226-232. [PMID: 37720262 PMCID: PMC10503816 DOI: 10.7224/1537-2073.2021-069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND Upper extremity function (UEF) is often compromised in multiple sclerosis (MS), although its importance is regularly underrecognized relative to ambulation. We explored the concurrent presence of impairment in UEF and ambulation by examining various aspects of UEF across different levels of ambulation. METHODS The cohort consisted of 247 patients with clinically definite MS or clinically isolated syndrome according to the revised 2010 McDonald criteria. The Nine-Hole Peg Test and the Expanded Disability Status Scale were used to stratify patients into clinically different subgroups. For UEF, cerebellar function (finger-to-nose test), pyramidal function (pronator drift test), and the ability to perform a task of activities of daily living (drinking-from-cup test) were examined. Patient-reported limitations of UEF in daily life were assessed using the Arm Function in Multiple Sclerosis Questionnaire. RESULTS Patients in more severely impaired ambulation groups displayed poorer performance on all UEF measures. Although most patients had normal to mild (n = 147) or moderate (n = 46) ambulatory impairment, 87.7% exhibited some level of UEF impairment as defined using the Nine-Hole Peg Test. Most patients had mild UEF impairment (n = 174), accounting for the largest proportion in all ambulation groups (51.9%-77.8%). CONCLUSIONS A distinct pattern of impairment was found for ambulation and multiple aspects of UEF. Independent assessment of multiple aspects of disability may be helpful in treatment decision-making and could support the development of rehabilitation strategies that specifically target UEF impairment.
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Affiliation(s)
- Caspar E.P. van Munster
- From the Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam, the Netherlands (CEPvM, JB, BMJU)
| | - Burggraaff Jessica
- From the Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam, the Netherlands (CEPvM, JB, BMJU)
| | - Saskia Steinheimer
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland (SS, CPK)
| | - Christian P. Kamm
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland (SS, CPK)
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Lucerne, Switzerland (CPK)
| | - Marcus D’Souza
- Neurology, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital Basel, Basel, Switzerland (MD’S, MD, LK)
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany (MD’S)
| | - Manuela Diederich
- Neurology, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital Basel, Basel, Switzerland (MD’S, MD, LK)
| | - Jonas Dorn
- Novartis Pharma AG, Basel, Switzerland (JD, LW, FD)
| | - Lorcan Walsh
- Novartis Pharma AG, Basel, Switzerland (JD, LW, FD)
| | - Frank Dahlke
- Novartis Pharma AG, Basel, Switzerland (JD, LW, FD)
| | - Ludwig Kappos
- Neurology, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital Basel, Basel, Switzerland (MD’S, MD, LK)
| | - Bernard M.J. Uitdehaag
- From the Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam, the Netherlands (CEPvM, JB, BMJU)
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Solaro C, Di Giovanni R, Grange E, Brichetto G, Mueller M, Tacchino A, Bertoni R, Patti F, Pappalardo A, Prosperini L, Castelli L, Rosato R, Cattaneo D, Marengo D. Correlation between patient-reported manual ability and three objective measures of upper limb function in people with multiple sclerosis. Eur J Neurol 2023; 30:172-178. [PMID: 36086993 PMCID: PMC10087787 DOI: 10.1111/ene.15560] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/14/2022] [Accepted: 09/04/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Upper limb (UL) function is often affected in people with multiple sclerosis (PwMS) and is typically assessed through objective measures, including the Nine Hole Peg Test (9-HPT), Box and Block Test (BBT), and Hand Grip Strength (HGS). It is important to include the subjective perspective of PwMS in the assessment. This study aims to evaluate associations between Manual Ability Measure-36 (MAM-36) and 9-HPT, BBT, and HGS in MS. METHODS The cross-sectional study included five Italian centers. Inclusion criteria were age ≥ 18 years, MS diagnosis, and stable disease course. Exclusion criteria were bilateral UL paralysis, and concomitant orthopedic or neurological diseases. RESULTS A total of 199 PwMS were included: 128 female, mean age = 50.7 ± 13.0 years, 119 relapsing-remitting MS (RRMS), 31 primary and 49 secondary progressive MS, mean disease duration = 14.0 ± 10.4, years, mean Expanded Disability Status Scale (EDSS) = 4.6 ± 2.0. The MAM-36 showed small correlations with 9-HPT, BBT, and HGS. Correlations between MAM-36 and 9-HPT and BBT were highest among subjects with EDSS ≥ 6 and progressive MS. MAM-36 and HGS showed the highest correlations in subjects with EDSS ≤ 5 and RRMS. Combining 9-HPT and HGS provided the strongest predictive power over the MAM-36. CONCLUSIONS Correlations between objective measures and MAM-36 were small to moderate, meaning that objective measures do not match subjects' perception of UL function. The combination of 9-HPT and HGS measures can help improve the assessment of UL function in activities of daily living.
