1
|
Moeller SB, Larsen PV, Austin S, Slade M, Arendt IMTP, Andersen MS, Simonsen S. Scalability, test-retest reliability and validity of the Brief INSPIRE-O measure of personal recovery in psychiatric services. Front Psychiatry 2024; 15:1327020. [PMID: 38807686 PMCID: PMC11130469 DOI: 10.3389/fpsyt.2024.1327020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 04/29/2024] [Indexed: 05/30/2024] Open
Abstract
Introduction Mental health services have transitioned from treating symptoms to emphasizing personal recovery. Despite its importance, integrating personal recovery into clinical practice remains work in progress. This study evaluates the psychometric qualities of the Brief INSPIRE-O, a five-item patient-reported outcome measure assessing personal recovery. Method The study collected data from 2018 to 2020 at the Mental Health Services, Capital Region of Denmark, using an internet-based system examining 8,192 non-psychotic patients - receiving outpatient treatment. Materials This study evaluated the Brief INSPIRE-O and used measures of symptomatology (SCL-10), well-being (WHO-5), and social functioning (modified SDS). Results The study population comprised 76.8% females with a mean age of 32.9 years, and diagnoses included anxiety (28%), depression (34%), and personality disorder (19%). The mean Brief INSPIRE-O score (39.9) was lower than the general population norm (71.1). The Brief INSPIRE-O showed acceptable test-retest reliability (0.75), scalability (0.39), and internal consistency (0.73). Correlations with other mental health criteria were in the expected direction for symptomatology (-0.46), well-being (0.60), and social functioning (-0.43) and remained consistent across diagnoses. Discussion The Brief INSPIRE-O demonstrated strong psychometric qualities and could be recommended as a measure of personal recovery for use in both research and clinical practice. Its strong theoretical basis and short completion time make it suitable for use for research. Incorporating Brief INSPIRE-O into clinical assessment will further support the process of mental health systems re-orientating towards personal recovery.
Collapse
Affiliation(s)
- Stine Bjerrum Moeller
- Psychotherapeutic Center Stolpegård, Region Hovedstad Psychiatry, København, Denmark
- Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Trauma and Torture Survivors, Mental Health Services of Southern Denmark, Vejle, Denmark
| | - Pia Veldt Larsen
- Mental Health Services in the Region of Southern Denmark, Vejle, Denmark
| | - Stephen Austin
- Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
| | - Mike Slade
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - Ida-Marie T. P. Arendt
- Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Trauma and Torture Survivors, Mental Health Services of Southern Denmark, Vejle, Denmark
| | | | - Sebastian Simonsen
- Psychotherapeutic Center Stolpegård, Region Hovedstad Psychiatry, København, Denmark
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
2
|
Cuijpers P, Franco P, Ciharova M, Miguel C, Segre L, Quero S, Karyotaki E. Psychological treatment of perinatal depression: a meta-analysis. Psychol Med 2023; 53:2596-2608. [PMID: 37310303 PMCID: PMC10123831 DOI: 10.1017/s0033291721004529] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 06/08/2021] [Accepted: 10/18/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Depression during pregnancy and after the birth of a child is highly prevalent and an important public health problem. Psychological interventions are the first-line treatment and, although a considerable number of randomized trials have been conducted, no recent comprehensive meta-analysis has evaluated treatment effects. METHODS We used an existing database of randomized controlled trials of psychotherapies for adult depression and included studies aimed at perinatal depression. Random effects models were used in all analyses. We examined the effects of the interventions in the short and long term, and also examined secondary outcomes. RESULTS Forty-three studies with 49 comparisons and 6270 participants between an intervention and control group were included. The overall effect size was g = 0.67 [95% confidence interval (CI) 0.45~0.89; numbers needed-to-be-treated = 4.39] with high heterogeneity (I2 = 80%; 95% CI 75~85). This effect size remained largely unchanged and significant in a series of sensitivity analyses, although some publication bias was found. The effects remained significant at 6-12 months follow-up. Significant effects were also found for social support, anxiety, functional limitations, parental stress and marital stress, although the number of studies for each outcome was low. All results should be considered with caution because of the high levels of heterogeneity in most analyses. CONCLUSIONS Psychological interventions are probably effective in the treatment of perinatal depression, with effects that last at least up to 6-12 months and probably also have effects on social support, anxiety, functional impairment, parental stress, and marital stress.
