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Saito Y, Sato S, Nishikawa Y, Oguro F, Moriyama N, Sato K, Kobashi Y, Sawano T, Ozaki A, Nakayama T, Tsubokura M, Yasumura S, Sakai S. Outpatient rehabilitation for an older couple in a repopulated village 10 years after the Fukushima nuclear disaster:An embedded case study. Fukushima J Med Sci 2024; 70:49-54. [PMID: 37952979 PMCID: PMC10867431 DOI: 10.5387/fms.2023-01] [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: 01/06/2023] [Accepted: 09/21/2023] [Indexed: 11/14/2023] Open
Abstract
BackgroundLittle information is available on the role of community-based rehabilitation after a nuclear disaster. Here, we report the case of an older couple living in an area repopulated after the Fukushima nuclear disaster of 2011 who received outpatient rehabilitation.Case presentationAn 84-year-old woman underwent total hip arthroplasty (THA) after she fell and sustained a trochanteric fracture while caring for her husband with Alzheimer's disease. The 85-year-old husband experienced worsening behavioral and psychological symptoms of dementia (BPSD) following his wife's hospitalization. The couple received rehabilitation at an outpatient facility in a nearby village using a shuttle service. The woman's postoperative anxiety was relieved and her physical function improved. Moreover, the husband's BPSD symptoms decreased.ConclusionA wife and husband showed improvement in physical function after THA and alleviation of BPSD, respectively, following rehabilitation. In post-disaster, resource-scarce areas, older adults may benefit from utilizing the outpatient rehabilitation services available in the surrounding area.
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Affiliation(s)
- Yuta Saito
- Department of Rehabilitation, Hirata Central Hospital
| | | | - Yoshitaka Nishikawa
- Department of Internal Medicine, Hirata Central Hospital
- Department of Internal Medicine, Kawauchi Village National Health Insurance Clinic
- Department of Health Informatics, Kyoto University School of Public Health
| | - Fumiya Oguro
- Department of Internal Medicine, Hirata Central Hospital
| | - Nobuaki Moriyama
- Department of Public Health, Fukushima Medical University School of Medicine
| | | | - Yurie Kobashi
- Department of Internal Medicine, Hirata Central Hospital
- Department of Radiation Health Management, Fukushima Medical University School of Medicine
| | - Toyoaki Sawano
- Department of Radiation Health Management, Fukushima Medical University School of Medicine
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation
| | - Akihiko Ozaki
- Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health
| | - Masaharu Tsubokura
- Department of Internal Medicine, Hirata Central Hospital
- Department of Radiation Health Management, Fukushima Medical University School of Medicine
| | - Seiji Yasumura
- Department of Public Health, Fukushima Medical University School of Medicine
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Michalowsky B, Rädke A, Scharf A, Mühlichen F, Buchholz M, Platen M, Kleinke F, Penndorf P, Pfitzner S, van den Berg N, Hoffmann W. Healthcare Needs Patterns and Pattern-Predicting Factors in Dementia: Results of the Comprehensive, Computerized Unmet Needs Assessment from the Randomized, Controlled Interventional Trial InDePendent. J Alzheimers Dis 2024; 100:345-356. [PMID: 38875036 DOI: 10.3233/jad-240025] [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] [Indexed: 06/16/2024]
Abstract
Background Determining unmet need patterns and associated factors in primary care can potentially specify assessment batteries and tailor interventions in dementia more efficiently. Objective To identify latent unmet healthcare need patterns and associated sociodemographic and clinical factors. Methods This Latent Class Analysis (LCA) includes n = 417 community-dwelling people living with dementia. Subjects completed a comprehensive, computer-assisted face-to-face interview to identify unmet needs. One-hundred-fifteen predefined unmet medical, medication, nursing, psychosocial, and social care needs were available. LCA and multivariate logistic regressions were performed to identify unmet needs patterns and patient characteristics belonging to a specific pattern, respectively. Results Four profiles were identified: [1] "few needs without any psychosocial need" (n = 44 (11%); mean: 7.4 needs), [2] "some medical and nursing care needs only" (n = 135 (32%); 9.7 needs), [3] "some needs in all areas" (n = 139 (33%); 14.3 needs), and [4] "many medical and nursing needs" (n = 99 (24%); 19.1 needs). Whereas the first class with the lowest number of needs comprised younger, less cognitively impaired patients without depressive symptoms, the fourth class had the highest number of unmet needs, containing patients with lower health status, less social support and higher comorbidity and depressive symptoms. Better access to social care services and higher social support reduced unmet needs, distinguishing the second from the third class (9.7 versus 14.3 needs). Conclusions Access to the social care system, social support and depressive symptoms should be assessed, and the patient's health status and comorbidities monitored to more comprehensively identify unmet needs patterns and more efficiently guide tailored interventions.
