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Pushpasanthy M, Ephraim R, Ayilliath A, Dhanya KB. Effectiveness of Aculief acupressure device on pain perception during local anesthesia in children: A double-blinded study. J Indian Soc Pedod Prev Dent 2023; 41:309-315. [PMID: 38235817 DOI: 10.4103/jisppd.jisppd_370_23] [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] [Received: 07/24/2023] [Accepted: 12/28/2023] [Indexed: 01/19/2024] Open
Abstract
AIM The aim of this study was to evaluate the effect of the Aculief acupressure device on the reduction of pain during local anesthesia (LA) in children and to compare it with the cryotherapy technique. METHODOLOGY 20 children of age group between 6 and 9 years, requiring pulpectomy or extraction bilaterally were chosen for the study. After ethical clearance and parental consent, children who were not experienced to prior local anesthesia were chosen for the study. A split-mouth study design was done to avoid bias, and children were divided into two groups. During the first visit cryotherapy application was done on any one side followed by the LA, and during the second visit Aculief acupressure application was done, which was followed by the LA. The objective and subjective evaluation of pain during the LA was carried out and analyzed. RESULTS The objective perception of pain was evaluated using the Sound-Eye-Motor Scale by an observer who was blinded, and the subjective perception of pain by the Wong-Baker Faces Pain Rating Scale was evaluated by the child patient. The statistical analysis and comparison of values were done using the Wilcoxon signed-rank test. The pain during administration of LA was eliminated after the application of the Aculief acupressure device, and the results were superior to the cryotherapy technique. CONCLUSION The Aculief acupressure device can be effectively used to eliminate pain perception while administering LA in children. It is a simple, safe, noninvasive, and effective device and is easy to perform.
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Affiliation(s)
- M Pushpasanthy
- Department of Pedodontics and Preventive Dentistry, Mahe Institute of Dental Sciences and Hospital, Mahe, Kerala, India
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Pillai Riddell RR, Bucsea O, Shiff I, Chow C, Gennis HG, Badovinac S, DiLorenzo-Klas M, Racine NM, Ahola Kohut S, Lisi D, Turcotte K, Stevens B, Uman LS. Non-pharmacological management of infant and young child procedural pain. Cochrane Database Syst Rev 2023; 6:CD006275. [PMID: 37314064 PMCID: PMC10265939 DOI: 10.1002/14651858.cd006275.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Despite evidence of the long-term implications of unrelieved pain during infancy, it is evident that infant pain is still under-managed and unmanaged. Inadequately managed pain in infancy, a period of exponential development, can have implications across the lifespan. Therefore, a comprehensive and systematic review of pain management strategies is integral to appropriate infant pain management. This is an update of a previously published review update in the Cochrane Database of Systematic Reviews (2015, Issue 12) of the same title. OBJECTIVES To assess the efficacy and adverse events of non-pharmacological interventions for infant and child (aged up to three years) acute pain, excluding kangaroo care, sucrose, breastfeeding/breast milk, and music. SEARCH METHODS For this update, we searched CENTRAL, MEDLINE-Ovid platform, EMBASE-OVID platform, PsycINFO-OVID platform, CINAHL-EBSCO platform and trial registration websites (ClinicalTrials.gov; International Clinical Trials Registry Platform) (March 2015 to October 2020). An update search was completed in July 2022, but studies identified at this point were added to 'Awaiting classification' for a future update. We also searched reference lists and contacted researchers via electronic list-serves. We incorporated 76 new studies into the review. SELECTION CRITERIA: Participants included infants from birth to three years in randomised controlled trials (RCTs) or cross-over RCTs that had a no-treatment control comparison. Studies were eligible for inclusion in the analysis if they compared a non-pharmacological pain management strategy to a no-treatment control group (15 different strategies). In addition, we also analysed studies when the unique effect of adding a non-pharmacological pain management strategy onto another pain management strategy could be assessed (i.e. additive effects on a sweet solution, non-nutritive sucking, or swaddling) (three strategies). The eligible control groups for these additive studies were sweet solution only, non-nutritive sucking only, or swaddling