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Calò PG, Catena F, Corsaro D, Costantini L, Falez F, Moretti B, Parrinello V, Romanini E, Spinarelli A, Venneri F, Vaccaro G. Guidelines for improvement of the procedural aspects of devices and surgical instruments in the operating theatre. Front Surg 2023; 10:1183950. [PMID: 37389104 PMCID: PMC10303800 DOI: 10.3389/fsurg.2023.1183950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/26/2023] [Indexed: 07/01/2023] Open
Abstract
Surgical site infections are a major complication for patients undergoing surgical treatment and a significant cause of mortality and morbidity. Many international guidelines suggest measures for the prevention of surgical site infections (SSI) in perioperative processes and the decontamination of surgical devices and instruments. This document proposes guidelines for improving the perioperative setting in view of the devices and instrumentation required for surgical procedures, aiming to reduce contamination rates and improve clinical performance and management for patients undergoing surgical treatment. This document is intended for doctors, nurses and other practitioners involved in operating theatre procedures, resource management and clinical risk assessment processes, and the procurement, organisation, sterilisation and reprocessing of surgical instruments.
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Affiliation(s)
- P. G. Calò
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
- General Multi-Specialist Surgery, University Hospital of Cagliari, Cagliari, Italy
| | - F. Catena
- Unit of Emergency Surgery, University Hospital of Parma, Parma, Italy
| | - D. Corsaro
- International Research Department, BHAVE, Rome, Italy
| | - L. Costantini
- Department of Medical and Surgical Sciences, School of Community Medicine and Primary Care, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - F. Falez
- Multi-Specialist Department of Orthopaedics and Traumatology, Santo Spirito Hospital, Rome, Italy
| | - B. Moretti
- Multi-Specialist Department of Orthopaedics and Traumatology, Polyclinic University Hospital Consortium, Bari, Italy
| | - V. Parrinello
- Quality and Clinical Risk Unit, University Hospital “G. Rodolico - San Marco”, Catania, Italy
| | - E. Romanini
- Guidelines Commission of the Italian Society of Orthopaedics and Traumatology, SIOT, Rome, Italy
| | - A. Spinarelli
- Multi-Specialist Department of Orthopaedics and Traumatology, Polyclinic University Hospital Consortium, Bari, Italy
| | - F. Venneri
- Clinical Risk Unit and Surgical Emergency, Florence Health Authority, Florence, Italy
| | - G. Vaccaro
- Social, Epidemiological and Outcome Research, BHAVE, Rome, Italy
- Education and Health Promotion, Catania Provincial Health Authority, Catania, Italy
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Calò P, Catena F, Corsaro D, Costantini L, Falez F, Moretti B, Parrinello V, Romanini E, Spinarelli A, Vaccaro G, Venneri F. Optimisation of perioperative procedural factors to reduce the risk of surgical site infection in patients undergoing surgery: a systematic review. Discov Health Syst 2023; 2:6. [PMID: 37520513 PMCID: PMC9924866 DOI: 10.1007/s44250-023-00019-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 01/26/2023] [Indexed: 02/15/2023]
Abstract
Surgical site infections (SSI) are the leading cause of hospital readmission after surgical procedures with significant impact on post-operative morbidity and mortality. Modifiable risk factors for SSI include procedural aspects, which include the possibility of instrument contamination, the duration of the operation, the number of people present and the traffic in the room and the ventilation system of the operating theatre.The aim of this systematic review was to provide literature evidence on the relationship between features of surgical procedure sets and the frequency of SSI in patients undergoing surgical treatment, and to analyse how time frames of perioperative processes and operating theatre traffic vary in relation to the features of the procedure sets use, in order tooptimise infection control in OT. The results of the systematic review brought to light observational studies that can be divided into two categories: evidence of purely clinical significance and evidence of mainly organisational, managerial and financial significance. These two systems are largely interconnected, and reciprocally influence each other. The decision to use disposable devices and instruments has been accompanied by a lower incidence in surgical site infections and surgical revisions for remediation. A concomitant reduction in post-operative functional recovery time has also been observed. Also, the rationalisation of traditional surgical sets has also been observed in conjunction with outcomes of clinical significance.