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Affiliation(s)
- Bernhard Michalowsky
- German Center for Neurodegenerative Diseases - DZNE, Rostock/Greifswald, Greifswald, Germany
| | - Anika Rädke
- German Center for Neurodegenerative Diseases - DZNE, Rostock/Greifswald, Greifswald, Germany
| | - Annelie Scharf
- German Center for Neurodegenerative Diseases - DZNE, Rostock/Greifswald, Greifswald, Germany
| | - Franka Mühlichen
- German Center for Neurodegenerative Diseases - DZNE, Rostock/Greifswald, Greifswald, Germany
| | - Maresa Buchholz
- German Center for Neurodegenerative Diseases - DZNE, Rostock/Greifswald, Greifswald, Germany
| | - Moritz Platen
- German Center for Neurodegenerative Diseases - DZNE, Rostock/Greifswald, Greifswald, Germany
| | - Fabian Kleinke
- Section of Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Peter Penndorf
- Section of Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Stefanie Pfitzner
- Section of Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Neeltje van den Berg
- Section of Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases - DZNE, Rostock/Greifswald, Greifswald, Germany
- Section of Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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Abdullah JM. Needs of older people living with dementia in low and middle-income Asian countries: A scoping review. DEMENTIA 2023; 22:1977-1993. [PMID: 37708304 PMCID: PMC10644686 DOI: 10.1177/14713012231198952] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
BACKGROUND Population ageing in low and middle-income Asian countries is associated with increased prevalence of dementia. The proportion of people with dementia in countries such as Bangladesh and Thailand are increasing. People with dementia can have complex care and health service needs. If these needs are not adequately met, this can result in a decreased quality of life and burden on the health system. There is considerable research into the needs of people with dementia in high-income countries. However, research on the needs of people living with dementia in low and middle-income countries remains underexplored. The aim of this study was to review and summarise the literature on the health and social care needs of older people with dementia in low and middle-income Asian countries. METHODS Five online databases (PubMed, Scopus, Web of Science, CINAHL and PsycINFO) and google scholar were searched. The databases were searched using a selection of key words. PRISMA-ScR approach was followed in reporting the process. KEY FINDINGS We extracted eight studies related to the health and social care needs of people with dementia that met our inclusion criteria. From the available literature, needs were categorised across five categories: (i) social, cognitive, and mental health needs; (ii) physical needs; (iii) care and service needs; (iv) knowledge-related needs; and (v) spiritual care needs. CONCLUSION While eight papers were located which discussed the needs of people with dementia across a range of domains, this review demonstrates a deficit in the current evidence-base about the health and social care needs of people living with dementia in low and middle-income Asian countries. Further research is needed to identify health and care needs of people with dementia and how these needs are being met.