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Affiliation(s)
- Claudio Solaro
- Department of Rehabilitation, CRRF "Mons. Luigi Novarese", Moncrivello, Italy
| | - Rachele Di Giovanni
- Department of Rehabilitation, CRRF "Mons. Luigi Novarese", Moncrivello, Italy
| | - Erica Grange
- Department of Rehabilitation, CRRF "Mons. Luigi Novarese", Moncrivello, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Margit Mueller
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Rita Bertoni
- LaRice Lab, Don Carlo Gnocchi Foundation, Institute of Hospitalization and Scientific Care, Milan, Italy
| | - Francesco Patti
- Multiple Sclerosis Center, Institute of Neurological Sciences, University of Catania, Catania, Italy
| | - Angelo Pappalardo
- Multiple Sclerosis Center, Institute of Neurological Sciences, University of Catania, Catania, Italy
| | - Luca Prosperini
- Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Letizia Castelli
- Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Rosalba Rosato
- Department of Psychology, University of Turin, Turin, Italy
| | - Davide Cattaneo
- LaRice Lab, Don Carlo Gnocchi Foundation, Institute of Hospitalization and Scientific Care, Milan, Italy.,Department of Physiopathology and Transplants, University of Milan, Milan, Italy
| | - Davide Marengo
- Department of Psychology, University of Turin, Turin, Italy
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Neurorehabilitation in Multiple Sclerosis-A Review of Present Approaches and Future Considerations. J Clin Med 2022; 11:jcm11237003. [PMID: 36498578 PMCID: PMC9739865 DOI: 10.3390/jcm11237003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Multiple sclerosis is an increasingly prevalent disease, representing the leading cause of non-traumatic neurological disease in Europe and North America. The most common symptoms include gait deficits, balance and coordination impairments, fatigue, spasticity, dysphagia and an overactive bladder. Neurorehabilitation therapeutic approaches aim to alleviate symptoms and improve the quality of life through promoting positive immunological transformations and neuroplasticity. The purpose of this study is to evaluate the current treatments for the most debilitating symptoms in multiple sclerosis, identify areas for future improvement, and provide a reference guide for practitioners in the field. It analyzes the most cited procedures currently in use for the management of a number of symptoms affecting the majority of patients with multiple sclerosis, from different training routines to cognitive rehabilitation and therapies using physical agents, such as electrostimulation, hydrotherapy, cryotherapy and electromagnetic fields. Furthermore, it investigates the quality of evidence for the aforementioned therapies and the different tests applied in practice to assess their utility. Lastly, the study looks at potential future candidates for the treatment and evaluation of patients with multiple sclerosis and the supposed benefits they could bring in clinical settings.