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Affiliation(s)
- P. Calò
- University Teaching Hospital of Cagliari and Surgical Department at University of Cagliari, Cagliari, Italy
| | - F. Catena
- Department General and Emergency Surgery at Bufalini Hospital, Cesena, Italy
| | - D. Corsaro
- International Research at BHAVE, Via GiambattistaVico 1, 00196 Rome, Italy
| | - L. Costantini
- Department of Medical and Surgical Sciences, School of Community Medicine and Primary Care, University of Modena and Reggio Emilia, Modena, Italy
| | - F. Falez
- Department of Orthopaedics ASL Roma 1 and Director UOC Orthopaedics Hospital San Filippo Neri, Rome, Italy
| | - B. Moretti
- Orthopedics and Traumatology Complex Operative Unit, University Teaching Hospital of Bari Polyclinic, Bari, Italy
| | - V. Parrinello
- Operative Unit of Quality and Clinical Risk Manager at “G.Rodolico-San Marco” University Teaching Hospital in Catania, Catania, Italy
| | - E. Romanini
- SIOT Guidelines Commission, Rome, Italy
- Complex Operative Unit of Orthopedics and Traumatology at University Teaching Hospital of Bari Polyclinic, Bari, Italy
| | - A. Spinarelli
- Operative Unit of Orthopedics and Traumatology at University Teaching Hospital of Bari Polyclinic, Bari, Italy
| | - G. Vaccaro
- Social, Epidemiological and Outcome Research at BHAVE, Via Giambattista Vico 1, 00196 Rome, Italy
- Sociologist UO Education and Health Promotion, Asp Catania, Via Santa Maria la Grande 5, 95124 Catania, Italy
| | - F. Venneri
- Simple Structure Clinical Risk and Surgical Emergency in Florence, Florence, Italy
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Parretti C, Tartaglia R, La Regina M, Venneri F, Sbrana G, Mandò M, Barach P. Improved FMEA Methods for Proactive Health Care Risk Assessment of the Effectiveness and Efficiency of COVID-19 Remote Patient Telemonitoring. Am J Med Qual 2022; 37:535-544. [PMID: 36250651 PMCID: PMC9622365 DOI: 10.1097/jmq.0000000000000089] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The COVID-19 pandemic exposed the need to more effectively harness and leverage digital tools and technology for remote patient monitoring (RPM). RPM gained great popularity given the need to provide effective, safe, efficient, and remote patient care. RPM is based on noninvasive digital technologies aimed at improving the safety and efficiency of health care delivery. We report on an RPM program in which 200 COVID-19 patients were followed remotely to evaluate the effectiveness in treating and monitoring patients in home settings. We analyzed the inherent risks using mixed methods, including failure mode and effect analysis, a prospective, team-based risk management methodology structured to identify high-risk process system failures before they occur in telemonitoring of remote patients. The RPM saved lives and improved decision-making during the pandemic and helped prevent the health system's collapse. The failure mode and effect analysis-based assessment offers important insights and considerations for evaluating future RPM implementation and direction. RPM solutions are technically feasible, staff friendly, and can achieve high adherence rates. Rigorous and ongoing evaluation of devices and platforms is essential to clarifying their value and guiding national health and insurance health coverage decisions and adoption programs.
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Affiliation(s)
- Chiara Parretti
- Department of Science Engineering, Marconi University, Italy
| | | | | | | | - Giovanni Sbrana
- Department of Eemergency, South East Tuscany Healtcare Agency, Italy
| | - Massimo Mandò
- Department of Eemergency, South East Tuscany Healtcare Agency, Italy
| | - Paul Barach
- Jefferson College of Population Health, Philadelphia, PA
- Sigmund Freud University, Vienna, Austria
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La Regina M, Tanzini M, Fineschi V, Venneri F, Toccafondi G, Lachman P, Tartaglia R. Responding to COVID-19: the experience from Italy and recommendations for management and prevention. Int J Qual Health Care 2021; 33:5840521. [PMID: 32427316 PMCID: PMC7543231 DOI: 10.1093/intqhc/mzaa057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/09/2020] [Accepted: 05/07/2020] [Indexed: 02/01/2023] Open
Affiliation(s)
| | | | | | | | | | - Peter Lachman
- International Society for Quality in Health Care, Dubin, Ireland
| | - Riccardo Tartaglia
- Italian Network for Safety in Health Care, Florence, Italy.,Clinical Risk Management Public Hospitals Florence, Italy
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Tartaglia R, La Regina M, Tanzini M, Pomare C, Urwin R, Ellis LA, Fineschi V, Venneri F, Seghieri C, Lachman P, Westbrook J, Braithwaite J. International survey of COVID-19 management strategies. Int J Qual Health Care 2021; 33:mzaa139. [PMID: 33219683 PMCID: PMC7717268 DOI: 10.1093/intqhc/mzaa139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/07/2020] [Accepted: 10/20/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND While individual countries have gained considerable knowledge and experience in coronavirus disease of 2019 (COVID-19) management, an international, comparative perspective is lacking, particularly regarding the measures taken by different countries to tackle the pandemic. This paper elicits the views of health system staff, tapping into their personal expertise on how the pandemic was initially handled. METHODS From May to July 2020, we conducted a cross-sectional, online, purpose-designed survey comprising 70 items. Email lists of