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Oji N, Onyeka T, Soyannwo O, Paal P, Elsner F. Perspectives, perceived self-efficacy, and preparedness of newly qualified physicians' in practising palliative care-a qualitative study. Palliat Care 2022; 21:141. [PMID: 35922778 PMCID: PMC9351146 DOI: 10.1186/s12904-022-01028-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dealing with life-limiting illnesses, death, dying and grief, is uncharted territory for medical graduates. It is a field that is heavily influenced by cultural, religio-spiritual and social factors. This adds complexity to palliative and end-of-life-care, which challenges newly qualified physicians and requires the formation of appropriate knowledge, skills, and attitudes in junior doctors. This study aimed to obtain insight into the perspectives, perceived self-efficacy, and preparedness of newly qualified Nigerian physicians in practising palliative care and identify potential variables influencing them. METHODS The study was a cross-sectional, multi-centre survey of newly qualified Nigerian physicians, using semi-structured, in-depth qualitative interviews. The data were analysed by applying content-structuring qualitative content analysis. RESULTS Forty semi-structured interviews were conducted with medical house officers at two tertiary institutions in Nigeria. The perceived self-efficacy and preparedness of newly qualified Nigerian physicians in practising palliative care were reported to be higher in areas of family involvement, and pain and symptom management than in areas of breaking bad news, prognosis, and diagnosing dying. Major influences on the young physicians' perceived self-efficacy and preparedness in practising palliative care were socio-economic circumstances of a resource-limited setting and cultural-religious considerations. In addition, the perceived impact of palliative care education and experience was documented. CONCLUSIONS This study offers valuable insights into the perceived self-efficacy and preparedness of newly qualified physicians and reveals the influence of socio-cultural and socio-economic variables in Nigeria. Evidence of the social, cultural, and religio-spiritual dimensions of palliative care is indispensable for culturally sensitive care. These results could aid in the development of appropriate knowledge, skills, and attitudes in newly qualified physicians through culturally and contextually appropriate palliative care training measures. The results may be applicable to other sub-Saharan African settings and may be used to improve future palliative care education, training, and practice.
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Affiliation(s)
- Nwabata Oji
- Department of Palliative Medicine, Uniklinik RWTH Aachen, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 57, 52074, Aachen, Germany.
| | - Tonia Onyeka
- Department of Anaesthesia / Pain and Palliative Care Unit, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
| | - Olaitan Soyannwo
- Hospice and Palliative Care Department, University College Hospital Ibadan, Queen Elizabeth Road, Ibadan, Oyo State, Nigeria
| | - Piret Paal
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - Frank Elsner
- Department of Palliative Medicine, Uniklinik RWTH Aachen, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 57, 52074, Aachen, Germany
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Caulfield A, Plymoth A, Nartey YA, Mölsted-Alvesson H. The 6-star doctor? Physicians' communication of poor prognosis to patients and their families in Cape Coast, Ghana. BMJ Glob Health 2021; 5:bmjgh-2020-002334. [PMID: 32565427 PMCID: PMC7311005 DOI: 10.1136/bmjgh-2020-002334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/03/2020] [Accepted: 05/04/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Communication is considered a key skill for physicians globally and has formed a central part of medical curricula since the WHO identified it as a key attribute of the '5-star doctor'. Communication of poor prognosis to patients and caregivers is particularly challenging, yet an important example of physicians' clinical communication, and a priority within palliative care research. Knowledge is scarce regarding the different positions physicians adopt during poor prognosis communication, especially in sub-Saharan countries. METHODS This qualitative study took place at the Cape Coast Teaching Hospital in Ghana's Central Region. Physicians in the internal medicine department, with experience in communicating poor prognosis to patients and families on a weekly basis were purposively sampled. Based on the concept of information power, a maximum variation of participants, in terms of age, sex, seniority and experience was achieved after conducting 10 semistructured interviews in March 2019. Positioning theory was used as a theoretical lens to inform study design. The data were analysed through a constructivist thematic analysis approach. RESULTS Physicians adopted six positions, considered as six different themes, during their communication of poor prognosis: clinical expert, educator, counsellor, communicator, protector and mentor. Physicians' choice of position was fluid, guided by local context and wider health system factors. Physicians' desire to communicate with patients and families in a way that met their needs highlighted three key challenges for communication of poor prognosis: linguistic difficulties, pluralistic health beliefs and the role of family. These challenges presented ethical complexities in relation to autonomy and non-maleficence. CONCLUSION Context is key to physicians' communication of poor prognosis. Communication of poor prognosis is multifaceted, complex and unpredictable. Physicians' communication training should be developed to emphasise contextual circumstances and physician support, and international policy models on physicians' roles developed to include a greater focus on social accountability.
