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Arnall JR, Moore DC, Michael M, Wolcott M, Cowgill N. Measuring the Impact of a Pharmacist-Driven Blood Factor Education Program: A Prospective, Single-Center Observational Study. Hosp Pharm 2023; 58:282-288. [PMID: 37216073 PMCID: PMC10192995 DOI: 10.1177/00185787221137901] [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: 06/04/2024]
Abstract
Introduction: Patients with bleeding disorders are best served by multidisciplinary teams. Pharmacists can play a critical role in the optimal management of patients with bleeding disorders through blood factor stewardship strategies and programs. An educational program was developed and implemented wherein a hematology pharmacist provided brief recorded lectures to an entire department of pharmacists in a multi-site health-system with the goal to improve the knowledge base and confidence among this population of general practitioners. Methods: The primary objective of this study was to evaluate the educational outcomes of a blood factor education program for pharmacists. The impact of the educational program was determined by measuring the difference in mean test scores between the pre- and post-program surveys. Results: The final analysis included 214 participants. The primary endpoint of mean competency test score was significantly improved in the post-test compared to pre-test (78.33% vs 52.83%; P < .0001). Any degree of test score improvement was observed in 99% (n = 212) of participants. Pharmacist confidence was significantly improved in all 20 domains of bleeding disorders and blood factor product verification and management. Conclusion: This program identified that most pharmacists in a large multi-site health-system were not familiar with bleeding disorders to a satisfactory degree, commonly because of the relative rare encounters with bleeding disorder-related orders, and that despite systems-based support there was an opportunity to improve practice through education. Such educational programming could be beneficial for the development of pharmacist-provided care and is a measure that could be implemented as part of blood factor stewardship initiatives.
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Affiliation(s)
- Justin R Arnall
- Specialty Pharmacy Servivce, Atrium
Health, Charlotte, NC, USA
| | - Donald C Moore
- Levine Cancer Institute, Atrium Health,
Concord, NC, USA
| | - Meghan Michael
- Specialty Pharmacy Servivce, Atrium
Health, Charlotte, NC, USA
| | - Michael Wolcott
- High Point University Fred Wilson
School of Pharmacy, High Point, NC, USA
| | - Nicole Cowgill
- Specialty Pharmacy Servivce, Atrium
Health, Charlotte, NC, USA
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2
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Dane KE, Naik RP, Streiff MB, Yui J, Shanbhag S, Nesbit TW, Lindsley J. Hemostatic and Antithrombotic Stewardship Programs: A Toolkit for Program Implementation. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1614] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Kathryn E. Dane
- The Johns Hopkins Hospital, Department of Pharmacy Baltimore Maryland
| | - Rakhi P. Naik
- The Johns Hopkins School of Medicine, Department of Medicine, Division of Hematology Baltimore Maryland
| | - Michael B. Streiff
- The Johns Hopkins School of Medicine, Department of Medicine, Division of Hematology Baltimore Maryland
| | - Jennifer Yui
- The Johns Hopkins School of Medicine, Department of Medicine, Division of Hematology Baltimore Maryland
| | | | - Todd W. Nesbit
- The Johns Hopkins Hospital, Department of Pharmacy Baltimore Maryland
| | - John Lindsley
- The Johns Hopkins Hospital, Department of Pharmacy Baltimore Maryland
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3
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PHarmacist Avoidance or Reductions in Medical Costs in CRITically Ill Adults: PHARM-CRIT Study. Crit Care Explor 2021; 3:e0594. [PMID: 34913039 PMCID: PMC8668016 DOI: 10.1097/cce.0000000000000594] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