contacts provided by the International Society for Quality in Health Care, the Italian Network for Safety in Health Care and the Australian Institute of Health Innovation were used to access healthcare professionals and managers across the world. We snowballed the survey to individuals and groups connected to these organizations. Key outcome measures were attitudes and information about institutional approaches taken; media communication; how acute hospitals were re-organized; primary health organization; personal protective equipment; and staffing and training. RESULTS A total of 1131 survey participants from 97 countries across the World Health Organization (WHO) regions responded to the survey. Responses were from all six WHO regions; 57.9% were female and the majority had 10 or more years of experience in healthcare; almost half (46.5%) were physicians; and all other major clinical professional groups participated. As the pandemic progressed, most countries established an emergency task force, developed communication channels to citizens, organized health services to cope and put in place appropriate measures (e.g. pathways for COVID-19 patients, and testing, screening and tracing procedures). Some countries did this better than others. We found several significant differences between the WHO regions in how they are tackling the pandemic. For instance, while overall most respondents (71.4%) believed that there was an effective plan prior to the outbreak, this was only the case for 31.9% of respondents from the Pan American Health Organization compared with 90.7% of respondents from the South-East Asia Region (SEARO). Issues with swab testing (e.g. delay in communicating the swab outcome) were less frequently reported by respondents from SEARO and the Western Pacific Region compared with other regions. CONCLUSION The world has progressed in its knowledge and sophistication in tackling the pandemic after early and often substantial obstacles were encountered. Most WHO regions have or are in the process of responding well, although some countries have not yet instituted widespread measures known to support mitigation, for example, effective swab testing and social control measures.
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Affiliation(s)
- Riccardo Tartaglia
- Italian Network for Safety in Health Care, Florence, Via de Renai, 23, 50125, Italy
| | - Micaela La Regina
- Italian Network for Safety in Health Care, Florence, Via de Renai, 23, 50125, Italy
| | - Michela Tanzini
- Italian Network for Safety in Health Care, Florence, Via de Renai, 23, 50125, Italy
| | - Chiara Pomare
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW, Sydney 2109, Australia
| | - Rachel Urwin
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW, Sydney 2109, Australia
| | - Louise A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW, Sydney 2109, Australia
- NHMRC Partnership Centre in Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW, Sydney 2109, Australia
| | - Vittorio Fineschi
- University La Sapienza, Rome, Piazzale Aldo Moro, 5, 00185 Roma RM, Italy
| | - Francesco Venneri
- Centre Gestione Rischio Clinico, Via Pietro Dazzi, 1, 50141 Firenze FI, Italy
| | - Chiara Seghieri
- Sant'Anna Pisa School of Advanced Studies, Piazza Martiri della Libertá, 33, 56127 Pisa PI, Italy
| | - Peter Lachman
- International Society for Quality in Health Care, Huguenot House, 4th Floor, 35-38 St Stephen's Green, Dublin D02 NY63, Ireland
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW, Sydney 2109, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW, Sydney 2109, Australia
- NHMRC Partnership Centre in Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW, Sydney 2109, Australia
- International Society for Quality in Health Care, Huguenot House, 4th Floor, 35-38 St Stephen's Green, Dublin D02 NY63, Ireland
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Venneri F, Williamson MA, Li N, Houts MG, Morley RA, Beller DE, Sailor W, Lawrence G. Disposition of Nuclear Waste Using Subcritical Accelerator-Driven Systems: Technology Choices and Implementation Scenarios. NUCL TECHNOL 2017. [DOI: 10.13182/nt00-a3126] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | | | - Ning Li
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545
| | | | | | - Denis E. Beller
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545
| | - William Sailor
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545
| | - George Lawrence
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545
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Affiliation(s)
- Yonghee Kim
- Korea Atomic Energy Research Institute 150 Deokjin-dong, Yuseong, Daejeon, 305-353, Korea
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Hartanto D, Kim Y, Venneri F. Neutronics evaluation of a super-deep-burn with TRU Fully Ceramic Microencapsulated (FCM) fuel in CANDU. Progress in Nuclear Energy 2015. [DOI: 10.1016/j.pnucene.2015.