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Belayneh AG, Temachu YZ, Messelu MA, Gebrie MH. Prolonged length of stay and its associated factors at adult emergency department in amhara region comprehensive specialized hospitals, northwest Ethiopia. BMC Emerg Med 2023; 23:34. [PMID: 36977998 PMCID: PMC10053138 DOI: 10.1186/s12873-023-00804-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
Abstract
Background
Prolonged length of stay at the emergency department interferes with the main goal of emergency care and results in adverse patient outcomes like nosocomial infection, dissatisfaction, morbidity, and mortality. Despite this, little is known about the length of stay and the factors that influence it in Ethiopia’s emergency department.
Methods
An institution-based cross-sectional study was conducted on 495 patients admitted at Amhara region comprehensive specialized hospitals emergency department from May 14 to June 15/2022. A systematic random sampling was employed to select study participants. A pretested structured interview-based questionnaire was used to collect data by using Kobo toolbox software. SPSS version 25 was used for data analysis. Bi-variable logistic regression analysis was carried out to select variables with P-value < 0.25. The significance of association was interpreted using an Adjusted Odds Ratio with a 95% confidence interval. Variables with P-value < 0.05 in the multivariable logistic regression analysis were inferred to be significantly associated with length of stay.
Result
Out of 512 enrolled participants, 495 were participated with a response rate of 96.7%. The prevalence of prolonged length of stay in the adult emergency department was 46.5% (95%CI: 42.1, 51.1). Lack of insurance (AOR: 2.11; 95% CI: 1.22, 3.65), non-communicative presentation (AOR: 1.98; 95% CI: 1.07, 3.68), delayed consultation (AOR: 9.5; 95% CI: 5.00, 18.03), overcrowding (AOR: 4.98; 95% CI: 2.13, 11.68), and shift change experience (AOR: 3.67; 95% CI: 1.30, 10.37) were significantly associated with prolonged length of stay.
Conclusion
The result of this study is found to be high based on Ethiopian target emergency department patient length of stay. Lack of insurance, presentation without communication, delayed consultation, overcrowding, and shift change experience were significant factors for prolonged emergency department length of stay. Therefore, interventions like expansion of organizational setup are needed to decrease the length of stay to an acceptable level.
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Ramzee AF, El-Menyar A, Asim M, Kanbar A, Ahmed K, Daoud B, Mathradikkal S, Kloub A, Al-Thani H, Rizoli S. The impact of emergency department length of stay on the outcomes of trauma patients requiring hospitalization: a retrospective observational study. World J Emerg Med 2023; 14:96-105. [PMID: 36911054 PMCID: PMC9999135 DOI: 10.5847/wjem.j.1920-8642.2023.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 09/20/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We aimed to explore the impact of the emergency department length of stay (EDLOS) on the outcome of trauma patients. METHODS A retrospective study was conducted on all trauma patients requiring hospitalization between 2015 and 2019. Patients were categorized into 4 groups based on the EDLOS (<4 h, 4-12 h,12-24 h, and >24 h). Data were analyzed using Chi-square test (categorical variables), Student's t-test (continuous variables), correlation coefficient, analysis of variance and multivariate logistic regression analysis for identifying predictors of short EDLOS and hospital mortality. RESULTS The study involved 7,026 patients with a mean age of 32.1±15.6 years. One-fifth of patients had a short EDLOS (<4 h) and had higher level trauma team T1 activation (TTA-1), higher Injury Severity Score (ISS), higher shock index (SI), and more head injuries than the other groups (P=0.001). Patients with an EDLOS >24 h were older (P=0.001) and had more comorbidities (P=0.001) and fewer deaths (P=0.001). Multivariate regression analysis showed that the predictors of short EDLOS were female gender, GCS, SI, hemoglobin level, ISS, and blood transfusion. The predictors of mortality were TTA-1 (odds ratio [OR]=4.081, 95%CI: 2.364-7.045), head injury (OR=3.920, 95%CI: 2.413-6.368), blood transfusion (OR=2.773, 95%CI: 1.668-4.609), SI (OR=2.132, 95%CI: 1.364-3.332), ISS (OR=1.077, 95%CI: 1.057-1.096), and age (OR=1.040, 95%CI: 1.026-1.054). CONCLUSIONS Patients with shorter EDLOS had different baseline characteristics and hospital outcomes compared with patients with longer EDLOS. Patients with prolonged EDLOS had better outcomes; however, the burden of prolonged boarding in the ED needs further elaboration.
