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Ernstzen DV, Hillier SL, Louw QA. Synthesis of clinical practice guideline recommendations for the primary health care of chronic musculoskeletal pain. J Eval Clin Pract 2022; 28:454-467. [PMID: 34913219 DOI: 10.1111/jep.13644] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 11/28/2022]
Abstract
RATIONALE AND AIMS The prevalence of chronic musculoskeletal pain (CMSP) is high and rising. The multidimensional impact of CMSP on individuals necessitates multidisciplinary evidence-based strategies to prevent and manage chronic pain. Primary health care (PHC) is the first point of care in many healthcare systems and evidence implementation at this point is important. We aim to describe the process of development of a comprehensive list of evidence-based recommendations derived from different high-quality clinical practice guidelines (CPGs) to inform the PHC healthcare of adults with CMSP. METHOD A systematic review was conducted of CPGs that focussed on PHC management of CMSP in adults. CPGs were identified by searching 13 guideline clearinghouses and five online databases. Eligible CPGs were critically appraised using Appraisal of Guidelines Research and Evaluation, Version II (AGREE II). A stepwise systematic process was followed to identify a core set of recommendations. This process comprised the following: extract recommendations; analyze recommendations; synthesize recommendations by assimilating similar recommendations; determine the strength of the body of evidence underpinning the recommendations and produce a list of synthesized recommendations. RESULTS Six high-quality CPGs were identified, providing 156 recommendations. These were condensed to 42 statements covering topics about the approach to care, assessment, advice and education, referral, pharmacological management, physical therapy, electrotherapy, psychological therapy, complementary therapy and self-management. The set of recommendations encompasses a person-centered approach, collaborative decision making, a biopsychosocial approach, patient education and empowerment towards self-management. CONCLUSION The process of developing composite recommendations from multiple CPGs enables end-users to access comprehensive information on managing CMSP in PHC settings that is not available from one singular CPG. The content and evidence base for recommendations varied between CPGs. A similar stepwise process may be used to develop a core set of recommendations for other health conditions, where multiple, diverse CPGs exist.
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Affiliation(s)
- Dawn V Ernstzen
- Department of Health and Rehabilitation Sciences, Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Susan L Hillier
- Division of Health Sciences, University of South Australia, Adelaide, Australia
| | - Quinette A Louw
- Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Ball SJ, McCauley JA, Pruitt M, Zhang J, Marsden J, Barth KS, Mauldin PD, Gebregziabher M, Moran WP. Academic detailing increases prescription drug monitoring program use among primary care practices. J Am Pharm Assoc (2003) 2021; 61:418-424.e2. [PMID: 33812783 PMCID: PMC8273068 DOI: 10.1016/j.japh.2021.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/10/2021] [Accepted: 02/25/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Clinical review of a prescription drug monitoring program (PDMP) is considered a valuable tool for opioid prescribing risk mitigation; however, PDMP use is often low, even in states with mandatory registration and use policies. The objective was to evaluate the impact of an academic detailing (AD) outreach intervention on PDMP use among primary care prescribers. METHODS AD intervention was delivered to primary care based controlled substance prescribers (N = 87) and their associated PDMP delegates (n = 42) by a clinical pharmacist as 1 component of a large-scale, statewide initiative to improve opioid prescribing safety. Prescriber PDMP use behavior was assessed by prescriber self-report and analysis of objective 2016-2018 PDMP data regarding the number of monthly report requests. We compared means between pre- and postintervention using a paired t test and plotted the monthly average reports over time to assess the trend of mean reports over time. Generalized linear mixed model with a negative binomial distribution was used to assess the difference in the trend and magnitude of the combined count of reports for the entire sample and prescriber subsets that were segmented on the basis of the adoption status of PDMP. RESULTS The monthly mean of reports by combined prescribers and delegates significantly increased after the AD intervention (mean 28.1 pre vs. 53.0 post; P < 0.001), with the increase in delegate reports (mean 17.1 pre vs. 60.0 post; P < 0.001) driving the overall increase. Reports were requested 40.4 times more often than in the preintervention period (P < 0.001). Patterns of pre- to postchanges in mean monthly report requests differed by baseline PDMP adoption status. CONCLUSION The AD intervention was transformative in facilitating practice change to use delegates to run reports. Visits with both prescribers and delegates, including hands-on PDMP training and registration assistance, can be viewed as beneficial for practice facilitation.
