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Courtwright SE, Turi E, Barr EA, Burns JC, Gigli KH, Bennett CR, Sonney J, Francis L, Poghosyan L. Facilitators and Barriers to Pediatric Nurse Practitioner Practice in the United States: A Systematic Review. J Pediatr Health Care 2024; 38:520-543. [PMID: 38284964 PMCID: PMC11222060 DOI: 10.1016/j.pedhc.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/21/2023] [Accepted: 12/02/2023] [Indexed: 01/30/2024]
Abstract
INTRODUCTION The pediatric nurse practitioner (PNP) workforce was designed to improve child health equity. We aimed to systematically review the evidence on facilitators and barriers to PNP practice. METHOD We included empirical studies on PNP practice in the United States and excluded studies with non-identifiable PNP data. We applied Joanna Briggs Institute tools to appraise studies and applied critical interpretive synthesis principles to synthesize. RESULTS The final sample is 26 studies, mostly published before 2013 and observational. Prescriptive privileges, training program availability, organizational climate, and telehealth are facilitators. Mandated physician supervision, reduced pediatric curricula, geographically disparate training programs, and poor data infrastructure are barriers. The sample is limited by a moderate to high risk of bias. DISCUSSION Evidence suggests modifiable factors impact PNP practice and could have important implications for child health equity. We offer a theoretical model to guide robust research studying the PNP workforce and health equity.
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Justice L, Florez AR, Diller C, Moellinger A, Ellis M, Riley C, Dugan E, Heichel J, Williams B, Dykton TI, Foerster LA, Callow L. Development and implementation of a paediatric cardiac intensive care advanced practice provider curriculum. Cardiol Young 2023; 33:1288-1295. [PMID: 35929440 DOI: 10.1017/s1047951122002542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Education of paediatric advanced practice providers takes a generalist approach which lacks in-depth exposure to subspecialties like paediatric cardiac intensive care. This translates into a knowledge gap related to congenital cardiac physiology and management for APPs transitioning to the paediatric cardiac ICU. METHODS A specialised interprofessional peer-reviewed curriculum was created and distributed through the Pediatric Cardiac Intensive Care Society. This curriculum includes a textbook which is complemented by a didactic and simulation review course. Course evaluations were collected following each course, and feedback from participants was incorporated into subsequent courses. Pediatric Cardiac Intensive Care Society partnered with the Pediatric Nursing Certification Board to develop a 200-question post-assessment (exam) bank. RESULTS From December 2017 to January 2022, 12 review courses were taught at various host sites (n = 314 participants). Feedback revealed that courses improved preparedness for practice, contributed to advanced practice provider empowerment, and emphasised the importance of professional networking. 97% of attendees agreed/strongly agreed that the course improved clinical knowledge, 97% agreed/strongly agreed that the course improved ability to care for patients, and 88% agreed/strongly agreed that the course improved confidence to practice. 49% of participants rated the course as extremely effective, 42% very effective, 6% moderately effective, and 3% as only slightly effective. CONCLUSIONS A standardised subspecialty curriculum dedicated to advanced practice provider practice in cardiac intensive care was needed to improve knowledge, advance practice, and empower APPs managing critically ill patients in the cardiac ICU. The developed curriculum provides standardised learning, increasing advanced practice provider knowledge acquisition, and confidence to practice.