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Affiliation(s)
- Ahmed Faidh Ramzee
- Trauma Surgery Section, Hamad General Hospital (HGH), Doha P.O Box 3050, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma & Vascular Surgery Section, HGH, Doha P.O Box 3050, Qatar.,Clinical Medicine, Weill Cornell Medical College, Doha P.O Box 3050, Qatar
| | - Mohammad Asim
- Clinical Research, Trauma & Vascular Surgery Section, HGH, Doha P.O Box 3050, Qatar
| | - Ahad Kanbar
- Trauma Surgery Section, Hamad General Hospital (HGH), Doha P.O Box 3050, Qatar
| | - Khalid Ahmed
- Trauma Surgery Section, Hamad General Hospital (HGH), Doha P.O Box 3050, Qatar
| | - Bahaa Daoud
- Trauma Surgery Section, Hamad General Hospital (HGH), Doha P.O Box 3050, Qatar
| | - Saji Mathradikkal
- Trauma Surgery Section, Hamad General Hospital (HGH), Doha P.O Box 3050, Qatar
| | - Ahmad Kloub
- Trauma Surgery Section, Hamad General Hospital (HGH), Doha P.O Box 3050, Qatar
| | - Hassan Al-Thani
- Trauma Surgery Section, Hamad General Hospital (HGH), Doha P.O Box 3050, Qatar
| | - Sandro Rizoli
- Trauma Surgery Section, Hamad General Hospital (HGH), Doha P.O Box 3050, Qatar
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Hispanic Farmers Experience Shorter EMS Response Times but Longer Emergency Department Length of Stay Following Occupational Injuries. World J Surg 2022; 46:2872-2881. [PMID: 36161352 DOI: 10.1007/s00268-022-06729-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Agriculture has the highest rate of fatal injuries by sector. Hispanic workers also experience more fatal work injuries than every other minority group combined. Pre-hospital and initial trauma evaluation represent an important marker to understand the impact of a trauma system. We sought to investigate whether Hispanic agricultural workers in the United States (US) experience disparities following traumatic occupational injuries in terms of pre-hospital and emergency department care. METHODS We retrospectively analyzed the National Trauma Data Bank from 2012-2016 to understand differences between Hispanic and non-Hispanic farmers in Emergency Medical Services (EMS) response and transport times (minutes), transport mode, transfer rates, presentation to University or Level I trauma hospitals, Injury Severity Scores (ISS), length of stay (LOS) in the emergency department (ED, minutes) or hospital (days), need for the operating room (OR), admittance to the Intensive Care Unit (ICU), and mortality. RESULTS A total of 6,161 farmers were included in our analyses (median age 47 years, females 7.0%). Multivariable analyses indicate differences regarding EMS response, EMS transport, and LOS in the ED. Rates of admission to the ICU, surgical operations, days on a ventilator, discharge from the hospital with supportive care, and mortality did not differ between groups. CONCLUSIONS Non-Hispanic patients have longer median EMS response and total transport times. Hispanic patients have longer median LOS in the ED. However, the lack of significant differences in management variables other than EMS times and ED LOS indicate an equitable delivery of trauma care once patients were transferred from the ED.
