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Zolkefli Y. Greater accountability in nursing handover. BELITUNG NURSING JOURNAL 2022; 8:84-85. [PMID: 37521075 PMCID: PMC10386806 DOI: 10.33546/bnj.1966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/06/2021] [Accepted: 12/14/2021] [Indexed: 08/01/2023] Open
Abstract
Nursing handover exemplifies both the nurse's professional ethics and the profession's integrity. The article by Yetti et al. acknowledges the critical role of structure and process in handover implementation. At the same time, they emphasised the fundamental necessity to establish and update handover guidelines. I assert that effective patient handover practices do not simply happen; instead, nurses require pertinent educational support. It is also pivotal to develop greater professional accountability throughout the handover process. The responsibility for ensuring consistent handover quality should be shared between nurse managers and those who do the actual handover practices.
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Affiliation(s)
- Yusrita Zolkefli
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Brunei Darussalam
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Black GB, van Os S, Machen S, Fulop NJ. Ethnographic research as an evolving method for supporting healthcare improvement skills: a scoping review. BMC Med Res Methodol 2021; 21:274. [PMID: 34865630 PMCID: PMC8647364 DOI: 10.1186/s12874-021-01466-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The relationship between ethnography and healthcare improvement has been the subject of methodological concern. We conducted a scoping review of ethnographic literature on healthcare improvement topics, with two aims: (1) to describe current ethnographic methods and practices in healthcare improvement research and (2) to consider how these may affect habit and skill formation in the service of healthcare improvement. METHODS We used a scoping review methodology drawing on Arksey and O'Malley's methods and more recent guidance. We systematically searched electronic databases including Medline, PsychINFO, EMBASE and CINAHL for papers published between April 2013 - April 2018, with an update in September 2019. Information about study aims, methodology and recommendations for improvement were extracted. We used a theoretical framework outlining the habits and skills required for healthcare improvement to consider how ethnographic research may foster improvement skills. RESULTS We included 283 studies covering a wide range of healthcare topics and methods. Ethnography was commonly used for healthcare improvement research about vulnerable populations, e.g. elderly, psychiatry. Focussed ethnography was a prominent method, using a rapid feedback loop into improvement through focus and insider status. Ethnographic approaches such as the use of theory and focus on every day practices can foster improvement skills and habits such as creativity, learning and systems thinking. CONCLUSIONS We have identified that a variety of ethnographic approaches can be relevant to improvement. The skills and habits we identified may help ethnographers reflect on their approaches in planning healthcare improvement studies and guide peer-review in this field. An important area of future research will be to understand how ethnographic findings are received by decision-makers.
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Affiliation(s)
| | - Sandra van Os
- Department of Applied Health Research, UCL, London, UK
| | | | - Naomi J Fulop
- Department of Applied Health Research, UCL, London, UK
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Spooner AJ, Aitken LM, Chaboyer W. Implementation of an Evidence-Based Practice Nursing Handover Tool in Intensive Care Using the Knowledge-to-Action Framework. Worldviews Evid Based Nurs 2018. [PMID: 29517146 DOI: 10.1111/wvn.12276] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Miscommunication during handover has been linked to adverse patient events and is an international patient safety priority. Despite the development of handover resources, standardized handover tools for nursing team leaders (TLs) in intensive care are limited. AIMS The study aim was to implement and evaluate an evidence-based electronic minimum data set for nursing TL shift-to-shift handover in the intensive care unit using the knowledge-to-action (KTA) framework. METHODS This study was conducted in a 21-bed medical-surgical intensive care unit in Queensland, Australia. Senior registered nurses involved in TL handover were recruited. Three phases of the KTA framework (select, tailor, and implement interventions; monitor knowledge use; and evaluate outcomes) guided the implementation and evaluation process. A postimplementation practice audit and survey were carried out to determine nursing TL use and perceptions of the electronic minimum data set 3 months after implementation. Results are presented using descriptive statistics (median, IQR, frequency, and percentage). RESULTS Overall (86%, n = 49), TLs' use of the electronic minimum data set for handover and communication regarding patient plan increased. Key content items, however, were absent from handovers and additional documentation was required alongside the minimum data set to conduct handover. Of the TLs surveyed (n = 35), those receiving handover perceived the electronic minimum data set more positively than TLs giving handover (n = 35). Benefits to using the electronic minimum data set included the patient content (48%), suitability for short-stay patients (16%), decreased time updating (12%), and printing the tool (12%). Almost half of the participants, however, found the minimum data set contained irrelevant information, reported difficulties navigating and locating relevant information, and pertinent information was missing. Suggestions for improvement focused on modifications to the electronic handover interface. LINKING EVIDENCE TO ACTION Prior to developing and implementing electronic handover tools, adequate infrastructure is required to support knowledge translation and ensure clinician and organizational needs are met.