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Affiliation(s)
- Sarah J. Ball
- Division of General Internal Medicine, Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Jenna A. McCauley
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Megan Pruitt
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, Medical University of South Carolina, USA
| | - Jingwen Zhang
- Division of General Internal Medicine, Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Justin Marsden
- Division of General Internal Medicine, Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Kelly S. Barth
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Patrick D. Mauldin
- Division of General Internal Medicine, Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Mulugeta Gebregziabher
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, USA
| | - William P. Moran
- Division of General Internal Medicine, Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
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Martorella G, McDougall GJ. Barriers and Facilitators to the Prevention of Chronic Pain in the Subacute Phase After Cardiac Surgery. Pain Manag Nurs 2021; 22:28-35. [PMID: 33189543 PMCID: PMC10673644 DOI: 10.1016/j.pmn.2020.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/01/2020] [Accepted: 09/09/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Although a transitional approach promoting continuity of care is warranted to prevent chronic post-surgical pain (CPSP) and opioid misuse, there is limited research examining interventions targeting the subacute phase after cardiac surgery. Contextual multi-level factors may explain this scarcity. AIMS The purpose of this study was to explore the potential implementation of a nursing intervention to prevent CPSP in the subacute phase by describing nurses' viewpoints of current barriers and facilitators. DESIGN A descriptive qualitative study was conducted using secondary data analysis. SETTINGS A Web-based survey was used along with in-person interviews. PARTICIPANTS 75 perioperative nurses. METHODS Qualitative data from individual interviews (n=10) and open-ended responses to a survey (n=65) regarding the intervention's acceptability were used. Content analysis was conducted using a deductive approach. RESULTS The introduction of nurses from various clinical settings to a new intervention allowed reflection on current practice and represented a shift toward a preventive approach. The main barrier expressed was the lack of communication and continuity of care between clinical settings. Several policy implications were outlined such as increasing the involvement of rehabilitation programs and strengthening collaboration between pain specialists and primary care providers. CONCLUSIONS Based on perceptions of nurses involved at different stages of the continuum, the findings provide a preliminary picture of clinical challenges and potential avenues for the prevention of CPSP in the subacute phase after cardiac surgery. An expanded pain management nursing role in primary care would allow earlier interventions and contribute to the prevention of CPSP for a tremendous number of patients undergoing surgeries.
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Smith A, Doran S, Daly M, Kennedy C, Barry M. Effect of an Online Reimbursement Application System on Prescribing of Lidocaine 5% Medicated Plaster in the Republic of Ireland. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2021; 19:133-140. [PMID: 32430656 DOI: 10.1007/s40258-020-00586-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND The lidocaine 5% medicated plaster, Versatis®, has one therapeutic indication listed on the Summary of Product Characteristics-symptomatic relief of post-herpetic neuralgia (PHN) in adults. Increased expenditure on Versatis® suggests that there is considerable off-label use. To support the appropriate use of Versatis®, the Health Service Executive's Primary Care Reimbursement Service (PCRS) introduced a reimbursement application system for Versatis® from 1 September 2017. OBJECTIVE The aim of this study was to investigate the effect of introducing a reimbursement application system on Versatis® prescribing under the General Medical Services (GMS) scheme. METHODS This study was carried out using prescription dispensing data from the PCRS pharmacy claims database. We carried out segmented linear regression to assess changes in the Versatis® prescribing rate per 1000 GMS eligible population, before and after the introduction of the online reimbursement application system. RESULTS The results of the segmented regression analysis show that there was a statistically significant level (- 4.91, p < 0.001) and trend change (- 0.69, p < 0.001) in the rate of Versatis® prescribing post-introduction of the reimbursement application system. In the year prior to the introduction of the system, 2016, the annual GMS expenditure on Versatis® lidocaine 5% patches was over €27 million, whereas the GMS expenditure in 2018 was reduced to just over €2 million. CONCLUSION In our study, a substantial decrease in the dispensing of Versatis® was seen after the implementation of a reimbursement application system. Prescribing of Versatis® should be restricted to patients with a diagnosis of PHN not only to reduce costs, but to ensure evidence-based use of this medication.