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Liu Q, Xin R, Zhao Y, Yu M, Jin C, Shou S, Chai Y, Jin H. Dynamic changes of emergency visits: a retrospective observational study. BMC Emerg Med 2022; 22:105. [PMID: 35690727 PMCID: PMC9187931 DOI: 10.1186/s12873-022-00654-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 05/24/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND With more emergency visits, there is increasing pressure to provide emergency medical services globally and locally. This study aimed to investigate the epidemiological characteristics and the disease spectrum of patients presenting in the last three years to the Department of Emergency Medicine of Tianjin Medical University General Hospital, a tertiary hospital in Tianjin, China, to improve the services of the emergency medicine department. METHODS A retrospective study was conducted on all patients in the Department of Emergency Medicine of Tianjin Medical University General Hospital from Jan 1, 2017, 00:00:00 to Dec 31, 2020, 23:59:59, including variables like medical record number, gender, age, date of admission, principal diagnosis. The data were analyzed by SPSS statistical software; statistical charts were prepared by GraphPad Prism9.0 and SPSS 20.0; statistical tables were made by Microsoft Excel. RESULTS A total of 1,314,916 patients presented to the Department of Emergency Medicine of Tianjin Medical University General Hospital from Jan 1, 2017, 00:00:00 to Dec 31, 2020, 23:59:59. In terms of gender distribution, the male-female ratio was 0.78∶1. As for age distribution, patients aged 60-69 were the most (23.47%), and patients younger than 20 years were the least (2.80%). Concerning monthly data, the number of visits peaked during January and December. The distribution of daily visits showed the feature of three highs and a low. The top three prevalence diseases in the emergency disease spectrum were respiratory, cardiovascular, and digestive diseases. The respiratory system was the most common in patients with infectious diseases (200,912, accounting for 86.97%). Among the patients suffering from infectious diseases, the number of patients with respiratory infections peaked in 2019 (73,530) and was the lowest in 2020 (20,078). CONCLUSIONS From 2017 to 2019, the demand for emergency services in Tianjin Medical University General Hospital continued to increase, but it was greatly affected by COVID-19 in 2020. This emergency department is mainly for patients with respiratory system, circulatory system and digestive system diseases, and its treatment time is relatively centralized. The prevention of diseases for people of all ages, especially female patients and the elderly, should be strengthened, and emergency medical resources should be allocated reasonably according to the peak months and crowed periods of patients.
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Affiliation(s)
- Qihui Liu
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Ranran Xin
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China.,Department of Critical Care Medicine, Tianjin Beichen Hospital, Tianjin, China
| | - Yibo Zhao
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Muming Yu
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Chunjie Jin
- Information Department, Tianjin Medical University General Hospital, Tianjin, China
| | - Songtao Shou
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Yanfen Chai
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China.
| | - Heng Jin
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China.
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Crilly J, Bartlett D, Sladdin I, Pellatt R, Young JT, Ham W, Porter L. Patient profile and outcomes of traumatic injury: The impact of mode of arrival to the emergency department. Collegian 2022. [DOI: 10.1016/j.colegn.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Does the time of the day affect multiple trauma care in hospitals? A retrospective analysis of data from the TraumaRegister DGU®. BMC Emerg Med 2021; 21:134. [PMID: 34773984 PMCID: PMC8590232 DOI: 10.1186/s12873-021-00525-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 10/22/2021] [Indexed: 12/01/2022] Open
Abstract
Background Optimal multiple trauma care should be continuously provided during the day and night. Several studies have demonstrated worse outcomes and higher mortality in patients admitted at night. This study involved the analysis of a population of multiple trauma patients admitted at night and a comparison of various indicators of the quality of care at different admission times. Methods Data from 58,939 multiple trauma patients from 2007 to 2017 were analyzed retrospectively. All data were obtained from TraumaRegister DGU®. Patients were grouped by the time of their admission to the trauma center (6.00 am–11.59 am (morning), 12.00 pm–5.59 pm (afternoon), 6.00 pm–11.59 pm (evening), 0.00 am–5.59 am (night)). Incidences, patient demographics, injury patterns, trauma center levels and trauma care times and outcomes were evaluated. Results Fewer patients were admitted during the night (6.00 pm–11.59 pm: 18.8% of the patients, 0.00–5.59 am: 4.6% of the patients) than during the day. Patients who arrived between 0.00 am–5.59 am were younger (49.4 ± 22.8 years) and had a higher injury severity score (ISS) (21.4 ± 11.5) and lower Glasgow Coma Scale (GCS) score (11.6 ± 4.4) than those admitted during the day (12.00 pm–05.59 pm; age: 55.3 ± 21.6 years, ISS: 20.6 ± 11.4, GCS: 12.6 ± 4.0). Time in the trauma department and time to an emergency operation were only marginally different. Time to imaging was slightly prolonged during the night (0.00 am–5.59 am: X-ray 16.2 ± 19.8 min; CT scan 24.3 ± 18.1 min versus 12.00 pm- 5.59 pm: X-ray 15.4 ± 19.7 min; CT scan 22.5 ± 17.8 min), but the delay did not affect the outcome. The outcome was also not affected by level of the trauma center. There was no relevant difference in the Revised Injury Severity Classification II (RISC II) score or mortality rate between patients admitted during the day and at night. There were no differences in RISC II scores or mortality rates according to time period. Admission at night was not a predictor of a higher mortality rate. Conclusion The patient population and injury severity vary between the day and night with regard to age, injury pattern and trauma mechanism. Despite the differences in these factors, arrival at night did not have a negative effect on the outcome.
