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Uslu Y, Akbayrak H, Kuytak Ortahisar B, Barak TH. The effect of lavender foot baths on postoperative pain and sleep quality in comparison with foot baths with warm water only-A prospective randomized controlled study. Explore (NY) 2024; 20:385-391. [PMID: 37863680 DOI: 10.1016/j.explore.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/28/2023] [Accepted: 10/04/2023] [Indexed: 10/22/2023]
Abstract
INTRODUCTION The aim of the study was to investigate the effect of warm water (WW) foot bath with or without lavender oil for pain and sleep quality in the patients who undergone abdominal surgeries. MATERIALS AND METHOD This study was designed as a prospective randomized controlled. The three study groups were defined as the control group (n = 44), the WW foot bath group (n = 46), WW foot bath with the lavender group (n = 40). Foot baths were done for 20 min with 40 °C every night for 3 days after surgery. Visual Analogue Scale and Richard-Campbell Sleep Questionnaire were used during data collection. RESULTS A total of 130 patients, mean age 55.99 ± ± 13.05 years, 66 male (51 %), 103 of whom underwent abdominal surgery, were included in the study. When the patients during the postoperative three days were evaluated, decreased pain score and increased sleep quality both the WW and WW foot bath with lavender groups (p < 0.001). Noise-related sleep quality was detected to be lesser in the control group patients on the 3rd day (p < 0.001). CONCLUSION WW foot bath with or without lavender oil is an uncomplicated, economical, and effective complementary therapy to reduce postoperative pain and improve sleep quality. WW foot baths with essential oils are optionally available in clinics and can be used according to patients' preferences.
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Affiliation(s)
- Yasemin Uslu
- Istanbul University, Nursing Faculty, Surgical Nursing Department, Istanbul, Turkey
| | - Hacer Akbayrak
- Acıbadem Health Group Altunizade Hospital, İstanbul, Turkey
| | | | - Timur Hakan Barak
- Acıbadem Mehmet Ali Aydınlar University, Faculty of Pharmacy, Department of Pharmacognosy, Istanbul, Turkey.
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Zhang C, Mu H, Yang YF, Zhang Y, Gou WJ. Effect of aromatherapy on quality of life in maintenance hemodialysis patients: a systematic review and meta-analysis. Ren Fail 2023; 45:2164202. [PMID: 36908215 PMCID: PMC10013488 DOI: 10.1080/0886022x.2022.2164202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Objective: Aromatherapy has been used for patients on maintenance hemodialysis (MHD), but the outcomes are still controversial. Thus, we conducted this study to systematically evaluate the effect of aromatherapy on the quality of life of patients on MHD.Methods: We searched the PubMed, Embays, Scopus, Web of Science, and CNKI databases for randomized controlled trials that evaluated the use of aromatherapy in dialysis patients and reported at least one outcome of interest.Results: Twenty-two relevant studies were included in the meta-analysis. The meta-analysis revealed that aromatherapy significantly increased subjective sleep quality (a lower score indicates better sleep quality) [standardized mean difference (SMD) = -1.52, 95% CI (-2.38, -0.67), p < 0.01] and reduced fatigue [SMD = -1.14, 95% CI (-1.95, -0.33), p = 0.01], anxiety [SMD = -1.38, 95% CI (-2.09, -0.67), p < 0.01], symptoms of restless legs syndrome [RLS; SMD = -1.71, 95% CI (-2.09, -1.33), p < 0.01], and arteriovenous fistula puncture pain [SMD= -1.56, 95% CI (-2.60, -0.52), p < 0.01].Conclusions: Aromatherapy may be used as a novel complementary and alternative therapy to improve sleep quality and reduce fatigue, anxiety, symptoms of RLS, and arteriovenous fistula puncture pain in patients on MHD.