Collapse
Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pamela Franco
- Department of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Lisa Segre
- College of Nursing, University of Iowa, Iowa City, USA
| | - Soledad Quero
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
- CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
3
|
Housing First for homeless people with severe mental illness: extended 4-year follow-up and analysis of recovery and housing stability from the randomized Un Chez Soi d'Abord trial. Epidemiol Psychiatr Sci 2022; 31:e14. [PMID: 35125129 PMCID: PMC8851060 DOI: 10.1017/s2045796022000026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIMS Housing First (HF), a recovery-oriented approach, was proven effective in stabilising housing situations of homeless individuals with severe mental disorders, yet had limited effectiveness on recovery outcomes on a short-term basis compared to standard treatment. The objective was to assess the effects of the HF model among homeless people with high support needs for mental and physical health services on recovery, housing stability, quality of life, health care use, mental symptoms and addiction issues on 4 years of data from the Un Chez Soi d'Abord trial. METHODS A multicentre randomised controlled trial was conducted from August 2011 to April 2018 with intent-to-treat analysis in four French cities: Lille, Marseille, Paris and Toulouse. Participants were homeless or precariously-housed patients with a DSM-IV-TR diagnosis of bipolar disorder or schizophrenia. Two groups were compared: the HF group (n = 353) had immediate access to independent housing and support from the assertive community treatment team; the Treatment-As-Usual (TAU) group (n = 350) had access to existing support and services. Main outcomes were personal recovery (Recovery Assessment Scale (RAS) scale), housing stability, quality of life (S-QoL), global physical and mental status (Medical Outcomes Study 36-item Short Form Health Survey (SF-36)), inpatient days, mental symptoms (Modified Colorado Symptom Index (MCSI)) and addictions (Mini International Neuropsychiatric Interview (MINI) and Alcohol Use Disorders Identification Test (AUDIT)). Mixed models using longitudinal and cluster designs were performed and adjusted to first age on the street, gender and mental disorder diagnosis. Models were tested for time × group and site × time interactions. RESULTS The 703 participants [123 (18%) female] had a mean age of 39 years (95% CI 38.0-39.5 years). Both groups improved RAS index from baseline to 48 months, with no statistically significant changes found between the HF and TAU groups over time. HF patients exhibited better autonomy (adjusted β = 2.6, 95% CI 1.2-4.1) and sentimental life (2.3, 95% CI 0.5-4.1), higher housing stability (28.6, 95% CI 25.1-32.1), lower inpatient days (-3.14, 95% CI -5.2 to -1.1) and improved SF-36 mental composite score (-0.8, 95% CI -1.6 to -0.1) over the 4-year follow-up. HF participants experienced higher alcohol consumption between baseline and 48 months. No significant differences were observed for self-reported mental symptoms or substance dependence. CONCLUSION Data at 4 years were consistent with 2-year follow-up data: similar improvement in personal recovery outcomes but higher housing stability, autonomy and lower use of hospital services in the HF group compared to the TAU group, with the exception of an ongoing alcohol issue. These sustained benefits support HF as a valuable intervention for the homeless patients with severe mental illness. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01570712.
Collapse
|
4
|
Weijers A, Rasing S, Creemers D, Vermulst A, Schellekens AFA, Westerhof GJ. Deconstructing recovery: A prospective study on well-being, symptom severity and acceptance in patients with major depressive disorders. J Affect Disord 2022; 296:653-659. [PMID: 34579968 DOI: 10.1016/j.jad.2021.09.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Perceived well-being is key in the recovery from major depressive disorder (MDD). It is however unclear how well-being relates to other aspects of recovery, like depressive symptom severity, acceptance, disease identification and social participation. In patients with MDD we investigated 1) changes in these five concepts over time, 2) which concepts associate with well-being, and 3) whether a relationship between depressive symptoms and well-being is moderated by acceptance, disease identification and social participation. METHODS Adult outpatients with MDD (n=77) were administered the Mental Health Continuum-Short Form, the Inventory of Depressive Symptomatology, the Acceptance and Action Questionnaire-II, the Pictorial Representation of Illness and Self Measure, and the Scale Functional Remission before treatment and six months later. Changes over time were tested using paired samples t-tests, associations between concepts were tested with correlations. Regression analyses were used to test moderation effects. RESULTS Participants improved on all outcome measures. Well-being correlated moderately with depressive symptom severity (negative correlation) and acceptance at baseline, and strongly at follow-up. At follow-up well-being also correlated moderately with disease identification and social participation. No evidence for moderation was found. LIMITATIONS Recruitment in one regional mental health center might limit generalizability. Furthermore, confounding effects of psychiatric comorbidity on recovery and well-being cannot be ruled out. CONCLUSION Recovery in patients with MDD is associated with improvement on multiple outcome domains. Symptom severity and acceptance showed the strongest association with perceived well-being. Future studies should explore whether treatments targeting symptom severity and acceptance have the strongest impact on recovery.