only, respectively. Finally, we qualitatively described six interventions that met the eligibility criteria for inclusion in the review, but not in the analysis. DATA COLLECTION AND ANALYSIS: The outcomes assessed in the review were pain response (reactivity and regulation) and adverse events. The level of certainty in the evidence and risk of bias were based on the Cochrane risk of bias tool and the GRADE approach. We analysed the standardised mean difference (SMD) using the generic inverse variance method to determine effect sizes. MAIN RESULTS: We included total of 138 studies (11,058 participants), which includes an additional 76 new studies for this update. Of these 138 studies, we analysed 115 (9048 participants) and described 23 (2010 participants) qualitatively. We described qualitatively studies that could not be meta-analysed due to being the only studies in their category or statistical reporting issues. We report the results of the 138 included studies here. An SMD effect size of 0.2 represents a small effect, 0.5 a moderate effect, and 0.8 a large effect. The thresholds for the I2 interpretation were established as follows: not important (0% to 40%); moderate heterogeneity (30% to 60%); substantial heterogeneity (50% to 90%); considerable heterogeneity (75% to 100%). The most commonly studied acute procedures were heel sticks (63 studies) and needlestick procedures for the purposes of vaccines/vitamins (35 studies). We judged most studies to have high risk of bias (103 out of 138), with the most common methodological concerns relating to blinding of personnel and outcome assessors. Pain responses were examined during two separate pain phases: pain reactivity (within the first 30 seconds after the acutely painful stimulus) and immediate pain regulation (after the first 30 seconds following the acutely painful stimulus). We report below the strategies with the strongest evidence base for each age group. In preterm born neonates, non-nutritive sucking may reduce pain reactivity (SMD -0.57, 95% confidence interval (CI) -1.03 to -0.11, moderate effect; I2 = 93%, considerable heterogeneity) and improve immediate pain regulation (SMD -0.61, 95% CI -0.95 to -0.27, moderate effect; I2 = 81%, considerable heterogeneity), based on very low-certainty evidence. Facilitated tucking may also reduce pain reactivity (SMD -1.01, 95% CI -1.44 to -0.58, large effect; I2 = 93%, considerable heterogeneity) and improve immediate pain regulation (SMD -0.59, 95% CI -0.92 to -0.26, moderate effect; I2 = 87%, considerable heterogeneity); however, this is also based on very low-certainty evidence. While swaddling likely does not reduce pain reactivity in preterm neonates (SMD -0.60, 95% CI -1.23 to 0.04, no effect; I2 = 91%, considerable heterogeneity), it has been shown to possibly improve immediate pain regulation (SMD -1.21, 95% CI -2.05 to -0.38, large effect; I2 = 89%, considerable heterogeneity), based on very low-certainty evidence. In full-term born neonates, non-nutritive sucking may reduce pain reactivity (SMD -1.13, 95% CI -1.57 to -0.68, large effect; I2 = 82%, considerable heterogeneity) and improve immediate pain regulation (SMD -1.49, 95% CI -2.20 to -0.78, large effect; I2 = 92%, considerable heterogeneity), based on very low-certainty evidence. In full-term born older infants, structured parent involvement was the intervention most studied. Results showed that this intervention has little to no effect in reducing pain reactivity (SMD -0.18, 95% CI -0.40 to 0.03, no effect; I2 = 46%, moderate heterogeneity) or improving immediate pain regulation (SMD -0.09, 95% CI -0.40 to 0.21, no effect; I2 = 74%, substantial heterogeneity), based on low- to moderate-certainty evidence. Of these five interventions most studied, only two studies observed adverse events, specifically vomiting (one preterm neonate) and desaturation (one full-term neonate hospitalised in the NICU) following the non-nutritive sucking intervention. The presence of considerable heterogeneity limited our confidence in the findings for certain analyses, as did the preponderance of evidence of very low to low certainty based on GRADE judgements. AUTHORS' CONCLUSIONS Overall, non-nutritive sucking, facilitated tucking, and swaddling may reduce pain behaviours in preterm born neonates. Non-nutritive sucking may also reduce pain behaviours in full-term neonates. No interventions based on a substantial body of evidence showed promise in reducing pain behaviours in older infants. Most analyses were based on very low- or low-certainty grades of evidence and none were based on high-certainty evidence. Therefore, the lack of confidence in the evidence would require further research before we could draw a definitive conclusion.