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Affiliation(s)
- Cong Zhang
- Department of Cardiothoracic and Vascular Surgery, The First Affiliated Hospital of Yangtze University, Jingzhou, PR China
| | - Hang Mu
- Department of Oncology, Jianli People's Hospital, Jianli, PR China
| | - Yong-Fang Yang
- Department of Nursing, Jianli People's Hospital, Jianli, PR China
| | - Yong Zhang
- Department of Nephrology, Jianli People's Hospital, Jianli, PR China
| | - Wen-Jun Gou
- Department of Nephrology, The First Affiliated Hospital of Yangtze University, Jingzhou, PR China
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de Melo Alves Silva LC, de Oliveira Mendes FDC, de Castro Teixeira F, de Lima Fernandes TE, Barros Ribeiro KR, da Silva Leal KC, Dantas DV, Neves Dantas RA. Use of Lavandula angustifolia essential oil as a complementary therapy in adult health care: A scoping review. Heliyon 2023; 9:e15446. [PMID: 37153408 PMCID: PMC10160692 DOI: 10.1016/j.heliyon.2023.e15446] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/07/2023] [Accepted: 04/09/2023] [Indexed: 05/09/2023] Open
Abstract
Background In addition to its low toxicity risk, Lavender (Lavandula angustifolia Mill.) essential oil is recognised worldwide for its sedative, antidepressant, antiseptic, antifungal, relaxing, and antiemetic properties. Thus, the action mechanism of lavender oil has attracted significant attention from researchers interested in improving the physical, emotional, and spiritual well-being of patients. Objective To investigate the scope of knowledge regarding the use of L. angustifolia essential oil as a complementary therapy in adult health care. Methods A scoping review was carried out using a PRISMA-ScR checklist followed by a critical assessment being performed using the Joanna Briggs Institute level of evidence. The following databases were used: SCOPUS, MEDLINE/PubMed, Web of Science, Science Direct, SCIELO, Cochrane Library, LILACS, Wiley Online Library, CAPES, and FIOCRUZ Dissertations. Results Eighty-three articles published between 2002 and 2022 were selected for the analysis; More articles came from Iran than from any other country and most articles reported clinical trials. The applicability of lavender essential oil and its route of administration in different clinical situations were the main topics addressed in the articles. Conclusions Most studies demonstrate the efficacy of L. angustifolia Mill. essential oil in relieving pain and decreasing anxiety. Few studies evaluated the anti-psoriatic, anti-toxoplasmotic, and wound healing properties and the protective actions against cerebral ischemia. One study reported on its safety, specifically the allergenic potential of linalool, the main chemical component of L. angustifolia essential oil. However, most studies did not involve the extensive investigations on this topic or report the safe quantities of this oil for human treatment, meaning further research into the safety of this treatment is required.
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Dewanjee S, Sohel M, Hossain MS, Ansari F, Islam MT, Sultana F, Al Mamun A, Islam MM, Amin MN. A comprehensive review on clinically proven natural products in the management of nerve pain, with mechanistic insights. Heliyon 2023; 9:e15346. [PMID: 37159686 PMCID: PMC10163606 DOI: 10.1016/j.heliyon.2023.e15346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 03/13/2023] [Accepted: 04/03/2023] [Indexed: 05/11/2023] Open
Abstract
Introduction People are treating their neuropathic pain with several approved and licensed pharmacological drugs. But due to having existing limitations like low efficacy with some side effects, there needs to be a more effective alternative and complementary therapeutic options. Purpose s: The study was designed to discuss the mechanistic role of several clinically proven natural products that have been shown to play a significant role against different nerve pain or neuropathic pain. Method ology: Information for this review article was salvaged using several accessible searching databases like SciVerse Scopus ® (Elsevier Properties S. A, USA), Web of Science® (Thomson Reuters, USA), and PubMed® (U.S. National Library of Medicine, USA) considering some search items like - nerve pain, natural products in pain/nerve pain management, clinically proven natural products in pain management, pain-reducing agents and so on. Result Our study reported the therapeutic efficacy of natural products and their possible mechanism against neuropathic pain in the human body. Natural products widely used to treat neuropathic pain include comfrey root extract ointment, lavender oil, Rose Oil, aromatic essential oil, ginger oil, vitex agnus-castus, peganum oil, and ajwain 10%. Some common pathways are involved in pain relief through sensory stimulation, enzymatic, anti-inflammatory, and pain-related receptor regulation. Conclusion The present study suggests that the mentioned natural products can be an appropriate choice for the treatment and management of neuropathic pain.
