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Rapti V, Iliopoulou K, Poulakou G. The Gordian Knot of C. auris: If You Cannot Cut It, Prevent It. Pathogens 2023; 12:1444. [PMID: 38133327 PMCID: PMC10747958 DOI: 10.3390/pathogens12121444] [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: 11/01/2023] [Revised: 11/30/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
Since its first description in 2009, Candida auris has, so far, resulted in large hospital outbreaks worldwide and is considered an emerging global public health threat. Exceptionally for yeast, it is gifted with a profoundly worrying invasive potential and high inter-patient transmissibility. At the same time, it is capable of colonizing and persisting in both patients and hospital settings for prolonged periods of time, thus creating a vicious cycle of acquisition, spreading, and infection. It exhibits various virulence qualities and thermotolerance, osmotolerance, filamentation, biofilm formation and hydrolytic enzyme production, which are mainly implicated in its pathogenesis. Owing to its unfavorable profile of resistance to diverse antifungal agents and the lack of effective treatment options, the implementation of robust infection prevention and control (IPC) practices is crucial for controlling and minimizing intra-hospital transmission of C. auris. Rapid and accurate microbiological identification, adherence to hand hygiene, use of adequate personal protective equipment (PPE), proper handling of catheters and implantable devices, contact isolation, periodical environmental decontamination, targeted screening, implementation of antimicrobial stewardship (AMS) programs and communication between healthcare facilities about residents' C. auris colonization status are recognized as coherent strategies for preventing its spread. Current knowledge on C. auris epidemiology, clinical characteristics, and its mechanisms of pathogenicity are summarized in the present review and a comprehensive overview of IPC practices ensuring yeast prevention is also provided.
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Affiliation(s)
- Vasiliki Rapti
- Third Department of Internal Medicine, School of Medicine, National & Kapodistrian University of Athens, Sotiria General Hospital, 115 27 Athens, Greece;
| | | | - Garyfallia Poulakou
- Third Department of Internal Medicine, School of Medicine, National & Kapodistrian University of Athens, Sotiria General Hospital, 115 27 Athens, Greece;
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Mpouzika M, Iordanou S, Kyranou M, Iliopoulou K, Parissopoulos S, Kalafati M, Karanikola M, Papathanassoglou E. Strategies of Screening and Treating Post-Extubation Dysphagia: An Overview of the Situation in Greek-Cypriot ICUs. Healthcare (Basel) 2023; 11:2283. [PMID: 37628481 PMCID: PMC10454777 DOI: 10.3390/healthcare11162283] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/30/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Post-extubation dysphagia (PED) can lead to serious health problems in critically ill patients. Contrasting its high incidence rate of 12.4% reported in a recent observational study, many ICUs lack routine bedside screening, likely due to limited awareness. This study aimed to establish baseline data on the current approaches and the status of perceived best practices in PED screening and treatment, as well as to assess awareness of PED. A nationwide cross-sectional, online survey was conducted in all fourteen adult ICUs in the Republic of Cyprus in June 2018, with a 100% response rate. Over 85% of ICUs lacked a standard screening protocol for PED. The most commonly reported assessment methods were cough reflex testing and the water swallow test. Treatment approaches included muscle strengthening exercises without swallowing and swallowing exercises. Only 28.6% of ICUs acknowledged PED as a common issue. The study identified significant gaps in awareness and knowledge regarding PED screening and treatment in Greek-Cypriot ICUs. Urgent implementation of comprehensive dysphagia education programs within the units is necessary, and interdisciplinary collaboration among nurses, intensivists, and speech and language therapists is crucial to improve the quality of care provided.
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Affiliation(s)
- Meropi Mpouzika
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, 3041 Limassol, Cyprus; (M.K.); (M.K.)
| | - Stelios Iordanou
- Limassol General Hospital, State Health Services Organization, 4131 Limassol, Cyprus;
| | - Maria Kyranou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, 3041 Limassol, Cyprus; (M.K.); (M.K.)
| | | | | | - Maria Kalafati
- Department of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Maria Karanikola
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, 3041 Limassol, Cyprus; (M.K.); (M.K.)
