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Cuijpers ACM, Linskens FG, Bongers BC, Stassen LPS, Lubbers T, van Meeteren NLU. Quality and clinical generalizability of feasibility outcomes in exercise prehabilitation before colorectal cancer surgery - A systematic review. Eur J Surg Oncol 2022; 48:1483-1497. [PMID: 35491361 DOI: 10.1016/j.ejso.2022.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 02/13/2022] [Accepted: 04/19/2022] [Indexed: 01/10/2023] Open
Abstract
Suboptimal quality of feasibility assessments might partially explain inconsistencies observed in the effectiveness of exercise prehabilitation before colorectal cancer (CRC) surgery. This systematic review aimed to assess the reporting quality and clinical generalizability of feasibility outcomes in feasibility studies addressing exercise prehabilitation before CRC surgery. PubMed/Medline, Embase, Cochrane, and CINAHL were searched to identify all feasibility studies focussing on exercise prehabilitation in CRC surgery. Reporting quality was assessed using the Thabane et al. checklist and the Consolidated Standards of Reporting Trials extension for feasibility studies. Clinical generalizability was evaluated by appraising patient participation in all steps of the study and intervention. Twelve studies were included. The main feasibility outcome in all studies was adherence to the intervention by the study sample. Based on adherence, 10 studies (83%) concluded exercise prehabilitation to be feasible. Six studies (50%) reported all details to assess patient participation showing retention rates between 18.4% and 58.2%, which was caused by non-participation and drop-out. Three feasibility studies (25%) discussed patient-reported barriers to participation and five additional studies (41%) described potential selection bias. Four studies (33%) reported lessons learned to solve issues hampering feasibility and clinical generalizability. Results suggest that true feasibility of exercise prehabilitation before CRC surgery remains questionable due to poor reporting quality, insufficient clarity regarding the representativeness of the study sample for the target population, and limited attention for clinical generalizability. Feasibility of exercise prehabilitation might be improved by offering supervised community- or home-based interventions tailored to the physical and mental abilities of the patient.
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Affiliation(s)
- Anne C M Cuijpers
- Department of Surgery - Maastricht University Medical Centre +, PO Box 5800, 6202, AZ, Maastricht, the Netherlands; Department of Surgery - School for Oncology and Developmental Biology (GROW) - Faculty of Health, Medicine and Life Sciences - Maastricht University, PO Box 616, 6200, MD, Maastricht, the Netherlands.
| | - Fieke G Linskens
- Physiotherapy Sciences, Program in Clinical Health Sciences, University Medical Centre Utrecht, Utrecht, the Netherlands.
| | - Bart C Bongers
- Department of Nutrition and Movement Sciences - School of Nutrition and Translational Research in Metabolism (NUTRIM) - Faculty of Health, Medicine and Life Sciences - Maastricht University, PO Box 616, 6200, MD, Maastricht, the Netherlands; Department of Epidemiology - Care and Public Health Research Institute (CAPHRI) - Faculty of Health, Medicine and Life Sciences - Maastricht University, PO Box 616, 6200, MD, Maastricht, the Netherlands.
| | - Laurents P S Stassen
- Department of Surgery - Maastricht University Medical Centre +, PO Box 5800, 6202, AZ, Maastricht, the Netherlands; Department of Surgery - School of Nutrition and Translational Research in Metabolism (NUTRIM) - Faculty of Health, Medicine and Life Sciences - Maastricht University, PO Box 616, 6200, MD, Maastricht, the Netherlands.
| | - Tim Lubbers
- Department of Surgery - Maastricht University Medical Centre +, PO Box 5800, 6202, AZ, Maastricht, the Netherlands; Department of Surgery - School for Oncology and Developmental Biology (GROW) - Faculty of Health, Medicine and Life Sciences - Maastricht University, PO Box 616, 6200, MD, Maastricht, the Netherlands.
| | - Nico L U van Meeteren
- Top Sector Life Sciences and Health (Health∼Holland), Wilhelmina van Pruisenweg 104, 2595, AN, The Hague, the Netherlands; Department of Anaesthesiology - Erasmus Medical Centre, PO Box 2040, 3000, CA, Rotterdam, the Netherlands.
