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Dusseljee-Peute LW, Van der Togt R, Jansen B, Jaspers MW. The Value of Radio Frequency Identification in Quality Management of the Blood Transfusion Chain in an Academic Hospital Setting. JMIR Med Inform 2019; 7:e9510. [PMID: 31381503 PMCID: PMC6699112 DOI: 10.2196/medinform.9510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 08/19/2018] [Accepted: 10/05/2018] [Indexed: 11/21/2022] Open
Abstract
Background A complex process like the blood transfusion chain could benefit from modern technologies such as radio frequency identification (RFID). RFID could, for example, play an important role in generating logistic and temperature data of blood products, which are important in assessing the quality of the logistic process of blood transfusions and the product itself. Objective This study aimed to evaluate whether location, time stamp, and temperature data generated in real time by an active RFID system containing temperature sensors attached to red blood cell (RBC) products can be used to assess the compliance of the management of RBCs to 4 intrahospital European and Dutch guidelines prescribing logistic and temperature constraints in an academic hospital setting. Methods An RFID infrastructure supported the tracking and tracing of 243 tagged RBCs in a clinical setting inside the hospital at the blood transfusion laboratory, the operating room complex, and the intensive care unit within the Academic Medical Center, a large academic hospital in Amsterdam, the Netherlands. The compliance of the management of 182 out of the 243 tagged RBCs could be assessed on their adherence to the following guidelines on intrahospital storage, transport, and distribution: (1) RBCs must be preserved within an environment with a temperature between 2°C and 6°C; (2) RBCs have to be transfused within 1 hour after they have left a validated cooling system; (3) RBCs that have reached a temperature above 10°C must not be restored or must be transfused within 24 hours or else be destroyed; (4) unused RBCs are to be returned to the BTL within 24 hours after they left the transfusion laboratory. Results In total, 4 blood products (4/182 compliant; 2.2%) complied to all applicable guidelines. Moreover, 15 blood products (15/182 not compliant to 1 out of several guidelines; 8.2%) were not compliant to one of the guidelines of either 2 or 3 relevant guidelines. Finally, 148 blood products (148/182 not compliant to 2 guidelines; 81.3%) were not compliant to 2 out of the 3 relevant guidelines. Conclusions The results point out the possibilities of using RFID technology to assess the quality of the blood transfusion chain itself inside a hospital setting in reference to intrahospital guidelines concerning the storage, transport, and distribution conditions of RBCs. This study shows the potentials of RFID in identifying potential bottlenecks in hospital organizations’ processes by use of objective data, which are to be tackled in process redesign efforts. The effect of these efforts can subsequently be evaluated by the use of RFID again. As such, RFID can play a significant role in optimization of the quality of the blood transfusion chain.
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Affiliation(s)
- Linda W Dusseljee-Peute
- Academic Medical Center- Amsterdam, Department of Medical Informatics, University of Amsterdam, Amsterdam, Netherlands
| | - Remko Van der Togt
- Academic Medical Center- Amsterdam, Department of Medical Informatics, University of Amsterdam, Amsterdam, Netherlands
| | - Bas Jansen
- Academic Medical Center- Amsterdam, Department of Medical Informatics, University of Amsterdam, Amsterdam, Netherlands
| | - Monique W Jaspers
- Academic Medical Center- Amsterdam, Department of Medical Informatics, University of Amsterdam, Amsterdam, Netherlands
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Frietsch T, Thomas D, Schöler M, Fleiter B, Schipplick M, Spannagl M, Knels R, Nguyen X. Administration Safety of Blood Products - Lessons Learned from a National Registry for Transfusion and Hemotherapy Practice. Transfus Med Hemother 2017; 44:240-254. [PMID: 28924429 DOI: 10.1159/000453320] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 10/28/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Compared to blood component safety, the administration of blood may not be as safe as intended. The German Interdisciplinary Task Force for Clinical Hemotherapy (IAKH) specialized registry for administration errors of blood products was chosen for a detailed analysis of reports. METHODS Voluntarily submitted critical incident reports (n = 138) from 2009 to 2013 were analyzed. RESULTS Incidents occurred in the operation room (34.1%), in the ICU (25.2%), and in the peripheral ward (18.5%). Procedural steps with errors were administration to the patient (27.2%), indication and blood order (17.1%), patient identification (17.1%), and blood sample withdrawal and tube labeling (18.0%). Bedside testing (BST) of blood groups avoided errors in only 2.6%. Associated factors were routine work conditions (66%), communication error (36%), emergency case (26%), night or weekend team (39%), untrained personnel (19%). Recommendations addressed process and quality (n = 479) as well as structure quality (n = 314). In 189 instances, an IT solution would have helped to avoid the error. CONCLUSIONS The administration process is prone to errors at the patient assessment for the need to transfuse and the application of blood products to patients. BST is only detecting a minority of handling errors. According to the expert recommendations for practice improvement, the potential to improve transfusion safety by a technical solution is considerable.