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Affiliation(s)
| | - Oana Bucsea
- Department of Psychology, York University, Toronto, Canada
| | - Ilana Shiff
- Department of Psychology, York University, Toronto, Canada
| | - Cheryl Chow
- Department of Psychology, York University, Toronto, Canada
| | | | | | | | - Nicole M Racine
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Sara Ahola Kohut
- Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Canada
| | - Diana Lisi
- Department of Psychology, University of British Columbia Okanagan, Kelowna, Canada
| | - Kara Turcotte
- Department of Psychology, University of British Columbia Okanagan, Kelowna, Canada
| | - Bonnie Stevens
- Nursing Research, The Hospital for Sick Children, Toronto, Canada
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Locher C, Petignat M, Wagner C, Hediger K, Roth B, Gaab J, Koechlin H. Animal-Assisted Psychotherapy for Pediatric Chronic Pain: Case Series of an Open Pilot Study to Test Initial Feasibility and Potential Efficacy. J Pain Res 2023; 16:1799-1811. [PMID: 37273273 PMCID: PMC10237188 DOI: 10.2147/jpr.s394270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/23/2023] [Indexed: 06/06/2023] Open
Abstract
Objective Chronic pain is a common complaint in children and adolescents, placing an enormous burden on individuals, their families, and the healthcare system. New innovative approaches for the treatment of pediatric chronic pain (PCP) are clearly warranted, as drop-out rates in intervention studies are high and it can be difficult to engage patients with PCP in therapy. Here, animal-assisted interventions (AAIs) might be promising, since there is preliminary evidence for the approach in adults with chronic pain, and AAIs are generally known to foster the therapeutic motivation of patients. To date, however, AAIs have not been examined in pediatric chronic pain. Methods The aim of this open pilot study was to examine the initial feasibility of recruitment and potential efficacy of an animal-assisted group psychotherapy (including horses, rabbits, chickens, goats, and a dog), providing case reports of three children with chronic pain. We applied a mixed-methods approach, including the conductance of semi-structured interviews and assessment of quantitative pre-post data with a focus on pain severity, avoidance behavior, pain acceptance, and ability to defocus from the pain. Results The three participating girls (age: 9-12 years) reported chronic pain in the head and abdomen. The process of recruitment turned out to be challenging. All three children reported reduced pain-related disability and pain-related distress, as well as an increased ability to accept pain and to defocus from the pain. The qualitative data revealed that patients and their parents had a positive attitude towards AAIs. Conclusion Our initial open pilot study is the first to investigate AAIs in the context of pediatric chronic pain. Notably, we had difficulties in the recruitment procedure, mostly due to the Covid-19 situation. Based on three case reports, we found some first indication that AAI approaches might be associated with symptom changes. Future randomized-control studies with larger sample sizes are clearly warranted. Clinicaltrialsgov Identifier NCT04171336.
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Affiliation(s)
- Cosima Locher
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Milena Petignat
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Cora Wagner
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Karin Hediger
- Division of Clinical Psychology and Animal-Assisted Interventions, Faculty of Psychology, University of Basel, Basel, Switzerland
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Faculty of Psychology, Open University, Heerlen, the Netherlands
| | - Binia Roth
- Interdisciplinary Pain Consultation, Child and Adolescent Psychiatry of Basel-Landschaft, Binningen, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Helen Koechlin
- Department of Psychosomatics and Psychiatry, University Children’s Hospital Zurich, Zurich, Switzerland
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
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Jackson HJ, Reneau MG, Hande K. A Scoping Review of Measures Utilized to Assess Patient Satisfaction with Acupuncture Treatments Within Randomized Controlled Trials. Med Acupunct 2022; 34:308-315. [PMID: 36311882 PMCID: PMC9595629 DOI: 10.1089/acu.2022.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective Patient satisfaction is an increasing priority for health care facilities in ensuring reimbursement for services, high-quality access to care, and transparent communication. Cumulatively, these metrics guide patient-centered care and facilitate optimal service delivery. The purpose of this scoping review was to evaluate measures of patient satisfaction with acupuncture treatments. Materials and Methods This scoping review was guided by the Arksey and O'Malley methodological framework. Analysis was performed based on the multidimensional hierarchical model of perceived service-quality conceptual framework. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement was used to organize included publications and to display search processes in a flow diagram. An academic reference librarian conducted a literature search, using electronic databases that included PubMed,® Cumulative Index to Nursing and Allied Health Literature, EMBASE,® and Web of Science. Results A total of 384 publications were initially identified and screened; 26 met the eligibility criteria and were included in the synthesis. Discrepancies in the use of patient-satisfaction measures among studies were found in only 1 study demonstrating holistic assessment. Conclusions There is a need for consistent measurement of patient satisfaction with acupuncture treatments. Future studies may evaluate development of a satisfaction tool to measure patient satisfaction with acupuncture treatments comprehensively.
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Affiliation(s)
- Heather J. Jackson
- Vanderbilt School of Nursing and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Karen Hande
- Vanderbilt School of Nursing and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
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Nakajima D, Mihara T, Hijikata T, Tomita M, Goto T. Effectiveness of acupuncture therapy for preventing emergence agitation in children: A protocol for systematic review and meta-analysis with trial sequential analysis. PLoS One 2022; 17:e0264197. [PMID: 35349573 PMCID: PMC8963563 DOI: 10.1371/journal.pone.0264197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 01/31/2022] [Indexed: 11/23/2022] Open
Abstract
Pain, autonomic distress, and emergence agitation occur commonly in children undergoing general anesthesia. While acupuncture therapy has been reported to effectively reduce such pain and autonomic distress in children, its effect in preventing emergence agitation remains unclear. Therefore, we will conduct a systematic review and meta-analysis with trial sequential analysis to evaluate the effect of acupuncture therapy in preventing emergence agitation in children undergoing general anesthesia. Methods and analysis This protocol was prepared according to the 2015 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for Protocols guidelines. We will conduct a search for randomized controlled trials that evaluated the effect of acupuncture therapy in preventing emergence agitation. The following databases will be searched for relevant articles: MEDLINE, CENTRAL, Embase, and Web of Science; four pre-registration sites will be accessed from inception to April 1, 2021. No language restrictions will be applied. Two authors will independently scan and select eligible studies, extract the data, and assess the risk of bias. The incidence of emergence agitation will be combined as a risk ratio with a 95% confidence interval using a random-effect model. The I2 statistics will be used to assess heterogeneity. We will evaluate the quality of the clinical trials using the Cochrane methodology and assess the quality of evidence using the Grading of Recommendation Assessment, Development, and Evaluation approach. If appropriate, a trial sequential analysis will be performed. Expected outcomes This meta-analysis will be the first to evaluate the effect of acupuncture therapy in preventing emergence agitation in children. The findings from this meta-analysis have the potential to reveal pivotal factors that affect the clinical effect of acupuncture therapy, thereby supporting the optimization of acupuncture therapy for emergence agitation. Protocol registration University Hospital Medical Information Network Clinical Trials Registry (UMIN000040775).