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Affiliation(s)
- Amelia Smith
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Trinity Centre for Health Sciences, St. James' Hospital, Dublin 8, Ireland.
- Medicines Management Programme, Health Service Executive, St. James' Hospital, Dublin 8, Ireland.
| | - Stephen Doran
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Trinity Centre for Health Sciences, St. James' Hospital, Dublin 8, Ireland
- Medicines Management Programme, Health Service Executive, St. James' Hospital, Dublin 8, Ireland
| | - Maria Daly
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Trinity Centre for Health Sciences, St. James' Hospital, Dublin 8, Ireland
- Medicines Management Programme, Health Service Executive, St. James' Hospital, Dublin 8, Ireland
| | - Cormac Kennedy
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Trinity Centre for Health Sciences, St. James' Hospital, Dublin 8, Ireland
| | - Michael Barry
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Trinity Centre for Health Sciences, St. James' Hospital, Dublin 8, Ireland
- Medicines Management Programme, Health Service Executive, St. James' Hospital, Dublin 8, Ireland
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Dale AM, Buckner-Petty S, Evanoff BA, Gage BF. Predictors of long-term opioid use and opioid use disorder among construction workers: Analysis of claims data. Am J Ind Med 2021; 64:48-57. [PMID: 33231876 PMCID: PMC7799490 DOI: 10.1002/ajim.23202] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Construction workers have high rates of work-related musculoskeletal disorders, which lead to frequent opioid use and opioid use disorder (OUD). This paper quantified the incidence of opioid use and OUD among construction workers with and without musculoskeletal disorders. METHODS We conducted a retrospective study using union health claims from January 2015 to June 2018 from 19,909 construction workers. Claims for diagnoses of chronic musculoskeletal disorders, acute musculoskeletal injuries, musculoskeletal surgery, and other conditions were linked to new opioid prescriptions. We examined the effects of high doses (≥50 morphine mg equivalents per day), large supply (more than 7 days per fill), long-term opioid use (60 or more days supplied within a calendar quarter), and musculoskeletal disorders, on the odds of a future OUD. RESULTS There were high rates (42.8% per year) of chronic musculoskeletal disorders among workers, of whom 24.1% received new opioid prescriptions and 6.3% received long-term opioid prescriptions per year. Workers receiving opioids for chronic musculoskeletal disorders had the highest odds of future OUD: 4.71 (95% confidence interval 3.09-7.37); workers prescribed long-term opioids in any calendar quarter had a nearly 10-fold odds of developing an OUD. CONCLUSIONS Among construction workers, opioids initiated for musculoskeletal pain were strongly associated with incident long-term opioid use and OUD. Musculoskeletal pain from physically demanding work is likely one driver of the opioid epidemic in occupations like construction. Prevention of work injuries and alternative pain management are needed for workers at risk for musculoskeletal injuries.