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Affiliation(s)
- Thomas Frietsch
- Department of Anesthesiology and Critical Care Medicine, Diakonissenkrankenhaus Mannheim, Teaching Hospital of the University Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Daffyd Thomas
- Department of Anaesthesia and Critical Care, Morriston Hospital, Swansea, Wales, UK
| | - Michael Schöler
- Department of Anesthesiology and Surgical Intensive Care Medicine, University Medical Center Mannheim, Mannheim, Germany
| | | | - Martin Schipplick
- Department of Anesthesiology and Critical Care Medicine, Krankenhaus Leonberg, Leonberg, Germany
| | - Michael Spannagl
- Department of Hemostasis and Transfusion Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Ralf Knels
- Medical Care Center Dresden, Labor Moebius, Dresden, Germany
| | - Xuan Nguyen
- Duc's Laboratories, Amita Monestry, Mannheim, Germany
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Radio Frequency Identification (RFID) in Health Care: Privacy and Security Concerns Limiting Adoption. J Med Syst 2014; 38:19. [DOI: 10.1007/s10916-014-0019-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 02/24/2014] [Indexed: 10/25/2022]
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Py JY, Daurat G. La place de l’informatique dans l’activité transfusionnelle et son évolution – Panorama 2013. Transfus Clin Biol 2013; 20:243-8. [DOI: 10.1016/j.tracli.2013.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 03/27/2013] [Indexed: 11/15/2022]
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Hohberger C, Davis R, Briggs L, Gutierrez A, Veeramani D. Applying radio-frequency identification (RFID) technology in transfusion medicine. Biologicals 2012; 40:209-13. [PMID: 22079476 DOI: 10.1016/j.biologicals.2011.10.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 10/18/2011] [Indexed: 10/15/2022] Open
Abstract
ISO/IEC 18000-3 mode 1 standard 13.56 MHz RFID tags have been accepted by the International Society for Blood Transfusion (ISBT) and the United States Food and Drug Administration (FDA) as data carriers to integrate with and augment ISBT 128 barcode data carried on blood products. The use of 13.56 MHz RFID carrying ISBT 128 data structures allows the global deployment and use of RFID, supporting both international transfer of blood and international disaster relief. The deployment in process at the BloodCenter of Wisconsin and testing at the University of Iowa Health Center is the first FDA-permitted implementation of RFID throughout in all phases of blood banking, donation through transfusion. RFID technology and equipment selection will be discussed along with FDA-required RF safety testing; integration with the blood enterprise computing system and required RFID tag performance. Tag design and survivability is an issue due to blood bag centrifugation and irradiation. Deployment issues will be discussed. Use of RFID results in significant return on investment over the use of barcodes in the blood center operations through labor savings and error reduction.
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Lartigue B, Catillon E. [Qualitative evaluation of blood products records in a hospital]. Transfus Clin Biol 2012; 19:11-6. [PMID: 22261347 DOI: 10.1016/j.tracli.2011.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 06/26/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE OF THE STUDY This study aimed at evaluating the qualitative performance of blood products traceability from paper and electronic medical records in a hospital. STUDY DESIGN Quality of date/time documentation was assessed by detection, for 20minutes or more, of chronological errors and inter-source inconsistencies, in a random sample of 168 blood products transfused during 2009. RESULTS A receipt date/time was confirmed in 52% of paper records; a data entry error was attested in 25% of paper records, and 21% of electronic records. A transfusion date/time was notified in 93% of paper records, with a data entry error in 26% of paper records and 25% of electronic records. The patient medical record held at least one date/time error in 18% and 17%, for receipt and transfusion respectively. Environmental factors (clinical setting, urgency, blood product category) did not contributed to data error rates. CONCLUSION Although blood products traceability has good quantitative results, the recorded documentation is not qualitative. In our study, data entry errors are similar in electronic or paper records, but the global failure rate is lesser in electronic records because omissions are controlled.