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Affiliation(s)
- Lindsey Justice
- Department of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Amy R Florez
- Department of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Christin Diller
- Department of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ashley Moellinger
- Department of Cardiology, Children's of Alabama, Birmingham, AL, USA
| | - Misty Ellis
- Department of Critical Care, Kentucky Children's Hospital, Lexington, KY, USA
| | - Christine Riley
- Division of Cardiac Critical Care, Children's National Medical Center, Washington, DC, USA
| | - Erin Dugan
- Department of Cardiology, Levine Children's Hospital at Atrium Health, Charlotte, NC, USA
| | - Jenna Heichel
- Department of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brenda Williams
- Center for Simulation and Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | | | - Louise Callow
- Department of Pediatric Cardiac Surgery, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
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Florez AR, Riley CM, Zender JE, Cooper DS, Henry BM, Justice LB. Evaluation of Pediatric Cardiac Intensive Care Advanced Practice Provider's Leadership Education and Experience During Emergencies. Dimens Crit Care Nurs 2022; 41:216-222. [PMID: 35617587 DOI: 10.1097/dcc.0000000000000531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The number of advanced practice providers (APPs) in pediatric critical care has increased dramatically over recent years, leading to increased opportunities to lead resuscitation teams during pediatric emergent events. OBJECTIVES The aim of this study was to better understand the emergency leadership experience, training, and education that pediatric cardiac intensive care unit APPs receive. METHODS This study was a cross-sectional descriptive studying using survey responses. The self-administered survey was administered to APP and attending physician members of the Pediatric Cardiac Intensive Care Society. Survey results were analyzed. RESULTS One hundred seven pediatric cardiac intensive care unit APPs (n = 53) and attending physicians (n = 54) responded to the survey. Half of APPs felt that attendings allowed APPs to lead emergent events, and 50.9% had never functioned in the team leader role. Most respondents (77.5%) rated their comfort functioning in the role during emergent situations as moderate or lower. Increased APP experience level was associated with a higher number of codes led, increased comfort leading codes, and improved mental model sharing (all Ps < .0001). The number of codes an APP had previously led was associated with increased comfort leading codes (P < .0001) and mental model sharing (P = .0002). One-third of attendings said they allow APPs to lead codes in their unit. Half of attendings who do not allow APPs to function as the team leader would follow formal training. DISCUSSION Opportunities for APPs to function as team leaders during emergent events continue to increase. A leadership educational program would be beneficial to pediatric critical care APPs. It may also have the additional benefit of improving physician comfort with APPs leading code events and patient outcomes.
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Maymi M, Madden M, Bauer C, Reuter-Rice K. Acute Care Pediatric Nurse Practitioner: The 2018 Practice Analysis. J Pediatr Health Care 2022; 36:e11-e21. [PMID: 34836734 DOI: 10.1016/j.pedhc.2021.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/31/2021] [Accepted: 09/10/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Practice research serves as the certification framework for validating advanced practice roles and updating national qualifying examinations. This national study informed an update of the Certified Pediatric Nurse Practitioner - Acute Care (CPNP-AC) examination content outline. METHOD A descriptive analysis of a survey completed in 2018 by 373 pediatric nurse practitioners (PNP) practicing as an acute care role (AC). RESULTS Respondents were primarily females aged 25 to 34 years (35.4%) and formally educated as AC PNPs (84.2%) and held the CPNP-AC credential (98.9%). Most respondents (83.6%) practiced in urban areas and spent 84% of their time in direct patient care with 74% working in inpatient settings. The majority (87%) worked in subspecialty practice such as critical care (18.5%) and cardiac intensive care (12.3%). DISCUSSION This is the fourth practice analysis of the AC PNP role that demonstrates continuous evolution in clinical practice, educational preparation, and subspecialty practice distribution.