To comprehensively classify interventions performed by ICU clinical pharmacists and quantify cost avoidance generated through their accepted interventions. DESIGN A multicenter, prospective, observational study was performed between August 2018 and January 2019. SETTING Community hospitals and academic medical centers in the United States. PARTICIPANTS ICU clinical pharmacists. INTERVENTIONS Recommendations classified into one of 38 intervention categories (divided into six unique sections) associated with cost avoidance. MEASUREMENTS AND MAIN RESULTS Two-hundred fifteen ICU pharmacists at 85 centers performed 55,926 interventions during 3,148 shifts that were accepted on 27,681 adult patient days and generated $23,404,089 of cost avoidance. The quantity of accepted interventions and cost avoidance generated in six established sections was adverse drug event prevention (5,777 interventions; $5,822,539 CA), resource utilization (12,630 interventions; $4,491,318), individualization of patient care (29,284 interventions; $9,680,036 cost avoidance), prophylaxis (1,639 interventions; $1,414,465 cost avoidance), hands-on care (1,828 interventions; $1,339,621 cost avoidance), and administrative/supportive tasks (4,768 interventions; $656,110 cost avoidance). Mean cost avoidance was $418 per intervention, $845 per patient day, and $7,435 per ICU pharmacist shift. The annualized cost avoidance from an ICU pharmacist is $1,784,302. The potential monetary cost avoidance to pharmacist salary ratio was between $3.3:1 and $9.6:1. CONCLUSIONS Pharmacist involvement in the care of critically ill patients results in significant avoidance of healthcare costs, particularly in the areas of individualization of patient care, adverse drug event prevention, and resource utilization. The potential monetary cost avoidance to pharmacist salary ratio employing an ICU clinical pharmacist is between $3.3:1 and $9.6:1.
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Rech MA, Adams W, Smetana KS, Gurnani PK, Van Berkel Patel MA, Peppard WJ, Hammond DA, Flannery AH. PHarmacist Avoidance or Reductions in Medical Costs in Patients Presenting the EMergency Department: PHARM-EM Study. Crit Care Explor 2021; 3:e0406. [PMID: 33912836 PMCID: PMC8078282 DOI: 10.1097/cce.0000000000000406] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To comprehensively classify interventions performed by emergency medicine clinical pharmacists and quantify cost avoidance generated through their accepted interventions. DESIGN A multicenter, prospective, observational study was performed between August 2018 and January 2019. SETTING Community and academic hospitals in the United States. PARTICIPANTS Emergency medicine clinical pharmacists. INTERVENTIONS Recommendations classified into one of 38 intervention categories associated with cost avoidance. MEASUREMENTS AND MAIN RESULTS Eighty-eight emergency medicine pharmacists at 49 centers performed 13,984 interventions during 917 shifts that were accepted on 8,602 patients and generated $7,531,862 of cost avoidance. The quantity of accepted interventions and cost avoidance generated in six established categories were as follows: adverse drug event prevention (1,631 interventions; $2,225,049 cost avoidance), resource utilization (628; $310,582), individualization of patient care (6,122; $1,787,170), prophylaxis (24; $22,804), hands-on care (3,533; $2,836,811), and administrative/supportive tasks (2,046; $342,881). Mean cost avoidance was $538.61 per intervention, $875.60 per patient, and $8,213.59 per emergency medicine pharmacist shift. The annualized cost avoidance from an emergency medicine pharmacist was $1,971,262. The monetary cost avoidance to pharmacist salary ratio was between $1.4:1 and $10.6:1. CONCLUSIONS Pharmacist involvement in the care of patients presenting to the emergency department results in significant avoidance of healthcare costs, particularly in the areas of hands-on care and adverse drug event prevention. The potential monetary benefit-to-cost ratio for emergency medicine pharmacists is between $1.4:1 and $10.6:1.