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Affiliation(s)
- Alexandra Caulfield
- Department of Global Public Health, Karolinska Institute, Stockholm, Stockholm County, Sweden
| | - Amelie Plymoth
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Stockholm County, Sweden
| | - Yvonne Ayerki Nartey
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Stockholm County, Sweden
| | - Helle Mölsted-Alvesson
- Department of Global Public Health, Karolinska Institute, Stockholm, Stockholm County, Sweden
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Hsu TH, Li IC, Fang CK, Tang WR, Lin CT. A preliminary study of the effectiveness of cancer communication skills training for interdisciplinary staff. Jpn J Clin Oncol 2020; 49:734-742. [PMID: 31063193 DOI: 10.1093/jjco/hyz065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 02/27/2019] [Accepted: 04/16/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Studies have emphasized that the disclosure of a diagnosis and prognosis is the doctor's responsibility, but little attention has been given to the importance of interdisciplinary cooperation. OBJECTIVE Therefore, this study examined and compared the effectiveness of cancer communication skills training (CST) for doctors and interdisciplinary staff in Taiwan. METHODS This study utilized a quasi-experimental design. The participants were 124 oncology professionals who participated in cancer CST. These 124 professionals included a group of 65 doctors and a group of 59 interdisciplinary professionals, both of which received the same CST. After the participants have received CST, the changes in their disease disclosure skills were evaluated. RESULTS Significant pretest-posttest differences were observed in the overall truth-telling scores for both groups (doctors: t = 6.94, P < 0.001; interdisciplinary professionals: t = 7.71, P < 0.001) and in different constructs. However, in many items, the doctors demonstrated no progress after receiving the training (P > 0.05), whereas the interdisciplinary professionals demonstrated significant progress (P < 0.05). In particular, the doctors' scores for 'disclosing information in a monotonous tone' showed significant retrogression (P < 0.05). There were no significant differences in the overall truth-telling scores of the two groups with regard to pre- and post-CST (P > 0.05 and P > 0.05, respectively), and there were also no significant differences in the four sub-scales' scores. CONCLUSION The CST for interdisciplinary professionals improved their cooperation and communication skills.
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Affiliation(s)
- Tsui-Hsia Hsu
- School of Nursing, National Yang-Ming University, Taiwan.,Health Promotion Administration, Ministry of Health and Welfare
| | - I-Chuan Li
- School of Nursing, National Yang-Ming University, Taiwan
| | - Chun-Kai Fang
- Department of Psychiatry and Suicide Prevention Center.,Department of Medicine, Mackay Medical College, New Taipei.,Mackay Memorial Hospital, Taipei.,Taiwan Psycho-Oncology Society
| | - Woung-Ru Tang
- Taiwan Psycho-Oncology Society.,School of Nursing, College of Medicine, Chang Gung University, Taoyuan
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Terminally-ill patients' prognosis information preferences in an African setting: A qualitative descriptive study. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2020. [DOI: 10.1016/j.ijans.2020.100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Tang WR, Hong JH, Rau KM, Wang CH, Juang YY, Lai CH, Fujimori M, Fang CK. Truth telling in Taiwanese cancer care: patients' and families' preferences and their experiences of doctors' practices. Psychooncology 2016; 26:999-1005. [DOI: 10.1002/pon.4257] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 06/24/2016] [Accepted: 08/05/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Woung-Ru Tang
- School of Nursing, College of Medicine; Chang Gung University; Taoyuan Taiwan
- Department of Psychiatry; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Ji-Hong Hong
- Department of Radiation Oncology; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Kun-Ming Rau
- Department of Hematology; Chang Gung Memorial Hospital; Kaohsiung Taiwan
| | - Cheng-Hsu Wang
- Department of Hematology; Chang Gung Memorial Hospital; Keelung Taiwan
| | - Yeong-Yuh Juang
- Department of Psychiatry; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Chien-Hong Lai
- Department of Hematology; Chang Gung Memorial Hospital; Keelung Taiwan
| | - Maiko Fujimori
- Center for Suicide Prevention, National Institute of Mental Health; National Center for Neurology & Psychiatry; Tokyo Japan
| | - Chun-Kai Fang
- Department of Psychiatry, Suicide Prevention Center & Hospice and Palliative Care Center; MacKay Memorial Hospital; Taipei Taiwan
- Department of Medicine; MacKay Medical College; New Taipei Taiwan
- Department of Thanatology and Health Counseling; National Taipei University of Nursing and Health Sciences; Taipei Taiwan
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Feelings, perceptions, and expectations of patients during the process of oral cancer diagnosis. Support Care Cancer 2015; 24:2323-2332. [DOI: 10.1007/s00520-015-3030-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 11/15/2015] [Indexed: 01/17/2023]