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Affiliation(s)
- Daisuke Nakajima
- Department of Health Data Science, Yokohama City University Graduate School of Data Science, Yokohama, Japan
| | - Takahiro Mihara
- Department of Health Data Science, Yokohama City University Graduate School of Data Science, Yokohama, Japan
| | - Toshiyuki Hijikata
- Department of Health Data Science, Yokohama City University Graduate School of Data Science, Yokohama, Japan
| | - Makoto Tomita
- Department of Health Data Science, Yokohama City University Graduate School of Data Science, Yokohama, Japan
| | - Takahisa Goto
- Department of Anesthesiology, Yokohama City University, School of Medicine, Yokohama, Japan
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Wang J, Zhang J, Sun D. Randomized Crossover Study of Auricular Plaster Therapy to Relieve Dental Anxiety in Children. Front Psychiatry 2022; 13:862575. [PMID: 35711607 PMCID: PMC9193370 DOI: 10.3389/fpsyt.2022.862575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine if auricular plaster therapy (APT) can alleviate dental anxiety in children aged 9 or 10 years old. METHODS A crossover research was conducted on children with at least two deep-arrested deciduous molar caries (N = 80?). The first group (N = 40) received APT intended to reduce anxiety prior to the first caries treatment, whereas the second group (N = 40) received placebo/control APT (no anticipated impact on anxiety). The APT approaches were exchanged after a washout period following the initial caries treatment. Additionally, both groups were also informed and given a demonstration regarding the procedures and equipment prior to their use as part of a Tell-Show-Do (TSD) protocol. The dentists, children, and parents were all involved in assessing the level of anxiety using general anxiety scales. Moreover, the average heart rate and salivary cortisol concentration, both of which are indications of anxiety, were compared between the pre- and post-intervention periods. The participants were unaware of the type of APT that was employed (anti-anxiety vs. control). To avoid inadvertently influencing the outcome, all psychologists, investigators, and data recorders were blinded to the randomized subject sequence. RESULTS Children treated with anti-anxiety APT demonstrated significantly higher levels of obedience than children treated with control APT (P < 0.05). In addition, children treated with APT had a lower average heart rate while awaiting treatment, undergoing local anesthesia, and receiving dental caries treatment (P < 0.05). These children had reduced salivary cortisol levels while awaiting treatment (P < 0.05). CONCLUSION Anti-anxiety APT can help relieve dental anxiety in children.
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Affiliation(s)
- Jiangtao Wang
- Department of Psychiatry, Xi'an Union Hospital, Xi'an, China.,Psychological Medicine Center, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, Xinjiang, China
| | - Jie Zhang
- Central Laboratory, School of Public Health, Xinjiang Medical University, Ürümqi, China
| | - Dalei Sun
- Stomatology Center, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China.,Departments of Pediatric Dentistry, Oral Health, and Preventive Dentistry, The First Affiliated Hospital of Xinjiang Medical University (Affiliated Stomatology Hospital), Research Institute of Stomatology, Xinjiang Uygur Autonomous Region, Ürümqi, China
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Sandhyarani B, Pawar RR, Patil AT, Kevadia MV. Effect of Low-level Laser on LI4 Acupoint in Pain Reduction during Local Anesthesia in Children. Int J Clin Pediatr Dent 2021; 14:462-466. [PMID: 34824496 PMCID: PMC8585907 DOI: 10.5005/jp-journals-10005-1995] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Pain is a multidimensional construct that involves sensory, emotional, and cognitive processes. It is an essential component of child behavior guidance. The injection of a local anesthetic agent during pediatric dental treatment is one of the most painful and distressing procedures performed, stimulation of acupoint LI4 provides an analgesic effect in the orofacial region, thus decreasing the pain during injection. Aims and objectives To compare and evaluate the effect of low-level laser on LI4 acupoint and surface-acting 20% benzocaine gel during local anesthesia. Materials and methods Children of age-group between 5 years and 9 years receiving bilateral local anesthesia were scheduled for dental treatment. Split-mouth cross-over study was planned and was divided into two groups, receiving low-level laser acupuncture on LI4 acupoint with placebo as a moist cotton swab in the first visit and 20% benzocaine gel with placebo as low-level laser acupuncture off mode in second visit and vice versa. Pain intensity was evaluated using the sound eye motor scale as subjective scale, Wong–Bakers pain rating scale. Pulse rate was measured before, during, and after the procedure using a pulse oximeter. Results The average heart rate, Wong–Bakers pain rating scale, and Sound Eye Motor scale were significantly lower in the group having low-level laser when compared with the group having placebo low-level laser therapy. Conclusion The low-level laser can be used to control pain during local anesthesia in children. How to cite this article Sandhyarani B, Pawar RR, Patil AT, et al. Effect of Low-level Laser on LI4 Acupoint in Pain Reduction during Local Anesthesia in Children. Int J Clin Pediatr Dent 2021;14(4):462–466.