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Molenaar P, Strijbis E, van Munster C, Uitdehaag B, Kalkers N. ‘Cross-sectional and longitudinal correlations between the Arm Function in Multiple Sclerosis Questionnaire (AMSQ) and other outcome measures in multiple sclerosis.’. Mult Scler Relat Disord 2022; 61:103725. [DOI: 10.1016/j.msard.2022.103725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 02/08/2022] [Accepted: 03/03/2022] [Indexed: 11/29/2022]
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Jansa J, Ferdinand S, Milo M, Løyning IG, Huilla T, Kallmayer L, Ilsbroukx S, Filló N, Raats J, Jakobson J, Kos D. Performance of Activities of daily living in people with multiple sclerosis. Mult Scler Relat Disord 2022; 57:103342. [PMID: 35158429 DOI: 10.1016/j.msard.2021.103342] [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: 10/16/2020] [Revised: 10/15/2021] [Accepted: 10/17/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Multiple sclerosis (MS) may result in activity and participation limitations, including the performance of activities of daily living (ADL). This study aims at systematically investigate ADL performance by using Assessment of Motor and Process Skills (AMPS) in people with MS (PwMS) of all disease types and within the Kurtzke Expanded Disability Status Scale (EDSS) range from 1.0 - 8.0. METHODS Eight multiple sclerosis (MS) centres participated in data collection of a consecutive sample of PwMS. Participants were referred for assessment to occupational therapy (OT) by treating physician or recruited from neurology department in each hospital and assessed by EDSS and AMPS. The AMPS is an observational, criterion referenced ADL assessment, providing values for a person's ADL performance in terms of motor and process skills. Criterion referenced cut-off scores were established at 2.0 for motor skills and at 1.0 for process skills and both values above the cut-off score indicate competent (independent, safe, efficient and effortless) ADL performance. Process skills refer to the act of carrying out a series of actions and is summarized in terms of efficiency, like initiating without pauses, continuing actions through to completion, performing actions in logical order (sequences), choosing, and completing the task as planned (heeds). RESULTS Two hundred and ten PwMS were recruited (48 +/- 13 years of age, 145 women/65 men, average disease duration was 11.8 +/- 9.6 years, average EDSS was 4.8+/-1.8). Average motor skills score was 1.01+/- 1.12 (indicating need for assistance with evidence of increased clumsiness/physical effort) and average process skills score was 1.02 +/- 0.66 (risk zone, questionable efficiency and more likely to need assistance). Overall, motor skills and process skills decreased with increasing EDSS score. No need for assistance in motor skills was indicated in subjects with lower EDSS scores (1.0 - 2.5). In higher EDSS group (≥4.5), 57% of subjects needed assistance in motor skills and 27% in process skills. The competency in process skills was either questionable or reduced within all EDSS scores. However, 33-38% of subjects with higher EDSS scores (6.0-8.5) showed competent performance in process skills. Overall correlation between motor and process scores was moderate (r = 0.56, p<0.0001), but no significant relationships between motor and process skills were found in the lower EDSS (1-2.5) and high EDSS scores (8-8.5). Further, EDSS and disease type were significant predictors, explaining 52.7% of motor skills and 22.3% of process skills performance. CONCLUSION Problems in ADL performance were found in EDSS categories 1.0 to 8.0 and in all disease types, therefore it is advisable to screen all PwMS for ADL deficits and provide relevant rehabilitation interventions.
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Affiliation(s)
- Jelka Jansa
- University Medical Centre Ljubljana, Slovenia; Rehabilitation in MS (RIMS) - SIG Occupation group, Tervuursevest 101, 3001 Leuven, Belgium.
| | - Sofie Ferdinand
- National MS Center Melsbroek, Belgium; Rehabilitation in MS (RIMS) - SIG Occupation group, Tervuursevest 101, 3001 Leuven, Belgium.
| | - Meta Milo
- National MS Center Melsbroek, Belgium; Rehabilitation in MS (RIMS) - SIG Occupation group, Tervuursevest 101, 3001 Leuven, Belgium.
| | - Inger G Løyning
- MS-Senteret Hakadal, Norway; Rehabilitation in MS (RIMS) - SIG Occupation group, Tervuursevest 101, 3001 Leuven, Belgium.
| | - Tarja Huilla
- MS Center Masku, Finland; Rehabilitation in MS (RIMS) - SIG Occupation group, Tervuursevest 101, 3001 Leuven, Belgium.