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Docter S, Lukacs MJ, Fathalla Z, Khan MCM, Jennings M, Liu SH, Dong S, Getgood A, Bryant DM. Inconsistencies in the Methodological Framework Throughout Published Studies in High-Impact Orthopaedic Journals: A Systematic Review. J Bone Joint Surg Am 2022; 104:181-188. [PMID: 34648473 DOI: 10.2106/jbjs.21.00116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Both the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) and Consolidated Standards of Reporting Trials (CONSORT) guidelines recommend that clinical trials follow a study framework that aligns with their objective to test the relative efficacy or safety (equality) or effectiveness (superiority, noninferiority, or equivalence) between interventions. We conducted a systematic review to assess the proportion of studies that demonstrated inconsistency between the framing of their research question, sample size calculation, and conclusion and those that should have framed their research question differently based on the compared interventions. METHODS We included studies from 5 high-impact-factor orthopaedic journals published in 2017 and 2019 that compared at least 2 interventions using patient-reported outcome measures. RESULTS We included 228 studies. The sample size calculation was reported in 60.5% (n = 138) of studies. Of these, 52.2% (n = 72) were inconsistent between the framing of their research question, sample size calculation, and conclusion. The majority (n = 137) of sample size calculations were for equality, but 43.8% of these studies concluded superiority, noninferiority, or equivalence. Studies that framed their research question as equality (n = 186) should have been framed as superiority (n = 129), equivalence (n = 52), or noninferiority (n = 3). Only 2 studies correctly framed their research question as equality. CONCLUSIONS Studies published in high-impact journals were inconsistent between the framing of their research question, sample size calculation, and conclusion. Authors may be misinterpreting research findings and making clinical recommendations solely based on p values. Researchers are encouraged to state and justify their methodological framework and choice of margin(s) in a publicly published protocol as they have implications for sample size and the applicability of conclusions. CLINICAL RELEVANCE The results of clinical research must be interpreted using confidence intervals, with careful consideration as to how the confidence intervals relate to clinically meaningful differences in outcomes between treatments. The more typical practice of relying on p values leaves the clinician at high risk of erroneous interpretation, recommendation, and/or action.
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Affiliation(s)
- Shgufta Docter
- Faculty of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada.,Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Michael J Lukacs
- Faculty of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada.,Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Zina Fathalla
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Michaela C M Khan
- Faculty of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada.,Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Morgan Jennings
- Faculty of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada.,Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Shu-Hsuan Liu
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Susan Dong
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Alan Getgood
- Bone and Joint Institute, Western University, London, Ontario, Canada.,Division of Orthopaedics, Department of Surgery, Fowler Kennedy Sport Medicine, Western University, London, Ontario, Canada
| | - Dianne M Bryant
- Faculty of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada.,Bone and Joint Institute, Western University, London, Ontario, Canada.,Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Division of Orthopaedics, Department of Surgery, Fowler Kennedy Sport Medicine, Western University, London, Ontario, Canada
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Aryan R, Jagroop D, Danells CJ, Rozanski G, Unger J, Huntley AH, Mansfield A. Publication Rate and Consistency of Registered Trials of Motor-Based Stroke Rehabilitation. Neurology 2021; 96:617-626. [PMID: 33568550 DOI: 10.1212/wnl.0000000000011660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/22/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the publication rate of motor-rehabilitation trials poststroke and the consistency between registry records and their corresponding main publications in trial design, primary objectives and outcomes, eligibility criteria, and sample size. METHODS We searched 18 clinical trial registries to identify randomized controlled trials of motor-based stroke rehabilitation registered after July 2005 and completed before April 2017. Eligible trials included adults with stroke, with at least one outcome measure related to motor function. Information in the registry records was compared with that of their main publications, if any. RESULTS Three hundred twenty-three trials met our eligibility criteria; we were unable to find a peer-reviewed publication reporting the main findings for 46% (150/323) of these. Of the 169 trials with peer-reviewed articles published in English, 141 (83%) were consistent with the registry record in trial design, 100 (59%) were consistent in primary objectives, 71 (42%) were consistent in primary outcomes, 28 (17%) were consistent in eligibility criteria, and 74 (44%) were consistent in sample size. CONCLUSIONS Approximately half of motor-based stroke rehabilitation trials were not published, even more than 3 years after the end of the trial. When main publications were found, they substantially deviated from information in the registry record. These findings highlight the importance of trial registries for identifying unpublished stroke rehabilitation trials and of searching trial registries when conducting systematic reviews and meta-analysis to help ensure that reviews are unbiased.