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hesselink G, Zegers M, Vernooij-Dassen M, Barach P, Kalkman C, Flink M, Ön G, Olsson M, Bergenbrant S, Orrego C, Suñol R, Toccafondi G, Venneri F, Dudzik-Urbaniak E, Kutryba B, Schoonhoven L, Wollersheim H. Improving patient discharge and reducing hospital readmissions by using Intervention Mapping. BMC Health Serv Res 2014; 14:389. [PMID: 25218406 PMCID: PMC4175223 DOI: 10.1186/1472-6963-14-389] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 09/10/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There is a growing impetus to reorganize the hospital discharge process to reduce avoidable readmissions and costs. The aim of this study was to provide insight into hospital discharge problems and underlying causes, and to give an overview of solutions that guide providers and policy-makers in improving hospital discharge. METHODS The Intervention Mapping framework was used. First, a problem analysis studying the scale, causes, and consequences of ineffective hospital discharge was carried out. The analysis was based on primary data from 26 focus group interviews and 321 individual interviews with patients and relatives, and involved hospital and community care providers. Second, improvements in terms of intervention outcomes, performance objectives and change objectives were specified. Third, 220 experts were consulted and a systematic review of effective discharge interventions was carried out to select theory-based methods and practical strategies required to achieve change and better performance. RESULTS Ineffective discharge is related to factors at the level of the individual care provider, the patient, the relationship between providers, and the organisational and technical support for care providers. Providers can reduce hospital readmission rates and adverse events by focusing on high-quality discharge information, well-coordinated care, and direct and timely communication with their counterpart colleagues. Patients, or their carers, should participate in the discharge process and be well aware of their health status and treatment. Assessment by hospital care providers whether discharge information is accurate and understood by patients and their community counterparts, are important examples of overcoming identified barriers to effective discharge. Discharge templates, medication reconciliation, a liaison nurse or pharmacist, regular site visits and teach-back are identified as effective and promising strategies to achieve the desired behavioural and environmental change. CONCLUSIONS This study provides a comprehensive guiding framework for providers and policy-makers to improve patient handover from hospital to primary care.
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Affiliation(s)
- Gijs Hesselink
- />Radboud University Medical Center, Scientific Institute for Quality of Healthcare (IQ healthcare), 114 IQ healthcare, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Marieke Zegers
- />Radboud University Medical Center, Scientific Institute for Quality of Healthcare (IQ healthcare), 114 IQ healthcare, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Myrra Vernooij-Dassen
- />Radboud University Medical Center, Scientific Institute for Quality of Healthcare (IQ healthcare), 114 IQ healthcare, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- />Radboud University Medical Center, Kalorama Foundation, Nijmegen, The Netherlands
- />Department of Primary Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul Barach
- />Patient Safety Center, University Medical Center Utrecht, Utrecht, The Netherlands
- />Department of Health Studies, University of Stavanger, Stavanger, Norway
- />University College Cork, Cork, Ireland
| | - Cor Kalkman
- />Patient Safety Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maria Flink
- />Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- />Department of Social Work, Karolinska University Hospital, Stockholm, Sweden
| | - Gunnar Ön
- />Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- />Quality and Patient Safety, Karolinska University Hospital, Stockholm, Sweden
| | - Mariann Olsson
- />Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- />Department of Social Work, Karolinska University Hospital, Stockholm, Sweden
| | - Susanne Bergenbrant
- />Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Carola Orrego
- />Avedis Donabedian Institute, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Rosa Suñol
- />Avedis Donabedian Institute, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Giulio Toccafondi
- />Clinical Risk Management and Patient Safety Centre, Tuscany region, Italy
| | - Francesco Venneri
- />Clinical Risk Management and Patient Safety Centre, Tuscany region, Italy
| | | | - Basia Kutryba
- />National Center for Quality Assessment in Health Care, Krakow, Poland
| | - Lisette Schoonhoven
- />Radboud University Medical Center, Scientific Institute for Quality of Healthcare (IQ healthcare), 114 IQ healthcare, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Hub Wollersheim
- />Radboud University Medical Center, Scientific Institute for Quality of Healthcare (IQ healthcare), 114 IQ healthcare, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - on behalf of the European HANDOVER Research Collaborative
- />Radboud University Medical Center, Scientific Institute for Quality of Healthcare (IQ healthcare), 114 IQ healthcare, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- />Radboud University Medical Center, Kalorama Foundation, Nijmegen, The Netherlands
- />Department of Primary Care, Radboud University Medical Center, Nijmegen, The Netherlands
- />Patient Safety Center, University Medical Center Utrecht, Utrecht, The Netherlands
- />Department of Health Studies, University of Stavanger, Stavanger, Norway
- />University College Cork, Cork, Ireland
- />Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- />Department of Social Work, Karolinska University Hospital, Stockholm, Sweden
- />Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- />Quality and Patient Safety, Karolinska University Hospital, Stockholm, Sweden
- />Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden