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Affiliation(s)
- Ann Marie Dale
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO; Institution at which the work was performed: Washington University School of Medicine in St. Louis
| | - Skye Buckner-Petty
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO; Institution at which the work was performed: Washington University School of Medicine in St. Louis
| | - Bradley A. Evanoff
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO; Institution at which the work was performed: Washington University School of Medicine in St. Louis
| | - Brian F. Gage
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO; Institution at which the work was performed: Washington University School of Medicine in St. Louis
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Embry J, Reis MD, Couchman G, Ledbetter TG, Zolfaghari K. Quality improvement initiative for pain management practices in primary care. Proc AMIA Symp 2020; 33:513-519. [PMID: 33100518 PMCID: PMC7549893 DOI: 10.1080/08998280.2020.1814181] [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: 07/08/2020] [Revised: 08/20/2020] [Accepted: 08/20/2020] [Indexed: 10/23/2022] Open
Abstract
In the context of both chronic pain and opioid crises, this large-system quality improvement project sought to increase use of evidence-based multimodal pain management strategies. Primary care providers (PCPs) in internal medicine and family medicine identified as above-median prescribers of 30-day opioid supplies were selected for intervention. PCPs received individualized email letters showing their opioid prescribing patterns relative to peers and urging them to view an internal pain/opioid educational video and related system guidelines. The median number of patients receiving 30-day opioid supplies from our target PCPs decreased over a 24-month period. For cohort patients identified at baseline and remaining in treatment over time, those receiving opioid prescriptions decreased, and those receiving nonopioid prescriptions increased. Percentages of PCPs prescribing nonopioids for cohort patients increased over the first year and nonpharmacologic referrals increased in range. Our evidence suggests that PCPs who are higher opioid prescribers will change their practices voluntarily when given feedback about their opioid prescribing patterns relative to their peers, as well as education regarding evidence-based pain management and opioid prescribing.
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Affiliation(s)
- Judy Embry
- Department of Family Medicine, Baylor Scott & White Health, Temple, Texas
- Pain Management and Opioid Prescribing Ambulatory Taskforce, Baylor Scott & White Health, Temple, Texas
| | - Michael D. Reis
- Department of Family Medicine, Baylor Scott & White Health, Temple, Texas
- Pain Management and Opioid Prescribing Ambulatory Taskforce, Baylor Scott & White Health, Temple, Texas
| | - Glen Couchman
- Pain Management and Opioid Prescribing Ambulatory Taskforce, Baylor Scott & White Health, Temple, Texas
- Chief Medical Officer of Clinical Operations, Baylor Scott & White Health, Dallas, Texas
| | - T. Glenn Ledbetter
- Pain Management and Opioid Prescribing Ambulatory Taskforce, Baylor Scott & White Health, Temple, Texas
- Quality Alliance Board of Managers, Baylor Scott & White Health, Dallas, Texas
| | - Kiumars Zolfaghari
- Center for Applied Health Research, Baylor Scott & White Health, Temple, Texas
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7
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Warth J, Puth MT, Tillmann J, Porz J, Zier U, Weckbecker K, Münster E. Over-indebtedness and its association with pain and pain medication use. Prev Med Rep 2019; 16:100987. [PMID: 31534901 PMCID: PMC6744525 DOI: 10.1016/j.pmedr.2019.100987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 08/26/2019] [Accepted: 09/05/2019] [Indexed: 11/25/2022] Open
Abstract
In developed countries, millions of households are over-indebted, and the number continues to rise. Studies have found an increased risk of adverse health effects among individuals that cannot cover payment obligations with available assets persistently. However, little is known about the role of over-indebtedness in pain. This study examined the association between over-indebtedness and pain and pain medication use. A cross-sectional study conducted among over-indebted individuals in 70 debt advisory centres in Germany (OID-survey; n = 699) was linked to the nationally representative German Health Interview and Examination Survey for Adults (DEGS1; n = 7987). Descriptive statistics and logistic regression analyses were used to examine the association between over-indebtedness and pain and pain medication use among participants with valid data on both outcome variables (n = 7560). Pain was experienced by over-indebted individuals more frequently (71.3%) compared to the general population (59.6%) whereas the prevalence of pain medication use was similar in both samples (DEGS1 12.6% vs. OID-survey 13.1%). Over-indebtedness significantly increased the odds of pain (aOR 1.30; 95%-CI 1.07-1.59) after adjusting for socioeconomic, demographic and health factors. The over-indebted were significantly less likely to use pain medication compared to the general population after adjustment (aOR 0.76; 95%-CI 0.58-0.99). Taking over-indebtedness into account as risk factor for pain and restricted pain medication use in research and clinical practice will help to advance the understanding of pain disparities, develop suitable interventions for preventive action and promote accessible pain management among those at risk.