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Xyrichis A, Iliopoulou K. Telehealth in the intensive care unit: Current insights and future directions. Intensive Crit Care Nurs 2023:103412. [PMID: 36813610 DOI: 10.1016/j.iccn.2023.103412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Endacott R, Scholes J, Jones C, Boulanger C, Egerod I, Blot S, Iliopoulou K, Francois G, Latour J. Development of competencies for advanced nursing practice in intensive care units across Europe: A modified e-Delphi study. Intensive Crit Care Nurs 2022; 71:103239. [DOI: 10.1016/j.iccn.2022.103239] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 03/02/2022] [Accepted: 03/10/2022] [Indexed: 12/21/2022]
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Xyrichis A, Iliopoulou K, Mackintosh NJ, Bench S, Terblanche M, Philippou J, Sandall J. Healthcare stakeholders' perceptions and experiences of factors affecting the implementation of critical care telemedicine (CCT): qualitative evidence synthesis. Cochrane Database Syst Rev 2021; 2:CD012876. [PMID: 33599282 PMCID: PMC8097132 DOI: 10.1002/14651858.cd012876.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Critical care telemedicine (CCT) has long been advocated for enabling access to scarce critical care expertise in geographically-distant areas. Additional advantages of CCT include the potential for reduced variability in treatment and care through clinical decision support enabled by the analysis of large data sets and the use of predictive tools. Evidence points to health systems investing in telemedicine appearing better prepared to respond to sudden increases in demand, such as during pandemics. However, challenges with how new technologies such as CCT are implemented still remain, and must be carefully considered. OBJECTIVES This synthesis links to and complements another Cochrane Review assessing the effects of interactive telemedicine in healthcare, by examining the implementation of telemedicine specifically in critical care. Our aim was to identify, appraise and synthesise qualitative research evidence on healthcare stakeholders' perceptions and experiences of factors affecting the implementation of CCT, and to identify factors that are more likely to ensure successful implementation of CCT for subsequent consideration and assessment in telemedicine effectiveness reviews. SEARCH METHODS We searched MEDLINE, Embase, CINAHL, and Web of Science for eligible studies from inception to 14 October 2019; alongside 'grey' and other literature searches. There were no language, date or geographic restrictions. SELECTION CRITERIA We included studies that used qualitative methods for data collection and analysis. Studies included views from healthcare stakeholders including bedside and CCT hub critical care personnel, as well as administrative, technical, information technology, and managerial staff, and family members. DATA COLLECTION AND ANALYSIS We extracted data using a predetermined extraction sheet. We used the Critical Appraisal Skills Programme (CASP) qualitative checklist to assess the methodological rigour of individual studies. We followed the Best-fit framework approach using the Consolidated Framework for Implementation Research (CFIR) to inform our data synthesis. We classified additional themes not captured by CFIR under a separate theme. We used the GRADE CERQual approach to assess confidence in the findings. MAIN RESULTS We found 13 relevant studies. Twelve were from the USA and one was from Canada. Where we judged the North American focus of the studies to be a concern for a finding's relevance, we have reflected this in our assessment of confidence in the finding. The studies explored the views and experiences of bedside and hub critical care personnel; administrative, technical, information technology, and managerial staff; and family members. The intensive care units (ICUs) were from tertiary hospitals in urban and rural areas. We identified several factors that could influence the implementation of CCT. We had high confidence in the following findings: Hospital staff and family members described several advantages of CCT. Bedside and hub staff strongly believed that the main advantage of CCT was having access to experts when bedside physicians were not available. Families also valued having access to critical care experts. In addition, hospital staff described how CCT could support clinical decision-making and mentoring of junior staff. Hospital staff greatly valued the nature and quality of social networks between the bedside and CCT hub teams. Key issues for them were trust, acceptance, teamness, familiarity and effective communication between the two teams. Interactions between some bedside and CCT hub staff were featured with tension, frustration and conflict. Staff on both sides commonly described disrespect of their expertise, resistance and animosity. Hospital staff thought it was important to promote and offer training in the use of CCT before its implementation. This included rehearsing every step in the process, offering staff opportunities to ask questions and disseminating learning resources. Some also complained that experienced staff were taken away from bedside care and re-allocated to the CCT hub team. Hospital staff's attitudes towards, knowledge about and value placed on CCT influenced acceptance of CCT. Staff were positive towards CCT because of its several advantages. But some were concerned that the CCT hub staff were not able to understand the patient's situation through the camera. Some were also concerned about confidentiality of patient data. We also identified other factors that could influence the implementation of CCT, although our confidence in these findings is moderate or low. These factors included the extent to which telemedicine software was adaptable to local needs, and hub staff were aware of local norms; concerns about additional administrative work and cost; patients' and families' desire to stay close to their local community; the type of hospital setting; the extent to which there was support from senior leadership; staff access to information about policies and procedures; individuals' stage of change; staff motivation, competence and values; clear strategies for staff engagement; feedback about progress; and the impact of CCT on staffing levels. AUTHORS' CONCLUSIONS Our review identified several factors that could influence the acceptance and use of telemedicine in critical care. These include the value that hospital staff and family members place on having access to critical care experts, staff access to sufficient training, and the extent to which healthcare providers at the bedside and the critical care experts supporting them from a distance acknowledge and respect each other's expertise. Further research, especially in contexts other than North America, with different cultures, norms and practices will strengthen the evidence base for the implementation of CCT internationally and our confidence in these findings. Implementation of CCT appears to be growing in importance in the context of global pandemic management, especially in countries with wide geographical dispersion and limited access to critical care expertise. For successful implementation, policymakers and other stakeholders should consider pre-empting and addressing factors that may affect implementation, including strengthening teamness between bedside and hub teams; engaging and supporting frontline staff; training ICU clinicians on the use of CCT prior to its implementation; and ensuring staff have access to information and knowledge about when, why and how to use CCT for maximum benefit.