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Affiliation(s)
- Raabeae Aryan
- From the Rehabilitation Sciences Institute (R.A., J.U.), University of Toronto; Toronto Rehabilitation Institute-University Health Network (R.A., D.J., C.J.D., G.R., J.U., A.H.H., A.M.); Department of Physical Therapy (C.J.D., A.M.), University of Toronto; School of Physical Therapy (J.U.), Faculty of Health Sciences, Western University, London; and Evaluative Clinical Sciences (A.M.), Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - David Jagroop
- From the Rehabilitation Sciences Institute (R.A., J.U.), University of Toronto; Toronto Rehabilitation Institute-University Health Network (R.A., D.J., C.J.D., G.R., J.U., A.H.H., A.M.); Department of Physical Therapy (C.J.D., A.M.), University of Toronto; School of Physical Therapy (J.U.), Faculty of Health Sciences, Western University, London; and Evaluative Clinical Sciences (A.M.), Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Cynthia J Danells
- From the Rehabilitation Sciences Institute (R.A., J.U.), University of Toronto; Toronto Rehabilitation Institute-University Health Network (R.A., D.J., C.J.D., G.R., J.U., A.H.H., A.M.); Department of Physical Therapy (C.J.D., A.M.), University of Toronto; School of Physical Therapy (J.U.), Faculty of Health Sciences, Western University, London; and Evaluative Clinical Sciences (A.M.), Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Gabriela Rozanski
- From the Rehabilitation Sciences Institute (R.A., J.U.), University of Toronto; Toronto Rehabilitation Institute-University Health Network (R.A., D.J., C.J.D., G.R., J.U., A.H.H., A.M.); Department of Physical Therapy (C.J.D., A.M.), University of Toronto; School of Physical Therapy (J.U.), Faculty of Health Sciences, Western University, London; and Evaluative Clinical Sciences (A.M.), Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Janelle Unger
- From the Rehabilitation Sciences Institute (R.A., J.U.), University of Toronto; Toronto Rehabilitation Institute-University Health Network (R.A., D.J., C.J.D., G.R., J.U., A.H.H., A.M.); Department of Physical Therapy (C.J.D., A.M.), University of Toronto; School of Physical Therapy (J.U.), Faculty of Health Sciences, Western University, London; and Evaluative Clinical Sciences (A.M.), Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Andrew H Huntley
- From the Rehabilitation Sciences Institute (R.A., J.U.), University of Toronto; Toronto Rehabilitation Institute-University Health Network (R.A., D.J., C.J.D., G.R., J.U., A.H.H., A.M.); Department of Physical Therapy (C.J.D., A.M.), University of Toronto; School of Physical Therapy (J.U.), Faculty of Health Sciences, Western University, London; and Evaluative Clinical Sciences (A.M.), Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Avril Mansfield
- From the Rehabilitation Sciences Institute (R.A., J.U.), University of Toronto; Toronto Rehabilitation Institute-University Health Network (R.A., D.J., C.J.D., G.R., J.U., A.H.H., A.M.); Department of Physical Therapy (C.J.D., A.M.), University of Toronto; School of Physical Therapy (J.U.), Faculty of Health Sciences, Western University, London; and Evaluative Clinical Sciences (A.M.), Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.