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Abstract
BACKGROUND Nurses play a major role all over the world in the palliative care team. AIM The aim of this study was to investigate the knowledge and attitude of nurses toward palliative care in a tertiary level hospital in Nigeria. SUBJECTS AND METHODS SETTING This cross-sectional questionnaire-based study was carried out among nurses at a tertiary health care facility in Ado-Ekiti, South-West Nigeria. A cross-sectional questionnaire-based study was carried out. The questionnaire sought information about the sociodemographic profile of respondents, their knowledge of definition and philosophy of palliative care among other things. Descriptive statistics was used to obtain the general characteristics of the study participants, while Chi-square was used to determine the association between categorical variables. A two-sided P < 0.05 was considered as significant. RESULTS A total of 100 questionnaires were returned with a female preponderance among the respondents with F: M ratio of 9:1. Regarding the definition of palliative care, 71.8% (48/66) of the respondents understood palliative care to be about pain medicine, 55% (33/60) thought it to be geriatric medicine, while 90.2% (83/92) felt palliative care is about the active care of the dying. Exactly 80.5% (66/82) respondents agreed that palliative care recognizes dying as a normal process while 84.1% (74/88) respondents were of the opinion that all dying patients would require palliative care. The use of morphine would improve the quality of life of patients according to 68.9% (42/61) of respondents. CONCLUSION There are gaps in the knowledge of healthcare workers in the area of palliative care and this call for a review of the current nursing curriculum and practice guidelines in Nigeria.
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Affiliation(s)
- Jo Fadare
- Department of Pharmacology, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
| | - Am Obimakinde
- Department of Family Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
| | - Do Olaogun
- Department of Obstetrics and Gynecology, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
| | - Jm Afolayan
- Department of Anesthesia, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
| | - O Olatunya
- Department of Pediatrics, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
| | - Ko Ogundipe
- Department of Surgery, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
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Sippel D, Marckmann G, Ndzie Atangana E, Strech D. Clinical Ethics in Gabon: The Spectrum of Clinical Ethical Issues Based on Findings from In-Depth Interviews at Three Public Hospitals. PLoS One 2015; 10:e0132374. [PMID: 26161655 PMCID: PMC4498757 DOI: 10.1371/journal.pone.0132374] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 06/13/2015] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Unlike issues in biomedical research ethics, ethical challenges arising in daily clinical care in Sub-Saharan African countries have not yet been studied in a systematic manner. However this has to be seen as a distinct entity as we argue in this paper. Our aim was to give an overview of the spectrum of clinical ethical issues and to understand what influences clinical ethics in the Sub-Saharan country of Gabon. MATERIALS AND METHODS In-depth interviews with 18 health care professionals were conducted at three hospital sites in Gabon. Interview transcripts were analyzed using a grounded theory approach (open and axial coding), giving a qualitative spectrum of categories for clinical ethical issues. Validity was checked at a meeting with study participants and other health care experts in Gabon after analysis of the data. RESULTS Twelve main categories (with 28 further-specified subcategories) for clinical ethical issues were identified and grouped under three core categories: A) micro level: "confidentiality and information", "interpersonal, relational and behavioral issues", "psychological strain of individuals", and "scarce resources"; B) meso level: "structural issues of medical institutions", "issues with private clinics", "challenges connected to the family", and "issues of education, training and competence"; and C) macro level: "influence of society, culture, religion and superstition", "applicability of western medicine", "structural issues on the political level", and "legal issues". DISCUSSION Interviewees reported a broad spectrum of clinical ethical issues that go beyond challenges related to scarce financial and human resources. Specific socio-cultural, historical and educational backgrounds also played an important role. In fact these influences are central to an understanding of clinical ethics in the studied local context. Further research in the region is necessary to put our study into perspective. As many participants reported a lack of awareness of ethical issues amongst other health care professionals in daily clinical practice, we suggest that international organizations and national medical schools should consider infrastructure and tools to improve context-sensitive capacity building in clinical ethics for Sub-Saharan African countries like Gabon.