| | - Lene Kallmayer
- The Multiple Sclerosis Hospital Ry, Denmark; Rehabilitation in MS (RIMS) - SIG Occupation group, Tervuursevest 101, 3001 Leuven, Belgium.
| | | | - Núria Filló
- MS Center of Catalonia, Cemcat, Universitat Autònoma de Barcelona, Spain; Rehabilitation in MS (RIMS) - SIG Occupation group, Tervuursevest 101, 3001 Leuven, Belgium.
| | - Joke Raats
- AZ Klina, RC De Mick, Belgium; Rehabilitation in MS (RIMS) - SIG Occupation group, Tervuursevest 101, 3001 Leuven, Belgium.
| | - Jytte Jakobson
- The Multiple Sclerosis Hospital Haslev, Denmark; Rehabilitation in MS (RIMS) - SIG Occupation group, Tervuursevest 101, 3001 Leuven, Belgium.
| | - Daphne Kos
- National MS Center Melsbroek, Belgium; KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; Rehabilitation in MS (RIMS) - SIG Occupation group, Tervuursevest 101, 3001 Leuven, Belgium.
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D'Souza M, Van Munster CEP, Dorn JF, Dorier A, Kamm CP, Steinheimer S, Dahlke F, Uitdehaag BMJ, Kappos L, Johnson M. Autoencoder as a New Method for Maintaining Data Privacy While Analyzing Videos of Patients With Motor Dysfunction: Proof-of-Concept Study. J Med Internet Res 2020; 22:e16669. [PMID: 32191621 PMCID: PMC7244995 DOI: 10.2196/16669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 02/19/2020] [Accepted: 03/19/2020] [Indexed: 12/26/2022] Open
Abstract
Background In chronic neurological diseases, especially in multiple sclerosis (MS), clinical assessment of motor dysfunction is crucial to monitor the disease in patients. Traditional scales are not sensitive enough to detect slight changes. Video recordings of patient performance are more accurate and increase the reliability of severity ratings. When these recordings are automated, quantitative disability assessments by machine learning algorithms can be created. Creation of these algorithms involves non–health care professionals, which is a challenge for maintaining data privacy. However, autoencoders can address this issue. Objective The aim of this proof-of-concept study was to test whether coded frame vectors of autoencoders contain relevant information for analyzing videos of the motor performance of patients with MS. Methods In this study, 20 pre-rated videos of patients performing the finger-to-nose test were recorded. An autoencoder created encoded frame vectors from the original videos and decoded the videos again. The original and decoded videos were shown to 10 neurologists at an academic MS center in Basel, Switzerland. The neurologists tested whether the 200 videos were human-readable after decoding and rated the severity grade of each original and decoded video according to the Neurostatus-Expanded Disability Status Scale definitions of limb ataxia. Furthermore, the neurologists tested whether ratings were equivalent between the original and decoded videos. Results In total, 172 of 200 (86.0%) videos were of sufficient quality to be ratable. The intrarater agreement between the original and decoded videos was 0.317 (Cohen weighted kappa). The average difference in the ratings between the original and decoded videos was 0.26, in which the original videos were rated as more severe. The interrater agreement between the original videos was 0.459 and that between the decoded videos was 0.302. The agreement was higher when no deficits or very severe deficits were present. Conclusions The vast majority of videos (172/200, 86.0%) decoded by the autoencoder contained clinically relevant information and had fair intrarater agreement with the original videos. Autoencoders are a potential method for enabling the use of patient videos while preserving data privacy, especially when non–health-care professionals are involved.
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Affiliation(s)
- Marcus D'Souza
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Caspar E P Van Munster
- Department of Neurology, Multiple Sclerosis Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | | | | | - Christian P Kamm
- Neurocenter, Luzerner Kantonsspital, Luzern, Switzerland.,Department of Neurology, Inselspital, University of Bern, Bern, Switzerland
| | - Saskia Steinheimer
- Department of Neurology, Inselspital, University of Bern, Bern, Switzerland
| | | | - Bernard M J Uitdehaag
- Department of Neurology, Multiple Sclerosis Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
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