- />Avedis Donabedian Institute, Universidad Autónoma de Barcelona, Barcelona, Spain
- />Clinical Risk Management and Patient Safety Centre, Tuscany region, Italy
- />National Center for Quality Assessment in Health Care, Krakow, Poland
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Hong SG, Park SY, Lee KH, Cho JY, Jo CK, Lee WJ, Venneri F. Physics study of deep-burning of spent fuel transuranics using commercial LWR cores. Nuclear Engineering and Design 2013. [DOI: 10.1016/j.nucengdes.2013.02.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Duranti E, Calzeroni G, Venneri F, Marziali M. [Simulation in medicine: first experiences under hemodialysis]. G Ital Nefrol 2013; 30:gin/30.2.7. [PMID: 25077335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Education and practical training in medicine is neglected and pass directly from theory to do on the field, while also each task requires the acquisition of health behaviors that are aware and accountable to the outreach. In hemodialysis is necessary to create synergies and partnerships between different cooperating figures. Addressing organizational and legal protection of the professionals (Clinical Risk). Acquiring operational capabilities of team work. Managing the team roles and functions.It is necessary then to acquire a modern methodology where the simulation represents the main tool, "the mistake" need to "learn" and the acquisition of "awareness" about event handling (in this case on Hemodialysis), in the context of clinical scenarios absolutely realistic.The methodology is based on simulated tasks using past experience as a business tool and innovative research. Debriefing and discussion with those involved and finally debrief collegiate looking for active/latent errors and use of international guidelines. Use of indicators to measure and review of performance during the various events and proactively promoting the reduction of the error.Among the types of participants was clear the minor presence of doctors of hemodialysis, probably for the wrong feeling of being checked and then judged in carrying out of actions made complex by urgency. In addition participating physicians have all stressed the usefulness of simulations of unusual events within the Hemodialysis treatment, but that if not solved can lead to death of the patient.Simulation under hemodialysis, although its first steps, appears to be an effective methodology able to stimulate self-criticism of the operators, but still with hesitations and fears above all by the nephrologists timorous of being judged more on technical skills than on organizational skills and leadership.
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Toccafondi G, Albolino S, Tartaglia R, Guidi S, Molisso A, Venneri F, Peris A, Pieralli F, Magnelli E, Librenti M, Morelli M, Barach P. The collaborative communication model for patient handover at the interface between high-acuity and low-acuity care. BMJ Qual Saf 2012; 21 Suppl 1:i58-66. [PMID: 23100546 DOI: 10.1136/bmjqs-2012-001178] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Cross-unit handovers transfer responsibility for the patient among healthcare teams in different clinical units, with missed information, potentially placing patients at risk for adverse events. OBJECTIVES We analysed the communications between high-acuity and low-acuity units, their content and social context, and we explored whether common conceptual ground reduced potential threats to patient safety posed by current handover practices. METHODS We monitored the communication of five content items using handover probes for 22 patient transitions of care between high-acuity 'sender units' and low-acuity 'recipient units'. Data were analysed and discussed in focus groups with healthcare professionals to acquire insights into the characteristics of the common conceptual ground. RESULTS High-acuity and low-acuity units agreed about the presence of alert signs in the discharge form in 40% of the cases. The focus groups identified prehandover practices, particularly for anticipatory guidance that relied extensively on verbal phone interactions that commonly did not involve all members of the healthcare team, particularly nursing. Accessibility of information in the medical records reported by the recipient units was significantly lower than reported by sender units. Common ground to enable interpretation of the complete handover content items existed only among selected members of the healthcare team. CONCLUSIONS The limited common ground reduced the likelihood of correct interpretation of important handover information, which may contribute to adverse events. Collaborative design and use of a shared set of handover content items may assist in creating common ground to enable clinical teams to communicate effectively to help increase the reliability and safety of cross-unit handovers.
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Affiliation(s)
- Giulio Toccafondi
- Clinical Risk Management and Patient Safety Centre-Tuscany Region, Via Taddeo Alderotti 26N, Firenze 50139, Italy.
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Abstract
Patient safety practices for enhancing the quality and safety of handover are context sensitive interventions. In this article we explore the use of cultural probes as a qualitative technique with a twofold objective: eliciting implicit activity pattern and tools that may constitute resources for the design of effective handover solutions and prompting health care practitioners' participation and involvement.