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Affiliation(s)
- Amy J Spooner
- Doctoral Candidate, Nurse Researcher, Adult Intensive Care Services, The Prince Charles Hospital, Chermside, Australia, and School of Nursing and Midwifery, Griffith University, Nathan, Australia
| | - Leanne M Aitken
- Professor of Critical Care, National Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Nathan, Australia, Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, Australia, and School of Health Sciences, City, University of London, London, United Kingdom
| | - Wendy Chaboyer
- Professor of Nursing, National Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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Kennell TI, Willig JH, Cimino JJ. Clinical Informatics Researcher's Desiderata for the Data Content of the Next Generation Electronic Health Record. Appl Clin Inform 2017; 8:1159-1172. [PMID: 29270955 DOI: 10.4338/aci-2017-06-r-0101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE Clinical informatics researchers depend on the availability of high-quality data from the electronic health record (EHR) to design and implement new methods and systems for clinical practice and research. However, these data are frequently unavailable or present in a format that requires substantial revision. This article reports the results of a review of informatics literature published from 2010 to 2016 that addresses these issues by identifying categories of data content that might be included or revised in the EHR. MATERIALS AND METHODS We used an iterative review process on 1,215 biomedical informatics research articles. We placed them into generic categories, reviewed and refined the categories, and then assigned additional articles, for a total of three iterations. RESULTS Our process identified eight categories of data content issues: Adverse Events, Clinician Cognitive Processes, Data Standards Creation and Data Communication, Genomics, Medication List Data Capture, Patient Preferences, Patient-reported Data, and Phenotyping. DISCUSSION These categories summarize discussions in biomedical informatics literature that concern data content issues restricting clinical informatics research. These barriers to research result from data that are either absent from the EHR or are inadequate (e.g., in narrative text form) for the downstream applications of the data. In light of these categories, we discuss changes to EHR data storage that should be considered in the redesign of EHRs, to promote continued innovation in clinical informatics. CONCLUSION Based on published literature of clinical informaticians' reuse of EHR data, we characterize eight types of data content that, if included in the next generation of EHRs, would find immediate application in advanced informatics tools and techniques.
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Affiliation(s)
- Timothy I Kennell
- Informatics Institute, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - James H Willig
- Informatics Institute, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States.,Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - James J Cimino
- Informatics Institute, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States.,Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
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Nelson P, Bell AJ, Nathanson L, Sanchez LD, Fisher J, Anderson PD. Ethnographic analysis on the use of the electronic medical record for clinical handoff. Intern Emerg Med 2017; 12:1265-1272. [PMID: 27832465 DOI: 10.1007/s11739-016-1567-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/24/2016] [Indexed: 02/07/2023]
Abstract
The objective of this study was to understand the social elements of clinical and organizational interactions of the key stakeholders in the specific context of an electronic dashboard used by the emergency department (ED) and inpatient medicine teams at the time of clinical referral and handover. An electronic handover function is utilised at the ED-inpatient interface at this institution and has given clinicians the ability to better communicate, monitor the department and strive to improve patient safety in streamline the delivery of care in the acute phase. This study uses an ethnographic qualitative research design incorporating semistructured interviews, participant observation on the ED floor and fieldwork notes. The setting for this research was in the ED at a tertiary University affiliated hospital. Triangulation was used to combine information obtained from multiple sources and information from fieldwork and interviews refined into useable chunks culminating in a thematic analysis. Thematic analysis yielded five central themes that reflected how the clinical staff utilised this IT system and why it had become embedded in the culture of clinical referral and handover. Efficient time management for improved patient flow was demonstrated, value added communication (at the interpersonal level), the building trust at the ED-inpatient interface, the maintenance of mutual respect across medical cultures and an overall enhancement of the quality of ED communication (in terms of the information available). A robust electronic handover process, resulted in an integrated approach to patient care by removing barriers to admission for medical inpatients, admitted via ED. The value proposition for patients was a more complete information transfer, both within the ED and between departments.
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Affiliation(s)
| | - Anthony J Bell
- RBWH Department of Emergency Medicine, Butterfield St, Herston, QLD, 4006, Australia.