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Affiliation(s)
- Jacqueline Warth
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Marie-Therese Puth
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), University Hospital Bonn, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Judith Tillmann
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Johannes Porz
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Ulrike Zier
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Klaus Weckbecker
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Eva Münster
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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Tan B, Li B, An Y, Ma X, Jiang Y, Song Y, Ge X, Yuan S, Liu L, Dou Y, Yu Y, Ji P, Li X, Cheng Y. A multicentre survey of pain management in cancer patients and physicians attending radiotherapy clinics in Shandong Province, China. J Int Med Res 2019; 47:5711-5722. [PMID: 31588825 PMCID: PMC6862914 DOI: 10.1177/0300060519867168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To obtain a better understanding of the prevalence and management of pain in patients undergoing radiotherapy for cancer in Shandong Province, China. Methods This cross-sectional study used a questionnaire during face-to-face interviews to collect data from physicians and patients regarding the recognition, prevalence and treatment of pain during the waiting period before commencement of radiotherapy and during the radiotherapy period. Physicians and patients were recruited from 10 tertiary Class A hospitals across Shandong Province, China. Results A total of 184 patients and 87 physicians were recruited to the study. During the waiting period, pain was reported by the physicians according to their experience to affect 26.0% of patients, which almost agreed with the patients’ data (36.5%; 160 of 438). During the radiotherapy period, there was a significant difference in the reported prevalence of pain during the radiotherapy period between the physicians’ data (23.0%) based on their experience and the patients’ data (84.1%; 169 of 201 patients). The majority of physicians (98.9%; 86 of 87) agreed to the use opioids for pain management and 90.8% (79 of 87) were satisfied with the analgesic effect, but more than half of the patients who received pain treatment reported inadequate analgesia. Conclusion There was a high incidence of cancer pain, but insufficient assessment, inadequate treatment and inadequate education about pain in both the waiting and radiotherapy periods.
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Affiliation(s)
- Bingxu Tan
- Department of Radiotherapy, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Baosheng Li
- Department of Radiotherapy, Shandong Cancer Hospital, Jinan, Shandong Province, China
| | - Yongheng An
- Department of Radiotherapy, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Xuezhen Ma
- Department of Radiotherapy, Qingdao Centre Medical Group, Qingdao, Shandong Province, China
| | - Yuhua Jiang
- Department of Radiotherapy, Second Hospital of Shandong University, Jinan, Shandong Province, China
| | - Yipeng Song
- Department of Radiotherapy, Yantai YuHuangDing Hospital, Yantai, Shandong Province, China
| | - Xingping Ge
- Department of Radiotherapy, Yantaishan Hospital, Yantai, Shandong Province, China
| | - Shengli Yuan
- Department of Radiotherapy, Qingdao Municipal Hospital, Qingdao, Shandong Province, China
| | - Liping Liu
- Department of Radiotherapy, Jining No.1 People's Hospital, Jining, Shandong Province, China
| | - Yan Dou
- Department of Radiotherapy, Jinan Central Hospital, Jining, Shandong Province, China
| | - Yanxia Yu
- Department of Radiotherapy, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Pu Ji
- Mundipharma (China) Pharmaceutical Co., Ltd., Beijing, China
| | - Xia Li
- Mundipharma (China) Pharmaceutical Co., Ltd., Beijing, China
| | - Yufeng Cheng
- Department of Radiotherapy, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
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