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Affiliation(s)
- B Sandhyarani
- Department of Pediatric and Preventive Dentistry, Bharati Vidyapeeth Dental College and Hospital, Sangli, Maharashtra, India
| | - Ramoli R Pawar
- Department of Pediatric and Preventive Dentistry, Bharati Vidyapeeth Dental College and Hospital, Sangli, Maharashtra, India
| | - Anil T Patil
- Department of Pediatric and Preventive Dentistry, Bharati Vidyapeeth Dental College and Hospital, Sangli, Maharashtra, India
| | - Mital V Kevadia
- Department of Pediatric and Preventive Dentistry, Bharati Vidyapeeth Dental College and Hospital, Sangli, Maharashtra, India
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Stadler J, Avian A, Pichler G, Posch K, Urlesberger B, Raith W. Laser acupuncture versus oral glucose administration for pain prevention in term neonates: an observer-blinded non-inferiority randomized controlled clinical trial. Acupunct Med 2021; 39:589-595. [PMID: 34088224 DOI: 10.1177/09645284211009544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Neonates undergoing intensive care are routinely submitted to minor painful procedures such as heel lances. Pharmacological treatment is limited in neonatal care and not recommended for minor painful interventions. Hence, non-pharmacological acute pain management is an important subject. Acupuncture could be a new strategy for neonatal pain prevention. Accordingly, the aim of the present study was to investigate whether laser acupuncture is non-inferior to oral sweet solutions in pain prevention. METHODS In total, 96 healthy term neonates were randomly assigned to receive either laser acupuncture with 10 mW at LI4 bilaterally (AG, acupuncture group) or 30% oral glucose solution (GG, glucose group) before heel lance for metabolic screening. The primary outcome was the difference in premature infant pain profile (PIPP) score between groups in a non-inferiority concept. Secondary outcomes were changes in heart rate and crying time. RESULTS Median (interquartile range) PIPP scores were comparable in the AG and GG (12 (10-14) vs 12 (9-14), p = 0.981). Nevertheless, the 95% confidence interval (CI) of location shift exceeded the predefined margin for non-inferiority of 1 (95% CI: -1.000006 to 1.000059). Heart rate was found to be significantly lower after intervention (p = 0.048) and after heel lance (p = 0.015) in the AG versus GG. There was no difference in crying time between groups (p = 0.890). CONCLUSION Laser acupuncture was not shown to be non-inferior to an oral glucose solution, possibly due to the higher than expected variability in PIPP scores within the studied groups. Future neonatal laser acupuncture studies for pain prevention with higher sample sizes are therefore warranted.
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Affiliation(s)
- Jasmin Stadler
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Research Group for Paediatric Traditional Chinese Medicine, TCM Research Centre Graz (Acupuncture Research), Medical University of Graz, Graz, Austria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Graz, Austria
| | - Gerhard Pichler
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Katrin Posch
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Berndt Urlesberger
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Research Group for Paediatric Traditional Chinese Medicine, TCM Research Centre Graz (Acupuncture Research), Medical University of Graz, Graz, Austria
| | - Wolfgang Raith
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Research Group for Paediatric Traditional Chinese Medicine, TCM Research Centre Graz (Acupuncture Research), Medical University of Graz, Graz, Austria
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9
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Erappa U, Konde S, Agarwal M, Peethambar P, Devi V, Ghosh S. Comparative Evaluation of Efficacy of Hypnosis, Acupressure and Audiovisual Aids in Reducing the Anxiety of Children during Administration of Local Anesthesia. Int J Clin Pediatr Dent 2021; 14:S186-S192. [PMID: 35645487 PMCID: PMC9108796 DOI: 10.5005/jp-journals-10005-2113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim The present study aimed to assess and compare the efficacy of acupressure, hypnosis and audiovisual aids in reducing anxiety in children during the administration of local anesthesia (LA). Methodology Two hundred apparently healthy children were selected randomly between 6 and 10 years of age and were divided into 4 groups with 50 children in each group. Group I: children were subjected to hypnosis, group II: acupressure, group III: AV aids i.e., VPT, and group IV: children were the control group where no anxiety-reducing techniques were used during administration of LA. The anxiety scores were recorded at three different time intervals by recording the pulse rate (PR), respiratory rate (RR) and anxiety rate (AR) and subjected to statistical analysis. Results The results showed that, all the three distraction techniques showed a significant reduction in PR, RR and AR at all time intervals, when compared to the control group. A significant reduction in PR, RR and AR was seen in the hypnosis group when compared to acupressure and only PR in comparison to AV aids. There was no significant difference between group II and III in reducing anxiety. Conclusion The present study indicates that all the three distraction techniques were effective in reducing anxiety in children. Hypnosis was most promising, followed by audiovisual aids and acupressure. Clinical significance The techniques can be utilized in a day-to-day practice to manage patients with anxiety. How to cite this article Erappa U, Konde S, Agarwal M, et al. Comparative Evaluation of Efficacy of Hypnosis, Acupressure and Audiovisual Aids in Reducing the Anxiety of Children during Administration of Local Anesthesia. Int J Clin Pediatr Dent 2021;14(S-2):S186-S192.