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Affiliation(s)
- Daniel Sippel
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
- Center for Regenerative Therapies Dresden (CRTD), Technische Universität Dresden, Dresden, Germany
| | - Georg Marckmann
- Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | | | - Daniel Strech
- Institute for History, Ethics and Philosophy of Medicine, Centre for Ethics and Law in the Life Sciences (CELLS), Hannover Medical School, Hannover, Germany
- * E-mail:
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Using a supportive care framework to understand and improve palliative care among cancer patients in Africa. Palliat Support Care 2015; 14:284-301. [PMID: 26073264 DOI: 10.1017/s1478951515000796] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Cancer incidence and mortality are increasing in Africa, which is leading to greater demands for palliative care. There has been little progress in terms of research, pain management, and policies related to palliative care. Palliative care in Africa is scarce and scattered, with most African nations lacking the basic services. To address these needs, a guiding framework that identifies care needs and directs palliative care services could be utilized. Therefore, using the supportive care framework developed by Fitch (Fitch, 2009), we here review the literature on palliative care for patients diagnosed with cancer in Africa and make recommendations for improvement. METHOD The PubMed, Scopus, CINAHL, Web of Science, Embase, PsycINFO, Social Sciences Citation Index, and Medline databases were searched. Some 25 English articles on research from African countries published between 2004 and 2014 were selected and reviewed. The reviewed literature was analyzed and presented using the domains of the supportive care framework. RESULTS Palliative care patients with cancer in Africa, their families, and caregivers experience increasing psychological, physical, social, spiritual, emotional, informational, and practical needs. Care needs are often inadequately addressed because of a lack of awareness as well as deficient and scattered palliative care services and resources. In addition, there is sparse research, education, and policies that address the dire situation in palliative care. SIGNIFICANCE OF RESULTS Our review findings add to the existing body of knowledge demonstrating that palliative care patients with cancer in Africa experience disturbing care needs in all domains of the supportive care framework. To better assess and address these needs, holistic palliative care that is multidomain and multi-professional could be utilized. This approach needs to be individualized and to offer better access to services and information. In addition, research, education, and policies around palliative care for cancer patients in Africa could be more comprehensive if they were based on the domains of the supportive care framework.