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Yilmaz S, Ak R, Hokenek NM, Yilmaz E, Tataroglu O. Comparison of trauma scores and total prehospital time in the prediction of clinical course in a plane crash: Does timing matter? Am J Emerg Med 2021; 50:301-308. [PMID: 34425323 DOI: 10.1016/j.ajem.2021.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/10/2021] [Accepted: 08/10/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate how the total prehospital time (TPT), Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), and Trauma Score-Injury Severity Score (TRISS) affect the outcome of plane crash victims from anatomical, physiological and psychological perspectives. The accuracy or strength of these scores and TPT in predicting hospitalization and surgery, sequelae development and psychiatric complications [permanent temporary disability (PoTDs)] and PTSD can allow medical professionals to direct and prioritize management efforts of the victims of mass casualties in general. METHODS The study was designed as a single-center retrospective study. By examining the records of victims of a plane crash transferred to the ED, AIS, ISS, TRISS and TPT were calculated on admission. The clinical severity of the patients was determined by a joint decision of five clinicians. The performances of the trauma scores on hospitalization, surgery, PTSD and PoTDs were compared. The study data were analyzed via the Mann-Whitney U test and descriptive statistical methods. Pearson's chi-square test was used for the comparison of qualitative data, and ROC analyses were employed to determine cutoff levels. RESULTS The AIS, ISS, and TRISS scores of the victims with an indication for hospitalization, calculated on admission to the ED, were significantly higher than those of the other victims (p = 0.001). In addition, TPT, AIS, ISS, and TRISS scores were significantly higher in hospitalized patients than in outpatients (p < 0.05). The cutoff levels for AIS and ISS were ≥ 1.50 and ≥ 4.50, respectively, while they were ≥ 123.5 min for TPT with regard to hospitalization decisions. The AIS, ISS, and TRISS scores calculated on admission for the patients who underwent surgery were significantly higher than those who did not (p = 0.001). Cutoff levels for AIS and ISS were ≥ 2.50 and ≥ 11.50, respectively, while they were ≥ 135.5 min for TPT with respect to the decision to operate on the victims. CONCLUSIONS It is expected that everyone who practices medicine be equipped to handle multiple casualties. As the number of people involved in mass casualties increases, diagnostic tools, workups such as laboratory and radiological studies, and prognostic markers such as trauma scores should be simpler and more user-friendly.