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Kho ME, Thabane L. Pilot and Feasibility Studies in Rehabilitation: Moving into the Next Decade. Physiother Can 2020; 72:225-227. [PMID: 35110789 DOI: 10.3138/ptc-72-3-gee2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Michelle E Kho
- School of Rehabilitation Science.,Department of Physiotherapy, St. Joseph's Healthcare.,Research Institute of St. Joe's, Hamilton, Ont
| | - Lehana Thabane
- Department of Physiotherapy, St. Joseph's Healthcare.,Department of Health Research Methods, Evidence, and Impact, McMaster University
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Kho ME, Thabane L. Les études pilotes et les études de faisabilité en réadaptation : la prochaine décennie. Physiother Can 2020; 72:227-229. [PMID: 35110790 DOI: 10.3138/ptc-72-3-gef2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Michelle E Kho
- École des sciences de la réadaptation.,Département de physiothérapie, St. Joseph's Healthcare.,Research Institute of St. Joe's, Hamilton (Ontario)
| | - Lehana Thabane
- Département de physiothérapie, St. Joseph's Healthcare.,Département des méthodes, données et répercussions de la recherche en santé, université McMaster
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Vaughan-Graham J, Patterson K, Brooks D, Zabjek K, Cott C. Transitions sit to stand and stand to sit in persons post-stroke: Path of centre of mass, pelvic and limb loading - A pilot study. Clin Biomech (Bristol, Avon) 2019; 61:22-30. [PMID: 30458329 DOI: 10.1016/j.clinbiomech.2018.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/06/2018] [Accepted: 11/08/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND To explore the movement patterns utilized by persons post stroke from the simultaneous perspective of pelvic and limb loading with the path of centre of mass during the movement transitions sit to stand and stand to sit. METHODS A descriptive pilot study where kinetic and kinematic data were collected and compared between the contribution made by the less affected versus more affected lower limb and trunk during sit to stand and stand to sit following stroke. Movement analysis was undertaken using force-plates and a 3D VICON motion capture system. FINDINGS Data were successfully collected on nine subjects of whom four presented with left side more affected and eight were male. Two patterns were demonstrated for pelvic loading, four patterns for limb loading and five patterns for deviation of centre of mass. There were no consistent patterns of movement demonstrated dependent upon the more or less affected side. There was no consistent relationship between pelvic and limb loading and deviation of centre of mass throughout the movement phases. INTERPRETATION In contrast to assumptions often made with respect to limb loading, we found large variability in movement patterns utilized by person's with a hemiparetic presentation during sit to stand and stand to sit. The findings suggest that movement problems encountered by persons post-stroke are complex and identifies limitations with respect to current measurement techniques.
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Affiliation(s)
- Julie Vaughan-Graham
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7, Canada.
| | - Kara Patterson
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7, Canada.
| | - Dina Brooks
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7, Canada.
| | - Karl Zabjek
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7, Canada.
| | - Cheryl Cott
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON M5G 1V7, Canada.