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Affiliation(s)
- Megan A Rech
- Department of Pharmacy, Loyola University Medical Center, Maywood, IL
- Department of Emergency Medicine, Loyola University Medical Center, Maywood, IL
| | - William Adams
- Department of Biostatistics, Loyola University, Maywood, IL
| | - Keaton S Smetana
- Department of Pharmacy, Ohio State University Medical Center, Columbus, OH
| | - Payal K Gurnani
- Department of Pharmacy, Rush University Medical Center, Chicago, IL
- Department of Internal Medicine, Rush Medical College, Chicago, IL
| | | | - William J Peppard
- Department of Pharmacy, Froedtert Hospital, Milwaukee, WI
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Drayton A Hammond
- Department of Pharmacy, Loyola University Medical Center, Maywood, IL
- Department of Emergency Medicine, Loyola University Medical Center, Maywood, IL
- Department of Biostatistics, Loyola University, Maywood, IL
- Department of Pharmacy, Ohio State University Medical Center, Columbus, OH
- Department of Pharmacy, Rush University Medical Center, Chicago, IL
- Department of Internal Medicine, Rush Medical College, Chicago, IL
- Department of Pharmacy, Erlanger Medical Center, Chattanooga, TN
- Department of Pharmacy, Froedtert Hospital, Milwaukee, WI
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
- Department of Pharmacy, University of Kentucky HealthCare, Lexington, KY
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY
| | - Alexander H Flannery
- Department of Pharmacy, University of Kentucky HealthCare, Lexington, KY
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY
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5
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May JE, Irelan PC, Boedeker K, Cahill E, Fein S, Garcia DA, Hicks LK, Lawson J, Lim MY, Morton CT, Rajasekhar A, Shanbhag S, Zumberg MS, Plovnick RM, Connell NT. Systems-based hematology: highlighting successes and next steps. Blood Adv 2020; 4:4574-4583. [PMID: 32960959 PMCID: PMC7509880 DOI: 10.1182/bloodadvances.2020002947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/10/2020] [Indexed: 12/21/2022] Open
Abstract
Systems-based hematology is dedicated to improving care delivery for patients with blood disorders. First defined by the American Society of Hematology in 2015, the idea of a systems-based hematologist arose from evolving pressures in the health care system and increasing recognition of opportunities to optimize the quality and cost effectiveness of hematologic care. In this review, we begin with a proposed framework to formalize the discussion of the range of initiatives within systems-based hematology. Classification by 2 criteria, project scope and method of intervention, facilitates comparison between initiatives and supports dialogue for future efforts. Next, we present published examples of successful systems-based initiatives in the field of hematology, including efforts to improve stewardship in the diagnosis and management of complex hematologic disorders (eg, heparin-induced thrombocytopenia and thrombophilias), the development of programs to promote appropriate use of hematologic therapies (eg, blood products, inferior vena cava filters, and anticoagulation), changes in care delivery infrastructure to improve access to hematologic expertise (eg, electronic consultation and disorder-specific care pathways), and others. The range of projects illustrates the broad potential for interventions and highlights different metrics used to quantify improvements in care delivery. We conclude with a discussion about future directions for the field of systems-based hematology, including extension to malignant disorders and the need to define, expand, and support career pathways.
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Affiliation(s)
- Jori E May
- Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | | | - David A Garcia
- Division of Hematology, University of Washington, Seattle, WA
| | - Lisa K Hicks
- Division of Hematology/Oncology, Department of Medicine, St. Michael's Hospital and University of Toronto, Toronto, ON, Canada
| | | | - Ming Y Lim
- Division of Hematology and Hematological Malignancies, University of Utah, Salt Lake City, UT
| | - Colleen T Morton
- Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Anita Rajasekhar
- Division of Hematology and Oncology, University of Florida, Gainesville, FL
| | - Satish Shanbhag
- Cancer Specialists of North Florida, Fleming Island, FL; and
| | - Marc S Zumberg
- Division of Hematology and Oncology, University of Florida, Gainesville, FL
| | | | - Nathan T Connell
- Hematology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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6