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Affiliation(s)
- Umadevi Erappa
- Department of Pediatric and Preventive Dentistry, Vydehi Institute of Dental Sciences, Bengaluru, Karnataka, India
| | - Sapna Konde
- Department of Pedodontics, AECS Maaruti College of Dental Sciences and Research Centre, Bengaluru, Karnataka, India
| | - Manisha Agarwal
- Department of Pedodontics, AECS Maaruti College of Dental Sciences and Research Centre, Bengaluru, Karnataka, India
| | - Preetha Peethambar
- Department of Pedodontics and Preventive Dentistry, AECS Maaruti College of Dental Sciences and Research Centre, Bengaluru, Karnataka, India
| | - V Devi
- Department of Pedodontics, Vishnu Dental College, Bengaluru, Karnataka, India
| | - Suryoday Ghosh
- Department of Pediatric and Preventive Dentistry, Bankura Sammilani Medical College and Hospital, Bankura, West Bengal, India
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Salma RG, Alsayeh A, Maneea AB, Alrassan F, Almarshad A. The effectiveness of electronic pulsed soft tissue vibration compared with topical anaesthesia in reducing the pain of injection of local anaesthetics in adults: a randomized controlled split-mouth clinical trial. Int J Oral Maxillofac Surg 2020; 50:407-415. [PMID: 32723512 DOI: 10.1016/j.ijom.2020.07.010] [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: 03/26/2020] [Revised: 05/02/2020] [Accepted: 07/06/2020] [Indexed: 01/21/2023]
Abstract
The purpose of this study was to evaluate the effectiveness of an electronic hand-held pulsed vibration device on the pain of local analgesia (LA) injection and physiologic changes. A prospective randomized controlled clinical trial using split-mouth (crossover) design was implemented. The control-side injection was performed after using topical anaesthesia. The experimental side injection was carried out without topical anaesthesia, but with the aid of a switched-on vibration device. Overall, 332 dental LA injections were given to 166 patients for routine exodontia. The pain at penetration and pain during injection were significantly lower in the experimental sides (vibrations sides) compared with those of the controls (P<0.001). Similarly, the heart rate changes at penetration and during injections were significantly lower in the experimental sides (P<0.001). The vibration device was clinically and statistically more effective than topical anaesthesia in the reduction of dental injection pain in adults, measured subjectively and objectively, regardless of the gender, injection technique (infiltration or block) or anxiety level.
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Affiliation(s)
- R G Salma
- Department of Oral and Maxillofacial Surgery, Riyadh Elm University, Saudi Arabia.
| | - A Alsayeh
- General Dental Practice, Riyadh Elm University, Saudi Arabia
| | - A B Maneea
- General Dental Practice, Riyadh Elm University, Saudi Arabia
| | - F Alrassan
- General Dental Practice, Riyadh Elm University, Saudi Arabia
| | - A Almarshad
- General Dental Practice, Riyadh Elm University, Saudi Arabia
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11
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Chien TJ, Liu CY, Fang CJ, Kuo CY. The maintenance effect of acupuncture on breast cancer-related menopause symptoms: a systematic review. Climacteric 2019; 23:130-139. [PMID: 31612733 DOI: 10.1080/13697137.2019.1664460] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Acupuncture has been used for many breast cancer treatment-related problems, but how long the effect lasts is unknown. This meta-analysis aims to evaluate how long the effect of acupuncture on breast cancer-related hot flushes and menopause symptoms lasts.Methods: The research design followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement, without language restrictions. Seven databases from inception through February 2019 were accessed; only randomized clinical trials (RCTs) that examined the maintenance effect of acupuncture on hot flushes or menopause symptoms after treatment were included. Cochrane criteria were followed and RevMan 5.2 software was used to analyze trials.Results: In total, 943 patients from 13 RCTs were analyzed. The meta-analysis showed that acupuncture had no significant long-term maintenance effect on the frequency or severity of hot flushes (p = 0.29; p = 0.34), but had a significant 3-month maintenance effect of ameliorating menopause symptoms at 3 months after treatment ended (p = 0.001). No adverse events were reported.Conclusions: Acupuncture significantly alleviated menopause symptoms for at least 3 months, but not hot flushes. Breast cancer patients concerned about the adverse effects of hormone therapy could consider acupuncture as an alternative. Additional acupuncture at 3 months after the initial treatment course could be considered. A large-scale study may help to define the optimal guideline for this issue.