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Eldridge SM, Lancaster GA, Campbell MJ, Thabane L, Hopewell S, Coleman CL, Bond CM. Defining Feasibility and Pilot Studies in Preparation for Randomised Controlled Trials: Development of a Conceptual Framework. PLoS One 2016; 11:e0150205. [PMID: 26978655 PMCID: PMC4792418 DOI: 10.1371/journal.pone.0150205] [Citation(s) in RCA: 654] [Impact Index Per Article: 81.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 02/10/2016] [Indexed: 12/18/2022] Open
Abstract
We describe a framework for defining pilot and feasibility studies focusing on studies conducted in preparation for a randomised controlled trial. To develop the framework, we undertook a Delphi survey; ran an open meeting at a trial methodology conference; conducted a review of definitions outside the health research context; consulted experts at an international consensus meeting; and reviewed 27 empirical pilot or feasibility studies. We initially adopted mutually exclusive definitions of pilot and feasibility studies. However, some Delphi survey respondents and the majority of open meeting attendees disagreed with the idea of mutually exclusive definitions. Their viewpoint was supported by definitions outside the health research context, the use of the terms 'pilot' and 'feasibility' in the literature, and participants at the international consensus meeting. In our framework, pilot studies are a subset of feasibility studies, rather than the two being mutually exclusive. A feasibility study asks whether something can be done, should we proceed with it, and if so, how. A pilot study asks the same questions but also has a specific design feature: in a pilot study a future study, or part of a future study, is conducted on a smaller scale. We suggest that to facilitate their identification, these studies should be clearly identified using the terms 'feasibility' or 'pilot' as appropriate. This should include feasibility studies that are largely qualitative; we found these difficult to identify in electronic searches because researchers rarely used the term 'feasibility' in the title or abstract of such studies. Investigators should also report appropriate objectives and methods related to feasibility; and give clear confirmation that their study is in preparation for a future randomised controlled trial designed to assess the effect of an intervention.
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Affiliation(s)
- Sandra M. Eldridge
- Centre for Primary Care and Public Health, Queen Mary University of London, London, United Kingdom
- * E-mail:
| | - Gillian A. Lancaster
- Department of Mathematics and Statistics, Lancaster University, Lancaster, Lancashire, United Kingdom
| | - Michael J. Campbell
- School of Health and Related Research, University of Sheffield, Sheffield, South Yorkshire, United Kingdom
| | - Lehana Thabane
- Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, United Kingdom
| | - Claire L. Coleman
- Centre for Primary Care and Public Health, Queen Mary University of London, London, United Kingdom
| | - Christine M. Bond
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, Scotland, United Kingdom
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Beattie KA, Macintyre NJ, Pierobon J, Coombs J, Horobetz D, Petric A, Pimm M, Kean W, Larché MJ, Cividino A. The sensitivity, specificity and reliability of the GALS (gait, arms, legs and spine) examination when used by physiotherapists and physiotherapy students to detect rheumatoid arthritis. Physiotherapy 2011; 97:196-202. [PMID: 21820537 DOI: 10.1016/j.physio.2010.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 11/15/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the sensitivity, specificity and reliability of the gait, arms, legs and spine (GALS) examination to detect signs and symptoms of rheumatoid arthritis when used by physiotherapy students and physiotherapists. METHODS Two physiotherapy students and two physiotherapists were trained to perform the GALS examination by viewing an instructional DVD and attending a workshop. Two rheumatologists familiar with the GALS examination also participated in the workshop. All healthcare professionals performed the GALS examination on 25 participants with rheumatoid arthritis recruited through a rheumatology practice and 23 participants without any arthritides recruited from a primary care centre. Each participant was assessed by one rheumatologist, one physiotherapist and one physiotherapy student. Abnormalities of gait, arms, legs and spine, including their location and description, were recorded, along with whether or not a diagnosis of rheumatoid arthritis was suspected. Healthcare professionals understood the study's objective to be their agreement on GALS findings and were unaware that half of the participants had rheumatoid arthritis. Sensitivity, specificity and likelihood ratios were calculated to determine the ability of the GALS examination to screen for rheumatoid arthritis. RESULTS Using rheumatologists' findings on the study day as the standard for comparison, sensitivity and specificity were 71 to 86% and 69 to 93%, respectively. Positive likelihood ratios ranged from 2.74 to 10.18, while negative likelihood ratios ranged from 0.21 to 0.38. CONCLUSIONS The GALS examination may be a useful tool for physiotherapists to rule out rheumatoid arthritis in a direct access setting. Differences in duration and type of experience of each healthcare professional may contribute to the variation in results. The merits of introducing the GALS examination into physiotherapy curricula and practice should be explored.
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Affiliation(s)
- Karen A Beattie
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
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