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Clark SL, Levasseur-Franklin K, Pajoumand M, Barra M, Armahizer M, Patel DV, Wyatt Chester K, Tully AP. Collaborative Management Strategies for Drug Shortages in Neurocritical Care. Neurocrit Care 2020; 32:226-237. [PMID: 31077080 PMCID: PMC7222107 DOI: 10.1007/s12028-019-00730-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Drug shortages have become all too familiar in the health care environment, with over 200 drugs currently on shortage. In the wake of Hurricane Maria in September 2017, hospitals across the USA had to quickly and creatively adjust medication preparation and administration techniques in light of decreased availability of intravenous (IV) bags used for compounding a vast amount of medications. Amino acid preparations, essential for compounding parenteral nutrition, were also directly impacted by the hurricane. Upon realization of the impending drug shortages, hospitals resorted to alternative methods of drug administration, such as IV push routes, formulary substitutions, or alternative drug therapies in hopes of preserving the small supply of IV bags available and prioritizing them for them most critical needs. In some cases, alternative drug therapies were required, which increased the risk of medication errors due to the use of less-familiar treatment options. Clinical pharmacists rounding with medical teams provided essential, patient-specific drug regimen alternatives to help preserve a dwindling supply while ensuring use in the most critical cases. Drug shortages also frequently occur in the setting of manufacturing delays or discontinuation and drug recalls, with potential to negatively impact patient care. The seriousness of the drug shortage crisis reached public attention by December 2017, when political and pharmacy organizations called for response to the national drug shortage crisis. In this article, we review institutional mitigation strategies in response to drug shortages and discuss downstream effects of these shortages, focusing on medications commonly prescribed in neurocritical care patients.
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Affiliation(s)
- Sarah L Clark
- Department of Pharmacy, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | | | - Mehrnaz Pajoumand
- Department of Pharmacy, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD, 21201, USA
| | - Megan Barra
- Department of Pharmacy, Massachusetts General Hospital, 55 Fruit Street GRB-005, Boston, MA, 02114, USA
| | - Michael Armahizer
- Department of Pharmacy, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD, 21201, USA
| | - Deepa V Patel
- Department of Pharmacy, Wellstar Kennestone Hospital, 677 Church Street, Marietta, GA, 30060, USA
| | - Katleen Wyatt Chester
- Department of Pharmacy and Clinical Nutrition, Emory University School of Nursing, Grady Memorial Hospital, 80 Jesse Hill Jr. Drive SE, Atlanta, GA, 30303, USA
| | - Andrea P Tully
- Department of Pharmacy, Christiana Care Health System, 4755 Ogletown-Stanton Rd, Newark, DE, 19718, USA
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7
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Marsh K, Green D, Raco V, Papadopoulos J, Ahuja T. Antithrombotic and hemostatic stewardship: evaluation of clinical outcomes and adverse events of recombinant factor VIIa (Novoseven ®) utilization at a large academic medical center. Ther Adv Cardiovasc Dis 2020; 14:1753944720924255. [PMID: 32449469 PMCID: PMC7249557 DOI: 10.1177/1753944720924255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 04/15/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Recombinant factor VIIa (rFVIIa) (Novoseven®) is utilized for the reversal of anticoagulation-associated bleeding and refractory bleeding in cardiac surgery. In August 2015, rFVIIa was transferred from the blood bank to the pharmacy at New York University (NYU) Langone Health. Concordantly, an off-label dosing guideline was developed. The objective of this study was to describe utilization and cost of rFVIIa and assess compliance to our dosing guideline. METHODS We performed a retrospective, observational review of rFVIIa administrations post-implementation of an off-label dosing guideline. All patients who received rFVIIa between September 2015 and June 2017 were evaluated. For each rFVIIa administration, anticoagulation and laboratory values, indications for use, dosing, ordering and administration times, concomitant blood products, and adverse events were collected. Adverse events included venous thromboembolism, stroke, myocardial infarction, and death due to systemic embolism and mortality. The primary endpoint was the utilization of rFVIIa in accordance with the off-label dosing guideline. Secondary endpoints included hemostatic efficacy of rFVIIa, adverse events, blood products administered, and cost-effectiveness of rFVIIa transition to pharmacy. RESULTS A total of 63 patients [pediatric (n = 6), adult (n = 57)] received rFVIIa, with the majority of use for refractory bleeding after cardiac surgery. The utilization of rVIIa decreased after development of the off-label dosing guideline and transition from blood bank to pharmacy. The total incidence of thromboembolic events within 30 days was 19.6%; 17.6% arterial and 2% venous; 70% of patients with an adverse event were over 70 years of age. Use of rFVIIa reduced the median number of units of blood products administered. CONCLUSION Administration of rFVIIa for cardiac surgery appears to be effective for hemostasis. Transitioning rFVIIa from the blood bank to pharmacy and implementation of a dosing guideline appears to have reduced utilization. Patients receiving rFVIIa should be monitored for thromboembolic events. Elderly patients may be at higher risk for thromboembolic events.