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Affiliation(s)
- T-J Chien
- Division of Hemato-Oncology, Department of Internal Medicine, Branch of Zhong-Zhou and Jen-Ai, Taipei City Hospital, Taipei, Taiwan.,Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan
| | - C-Y Liu
- Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,School of Chinese Medicine, China Medical University, Taichung, Taiwan.,Flourish Traditional Chinese Medicine Clinic, Taipei, Taiwan
| | - C-J Fang
- Medical Library, National Cheng Kung University, Tainan, Taiwan.,Department of Secretariat, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - C-Y Kuo
- Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan
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12
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Lin YC, Perez S, Tung C. Acupuncture for pediatric pain: The trend of evidence-based research. J Tradit Complement Med 2019; 10:315-319. [PMID: 32695647 PMCID: PMC7365776 DOI: 10.1016/j.jtcme.2019.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/14/2019] [Accepted: 08/16/2019] [Indexed: 11/26/2022] Open
Abstract
Background and aim Acupuncture is part of thousand years Traditional Chinese Medicine. There was promising evidence to support the efficacy of acupuncture in reducing postoperative surgery and dental pain, as well as chemotherapy-related nausea and vomiting. The US National Health Statistics Report indicated that there was significant increase in the use of acupuncture. Research on acupuncture has allowed for its integration into common adult pain practice. Acupuncture can also be utilized in pediatric patients. Experimental procedure We evaluate the evidence-based acupuncture for pediatric pain research from 2008 to 2017. Results and Conclusions: Acupuncture treatment is well supported to be effective treatment for pediatric procedural pain, infantile colic, adolescent pelvic pain, and headaches under specific intervention methods. There is increasing interest in using acupuncture and related techniques for pediatric pain management. However, the evidence-based randomized controlled trials using acupuncture for pediatric pain management is very limited. Further randomized controlled trial research in pediatric pain is urgently needed.
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Affiliation(s)
- Yuan-Chi Lin
- Medical Acupuncture Service, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, USA
| | - Sierra Perez
- Medical Acupuncture Service, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, USA
| | - Cynthia Tung
- Medical Acupuncture Service, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, USA
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13
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Stadler J, Raith W, Mileder LP, Schmölzer GM, Urlesberger B. Invasive and non-invasive acupuncture techniques for pain management in neonates: a systematic review. Acupunct Med 2019; 37:201-210. [PMID: 31271304 DOI: 10.1136/acupmed-2017-011549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Neonatal pain is an extensive research field and there are many possibilities to treat pain in neonates. Acupuncture is one new and non-pharmacological option and a promising tool to reduce pain in neonates undergoing minor painful interventions during routine medical care. OBJECTIVES This review summarises trials of acupuncture for pain reduction in neonates undergoing painful interventions during routine medical care. DATA SOURCE MEDLINE, Embase, CINAHL, electronic clinical trials registry platforms and reference lists were systematically screened for trials from their dates of inception to February 2017 (English language database search). STUDY SELECTION Inclusion criteria were (1) preterm or term neonates, (2) acupuncture for painful medical interventions and (3) formal pain assessment as a primary or secondary study outcome. We included only randomised controlled trials. DATA EXTRACTION Data were extracted using a standardised protocol and individual risk of bias was assessed. RESULTS The literature search revealed a total of 12 196 records. After application of inclusion criteria, five studies were included in this review. Two studies demonstrated significant pain reduction, one found equal outcomes in comparison to standard care, and two showed significantly higher pain scores with acupuncture alone. LIMITATIONS The main limitation of the results is the heterogeneity across trials in acupuncture modality, acupuncture point selection, control groups and pain assessment (heterogeneity: I2=87%). CONCLUSION The results of this review suggest that acupuncture may have a positive pain-relieving effect in neonates. However, due to the low number of available high-quality trials and heterogeneity across the studies it is not possible to state clear recommendations.