Collapse
Affiliation(s)
| | - Sanne Rasing
- GGZ Oost Brabant, Netherlands; Radboud University, Nijmegen, Netherlands
| | - Daan Creemers
- GGZ Oost Brabant, Netherlands; Radboud University, Nijmegen, Netherlands
| | | | - Arnt F A Schellekens
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, The Netherlands; Nijmegen Institute for Science Practitioners in Addiction (NISPA), Netherlands
| | | |
Collapse
|
5
|
Cid-Jofré V, Moreno M, Reyes-Parada M, Renard GM. Role of Oxytocin and Vasopressin in Neuropsychiatric Disorders: Therapeutic Potential of Agonists and Antagonists. Int J Mol Sci 2021; 22:ijms222112077. [PMID: 34769501 PMCID: PMC8584779 DOI: 10.3390/ijms222112077] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 10/20/2021] [Accepted: 11/02/2021] [Indexed: 12/27/2022] Open
Abstract
Oxytocin (OT) and vasopressin (AVP) are hypothalamic neuropeptides classically associated with their regulatory role in reproduction, water homeostasis, and social behaviors. Interestingly, this role has expanded in recent years and has positioned these neuropeptides as therapeutic targets for various neuropsychiatric diseases such as autism, addiction, schizophrenia, depression, and anxiety disorders. Due to the chemical-physical characteristics of these neuropeptides including short half-life, poor blood-brain barrier penetration, promiscuity for AVP and OT receptors (AVP-R, OT-R), novel ligands have been developed in recent decades. This review summarizes the role of OT and AVP in neuropsychiatric conditions, as well as the findings of different OT-R and AVP-R agonists and antagonists, used both at the preclinical and clinical level. Furthermore, we discuss their possible therapeutic potential for central nervous system (CNS) disorders.
Collapse
Affiliation(s)
- Valeska Cid-Jofré
- Centro de Investigación Biomédica y Aplicada (CIBAP), Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Santiago 9170022, Chile; (V.C.-J.); (M.M.)
| | - Macarena Moreno
- Centro de Investigación Biomédica y Aplicada (CIBAP), Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Santiago 9170022, Chile; (V.C.-J.); (M.M.)
- Facultad de Ciencias Sociales, Escuela de Psicología, Universidad Bernardo OHiggins, Santiago 8370993, Chile
| | - Miguel Reyes-Parada
- Centro de Investigación Biomédica y Aplicada (CIBAP), Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Santiago 9170022, Chile; (V.C.-J.); (M.M.)
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Providencia 7500912, Chile
- Correspondence: (M.R.-P.); (G.M.R.)
| | - Georgina M. Renard
- Centro de Investigación Biomédica y Aplicada (CIBAP), Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Santiago 9170022, Chile; (V.C.-J.); (M.M.)
- Correspondence: (M.R.-P.); (G.M.R.)
| |
Collapse
|
6
|
Moriarty AS, Paton LW, Snell KIE, Riley RD, Buckman JEJ, Gilbody S, Chew-Graham CA, Ali S, Pilling S, Meader N, Phillips B, Coventry PA, Delgadillo J, Richards DA, Salisbury C, McMillan D. The development and validation of a prognostic model to PREDICT Relapse of depression in adult patients in primary care: protocol for the PREDICTR study. Diagn Progn Res 2021; 5:12. [PMID: 34215317 PMCID: PMC8254312 DOI: 10.1186/s41512-021-00101-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/19/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Most patients who present with depression are treated in primary care by general practitioners (GPs). Relapse of depression is common (at least 50% of patients treated for depression will relapse after a single episode) and leads to considerable morbidity and decreased quality of life for patients. The majority of patients will relapse within 6 months, and those with a history of relapse are more likely to relapse in the future than those with no such history. GPs see a largely undifferentiated case-mix of patients, and once patients with depression reach remission, there is limited guidance to help GPs stratify patients according to risk of relapse. We aim to develop a prognostic model to predict an individual's risk of relapse within 6-8 months of entering remission. The long-term objective is to inform the clinical management of depression after the acute phase. METHODS We will develop a prognostic model using secondary analysis of individual participant data drawn from seven RCTs and one longitudinal cohort study in primary or community care settings. We will use logistic regression to predict the outcome of relapse of depression within 6-8 months. We plan to include the following established relapse predictors in the model: residual depressive symptoms, number of previous depressive episodes, co-morbid anxiety and severity of index episode. We will use a "full model" development approach, including all available predictors. Performance statistics (optimism-adjusted C-statistic, calibration-in-the-large, calibration slope) and calibration plots (with smoothed calibration curves) will be calculated. Generalisability of predictive performance will be assessed through internal-external cross-validation. Clinical utility will be explored through net benefit analysis. DISCUSSION We will derive a statistical model to predict relapse of depression in remitted depressed patients in primary care. Assuming the model has sufficient predictive performance, we outline the next steps including independent external validation and further assessment of clinical utility and impact. STUDY REGISTRATION ClinicalTrials.gov ID: NCT04666662.
Collapse
Affiliation(s)
- Andrew S Moriarty
- Department of Health Sciences, University of York, York, England.