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Duff E, Golonka R, O' Rourke T, Alraja AA. The Nurse Practitioner Workforce in Western Canada: A Cross-Sectional Practice Analysis Comparison. Policy Polit Nurs Pract 2021; 23:32-40. [PMID: 34939870 PMCID: PMC8801661 DOI: 10.1177/15271544211065432] [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] [Indexed: 11/17/2022]
Abstract
Regular examination of health workforce data is essential given the pace of health system and legislative changes. Health workforce studies pertaining to nurse practitioner (NP) practice are needed to examine the gaps between work activities, policy, human resource supply, or for population needs. Jurisdictional comparison studies can provide essential information about NP practice for governments to respond to health workforce deficiencies or engage in service planning. In Canada, there is limited provincial-territorial jurisdictional NP workforce data to support health planning or policy change. This descriptive cross-sectional study was to examine the similarities and differences in practice patterns of Canadian NPs. In 2016 and 2017, an electronic survey was sent to all 852 registered NPs in three Canadian provinces, yielding a large convenience sample of 375 NP respondents. The results of this study underscore the value of NPs’ extensive registered nurse expertize as well as their ability to serve diverse patient populations, work in varied healthcare settings, and provide care to medically complex patients. The study findings also show that NPs in all three jurisdictions work to their full scope of practice, in both rural and urban settings. This study is the first to compare NP workforce data across multiple Canadian jurisdictions simultaneously. Studies of this type are valuable tools for understanding the demographics, education, integration, and employment activities of NPs and can aid governments in addressing workforce planning.
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Affiliation(s)
- E Duff
- Health Science, 8664University of Manitoba, Winnipeg, Manitoba, Canada
| | - Richard Golonka
- School of Public Health, 3158University of Alberta, Edmonton, Alberta, Canada
| | | | - Abeer A Alraja
- Health Science, 8664University of Manitoba, Winnipeg, Manitoba, Canada
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McDermott KL, Schindler CA, Olson KR, Petersen TL. Acute Care Pediatric Nurse Practitioners as Leaders: Perceptions, Self-Identity, and Role Congruity. J Pediatr Health Care 2021; 35:559-563. [PMID: 33879358 DOI: 10.1016/j.pedhc.2020.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/19/2020] [Accepted: 12/22/2020] [Indexed: 10/21/2022]
Abstract
INTRODUCTION This study aimed to gain an understanding of practicing acute care pediatric nurse practitioners' (AC-PNPs') perceptions of themselves as leaders in both clinical and professional contexts. METHOD This qualitative study was conducted at a midwestern quaternary care children's hospital. Cultural domain analysis, semistructured interviews, and free listing techniques were employed to identify areas of consensus and variation among a convenience sample of AC-PNPs. RESULTS Findings demonstrated the AC-PNPs have a limited self-view of leadership. DISCUSSION Nurse practitioners need additional leadership capacity and capability building during graduate education, the transition to practice, and throughout their careers.
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Alignment of Nurse Practitioner Educational Preparation and Scope of Practice in United States Emergency Departments: A Systematic Review of the Literature. J Emerg Nurs 2021; 47:563-581. [PMID: 34275527 DOI: 10.1016/j.jen.2021.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION National debate persists surrounding the expanded use of nurse practitioners in the emergency department. Current understanding of the alignment of nurse practitioner educational preparation and practice parameters in United States emergency departments is inchoate. The objective of this review was to seek evidence to support that nurse practitioner education and training align with current practices in the emergency department. METHODS A Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided systematic review of the existing literature was conducted of 4 relevant databases. Level of evidence and quality assignments were made for each article using Grading of Recommendations, Assessment, Development, and Evaluation or Confidence in Evidence from Reviews of Qualitative Research as appropriate. RESULTS Nurse practitioners are increasingly staffing emergency departments, providing care to both patients classified as high-acuity and low-acuity. Reports of nurse practitioner scope of practice vary widely. No studies evaluated alignment of educational preparation and training for actual clinical practice. DISCUSSION This review of the literature was inconclusive, and the review team we was unable to find evidence that supports the alignment of nurse practitioner educational preparation and training with scope of clinical practice in United States emergency departments. Future research should seek to articulate the landscape of nurse practitioner academic preparation for specialty practice in the emergency department and to specifically examine the alignment of educational preparation with scope of practice and impact on clinical outcomes of patients seen in the emergency department.