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Affiliation(s)
- Sanchita Dewanjee
- Department of Applied Chemistry and Chemical Engineering, Noakhali Science and Technology University, Noakhali, Bangladesh
| | - Md Sohel
- Department of Biochemistry and Molecular Biology, Primeasia University, Banani, Dhaka, 1213, Bangladesh
- Pratyasha Health Biomedical Research Center, Dhaka, 1230, Bangladesh
| | - Md Shahadat Hossain
- Department of Pharmacy, Atish Dipankar University of Science and Technology, Dhaka, 1230, Bangladesh
| | - Farzana Ansari
- Department of Biochemistry and Molecular Biology, Laboratory of Nutrition and Health Research, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Md Tofikul Islam
- Department of Pharmacy, Atish Dipankar University of Science and Technology, Dhaka, 1230, Bangladesh
| | - Farhana Sultana
- Pratyasha Health Biomedical Research Center, Dhaka, 1230, Bangladesh
- Department of Pharmacy, Atish Dipankar University of Science and Technology, Dhaka, 1230, Bangladesh
| | - Abdullah Al Mamun
- Department of Biochemistry and Molecular Biology, Primeasia University, Banani, Dhaka, 1213, Bangladesh
| | - Md Monirul Islam
- Department of Pharmacy, State University of Bangladesh, Dhaka, 1205, Bangladesh
- Corresponding author.
| | - Mohammad Nurul Amin
- Pratyasha Health Biomedical Research Center, Dhaka, 1230, Bangladesh
- Department of Pharmacy, Atish Dipankar University of Science and Technology, Dhaka, 1230, Bangladesh
- Corresponding author. Department of Pharmacy, Atish Dipankar University of Science and Technology, Dhaka, 1230. Bangladesh.
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Tüzün Özdemir S, Akyol A. Effect of inhaler and topical lavender oil on pain management of arteriovenous fistula cannulation. J Vasc Access 2023; 24:465-474. [PMID: 34396816 DOI: 10.1177/11297298211031086] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The recurrent arteriovenous fistula (AVF) intervention in the treatment of hemodialysis induces pain in patients. Lavender oil has analgesic, antimicrobial, and calming effects. This oil is widely used in patients to reduce anxiety and stress associated with pain caused by analgesics. METHOD The present study is a randomized controlled and experimental clinical trial in which patients (n = 90) who underwent hemodialysis with AVFs were randomly divided into three groups. The intensity of pain was measured in all patients at three different stages during the insertion of arterial needles for hemodialysis: (1) The topical application of 100% lavender essential oil, (2) the inhaler application of 100% lavender essential oil, and (3) no intervention. The placebo (water) was applied to groups 1 and 2. RESULTS Our findings revealed that the mean pre-application pain scores in hemodialysis patients were 57.58 ± 20.28 in the working group, 48.53 ± 20.23 in the control group, 19.49 ± 15.66 in the post-application group, and 45.33 ± 25.52 in the control group (p < 0.005). The average pain scores after the application of lavender oil were 22.66 ± 15.35 in the inhaler lavender group, 16.33 ± 15.97 in the topical lavender group, and 45.33 ± 25.52 in the control group. CONCLUSIONS After inhaler and topical application of lavender oil, a significant decrease in the severity of pain was recorded for patients at the time of arterial insertion of needles.
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Affiliation(s)
| | - Asiye Akyol
- Department of Internal Medicine Nursing, Ege University, Faculty of Nursing, Izmir, Turkey
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Nascimento JC, Gonçalves VS, Souza BR, Nascimento LDC, Carvalho BM, Ziegelmann PK, Goes TC, Guimarães AG. New approaches to the effectiveness of inhalation aromatherapy in controlling painful conditions: A systematic review with meta-analysis. Complement Ther Clin Pract 2022; 49:101628. [DOI: 10.1016/j.ctcp.2022.101628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 06/16/2022] [Accepted: 06/26/2022] [Indexed: 11/03/2022]
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Liktor-Busa E, Keresztes A, LaVigne J, Streicher JM, Largent-Milnes TM. Analgesic Potential of Terpenes Derived from Cannabis sativa. Pharmacol Rev 2021; 73:98-126. [PMID: 34663685 PMCID: PMC11060501 DOI: 10.1124/pharmrev.120.000046] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Pain prevalence among adults in the United States has increased 25% over the past two decades, resulting in high health-care costs and impacts to patient quality of life. In the last 30 years, our understanding of pain circuits and (intra)cellular mechanisms has grown exponentially, but this understanding has not yet resulted in improved therapies. Options for pain management are limited. Many analgesics have poor efficacy and are accompanied by severe side effects such as addiction, resulting in a devastating opioid abuse and overdose epidemic. These problems have encouraged scientists to identify novel molecular targets and develop alternative pain therapeutics. Increasing preclinical and clinical evidence suggests that cannabis has several beneficial pharmacological activities, including pain relief. Cannabis sativa