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Affiliation(s)
- Jasmin Stadler
- 1 Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,2 Research Group for Paediatric Traditional Chinese Medicine, TCM Research Center Graz (Acupuncture Research), Medical University of Graz, Graz, Austria
| | - Wolfgang Raith
- 1 Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,2 Research Group for Paediatric Traditional Chinese Medicine, TCM Research Center Graz (Acupuncture Research), Medical University of Graz, Graz, Austria
| | - Lukas P Mileder
- 1 Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Georg M Schmölzer
- 3 Department of Paediatrics, University of Alberta, Edmonton, Alberta, Canada.,4 Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Berndt Urlesberger
- 1 Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,2 Research Group for Paediatric Traditional Chinese Medicine, TCM Research Center Graz (Acupuncture Research), Medical University of Graz, Graz, Austria
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14
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Hegde KM, R N, Srinivasan I, D R MK, Melwani A, Radhakrishna S. Effect of vibration during local anesthesia administration on pain, anxiety, and behavior of pediatric patients aged 6-11 years: A crossover split-mouth study. J Dent Anesth Pain Med 2019; 19:143-149. [PMID: 31338420 PMCID: PMC6620534 DOI: 10.17245/jdapm.2019.19.3.143] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/07/2019] [Accepted: 06/17/2019] [Indexed: 11/23/2022] Open
Abstract
Background Uncooperative behavior of children due to dental anxiety may interfere with the effective delivery of dental care and compromise the quality of treatment provided. Injection of local anesthesia is one of the most anxiety-inducing stimuli in pediatric dentistry. This study aimed to compare the efficacy of a child-friendly device, having a combined effect of vibration and distraction, with the conventional method of injection on pain, anxiety, and behavior of pediatric patients aged 6–11 years. Methods This randomized, crossover, split-mouth study included 30 children requiring a bilateral inferior alveolar nerve block. The children were equally divided into two groups: group 1, aged 6–8 and group 2, aged 9–11 years. All children were injected with anesthesia using the conventional and device method in two separate sessions. They were assessed for anxiety by measuring the pulse rate before and during the administration of local anesthesia. Behavior was assessed using Faces, Legs, Activity, Cry, Consolability (FLACC) scale, and the child's experience while receiving anesthesia was assessed using the Wong Bakers Pain Rating Scale. Results Results showed that the children who received local anesthesia using the device method had a lower mean pulse rate, FLACC scores, and pain rating scores than those who received local anesthesia using the conventional method. Conclusion The device method was more effective than the conventional method in managing pain, anxiety, and behavior of patients aged 6–11 years. The device is a cost effective, simple, and child-friendly product for administrating local anesthesia in pediatric patients.
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Affiliation(s)
- Kuthpady Manasa Hegde
- Department of Pediatric ad Preventive Dentistry, MR Ambedkar Dental College and Hospital, Bengaluru, Karnataka, India
| | - Neeraja R
- Department of Pediatric ad Preventive Dentistry, MR Ambedkar Dental College and Hospital, Bengaluru, Karnataka, India
| | - Ila Srinivasan
- Department of Pediatric ad Preventive Dentistry, MR Ambedkar Dental College and Hospital, Bengaluru, Karnataka, India
| | - Murali Krishna D R
- Department of Pediatric ad Preventive Dentistry, MR Ambedkar Dental College and Hospital, Bengaluru, Karnataka, India
| | - Anjana Melwani
- Department of Pediatric ad Preventive Dentistry, MR Ambedkar Dental College and Hospital, Bengaluru, Karnataka, India
| | - Sreeraksha Radhakrishna
- Department of Pediatric ad Preventive Dentistry, MR Ambedkar Dental College and Hospital, Bengaluru, Karnataka, India
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Murg K, Raith W, Urlesberger B. Use of Acupuncture in an Infant with Restlessness and Agitation. MEDICINES 2018; 5:medicines5020055. [PMID: 29899266 PMCID: PMC6023510 DOI: 10.3390/medicines5020055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 06/07/2018] [Accepted: 06/11/2018] [Indexed: 11/24/2022]
Abstract
Abstract: Background: We are reporting here about a 3-month-old boy with a history of failure to thrive, hypertrophic obstructive cardiomyopathy and neurological misbehaviour including hypotension in body muscles, who was found to have screaming attacks, agitation and restlessness. Methods/Results: Body and ear acupuncture was used both as supporting and integrative therapy to reduce the phases of restlessness and screaming and, simultaneously, the use of hypnotic drugs, as well as to improve the baby’s thriving. Conclusions: Our case has proved that standardised ear and body acupuncture applied by trained acupuncturist paediatricians is a helpful non-pharmacological treatment tool. While acupuncture is typically used in the outpatient setting, it can equally be used in the inpatient setting, as exemplified by the positive outcome of the presented case.
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Affiliation(s)
- Katharina Murg
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz 8036, Austria.
| | - Wolfgang Raith
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz 8036, Austria.
- Research Group for Paediatric Traditional Chinese Medicine, TCM Research Centre Graz, Medical University of Graz, Graz 8036, Austria.
| | - Berndt Urlesberger
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz 8036, Austria.
- Research Group for Paediatric Traditional Chinese Medicine, TCM Research Centre Graz, Medical University of Graz, Graz 8036, Austria.
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16
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Comparing the effects of acupressure at LI4 and BL32 points on intramuscular injection pain. Eur J Integr Med 2017. [DOI: 10.1016/j.eujim.2017.01.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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