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Affiliation(s)
- Giulio Toccafondi
- Patient Safety and Clinical Risk Management Tuscany Region, Taddeo Alderotti 26N, 50129 Florence, Italy
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Kim YM, Jo CK, Jun JS, Cho MS, Venneri F. A fuel performance analysis for a 450MWth deep burn-high temperature reactor. Nuclear Engineering and Design 2011. [DOI: 10.1016/j.nucengdes.2011.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Jun JS, Lim HS, Jo CK, Noh JM, Venneri F. Thermal-fluid characteristics of the transuranics fuel in a deep-burn HTR core. Nuclear Engineering and Design 2011. [DOI: 10.1016/j.nucengdes.2011.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Talamo A, Gudowski W, Cetnar J, Venneri F. Key physical parameters and temperature reactivity coefficients of the deep burn modular helium reactor fueled with LWRs waste. ANN NUCL ENERGY 2004. [DOI: 10.1016/j.anucene.2004.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fabbri LP, Nucera M, Becucci A, Grippo A, Venneri F, Merciai V, Boncinelli S. Erratum to “An exceptional case of complete neurologic recovery after more than 5-h cardiac arrest”. Resuscitation 2001. [DOI: 10.1016/s0300-9572(01)00369-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Fabbri LP, Nucera M, Becucci A, Grippo A, Venneri F, Merciai V, Boncinelli S. An exceptional case of complete neurologic recovery after more than 5-h cardiac arrest. Resuscitation 2001; 48:175-80. [PMID: 11426479 DOI: 10.1016/s0300-9572(00)00327-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We describe a case of more than 5 h cardiac arrest in a 60-year-old patient who underwent general anesthesia for a urologic operation. Before extubation, the patient suddenly developed ventricular fibrillation, pulseless ventricular tachycardia and asystole which was immediately treated by advanced life support (ALS) measures. Thirty minutes later seizures developed and were controlled by 200 mg of thiopentone and 10 mg of diazepam. A pattern of ventricular tachycardia, coarse ventricular fibrillation and asystole lasted for nearly 120 min. Termination of resuscitation maneuvers was considered, but long-term life support was continued for 5 h. After this time, peripheral pulses, with a supraventricular tachycardia-like rhythm and regular spontaneous breathing reappeared. Seven hours later, the patient had a Glasgow Coma Scale (GCS) of 5, dilated unresponsive, absence of pupils, and a systolic arterial pressure of 100 mmHg. He was then transferred to intensive care unit (ICU). The morning after, the patient was awake, responded to simple orders, breathing spontaneously, and free from sensomotor deficit. He was, therefore, extubated. Subsequently, other episodes of transitory ST-line upper wave followed by ventricular fibrillation appeared, suggesting Prinzmetal angina. This was successfully treated by percutaneous coronary angioplasty. The first electroencephalogram recorded the day after cardiac arrest showed a mild widespread background slowing. An electroencephalogram 6 days later showed a return to alpha rhythm with only mild theta-wave abnormalities. Four weeks after the first cardiac arrest the patient was discharged. This is an exceptional experience compared with the others reported. We believe that all the efforts must not be given up when such an event occurs during anesthesia and there are optimal conditions for resuscitation maneuvers.
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Affiliation(s)
- L P Fabbri
- Department of Pathophysiology, University of Florence, Italy.
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Valeri A, Borrelli A, Presenti L, Lucchese M, Venneri F, Mannelli M, Regio S, Borrelli D. Adrenal masses in neoplastic patients: the role of laparoscopic procedure. Surg Endosc 2001; 15:90-3. [PMID: 11178771 DOI: 10.1007/s004640000245] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The incidence of complications resulting from fine-needle biopsy of adrenal masses in patients already treated by radical procedures for primitive neoplasms of the lungs and kidneys substantiates our opinion concerning laparoscopy as both a diagnostic and therapeutic procedure. METHODS We performed 70 laparoscopic adrenalectomies from April 1995 to December 1999. In five patients, the adrenal mass appeared at follow-up evaluation in patients submitted to surgery for a spinocellular lung cancer. One patient underwent surgery for renal adenocarcinoma. In two patients, the adrenal mass was present already at the time primitive lung tumor was diagnosed, so adrenalectomy was performed at the first lung surgery in one patient and 2 weeks before lung surgery in the other patient. All the patients were placed in a lateral position for a transperitoneal approach. Right adrenal masses were present in seven patients, whereas one patient had an adrenal mass in a left location. RESULTS No laparotomy was required. The average surgical time was 160 min. (range, 115-120 min). No morbility or mortality occurred, and the average hospital stay was 4 days (range, 3-11 days). All the patients had a complete removal of their masses, which averaged 4.5 cm (range, 2.5-6 cm) in size. Histology confirmed the metastatic origin of the mass in five of seven patients with primary lung cancer, and in one patient with previous kidney cancer. At this writing, three patients were disease free and still alive respectively at 3, 5, and 18 months. Three patients died of brain metastases respectively at 16, 36, and 36 months. An adenoma was proved in the other two cases. CONCLUSIONS Laparoscopic adrenalectomy allows us to propose a much more aggressive approach to adrenal masses demonstrated at follow-up evaluation or in patients with primary lung or kidney cancer and no masses at other locations. Nevertheless a much larger study is required for definitive conclusions on a survival rate. We believe that a mini-invasive procedure such as laparoscopy may allow us to replace a rational surgical approach with a more certain pathologic diagnosis.