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Affiliation(s)
- Andreas Xyrichis
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Katerina Iliopoulou
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Nicola J Mackintosh
- SAPPHIRE, Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Suzanne Bench
- School of Health and Social Care, London South Bank University, London, UK
| | - Marius Terblanche
- Critical Care Medicine/ Division of Health and Social Care Research, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Julia Philippou
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Jane Sandall
- Department of Women and Children's Health, School of Life Course Science, Faculty of Life Sciences & Medicine, King's College London, London, UK
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Azoulay E, De Waele J, Ferrer R, Staudinger T, Borkowska M, Povoa P, Iliopoulou K, Artigas A, Schaller SJ, Hari MS, Pellegrini M, Darmon M, Kesecioglu J, Cecconi M. Symptoms of burnout in intensive care unit specialists facing the COVID-19 outbreak. Ann Intensive Care 2020; 10:110. [PMID: 32770449 PMCID: PMC7414284 DOI: 10.1186/s13613-020-00722-3] [Citation(s) in RCA: 187] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/25/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has resulted in an unprecedented healthcare crisis with a high prevalence of psychological distress in healthcare providers. We sought to document the prevalence of burnout syndrome amongst intensivists facing the COVID-19 outbreak. METHODS Cross-sectional survey among intensivists part of the European Society of Intensive Care Medicine. Symptoms of severe burnout, anxiety and depression were collected. Factors independently associated with severe burnout were assessed using Cox model. RESULTS Response rate was 20% (1001 completed questionnaires were returned, 45 years [39-53], 34% women, from 85 countries, 12 regions, 50% university-affiliated hospitals). The prevalence of symptoms of anxiety and depression or severe burnout was 46.5%, 30.2%, and 51%, respectively, and varied significantly across regions. Rating of the relationship between intensivists and other ICU stakeholders differed significantly according to the presence of anxiety, depression, or burnout. Similar figures were reported for their rating of the ethical climate or the quality of the decision-making. Factors independently associated with anxiety were female gender (HR 1.85 [1.33-2.55]), working in a university-affiliated hospital (HR 0.58 [0.42-0.80]), living in a city of > 1 million inhabitants (HR 1.40 [1.01-1.94]), and clinician's rating of the ethical climate (HR 0.83 [0.77-0.90]). Independent determinants of depression included female gender (HR 1.63 [1.15-2.31]) and clinician's rating of the ethical climate (HR 0.84 [0.78-0.92]). Factors independently associated with symptoms of severe burnout included age (HR 0.98/year [0.97-0.99]) and clinician's rating of the ethical climate (HR 0.76 [0.69-0.82]). CONCLUSIONS The COVID-19 pandemic has had an overwhelming psychological impact on intensivists. Follow-up, and management are warranted to assess long-term psychological outcomes and alleviate the psychological burden of the pandemic on frontline personnel.
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Affiliation(s)
- Elie Azoulay
- Médecine Intensive et Réanimation, PHP, Hôpital Saint-Louis, Paris University, Paris, France.
| | - Jan De Waele
- Department of Critical Care Medicine, Ghent University Hospital, 9000, Gent, The Netherlands
| | - Ricard Ferrer
- Shock, Organ Dysfunction, and Resuscitation Research Group (SODIR), Instituto de Investigación de Vall d'Hebron, Barcelona, Spain
- Departmento de Medicina Intensiva, Hospital Universitario de Vall d́Hebron, Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Respiratorias, Barcelona, Spain
| | - Thomas Staudinger
- Department of Medicine I, Intensive Care Unit, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Marta Borkowska
- Department of Critical Care Medicine, Ghent University Hospital, 9000, Gent, The Netherlands
| | - Pedro Povoa
- NOVA Medical School, CHRC, New University of Lisbon, Lisbon, Portugal
- Unidade de Cuidados Intensivos Polivalente, Hospital de São Francisco Xavier, CHLO, Estrada Do Forte Do Alto Do Duque, 1449-005, Lisbon, Portugal
| | | | - Antonio Artigas
- Critical Care Center, Sabadell Hospital, University Institute Parc Taulí, Autonomous University of Barcelona, Ciberes, Barcelona, Spain
| | - Stefan J Schaller
- Department of Anesthesiology and Intensive Care, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Manu Shankar Hari
- School of Immunology and Microbial Science, Kings College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, ICU Support Offices, St Thomas' Hospital, London, UK
| | - Mariangela Pellegrini
- Department of Surgical Sciences and Central Intensive Care Unit, Department of Anesthesia, Operation, and Intensive Care and Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michael Darmon