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Affiliation(s)
- JM Abdullah
- College of Health and Medicine, University of Tasmania, Lilyfield, NSW, Australia
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Gillis K, van Diermen L, Lahaye H, De Witte M, De Wit Y, Roelant E, Lips D, Zhiri A, Hockley J, Van Bogaert P. Effect of need-based care on behavioural and psychological symptoms in residents with dementia and formal caregivers' distress in nursing homes: a three-arm cluster randomized controlled trial. Eur Geriatr Med 2023; 14:1083-1096. [PMID: 37405630 DOI: 10.1007/s41999-023-00825-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 06/19/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE To evaluate to what extent the standardized concept of need-based care on Behavioural and Psychological Symptoms of Dementia (BPSD), and formal caregiver distress, is superior when compared to spending more time or standard care with residents with BPSD. METHODS A longitudinal cluster randomized controlled study in 23 nursing homes in Belgium with 3 parallel groups was set up. A total of 481 residents with dementia participated. Formal caregivers in the need-based care group treated residents who displayed agitated or aggressive behaviour with a non-pharmacological intervention, tailored to unmet needs, twice a week with re-evaluation every 8 weeks. In the time group, formal caregivers spent 'extra time'. In the standard care group, it was 'care as usual'. Outcomes were measured at four different time points with the Doloplus-2 (to assess pain behaviour), Cohen-Mansfield Agitation Inventory (CMAI) for agitation, the Neuropsychiatric Inventory (NPI-NH) for BPSD and formal caregivers' distress. RESULTS Need-based interventions had a significant effect on residents' levels of pain behaviour. In the need-based care group, scores on overall BPSD (agitation and aggression, depression, euphoria, irritability, sleep and night-time behaviour) improved significantly from baseline when compared to other timepoints. No significant different interactions over time were found between all three groups for categorized versions of NPI scores (ever versus never). CONCLUSION Need-based care reduced the level of BPSD in residents with dementia as well as formal caregivers' distress. The study supports the importance of tailored non-pharmacological interventions in the residential care for people with dementia. TRIAL REGISTRY Trial registration number B300201942084 (18/11/2019).
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Affiliation(s)
- Katrin Gillis
- Research Group Health for Older People (HOPE), Odisee University College, Hospitaalstraat 23, 9100, Sint-Niklaas, Belgium.
- Centre for Research and Innovation in Care, Antwerp University, Universiteitsplein 1, 2600, Wilrijk, Belgium.
| | - Linda van Diermen
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, Campus Drie Eiken, Universiteitsplein 1, 2610, Wilrijk, Belgium
- Psychiatric Centre Bethanië, Andreas Vesaliuslaan 39, 2980, Zoersel, Belgium
| | - Hilde Lahaye
- Research Group Health for Older People (HOPE), Odisee University College, Hospitaalstraat 23, 9100, Sint-Niklaas, Belgium
| | - Marianne De Witte
- Research Group Health for Older People (HOPE), Odisee University College, Hospitaalstraat 23, 9100, Sint-Niklaas, Belgium
- , Curando Vzw, Pensionaatstraat 58A, Ruiselede, Belgium
| | - Yentl De Wit
- Research Group Health for Older People (HOPE), Odisee University College, Hospitaalstraat 23, 9100, Sint-Niklaas, Belgium
- Department of Geriatrics, Ghent University Hospital, C. Heymanslaan, 10, 9000, Ghent, Belgium
| | - Ella Roelant
- Center for Statistics, StatUa, University of Antwerp, Prinsstraat 13, Antwerp, Belgium
- Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, Edegem, Belgium
| | - Dirk Lips
- , Curando Vzw, Pensionaatstraat 58A, Ruiselede, Belgium
| | - Abdesselam Zhiri
- R&D Department, Pranarôm International S.A. 37, Avenue des Artisans, 7822, Ghislenghien, Belgium
- Plant Biotechnology Research Unit, Université Libre de Bruxelles (ULB), Plant Biotechnology Research Unit, CP 300, Rue Prof. Jeener & Brachet 12, 6041, Gosselies, Belgium
| | - Jo Hockley
- Primary Palliative Care Research Group, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
| | - Peter Van Bogaert
- Centre for Research and Innovation in Care, Antwerp University, Universiteitsplein 1, 2600, Wilrijk, Belgium
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Möhler R, Calo S, Renom A, Renom H, Meyer G. Personally tailored activities for improving psychosocial outcomes for people with dementia in long-term care. Cochrane Database Syst Rev 2023; 3:CD009812. [PMID: 36930048 PMCID: PMC10010156 DOI: 10.1002/14651858.cd009812.