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Affiliation(s)
- A Valeri
- U.O. Chirurgia Generale e Vascolare, Azienda Ospedaliera Careggi, Firenze, Italy
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Abstract
BACKGROUND Adjustable gastric banding has many advantages in the treatment of severe obesity. METHODS The authors report their experience with open and laparoscopic adjustable gastric banding in the treatment of severe obesity. RESULTS This procedure presents some risks and complications, which are described. CONCLUSIONS Patients must be well informed about the procedure and accept a strict behavioral therapeutic pattern. Follow-up requires strict surveillance. When the band necessitates increase of pressure, follow-up must be very close in order to avoid a complication that may invalidate this procedure.
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Affiliation(s)
- M Lucchese
- Department of General and Vascular Surgery, Policlinico di Careggi, Florence, Italy
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Abstract
Portal thrombosis is a rare complication of splenectomy. We performed 12 laparoscopic splenectomies and observed this complication only in one patient with idiopathic thrombocytopenia (ITP). The right branch of the portal vein presented a partial thrombosis, while the left branch was completely obstructed by thrombi. Abdominal ultrasonography and an ultrasound doppler exam allowed us to diagnose this event and a retrograde angiography performed afterward confirmed our diagnosis. A 48-h intravenous heparin treatment was promptly begun, followed by anticoagulant drugs (dicumarol). The patient was dismissed 5 days afterward, presenting a steady-state ultrasound doppler pattern and a complete normalization of liver parameters. An ultrasound doppler exam performed 1 month after anticoagulant therapy showed a complete resolution of portal thrombosis. We believe that early diagnosis of this rare complication, prompt beginning of anticoagulant therapy, and care in surgical procedures may reduce patient life-threatening risks and assure complete remission.
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Affiliation(s)
- A Valeri
- U.O. Chirurgia Generale e Vascolare, Azienda Ospedlaiera Careggi, Firenze, Italy
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Abstract
BACKGROUND Gastric banding is a very satisfactory procedure for the treatment of morbid obesity. The significant incidence of skin suppuration in these patients makes the laparoscopic approach a suitable technique. Regardless of this, in some cases, suppuration can still rarely result. METHODS AND RESULTS In four patients the authors observed diffusion of suppuration in both directions along the catheter which connects the port to the band, necessitating band removal and thus invalidating the procedure. CONCLUSIONS Suppuration of port location is an undesirable complication that must be avoided because it may contaminate the entire device system. This complication must be carefully evaluated for a correct diagnosis and an eventual removal of the band.
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Affiliation(s)
- M Lucchese
- Department of General and Vascular Surgery, Careggi Hospital, Florence, Italy
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Abstract
BACKGROUND Morbid obesity is a very severe pathology, deriving partly from a psychological disturbance of nutritional behavior. Besides a behavioral therapeutic approach, surgery appears to be necessary to resolve associated diseases by causing a satisfactory weight loss. Adjustable gastric banding is a less-invasive, potentially reversible procedure that guarantees an optimal quality of life. METHODS The authors have performed Kuzmak's gastric banding since 1992, with the lap-band approach since 1995; 183 patients were submitted to surgery, and 68 of these were operated by the laparoscopic approach. Average body mass index was 45.5 kg/m2. The complications were always under control and have decreased since the introduction of the recent lap-band. RESULTS Gastric banding is still a very young procedure and it is difficult to state definitive results yet. Preliminary results, according to our experience are satisfactory in terms of weight loss, without metabolic changes and without mortality. CONCLUSIONS Our experience is encouraging if patient selection is accurate and rigid.
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Affiliation(s)
- M Lucchese
- Department of General and Vascular Surgery, Careggi Hospital, Florence, Italy
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Laino GM, Anastasi A, Fabbri LP, Gandini E, Valanzano R, Fontanari P, Venneri F, Mazzoni P, Ieri A, Spini S, Scalzi E, Batignani G. [Experimental liver transplantation in pigs. Surgical technique and complications]. MINERVA CHIR 1996; 51:765-72. [PMID: 9082203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Only recently, in our laboratory of experimental surgery, we started with a protocol for orthotopic liver transplantation (OLT) in a pig model. This was felt as mandatory for experimental purposes as well as for future clinical applications at our center. We report herein our own experience with 41 OLTx. Intraoperative "lethal" complications occurred in up to 32% (14/41) whereas postoperative complications occurred in the remainders at different intervals of time with a maximum survival of 30 days. No attention was paid to prevent rejection-infection episodes. The main cause of death was the primary non-function (PNF) or dis-function (PDF) manifested either intra or postoperatively in 16 out the 41 OLTx (39%). Intraoperative technical errors accounted for up to 9% (4/41 OLTx). Acute hemorrhage gastritis and gastric perforations occurred postoperatively in 6 animals (14%) and represent one of the peculiar aspects of OLT in pig model.