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Ethical, Socioeconomic, and Cultural Considerations in Gynecologic Cancer Care in Developing Countries. ACTA ACUST UNITED AC 2014. [DOI: 10.1155/2014/141627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Gynaecologic cancers contribute significantly to the cancer burden in developing countries, resulting in higher mortality and morbidity rates among women in these nations. This situation is further compounded by the occurrence of wars, famine, poverty and natural disasters, and infectious diseases like hepatitis B and HIV/AIDS. In addition, merge resources and manpower lack in these countries further compound this very delicate situation. Often times, socioeconomic, cultural, and ethical factors such as truth-telling, choice of place of care, place of death, treatment choices, medication use, and terminal sedation can interfere in patient management. Availability and use of oral morphine for pain relief, spiritual care and availability of palliative care services, the individuals’ autonomy, and family and community participation in care, end of life issues, and preservation of fertility are also big issues that determine the course of care. This review discusses these pertinent factors, discusses how they affect cancer care in women, and proffers ideas for healthcare workers and policy makers on implementation of sustainable models for cancer care in developing countries. Addressing socioeconomic, cultural, and ethical issues affecting gynaecologic cancer care will aid in ensuring development of viable models of cancer care in resource-limited countries.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to give an overview of challenges that have been addressed in recent research in end-of-life communication. RECENT FINDINGS Diversity of difficulties that may occur in communication about end-of-life issues has been showed. The emotional quality of this communication requires special skills from professionals involved. Studies showed that physicians and medical students are often overstrained and avoid end-of-life discussions. Health professionals and patients are often ambivalent about end-of-life discussions. Nevertheless, professionals are expected to initiate these in an honest, needs-oriented way. Patient preferences are difficult to infer and have to be assessed explicitly and regularly. Studies showed that the emotional impact of end-of-life discussions can lead to a high burden or avoidance of professionals. Interdisciplinary, multi-professional work can support health professionals in end-of-life care but often structural barriers obstruct possible benefits. SUMMARY Health professionals need to initiate end-of-life communication in a sensitive way. Specific demands for health professionals in end-of-life communication are to differentiate own emotions and life events from those of patients and to deal with both adequately. Moreover, structural aspects can lead to difficulties between different specialties, professions and sectors, which can have a negative impact on adequate care for patient and relatives. Special efforts for improvement are needed.
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Nwankwo KC, Anarado AN, Ezeome ER. Attitudes of cancer patients in a university teaching hospital in southeast Nigeria on disclosure of cancer information. Psychooncology 2012; 22:1829-33. [DOI: 10.1002/pon.3220] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Revised: 10/01/2012] [Accepted: 10/11/2012] [Indexed: 11/05/2022]
Affiliation(s)
- K. C. Nwankwo
- Radiation Oncology Unit; Oncology Center, University of Nigeria Teaching Hospital; Enugu Nigeria
| | - Agnes N. Anarado
- Oncology Nursing unit; Oncology Center, University of Nigeria Teaching Hospital; Enugu Nigeria
| | - E. R. Ezeome
- Surgical Oncology unit; Oncology Center, University of Nigeria Teaching Hospital; Enugu Nigeria
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Tang WR, Fang JT, Fang CK, Fujimori M. Truth telling in medical practice: students' opinions versus their observations of attending physicians' clinical practice. Psychooncology 2012; 22:1605-10. [PMID: 22962020 DOI: 10.1002/pon.3174] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 08/01/2012] [Accepted: 08/16/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Truth telling or transmitting bad news is a problem that all doctors must frequently face. The purpose of this cross-sectional study was to investigate if medical students' opinions of truth telling differed from their observations of attending physicians' actual clinical practice. METHODS The subjects were 275 medical clerks/interns at a medical center in northern Taiwan. Data were collected on medical students' opinions of truth telling, their observations of physicians' clinical practice, students' level of satisfaction with truth telling practiced by attending physicians, and cancer patients' distress level when they were told the truth. RESULTS Students' truth-telling awareness was significantly higher than the clinical truth-telling practice of attending physicians (p<0.001), and the means for these parameters had a moderate difference, especially in three aspects: method, emotional support, and providing additional information (p<0.001). Regardless of this difference, students were satisfied with the truth telling of attending physicians (mean ± SD=7.33 ± 1.74). However, our data also show that when cancer patients were informed of bad news, they all experienced medium to above average distress (5.93 ± 2.19). CONCLUSIONS To develop the ability to tell the truth well, one must receive regular training in communication skills, including experienced attending physicians. This study found a significant difference between medical students' opinions on truth telling and attending physicians' actual clinical practice. More research is needed to objectively assess physicians' truth telling in clinical practice and to study the factors affecting the method of truth telling used by attending physicians in clinical practice.
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Affiliation(s)
- Woung-Ru Tang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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