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Affiliation(s)
- Sarper Yilmaz
- University of Health Sciences, Dept. of Emergency Medicine, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Rohat Ak
- University of Health Sciences, Dept. of Emergency Medicine, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Nihat Mujdat Hokenek
- University of Health Sciences, Dept. of Emergency Medicine, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey.
| | - Erdal Yilmaz
- University of Health Sciences, Dept. of Emergency Medicine, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Ozlem Tataroglu
- University of Health Sciences, Dept. of Emergency Medicine, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
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Kegel F, Luo OD, Richer S. The Impact of Extreme Heat Events on Emergency Departments in Canadian Hospitals. Wilderness Environ Med 2021; 32:433-440. [PMID: 34364750 DOI: 10.1016/j.wem.2021.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Mean daily temperatures in Canada rose 1.7°C between 1948 and 2016, and the frequency, severity, and duration of extreme heat events has increased. These events can exacerbate underlying health conditions, bringing patients to emergency departments (EDs). This retrospective analysis assessed the impact of temperature and humidex on ED volume and length of stay (LOS). METHODS LOS is an indicator of ED overcrowding and system performance. Using daily maximum temperatures and humidex values, this study investigated the impact of mean 3-d temperatures and humidex preceding ED presentation on the median and maximum ED LOS and patient volume in 2 community hospitals in Montreal, Quebec, during the summer months of 2016 to 2018. Data were analyzed with 1-way analysis of variance with post hoc Fisher least significant difference tests and Spearman correlation tests. RESULTS The mean maximum temperature and humidex were 26.1°C and 30.4°C, respectively (n=276 d). Mean 3-d temperatures ≥30°C were associated with higher daily ED volumes in both hospitals (138 vs 121, P=0.002 and 132 vs 125, P=0.03) and with increased median LOS at 1 hospital (8.9 vs 7.6 h, P=0.03). Mean 3-d humidex ≥35 was associated with higher daily ED volumes at both hospitals as well (136 vs 123, P=0.01 and 133 vs 125, P=0.009) with an increased median LOS at 1 hospital (8.6 vs 6.9 h, P=0.0001) with humidex values of 25 to 29.9°C. CONCLUSIONS Heat events were associated with increased ED presentations and LOS. This study suggests that a warming climate can impede emergency service provision by increasing the demand for and delaying timely care.
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Affiliation(s)
- Fraser Kegel
- Department of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Owen D Luo
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Signe Richer
- Verdun Hospital, McGill University, Montreal, Quebec, Canada.
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Uranaka K, Takaira H, Shinohara R, Yamagata Z. Comparison of Japan nurse practitioner-led care and physician trainee-led care on patients' length of stay in a secondary emergency department: A retrospective study. Jpn J Nurs Sci 2021; 18:e12437. [PMID: 34169664 PMCID: PMC8518728 DOI: 10.1111/jjns.12437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/01/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022]
Abstract
Aim We compared Japan nurse practitioner‐led care and physician trainee‐led care in terms of patients' length of stay in a secondary emergency department in Japan. Methods This was a retrospective observational study, utilizing medical records. Participants (n = 1419; mean age = 63.9 ± 23.4 years; 52.3% men) were patients transferred to the emergency department by ambulance between April 2016 and March 2018 in western Tokyo. Multiple linear regression analyses were performed, with length of stay as the dependent variable and factors related to the length of stay, including medical care leaders, as the independent variable. Results Approximately half of the patients (n = 763; 53.8%) received Japan nurse practitioner‐led care. Patients' length of stay was significantly shorter, by 6 min, in the Japan nurse practitioner‐led care group, compared with the physician trainee‐led care group (unstandardized coefficient: −6.81; 95% confidence interval: −13.35 to −0.26; p < 0.05). Conclusion Patients' shorter length of stay in the Japan nurse practitioner group, compared with the physician trainee group, suggests that Japan nurse practitioners are not inferior to physician trainees in terms of the time spent to manage patients.
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Affiliation(s)
- Keiichi Uranaka
- Division of Nursing Postgraduate School, Tokyo Healthcare University, Tokyo, Japan.,Integrated Graduate School of Medicine, Engineering, and Agricultural Sciences, University of Yamanashi, Chuo, Japan
| | - Hitoshi Takaira
- National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Ryoji Shinohara
- Center for Birth Cohort Studies, University of Yamanashi, Chuo, Japan
| | - Zentaro Yamagata
- Department of Health Science, Basic Science for Clinical Medicine, Division of Medicine, Graduate School Department of Interdisciplinary Research, University of Yamanashi, Chuo, Japan
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