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND People with dementia who are being cared for in long-term care settings are often not engaged in meaningful activities. We wanted to know whether offering them activities which are tailored to their individual interests and preferences could improve their quality of life and reduce agitation. This review updates our earlier review published in 2018. OBJECTIVES ∙ To assess the effects of personally tailored activities on psychosocial outcomes for people with dementia living in long-term care facilities. ∙ To describe the components of the interventions. ∙ To describe conditions which enhance the effectiveness of personally tailored activities in this setting. SEARCH METHODS We searched the Cochrane Dementia and Cognitive Improvement Group's Specialized Register, on 15 June 2022. We also performed additional searches in MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, ClinicalTrials.gov, and the World Health Organization (WHO) ICTRP, to ensure that the search for the review was as up-to-date and as comprehensive as possible. SELECTION CRITERIA We included randomised controlled trials (RCTs) and controlled clinical trials offering personally tailored activities. All interventions included an assessment of the participants' present or past preferences for, or interest in, particular activities as a basis for an individual activity plan. Control groups received either usual care or an active control intervention. DATA COLLECTION AND ANALYSIS Two authors independently selected studies for inclusion, extracted data and assessed the risk of bias of included studies. Our primary efficacy outcomes were agitation and participant quality of life. Where possible, we pooled data across studies using a random effects model. MAIN RESULTS We identified three new studies, and therefore included 11 studies with 1071 participants in this review update. The mean age of participants was 78 to 88 years and most had moderate or severe dementia. Ten studies were RCTs (three studies randomised clusters to the study groups, six studies randomised individual participants, and one study randomised matched pairs of participants) and one study was a non-randomised clinical trial. Five studies included a control group receiving usual care, five studies an active control group (activities which were not personally tailored) and one study included both types of control group. The duration of follow-up ranged from 10 days to nine months. In nine studies personally tailored activities were delivered directly to the participants. In one study nursing staff, and in another study family members, were trained to deliver the activities. The selection of activities was based on different theoretical models, but the activities delivered did not vary substantially. We judged the risk of selection bias to be high in five studies, the risk of performance bias to be high in five studies and the risk of detection bias to be high in four studies. We found low-certainty evidence that personally tailored activities may slightly reduce agitation (standardised mean difference -0.26, 95% CI -0.53 to 0.01; I² = 50%; 7 studies, 485 participants). We also found low-certainty evidence from one study that was not included in the meta-analysis, indicating that personally tailored activities may make little or no difference to general restlessness, aggression, uncooperative behaviour, very negative and negative verbal behaviour (180 participants). Two studies investigated quality of life by proxy-rating. We found low-certainty evidence that personally tailored activities may result in little to no difference in quality of life in comparison with usual care or an active control group (MD -0.83, 95% CI -3.97 to 2.30; I² = 51%; 2 studies, 177 participants). Self-rated quality of life was only available for a small number of participants from one study, and there was little or no difference between personally tailored activities and usual care on this outcome (MD 0.26, 95% CI -3.04 to 3.56; 42 participants; low-certainty evidence). Two studies assessed adverse effects, but no adverse effects were observed. We are very uncertain about the effects of personally tailored activities on mood and positive affect. For negative affect we found moderate-certainty evidence that there is probably little to no effect of personally tailored activities compared to usual care or activities which are not personalised (standardised mean difference -0.02, 95% CI -0.19 to 0.14; 6 studies, 632 participants). We were not able to undertake meta-analyses for engagement and sleep-related outcomes, and we are very uncertain whether personally tailored activities have any effect on these outcomes. Two studies that investigated the duration of the effects of personally tailored activities indicated that the intervention effects they found persisted only during the period of delivery of the activities. AUTHORS' CONCLUSIONS Offering personally tailored activities to people with dementia in long-term care may slightly reduce agitation. Personally tailored activities may result in little to no difference in quality of life rated by proxies, but we acknowledge concerns about the validity of proxy ratings of quality of life in severe dementia. Personally tailored activities probably have little or no effect on negative affect, and we are uncertain whether they have any effect on positive affect or mood. There was no evidence that interventions were more likely to be effective if based on one theoretical model rather than another. We included three new studies in this updated review, but two studies were pilot trials and included only a small number of participants. Certainty of evidence was predominately very low or low due to several methodological limitations of and inconsistencies between the included studies. Evidence is still limited, and we remain unable to describe optimal activity programmes. Further research should focus on methods for selecting appropriate and meaningful activities for people in different stages of dementia.