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Pfister JK, Kuester JC, McDermott K, Talbert L, Schindler CA. Living the Manatt report: Advancing the future of nursing through joint academic appointments. J Prof Nurs 2020; 37:422-425. [PMID: 33867100 DOI: 10.1016/j.profnurs.2020.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 11/26/2022]
Abstract
In 2016, the American Association of Colleges of Nursing published the Manatt Report which outlines recommendations to address the future of academic nursing. This report asserts that in order to influence the direction of healthcare, academic nursing needs to partner with academic health centers in leadership positions, embrace current clinical practice, and prioritize research. The following paper details the successful implementation of joint academic appointments between a college of nursing and a medical college. Joint appointments have formalized the role of clinician-educator, brought current clinical knowledge to academia, and allowed for protected academic time that is focused on enhancing the nursing curriculum. The development of joint appointments must be approached in a structured fashion ensuring a symbiotic relationship for all parties. This arrangement validates the commitment of both organizations to the education of future providers within the interdisciplinary team.
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Affiliation(s)
- Jennifer K Pfister
- Medical College of Wisconsin, Pediatric Critical Care, 8701 W. Watertown Plank Rd., Wauwatosa 53226, WI, USA; Marquette University College of Nursing, 1250 W. Wisconsin Ave, Milwaukee 53223, WI, USA.
| | - Jill C Kuester
- Medical College of Wisconsin, Pediatric Critical Care, 8701 W. Watertown Plank Rd., Wauwatosa 53226, WI, USA; Marquette University College of Nursing, 1250 W. Wisconsin Ave, Milwaukee 53223, WI, USA
| | - Katie McDermott
- Medical College of Wisconsin, Pediatric Critical Care, 8701 W. Watertown Plank Rd., Wauwatosa 53226, WI, USA; Marquette University College of Nursing, 1250 W. Wisconsin Ave, Milwaukee 53223, WI, USA
| | - Leslie Talbert
- Medical College of Wisconsin, Pediatric Critical Care, 8701 W. Watertown Plank Rd., Wauwatosa 53226, WI, USA; Marquette University College of Nursing, 1250 W. Wisconsin Ave, Milwaukee 53223, WI, USA
| | - Christine A Schindler
- Medical College of Wisconsin, Pediatric Critical Care, 8701 W. Watertown Plank Rd., Wauwatosa 53226, WI, USA; Marquette University College of Nursing, 1250 W. Wisconsin Ave, Milwaukee 53223, WI, USA
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Justice LB, Callow L, Loomba R, Harvey J, FitzGerald M, Cooper DS. Evaluation of Pediatric Cardiac ICU Advanced Practice Provider Education and Practice Variation. Pediatr Crit Care Med 2019; 20:1164-1169. [PMID: 31274773 DOI: 10.1097/pcc.0000000000002069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The education, training, and scope of practice of cardiac ICU advanced practice providers is highly variable. A survey was administered to cardiac ICU advanced practice providers to examine specific variations in orientation format, competency assessment during and at the end of orientation, and scope of clinical practice to determine gaps in resources and need for standardization. DESIGN This study was a cross-sectional descriptive study utilizing survey responses. SETTING Pediatric cardiac ICUs in the United States. SUBJECTS The survey was delivered to a convenience sample of advanced practice providers currently practicing in pediatric cardiac ICUs. INTERVENTIONS A list of pediatric cardiothoracic surgery programs was generated from the Society of Thoracic Surgery database. A self-administered, electronic survey was delivered via email to advanced practice providers at those institutions. Descriptive data were compared using a chi-square test or Fisher exact test depending on the normalcy of data. Continuous data were compared using a Student t test or Mann-Whitney U test. MEASUREMENTS AND MAIN RESULTS Eighty-three of 157 advanced practice providers responded (53% response rate, representing 36 institutions [35% of institutions]). Sixty-five percent of respondents started as new graduates. Ninety-three to one-hundred percent obtain a history and physical, order/interpret laboratory, develop management plans, order/titrate medications, and respiratory support. Ability to perform invasive procedures was highly variable but more likely for those in a dedicated cardiac ICU. Seventy-seven percent were oriented by another advanced practice provider, with a duration of orientation less than 4 months (66%). Fifty percent of advanced practice providers had no guidelines in place to guide learning/competency during orientation. Sixty-seven percent were not evaluated in any way on their knowledge or skills during or at the end of orientation. Orientation was rated as poor/fair by the majority of respondents for electrophysiology (58%) and echocardiography (69%). Seventy-one percent rated orientation as moderately effective or less. Respondents stated they would benefit from more structured didactic education with clear objectives, standardized management guidelines, and more simulation/procedural practice. Eighty-five percent were very/extremely supportive of a standardized cardiac ICU advanced practice provider curriculum. CONCLUSIONS Orientation for cardiac ICU advanced practice providers is highly variable, content depends on the institution/preceptor, and competency is not objectively defined or measured. A cardiac ICU advanced practice provider curriculum is needed to standardize education and promote the highest level of advanced practice provider practice.