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Affiliation(s)
| | - David Green
- Department of Medicine, Division of Hematology, NYU Langone Health, NY, USA
| | | | | | - Tania Ahuja
- Department of Pharmacy, NYU Langone Health, 550 First Avenue, New York, NY 10016, USA
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8
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Abstract
The approval of several new clotting factor concentrates and anticoagulation antidotes has resulted in increased complexity and cost of care. A multidisciplinary hemostatic stewardship program is essential to optimize utilization of these resources. This article summarizes the authors' approach to the stewardship of clotting factor concentrates and anticoagulation antidotes.
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9
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Hammond DA, Gurnani PK, Flannery AH, Smetana KS, Westrick JC, Lat I, Rech MA. Scoping Review of Interventions Associated with Cost Avoidance Able to Be Performed in the Intensive Care Unit and Emergency Department. Pharmacotherapy 2019; 39:215-231. [PMID: 30664269 DOI: 10.1002/phar.2224] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A framework for evaluating pharmacists' impact on cost avoidance in the intensive care unit (ICU) and emergency department (ED) has not been established. This scoping review was registered (CRD42018091217) and conducted to identify, aggregate, and qualitatively describe the highest quality evidence for cost avoidance generated by clinical pharmacists on interventions performed in an ICU or ED. Searches were conducted in PubMed, Scopus, CINAHL, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews from inception until April 2018. The level of evidence (LOE) for each specific category of intervention was evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation evidence-to-decision framework. The risks of bias for articles were evaluated using Newcastle Ottawa and Cochrane Collaboration tools. The values from all interventions were inflated to 2018 U.S. dollars using the consumer price index for medical care. Of the 464 articles initially identified, 371 were excluded and 93 were included. After reviewing references from the articles included, an additional 71 articles were also reviewed. The 38 cost intervention categories were supported by varying LOEs: IA (0 categories), IB (1 category), IIA (4 categories), IIB (0 categories), III (27 categories), and IV (6 categories), and articles mostly displayed low to moderate risks of bias. Pharmacists generate cost avoidance through a variety of interventions in critically and emergently ill patients. The quality of evidence supporting specific cost avoidance values is generally low. Quantification of and factors associated with the cost avoidance generated from pharmacists caring for these patients are of paramount importance.
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Affiliation(s)
- Drayton A Hammond
- Medical Intensive Care Unit, Rush University Medical Center, Chicago, Illinois
| | - Payal K Gurnani
- Cardiovascular Intensive Care Unit, Rush University Medical Center, Chicago, Illinois
| | - Alexander H Flannery
- Medical Intensive Care Unit, University of Kentucky HealthCare, Lexington, Kentucky
| | - Keaton S Smetana
- Neurosciences Intensive Care Unit, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Ishaq Lat
- Department of Pharmacy, Shirley Ryan AbilityLab, Chicago, Illinois
| | - Megan A Rech
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
- Department of Emergency Medicine, Loyola University Medical Center, Maywood, Illinois
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10
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Wychowski MK, Ruscio CI, Kouides PA, Sham RL. The scope and value of an anticoagulation stewardship program at a community teaching hospital. J Thromb Thrombolysis 2016; 43:380-386. [DOI: 10.1007/s11239-016-1455-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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