- Médecine Intensive et Réanimation, PHP, Hôpital Saint-Louis, Paris University, Paris, France
| | - Jozef Kesecioglu
- Department of Intensive Care Medicine, Division of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maurizio Cecconi
- Humanitas Clinical and Research Center, Humanitas University, Milan, Italy
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Azoulay E, de Waele J, Ferrer R, Staudinger T, Borkowska M, Povoa P, Iliopoulou K, Artigas A, Schaller SJ, Shankar-Hari M, Pellegrini M, Darmon M, Kesecioglu J, Cecconi M. International variation in the management of severe COVID-19 patients. Crit Care 2020; 24:486. [PMID: 32758266 PMCID: PMC7403819 DOI: 10.1186/s13054-020-03194-w] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [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: 06/17/2020] [Accepted: 07/20/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND There is little evidence to support the management of severe COVID-19 patients. METHODS To document this variation in practices, we performed an online survey (April 30-May 25, 2020) on behalf of the European Society of Intensive Care Medicine (ESICM). A case vignette was sent to ESICM members. Questions investigated practices for a previously healthy 39-year-old patient presenting with severe hypoxemia from COVID-19 infection. RESULTS A total of 1132 ICU specialists (response rate 20%) from 85 countries (12 regions) responded to the survey. The survey provides information on the heterogeneity in patient's management, more particularly regarding the timing of ICU admission, the first line oxygenation strategy, optimization of management, and ventilatory settings in case of refractory hypoxemia. Practices related to antibacterial, antiviral, and anti-inflammatory therapies are also investigated. CONCLUSIONS There are important practice variations in the management of severe COVID-19 patients, including differences at regional and individual levels. Large outcome studies based on multinational registries are warranted.
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Affiliation(s)
- Elie Azoulay
- Médecine Intensive et Réanimation, Department of the St-Louis Hospital, APHP, Hôpital Saint-Louis, Paris University, 1 avenue Claude Vellefaux, 75010, Paris, France.
| | - Jan de Waele
- Department of Critical Care Medicine, Ghent University Hospital, 9000, Gent, Netherlands
| | - Ricard Ferrer
- Shock, Organ Dysfunction, and Resuscitation Research Group (SODIR), Instituto de Investigación de Vall d'Hebron, Barcelona, Spain
- Departmento de Medicina Intensiva, Hospital Universitario de Vall d́Hebron, Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Respiratorias, Barcelona, Spain
| | - Thomas Staudinger
- Department of Medicine I, Intensive Care Unit, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Marta Borkowska
- Department of Critical Care Medicine, Ghent University Hospital, 9000, Gent, Netherlands
| | - Pedro Povoa
- NOVA Medical School, CHRC, New University of Lisbon, Unidade de Cuidados Intensivos Polivalente, Hospital de São Francisco Xavier, CHLO, Estrada Do Forte Do Alto Do Duque, 1449-005, Lisbon, Portugal
| | | | - Antonio Artigas
- Critical Care Center, Sabadell Hospital, University Institute Parc Taulí, Autonomous University of Barcelona, Ciberes, Barcelona, Spain
| | - Stefan J Schaller
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Anesthesiology and Surgical Intensive Care, Berlin, Germany
| | - Manu Shankar-Hari
- School of Immunology and Microbial Science, Kings College London. Guy's and St Thomas' NHS Foundation Trust, ICU Support Offices, St Thomas' Hospital, London, UK
| | - Mariangela Pellegrini
- Department of Surgical Sciences and Central Intensive Care Unit, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Anesthesia, Operation, and Intensive Care; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michael Darmon
- Médecine Intensive et Réanimation, Department of the St-Louis Hospital, APHP, Hôpital Saint-Louis, Paris University, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - Jozef Kesecioglu
- Department of Intensive Care Medicine, Division of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maurizio Cecconi
- Humanitas Clinical and Research Center, Humanitas University, Milan, Italy
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Endacott R, Jones C, Blot S, Boulanger C, Ben-Nun M, Iliopoulou K, Egerod I, Bloomer MJ. International nursing advanced competency-based training for intensive care: a europe-wide survey. Intensive Care Med Exp 2015. [PMCID: PMC4798071 DOI: 10.1186/2197-425x-3-s1-a920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Iliopoulou K, Anderson J, Day T. BEHAVIOURAL INFLUENCES OF CRITICAL CARE PHYSICIANS AND NURSES INTENTION TO IMPLEMENT PREVENTIVE EVIDENCE-BASED MEASURES TOWARDS CENTRAL LINE ASSOCIATED BLOOD STREAM INFECTIONS (CLABSIS). Intensive Care Med Exp 2015. [PMCID: PMC4797494 DOI: 10.1186/2197-425x-3-s1-a890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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