| | - Larry Nathanson
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, USA
| | - Jonathan Fisher
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, USA
| | - Philip D Anderson
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, USA
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Spooner AJ, Aitken LM, Chaboyer W. Barriers and facilitators to the implementation of an evidence-based electronic minimum dataset for nursing team leader handover: A descriptive survey. Aust Crit Care 2017; 31:278-283. [PMID: 29153960 DOI: 10.1016/j.aucc.2017.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/06/2017] [Accepted: 09/17/2017] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION There is widespread use of clinical information systems in intensive care units however, the evidence to support electronic handover is limited. OBJECTIVES The study aim was to assess the barriers and facilitators to use of an electronic minimum dataset for nursing team leader shift-to-shift handover in the intensive care unit prior to its implementation. METHODS The study was conducted in a 21-bed medical/surgical intensive care unit, specialising in cardiothoracic surgery at a tertiary referral hospital, in Queensland, Australia. An established tool was modified to the intensive care nursing handover context and a survey of all 63 nursing team leaders was undertaken. Survey statements were rated using a 6-point Likert scale with selections from 'strongly disagree' to 'strongly agree', and open-ended questions. Descriptive statistics were used to summarise results. RESULTS AND DISCUSSION A total of 39 team leaders responded to the survey (62%). Team leaders used general intensive care work unit guidelines to inform practice however they were less familiar with the intensive care handover work unit guideline. Barriers to minimum dataset uptake included: a tool that was not user friendly, time consuming and contained too much information. Facilitators to minimum dataset adoption included: a tool that was user friendly, saved time and contained relevant information. Identifying the complexities of a healthcare setting prior to the implementation of an intervention assists researchers and clinicians to integrate new knowledge into healthcare settings. CONCLUSION Barriers and facilitators to knowledge use focused on usability, content and efficiency of the electronic minimum dataset and can be used to inform tailored strategies to optimise team leaders' adoption of a minimum dataset for handover.
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Affiliation(s)
- Amy J Spooner
- School of Nursing and Midwifery, Griffith University, Nathan, Australia.
| | - Leanne M Aitken
- NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; School of Nursing and Midwifery, Griffith University, Nathan, Australia; Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, Australia; School of Health Sciences, City University London, London, United Kingdom
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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Yen PY, McAlearney AS, Sieck CJ, Hefner JL, Huerta TR. Health Information Technology (HIT) Adaptation: Refocusing on the Journey to Successful HIT Implementation. JMIR Med Inform 2017; 5:e28. [PMID: 28882812 PMCID: PMC5608986 DOI: 10.2196/medinform.7476] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 08/04/2017] [Accepted: 08/04/2017] [Indexed: 11/26/2022] Open
Abstract
In past years, policies and regulations required hospitals to implement advanced capabilities of certified electronic health records (EHRs) in order to receive financial incentives. This has led to accelerated implementation of health information technologies (HIT) in health care settings. However, measures commonly used to evaluate the success of HIT implementation, such as HIT adoption, technology acceptance, and clinical quality, fail to account for complex sociotechnical variability across contexts and the different trajectories within organizations because of different implementation plans and timelines. We propose a new focus, HIT adaptation, to illuminate factors that facilitate or hinder the connection between use of the EHR and improved quality of care as well as to explore the trajectory of changes in the HIT implementation journey as it is impacted by frequent system upgrades and optimizations. Future research should develop instruments to evaluate the progress of HIT adaptation in both its longitudinal design and its focus on adaptation progress rather than on one cross-sectional outcome, allowing for more generalizability and knowledge transfer.
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Affiliation(s)
- Po-Yin Yen
- Washington University in St Louis, Institute for Informatics, St Louis, MO, United States.,Goldfarb School of Nursing, BJC Healthcare, St Louis, MO, United States
| | - Ann Scheck McAlearney
- The Ohio State University, Department of Family Medicine, Columbus, OH, United States
| | - Cynthia J Sieck
- The Ohio State University, Department of Family Medicine, Columbus, OH, United States
| | - Jennifer L Hefner
- The Ohio State University, Department of Family Medicine, Columbus, OH, United States
| | - Timothy R Huerta
- The Ohio State University, Department of Family Medicine, Columbus, OH, United States
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Swain MJ, Kharrazi H. Feasibility of 30-day hospital readmission prediction modeling based on health information exchange data. Int J Med Inform 2015; 84:1048-56. [PMID: 26412010 DOI: 10.1016/j.ijmedinf.2015.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 08/06/2015] [Accepted: 09/11/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Unplanned 30-day hospital readmission account for roughly $17 billion in annual Medicare spending. Many factors contribute to unplanned hospital readmissions and multiple models have been developed over the years to predict them. Most researchers have used insurance claims or administrative data to train and operationalize their Readmission Risk Prediction Models (RRPMs). Some RRPM developers have also used electronic health records data; however, using health informatics exchange data has been uncommon among such predictive models and can be beneficial in its ability to provide real-time alerts to providers at the point of care. METHODS We conducted a semi-systematic review of readmission predictive factors published prior to March 2013. Then, we extracted and merged all significant variables listed in those articles for RRPMs. Finally, we matched these variables with common HL7 messages transmitted by a sample of health information exchange organizations (HIO). RESULTS The semi-systematic review resulted in identification of 32 articles and 297 predictive variables. The mapping of these variables with common HL7 segments resulted in an 89.2% total coverage, with the DG1 (diagnosis) segment having the highest coverage of 39.4%. The PID (patient identification) and OBX (observation results) segments cover 13.9% and 9.1% of the variables. Evaluating the same coverage in three sample HIOs showed data incompleteness. DISCUSSION HIOs can utilize HL7 messages to develop unique RRPMs for their stakeholders; however, data completeness of exchanged messages should meet certain thresholds. If data quality standards are met by stakeholders, HIOs would be able to provide real-time RRPMs that not only predict intra-hospital readmissions but also inter-hospital cases. CONCLUSION A RRPM derived using HIO data exchanged through may prove to be a useful method to prevent unplanned hospital readmissions. In order for the RRPM derived from HIO data to be effective, hospitals must actively exchange clinical information through the HIO and develop actionable methods that integrate into the workflow of providers to ensure that patients at high-risk for readmission receive the care they need.