contains more than 500 chemical compounds, with two principle phytocannabinoids, Δ9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD). Beyond phytocannabinoids, more than 150 terpenes have been identified in different cannabis chemovars. Although the predominant cannabinoids, Δ9-THC and CBD, are thought to be the primary medicinal compounds, terpenes including the monoterpenes β-myrcene, α-pinene, limonene, and linalool, as well as the sesquiterpenes β-caryophyllene and α-humulene may contribute to many pharmacological properties of cannabis, including anti-inflammatory and antinociceptive effects. The aim of this review is to summarize our current knowledge about terpene compounds in cannabis and to analyze the available scientific evidence for a role of cannabis-derived terpenes in modern pain management. SIGNIFICANCE STATEMENT: Decades of research have improved our knowledge of cannabis polypharmacy and contributing phytochemicals, including terpenes. Reform of the legal status for cannabis possession and increased availability (medicinal and recreational) have resulted in cannabis use to combat the increasing prevalence of pain and may help to address the opioid crisis. Better understanding of the pharmacological effects of cannabis and its active components, including terpenes, may assist in identifying new therapeutic approaches and optimizing the use of cannabis and/or terpenes as analgesic agents.
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Affiliation(s)
| | - Attila Keresztes
- Department of Pharmacology, University of Arizona, Tucson, Arizona
| | - Justin LaVigne
- Department of Pharmacology, University of Arizona, Tucson, Arizona
| | - John M Streicher
- Department of Pharmacology, University of Arizona, Tucson, Arizona
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Effect of aromatherapy on the pain of arteriovenous fistula puncture in patients on hemodialysis: a systematic review. JOURNAL OF HEALTH RESEARCH 2021. [DOI: 10.1108/jhr-05-2021-0280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
This study aims to determine the effect of aromatherapy used in reducing the pain caused by fistula puncture in hemodialysis patients.
Design/methodology/approach
In this study, the effect of aromatherapy application on fistula puncture was analyzed and carried out by scanning the relevant literature. The literature review was conducted between August and October 2020. While reviewing the literature, the authors used “aromatherapy,” “pain,” “fistula,” “puncture,” “hemodialysis” keywords and various combinations of these; moreover, Google scientist, Pubmed, Cochrane, ScienceDirect, Web of Science, Medline and Ovid databases and studies, which were conducted in the last 10 years were reviewed. As a result of the literature review, 1183 studies were reached and seven of them were included in the study by taking the inclusion criteria into account.
Findings
The randomized controlled studies are six studies and nonrandomized controlled experimental 1 study were added to the scope of the study and seven studies were included in the sample. In these studies, personal information forms developed by the researchers as data collection tools and the VAS scale, Numerical pain rating, the numeric rating scale were used to evaluate pain.
Practical implications
It has been determined that aromatherapy application in hemodialysis patients has positive effects on reducing pain due to puncture fistula intervention.
Originality/value
This study provides reduction or elimination of fistula needle insertion pain in hemodialysis patients.
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Kosmadakis G, Amara I, Costel G. Pain on arteriovenous fistula cannulation: A narrative review. Semin Dial 2021; 34:275-284. [PMID: 33962481 DOI: 10.1111/sdi.12979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pain on arteriovenous fistula (AVF) cannulation is a rather persistent problem in the daily hemodialysis practice. Its prevalence varies from 12% to even 80% depending on the definition and the pain-assessment tools and it affects the quality of life of hemodialysis patients. It is associated with fear of the cannulation process, the decision of hemodialysis from an AVF and sometimes the hemodialysis itself. In this narrative review, we tried to tackle the extent of the problem and to present the available published solutions. The literature suggests a large array of methods based on the application of local anesthetic creams, application of cold or hot directly on the cannulation sites or on the contralateral arm, cannulation techniques and AVF localization, distraction as well as alternative treatments. All of them have shown a relative success. There is a serious lack of large multicenter randomized trials and a gap concerning work groups and guidelines or recommendations from national or international societies on this matter. Complementary training starting from the predialysis patient education programs may be useful. Alternative prophylactic measures including counseling, hypnosis, or other physicochemical interventions could also improve our knowledge on the treatment of this seriously uncomfortable condition.