- Hull York Medical School, University of York, York, England.
| | - Lewis W Paton
- Department of Health Sciences, University of York, York, England
| | - Kym I E Snell
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, England
| | - Richard D Riley
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, England
| | - Joshua E J Buckman
- Centre for Outcomes and Research Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, England
- iCope - Camden and Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, London, England
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, England
- Hull York Medical School, University of York, York, England
| | | | - Shehzad Ali
- Department of Health Sciences, University of York, York, England
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Stephen Pilling
- Centre for Outcomes and Research Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, England
- Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, England
| | - Nick Meader
- Centre for Reviews and Dissemination, University of York, York, England
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, York, England
| | - Peter A Coventry
- Department of Health Sciences, University of York, York, England
| | - Jaime Delgadillo
- Department of Psychology, University of Sheffield, Sheffield, England
| | - David A Richards
- Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, England
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Inndalsveien 28, 5063 Bergen, Norway, USA
| | - Chris Salisbury
- Centre for Academic Primary Care, University of Bristol, Bristol, England
| | - Dean McMillan
- Department of Health Sciences, University of York, York, England
- Hull York Medical School, University of York, York, England
| |
Collapse
|
7
|
Mullarkey MC, Schleider JL. Embracing Scientific Humility and Complexity: Learning "What Works for Whom" in Youth Psychotherapy Research. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2021; 50:443-449. [PMID: 34096811 PMCID: PMC8497399 DOI: 10.1080/15374416.2021.1929252] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Clinical psychological scientists have spent decades attempting to understand "what works for whom" in the context of youth psychotherapy, toward the longstanding goal of personalizing psychosocial interventions to fit individual needs and characteristics. However, as the articles in this Special Issue jointly underscore, more than 50 years of psychotherapy research has yet to help us realize this goal. In this introduction to the special issue, we outline how and why "aspiration-method mismatches" have hampered progress toward identifying moderators of youth psychotherapy; emphasize the need to embrace etiological complexity and scientific humility in pursuing new methodological solutions and propose individual and structural strategies for better-aligning clinical research methods with the goal of personalizing mental health care for youth with diverse identities and treatment needs.
Collapse
|
8
|
Weijers A, Rasing S, Creemers D, Vermulst A, Schellekens AFA, Westerhof GJ. The relationship between depressive symptoms, general psychopathology, and well-being in patients with major depressive disorder. J Clin Psychol 2021; 77:1472-1486. [PMID: 33188711 PMCID: PMC8246916 DOI: 10.1002/jclp.23083] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/08/2020] [Accepted: 10/18/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE In mental health care, treatment effects are commonly monitored by symptom severity measures. This study aimed to investigate the relationship between symptom severity and well-being in the treatment of patients with major depressive disorder (MDD). METHODS Adult MDD outpatients (n = 77) were administered the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR), the Outcome Questionnaire (OQ-45), and the Mental Health Continuum-Short Form (MHC-SF) before treatment and 6 months later. RESULTS Symptom severity correlated moderately with well-being at baseline and strongly at follow-up. Reliable change index scores showed improvement on the QIDS-SR, OQ-45, and MHC-SF in 65%, 59%, and 40%, respectively. A quarter of patients improved in symptom severity but not well-being (Inventory of Depressive Symptomatology-Self-Report [IDS-SR]: 25%; OQ-45: 24%). CONCLUSION Findings suggest that symptom severity and subjective well-being are related, but distinct concepts. Several reasons for the stronger improvements in symptoms than in well-being are discussed.
Collapse
Affiliation(s)
| | - Sanne Rasing
- GGZ Oost BrabantBoekelThe Netherlands
- Behavioral Science InstituteRadboud UniversityNijmegenThe Netherlands
| | - Daan Creemers
- GGZ Oost BrabantBoekelThe Netherlands
- Behavioral Science InstituteRadboud UniversityNijmegenThe Netherlands
| | | | - Arnt F. A. Schellekens
- Department of Psychiatry, Donders Institute for Brain, Cognition and BehaviorRadboud University Medical CenterNijmegenThe Netherlands
- Nijmegen Institute for Science Practitioners in Addiction (NISPA)Radboud UniversityNijmegenThe Netherlands
| | - Gerben J. Westerhof
- Department Psychology, Health, and TechnologyUniversity of TwenteEnschedeThe Netherlands
| |
Collapse
|
9
|
Mew EJ, Monsour A, Saeed L, Santos L, Patel S, Courtney DB, Watson PN, Szatmari P, Offringa M, Monga S, Butcher NJ. Systematic scoping review identifies heterogeneity in outcomes measured in adolescent depression clinical trials. J Clin Epidemiol 2020; 126:71-79. [DOI: 10.1016/j.jclinepi.2020.06.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/15/2020] [Accepted: 06/10/2020] [Indexed: 12/18/2022]
|