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Affiliation(s)
- Ralph Möhler
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Stella Calo
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Anna Renom
- Department of Geriatrics, Parc de Salut Mar, Barcelona, Spain
| | - Helena Renom
- Physical Medicine and Rehabilitation (MFRHB), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gabriele Meyer
- Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Tsukii N, Nakamura K, Yamaguchi H. [Effectiveness in reducing BPSD of care intervention using the Himotoki Sheet from the perspective of individuals with dementia]. Nihon Ronen Igakkai Zasshi 2023; 60:424-433. [PMID: 38171760 DOI: 10.3143/geriatrics.60.424] [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] [Indexed: 01/05/2024]
Abstract
AIM This study aimed to examine the effect of intervention using the Himotoki Sheet versus conventional care on behavioral and psychological symptoms of dementia (BPSD) in residents of care facilities. METHODS This non-randomized controlled trial included 37 institutionalized individuals with dementia. During the four-week intervention period, the care workers in the intervention group, which consisted of 17 participants, were asked to 1) select one BPSD item for intervention from the items of the Behavioral and Psychological Symptoms of Dementia Plus Questionnaire (BPSD+Q), 2) complete the Himotoki Sheet and share information about the BPSD focused on by the team led by the Himotoki Sheet manager, and 3) provide care according to the contents of the Himotoki Sheet. The 18 patients in the control group received conventional care for four weeks. A two-way analysis of variance was used to compare changes in scores between groups and the BPSD+Q. RESULTS A total of 32 participants (intervention group, n=16; control group, n=16) were analyzed. There were no significant differences in basic attributes between the groups. There was a significant interaction between the group and the BPSD+Q distress score (F=4.704, p=0.038) and Hyperactive domain distress score (F=4.946, p=0.034). The BPSD+Q (p=0.002) and Hyperactive domain (p=0.001) distress scores were significantly reduced in the intervention group but not the control group. CONCLUSIONS In comparison to conventional care, care using the Himotoki Sheet was associated with a significant reduction in the BPSD+Q and Hyperactive domain distress scores.
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Affiliation(s)
- Naoya Tsukii
- Tokyo Center for Dementia Care Research and Practices
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Warren A. Behavioral and Psychological Symptoms of Dementia as a Means of Communication: Considerations for Reducing Stigma and Promoting Person-Centered Care. Front Psychol 2022; 13:875246. [PMID: 35422728 PMCID: PMC9002111 DOI: 10.3389/fpsyg.2022.875246] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/07/2022] [Indexed: 11/16/2022] Open
Abstract
Dementia has rapidly become a major global health crisis. As the aging population continues to increase, the burden increases commensurately on both individual and societal levels. The behavioral and psychological symptoms of dementia (BPSD) are a prominent clinical feature of Alzheimer’s disease and related dementias (ADRD). BPSD represent a myriad of manifestations that can create significant challenges for persons living with dementia and their care providers. As such, BPSD can result in detriments to social interaction with others, resulting in harm to the psychosocial health of the person with dementia. While brain deterioration can contribute to BPSD as the disease progresses, it may be confounded by language and communication difficulties associated with ADRD. Indeed, when a person with dementia cannot effectively communicate their needs, including basic needs such as hunger or toileting, nor symptoms of pain or discomfort, it may manifest as BPSD. In this way, a person with dementia may be attempting to communicate with what little resources are available to them in the form of emotional expression. Failing to recognize unmet needs compromises care and can reduce quality of life. Moreover, failing to fulfill said needs can also deteriorate communication and social bonds with loved ones and caregivers. The aim of this review is to bring the differential of unmet needs to the forefront of BPSD interpretation for both formal and informal caregivers. The overarching goal is to provide evidence to reframe the approach with which caregivers view the manifestations of BPSD to ensure quality of care for persons with dementia. Understanding that BPSD may, in fact, be attempts to communicate unmet needs in persons with dementia may facilitate clinical care decisions, promote quality of life, reduce stigma, and foster positive communications.
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Affiliation(s)
- Alison Warren
- The Department of Clinical Research and Leadership, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
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