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Affiliation(s)
- Matthew J Swain
- U.S. Department of Health and Human Services, United States.
| | - Hadi Kharrazi
- Johns Hopkins Bloomberg School of Public Health, Center for Population Health Information Technology, Baltimore, United States
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Davis J, Riesenberg LA, Mardis M, Donnelly J, Benningfield B, Youngstrom M, Vetter I. Evaluating Outcomes of Electronic Tools Supporting Physician Shift-to-Shift Handoffs: A Systematic Review. J Grad Med Educ 2015; 7:174-80. [PMID: 26221430 PMCID: PMC4512785 DOI: 10.4300/jgme-d-14-00205.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 10/15/2014] [Accepted: 12/16/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Multiple organizations have recognized that handoffs are prone to errors, and there has been an increase in the use of electronic health records and computerized tools in health care. OBJECTIVE This systematic review evaluates the current evidence on the effectiveness of electronic solutions used to support shift-to-shift handoffs. METHODS We searched the English-language literature for research studies published between January 1, 2008, and September 19, 2014, using National Library of Medicine PubMed, EBSCO CINAHL, OvidSP All Journals, and ProQuest PsycINFO. Included studies focused on the evaluation of physician shift-to-shift handoffs and an electronic solution designed to support handoffs. We assessed articles using a quality scoring system, conducted a review of barriers and strategies, and categorized study outcomes into self-report, process, and outcome measures. RESULTS Thirty-seven articles met inclusion criteria, including 20 single group pre- and posttest studies; 8 posttest only or cross-sectional studies; 4 nonrandomized controlled trials; 1 cohort study; 1 randomized crossover study; and 3 qualitative studies. Quality scores ranged from 3.5 to 14 of a possible 16. Most articles documented some positive outcomes, with 2 of the 3 studies evaluating patient outcomes yielding statistically significant improvements. The only other study that analyzed patient outcomes showed that interventions other than the electronic tool were responsible for most of the significant improvements. CONCLUSIONS The majority of studies supported using an electronic tool, yet few measured patient outcomes, and numerous studies suffered from methodology issues. Future studies should evaluate patient outcomes, improve study design, assess the role of faculty oversight, and broaden the focus to recognize the role of human factors.
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Declerck G, Aimé X. Reasons (not) to Spend a Few Billions More on EHRs: How Human Factors Research Can Help. Yearb Med Inform 2014; 9:90-6. [PMID: 25123727 DOI: 10.15265/iy-2014-0033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To select best medical informatics research works published in 2013 on electronic health record (EHR) adoption, design, and impact, from the perspective of human factors and organizational issues (HFOI). METHODS We selected 2,764 papers by querying PubMed (Mesh and TIAB) as well as using a manual search. Papers were evaluated based on pre-defined exclusion and inclusion criteria from their title, keywords, and abstract to select 15 candidate best papers, finally reviewed by 4 external reviewers using a standard evaluation grid. RESULTS Five papers were selected as best papers to illustrate how human factors approaches can improve EHR adoption and design. Among other contributions, these works: (i) make use of the observational and analysis methodologies of social and cognitive sciences to understand clinicians' attitudes towards EHRs, EHR use patterns, and impact on care processes, workflows, information exchange, and coordination of care; (ii) take into account macro- (environmental) and meso- (organizational) level factors to analyze EHR adoption or lack thereof; (iii) highlight the need for qualitative studies to analyze the unexpected side effects of EHRs on cognitive and work processes as well as the persistent use of paper. CONCLUSION Selected papers tend to demonstrate that HFOI approaches and methodologies are essential to bridge the gap between EHR systems and end users, and to reduce regularly reported adoption failures and unexpected consequences.
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A sociotechnical perspective of health information technology. Int J Med Inform 2013; 82:1133-5. [PMID: 24216291 DOI: 10.1016/j.ijmedinf.2013.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 10/16/2013] [Indexed: 11/24/2022]
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