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Affiliation(s)
- Lindsey B Justice
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Rohit Loomba
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Mike FitzGerald
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - David S Cooper
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Gigli KH, Beauchesne MA, Dirks MS, Peck JL. White Paper: Critical Shortage of Pediatric Nurse Practitioners Predicted. J Pediatr Health Care 2019; 33:347-355. [PMID: 30878267 DOI: 10.1016/j.pedhc.2019.02.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/11/2019] [Accepted: 02/18/2019] [Indexed: 11/29/2022]
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Rutledge TR, Merritt LS. Pediatric Nurse Practitioners in the Emergency Department: Implications for Education and Research. J Pediatr Health Care 2017; 31:729-733. [PMID: 28511844 DOI: 10.1016/j.pedhc.2017.04.001] [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: 01/02/2017] [Revised: 03/27/2017] [Accepted: 04/04/2017] [Indexed: 11/17/2022]
Abstract
The use of pediatric nurse practitioners in emergency departments is common in the United States. Defining competencies that are specific to the wide span of urgent and emergent pediatric conditions, along with a recognized practice standard for education and specialty certification for pediatric nurse practitioners practicing in emergency care, is needed. Pediatric emergency departments require a team of providers with a skill set that aligns with each patient's needs. The use of qualified pediatric nurse practitioners on these teams, both primary care and acute care certified, to provide care to these children is expanding, with implications for education and research.
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Rejtar M, Ranstrom L, Allcox C. Development of the 24/7 Nurse Practitioner Model on the Inpatient Pediatric General Surgery Service at a Large Tertiary Care Children's Hospital and Associated Outcomes. J Pediatr Health Care 2017; 31:131-140. [PMID: 27692506 DOI: 10.1016/j.pedhc.2016.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/16/2016] [Accepted: 08/16/2016] [Indexed: 11/25/2022]
Abstract
Nurse practitioners (NPs) have been providing high-quality and safe patient care for a few decades, and evidence showing the extent of their impact is emerging. This article describes the implementation of a 24/7 NP patient care model on an inpatient pediatric general surgery service in a tertiary free-standing Children's Hospital in the Northeastern United States. The literature shows that there is limited evidence regarding NP models of care and their effect on patient outcomes. In response to policy changes leading to reduction of resident work hours and a more acute and complex inpatient pediatric general surgery patient population, our existing NP model evolved into a 24/7 NP Model in June 2011. The results from two quality improvement projects showed positive registered nurse and attending surgeon staff satisfaction with the 24/7 NP Model of care and a decreased trend of unplanned intensive care unit patient transfers after the 24/7 NP Model implementation. These findings further support the evidence in the literature that NPs provide safe and quality patient care.
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Advanced Practice Providers in the Post Work Hour Era: Perceptions, Reality, and Future Directions. Pediatr Crit Care Med 2016; 17:899-900. [PMID: 27585047 DOI: 10.1097/pcc.0000000000000893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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