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Affiliation(s)
- G M Laino
- Dipartimento di Fisiopatologia Clinica, Università degli Studi-Firenze
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Fabbri LP, Tozzi F, Batacchi S, Bucciardini L, Fontanari P, Linden M, Lorenzi P, Marsili M, Manetta G, Venneri F. Haemodynamic and haemoximetric aspects of experimental orthotopic liver transplantation: comparison between two different doses of propofol. Minerva Anestesiol 1995; 61:441-50. [PMID: 8677034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Evaluation of haemodynamic and gas exchange modifications using propofolnitrous oxide anaesthesia after ketamine induction during experimental orthotopic liver transplantation (OLT). DESIGN Measurements of haemodynamic and haemoximetric effects of two anaesthesiological conditions, differing each other for the different dose of propofol, performed in an experimental model characterized by temporary anhepatism followed by revascularization. SETTING Surgical experimental laboratory of the University Hospital of Florence. ANIMALS Thirty experimental OLT on female pigs (weight 30 +/- 2 kg) were performed. MEASUREMENTS AND MAIN RESULTS The following haemodynamic: HR, MAP, MPAP, PCWP, CI, SI, RVSWI, LVSWI, SVR, PVR, RPP and gas-exchange parameters: PaCO2, etCO2, D(aA)CO2, PaO2/PAO2, VD/VTphys, HB, PaO2, SaO2, DO2, O2ER, VO2, SvO2, VO2/DO2 relationship were evaluated. Anaesthesia was induced by ketamine and maintained by N2O and propofol infusion using 0.28 mg x kg(-1)x min(-1) (Group 1) and 0.19mg x kg(-1) x min(-1) (Group 2). During the anhepatic phase we used cavalportal-jugular by-pass (CPJ). Haemodynamic preoperative data confirmed the absence of any myocardial depressant effect at the lower dose of propofol. During the most critical stages of surgery a progressive decrease of CI associated with low values of PCWP was observed. The decrease of etCO2 during the anhepatic phase is due to the VD/VT increase following CI reduction and CO2 production decrease. VO2 decreased significantly during the anhepatic phase and successively increased during the reperfusion phase whereas CI remained low, during both surgical phases. These results demonstrated that VO2 was largely independent from DO2 because cellular O2ER gradually increased as DO2 remained constantly low, thus indicating a good cellular metabolism reuptake. The decrease of SVO2 is related to the decrease of CI and to the increase of VO2 and O2ER. CONCLUSION The VO2/DO2 relationship showed a complete O2 supply-non-dependency suggesting an adequate cellular metabolism maintenance during the anhepatic and postanhepatic phases. According to these results, the authors suggest that propofol, within the two different anaesthesiological protocols at two different doses, surely favoured a good cellular perfusion also under low cardiac output conditions, undoubtedly contributing to the realization of stress-resistant conditions and influencing a good recovery and postoperative outcome.
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Affiliation(s)
- L P Fabbri
- Department of Clinical Pathophysiology, Anaesthesia and Intensive Care Unit, University of Florence, Policlinico di Careggi, Italy
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Bowman CD, Venneri F. Nuclear Waste Storage at Yucca Mountain. Science 1995; 269:906-7. [PMID: 17807714 DOI: 10.1126/science.269.5226.906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Fabbri LP, Batacchi S, Linden M, Bucciardini L, Fontanari P, Venneri F, Marsili M. Anaesthesia for urological endoscopic procedures in adult outpatients. Ugeskr Laeger 1995; 12:319-24. [PMID: 7641724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The aim of this study was to establish whether propofol in combination with fentanyl or ketamine provides a good quality of anaesthesia and recovery time in urological endoscopic outpatient surgery. Sixty patients (ASA I-II) were assigned randomly to receive either 2.5 micrograms kg-1 fentanyl or 1 mg kg-1 ketamine. In both groups anaesthesia was induced with propofol 1.5 mg kg-1 and maintained with 7 mg kg-1 h-1. Patients breathed nitrous oxide and oxygen 3:2 spontaneously. Cardiovascular parameters were more stable after ketamine. The most important side effect was the presence of apnoea lasting longer than 60 s in 14 patients receiving fentanyl. The time to establish alertness was shorter in the ketamine group, who also had a better (P < 0.05) as well as post-anaesthetic recovery room score.
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Affiliation(s)
- L P Fabbri
- Department of Clinical Pathophysiology, University of Florence, Policlinico di Careggi, Italy
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Sailor W, Beard C, Venneri F, Davidson J. Comparison of accelerator-based with reactor-based nuclear waste transmutation schemes. Progress in Nuclear Energy 1994. [DOI: 10.1016/0149-1970(94)90012-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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