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Scientific and Clinical Abstracts From WOCNext® 2021: An Online Event ♦ June 24-26, 2021. J Wound Ostomy Continence Nurs 2021; 48:S1-S49. [PMID: 37632236 DOI: 10.1097/won.0000000000000772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Bagheri H, Salmani T, Nourian J, Mirrezaie SM, Abbasi A, Mardani A, Vlaisavljevic Z. The Effects of Inhalation Aromatherapy Using Lavender Essential Oil on Postoperative Pain of Inguinal Hernia: A Randomized Controlled Trial. J Perianesth Nurs 2020; 35:642-648. [DOI: 10.1016/j.jopan.2020.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/22/2020] [Accepted: 03/22/2020] [Indexed: 02/07/2023]
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Optimal Time of Thermotherapy for Reducing Pain, Anxiety, and Side Effects in Arteriovenous Fistula Puncture Patients: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197147. [PMID: 33003591 PMCID: PMC7579075 DOI: 10.3390/ijerph17197147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/21/2020] [Accepted: 09/28/2020] [Indexed: 11/28/2022]
Abstract
Chronic renal failure patients undergoing hemodialysis complain of moderate pain from repeated punctures of the arteriovenous fistula. This study examined the optimal application time of thermotherapy for reducing pain, anxiety, and side effects during arteriovenous fistula puncture. This study was conducted as a single-blinded randomized controlled trial. The participants were arteriovenous fistula puncture patients with chronic renal failure who were divided into two thermotherapy groups and one control group. This study was approved by the institutional review board and registered with the Clinical Research Information Service (KCT0003768). Differences between groups regarding pain, anxiety, and side effects were analyzed using one-way ANOVA, the χ2 test, and the Scheffé test. A significant difference was observed between the 10-min and 20-min thermotherapy groups and the control group in terms of the pain they experienced. Additionally, more side effects were encountered in the 20-min thermotherapy group than in the 10-min group. The 10-min application of thermotherapy for an arteriovenous fistula puncture showed the same pain-reducing effect as the conventional 20-min application. The study confirmed a 10-min application of thermotherapy to be an effective nursing intervention for pain relief without side effects.
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Citlik Saritas S, Buyukbayram Z, Kaplan Serin E, Bilgic Y. Effects of lavender oil intervention before endoscopic retrograde cholangiopancreatography on patients' vital signs, pain and anxiety: A randomized controlled study. Explore (NY) 2020; 17:446-450. [PMID: 32798174 DOI: 10.1016/j.explore.2020.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 07/16/2020] [Accepted: 07/29/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND This study was carried out to determine the effects of lavender oil intervention before endoscopic retrograde cholangiopancreatography (ERCP) on patients' vital signs, pain and anxiety. MATERIALS AND METHODS This study was designed as a randomized controlled study. The population of the study consisted of adult patients who were going to receive ERCP at the gastroenterology clinic of a university hospital. Ninety patients participated in the study. The data were collected using a Patient Information Form, a Pre-Post Test Record Form, VAS and the State Anxiety Scale. RESULTS After lavender oil intervention, the pulse rate, systolic-diastolic blood pressure, pain and anxiety levels of the patients in the experiment group were reduced, their oxygen saturation levels were increased, and the difference between the groups was statistically significant (p < 0.05). CONCLUSION Lavender oil applied on the patients before the ERCP procedure reduced their pulse rate, systolic-diastolic blood pressure, pain and anxiety levels, while it increased their oxygen saturation levels.
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Affiliation(s)
- Seyhan Citlik Saritas
- Medical Nursing Department, Faculty of Nursing, Inonu University, 44280 Malatya, Turkey.
| | - Zeliha Buyukbayram
- Medical Nursing Department, Siirt Health School, Siirt University, Siirt, Turkey
| | - Emine Kaplan Serin
- Medical Nursing Department, Health School, Munzur University, Tunceli, Turkey
| | - Yilmaz Bilgic
- Gastroenterology Department, Medical School, Inonu University, Malatya, Turkey
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Efe Arslan D, Kılıç Akça N. The effect of aromatherapy hand massage on distress and sleep quality in hemodialysis patients: A randomized controlled trial. Complement Ther Clin Pract 2020; 39:101136. [DOI: 10.1016/j.ctcp.2020.101136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/26/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
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