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Affiliation(s)
- B Lartigue
- Unité d'hémovigilance, CHU, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
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Kozma N, Speletz H, Reiter U, Lanzer G, Wagner T. Impact of 13.56-MHz radiofrequency identification systems on the quality of stored red blood cells. Transfusion 2011; 51:2384-90. [DOI: 10.1111/j.1537-2995.2011.03169.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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van der Togt R, Bakker PJ, Jaspers MW. A framework for performance and data quality assessment of Radio Frequency IDentification (RFID) systems in health care settings. J Biomed Inform 2011; 44:372-83. [DOI: 10.1016/j.jbi.2010.12.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2010] [Revised: 11/21/2010] [Accepted: 12/13/2010] [Indexed: 12/13/2022]
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Davis R, Gottschall J, Gutierrez A, Hohberger C, Veeramani D, Holcombe J. Absence of acute adverse in-vitro effects on AS-1 RBCs and whole blood-derived platelets following prolonged exposure to 13.56 MHz radio energy. Transfusion 2011; 50:1596-603. [PMID: 21175470 DOI: 10.1111/j.1537-2995.2010.02733.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is growing interest in radio frequency identification (RFID) technology application for tracking blood products to achieve higher productivity and safety in the transfusion medicine supply chain. We have conducted a limited study to assess the temperature and biological effects of 13.56 MHz RF radiation on RBCs and whole blood-derived platelets (WBDP) under extreme exposure conditions. STUDY DESIGN AND METHODS Using an FDA-approved protocol, test units of both RBC and WBDP were subjected to approximately 100 watts of RF energy for an extended duration (23-25 h) to assess worst-case effects. Three replications of the test were performed. RESULTS Hemolysis after 23-25 hours of RF energy exposure was 0.09% and 0.05%, respectively, for TEST and CONTROL RBC units and well within the ≤1% limit in the FDA-approved acceptance criteria. For WBDP units, the mean pH of TEST and CONTROL units were 7.27 and 7.19, respectively, following 23-25 hours of RF energy exposure, and well above the ≥6.2 acceptance limit. Further, there was no detectable acceleration in cellular degradation of RBC and WBDP products. While there was minimal temperature rise, the relative temperature increase between TEST and CONTROL units never exceeded the 1.5°C acceptance criterion. CONCLUSIONS 13.56 MHz-based RFID technology is unlikely to have any significant temperature or biological effects on RBC and WBDP units under the normal operating conditions (a maximum of 4 watts RF power exposure for about 20 nonconsecutive minutes for RFID tracking during the life of the blood product).
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Affiliation(s)
- Rodeina Davis
- BloodCenter of Wisconsin, Milwaukee, Wisconsin 53233, USA.
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Patients' positive identification systems. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2010; 7:313-8. [PMID: 20011643 DOI: 10.2450/2009.0001-09] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Accepted: 01/15/2009] [Indexed: 11/21/2022]
Abstract
BACKGROUND Blood safety must be maintained throughout the whole transfusion chain to prevent the transfusion of incorrect blood components. The estimated risk of an incorrect transfusion is in the order of 1 per 10,000 units of blood. Although several kinds of errors contribute to "wrong blood" events, 70% of errors occur in clinical areas with the most common being due to failure of the pre-transfusion bedside checking procedure. MATERIALS AND METHODS Several methods are available to reduce such errors. The I-TRAC Plus system by Immucor consists of an identification bracelet which is a bar-coded wristband and a handheld portable computer that identifies patients and blood bags by a scanner and prints the information through a portable printer. The labels attached on the blood order forms and on the sample tubes are read and recorded in the blood bank's informatics system (EmoNet INSIEL). Labels showing the bar-code of the assigned number, which includes the ID number of the patient, the ID number of the unit and a code identifying the kind of product and use (allogeneic or autologous), are generated and applied to the blood components. The transfusions are administered after checking the unit and the patient's wristband using the scanner of a portable PC. RESULTS In 5 years a total of 71,400 units of blood components were transfused to 15,430 patients using the I-TRAC Plus system. The system prevented 12 cases of mis-identification of patients (5 in 2003, 0 in 2004, 1 in 2005, 1 in 2006 and 5 in 2007). CONCLUSIONS In 2003 we introduced the use of a bar-code matching system between a patient's wristband and the blood bag to avoid mistakes at the bedside. In 5 years the system provided benefits by avoiding errors in the identification of patients, thus preventing "wrong blood" transfusions.
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Jones E, Henry M, Cochran D, Frailey T. RFID Pharmaceutical Tracking: From Manufacturer Through In Vivo Drug Delivery. J Med Device 2009. [DOI: 10.1115/1.4000495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Advances in medical technology rely heavily on the collection and analysis of measured data to facilitate patient diagnosis and business decisions. The healthcare industry, particularly pharmaceuticals and diagnostic processes, has an ongoing need to improve item tracking and data collection to improve the quality of care while reducing cost. The remote, non-invasive characteristics of radio frequency identification (RFID) can facilitate the information needs of healthcare without imposing additional burden onto the patient or the staff. Properly deployed RFID enabled devices can provide convenient and accurate data for disease diagnosis, evaluation of prescription noncompliance, and identification of medication dosage errors. This paper describes an overview of the concept of an all-encompassing RFID pharmaceutical tracking system that begins with compliance documentation from the drug manufacturer and continues through the confirmation of patient compliance by capsule extraction from the bottle into a pill case and ultimately ingested or inserted into the body. This system also facilitates compliance with Food and Drug Administration proposed e-pedigree requirements and provides data for healthcare decision making. An introduction to healthcare trends is provided in order to communicate the need for such a biocompatible RFID pharmaceutical tracking system. Also presented in this paper is the overall scope of research and in vitro test method to develop biocompatible RFID tag components for use in a “pharmaceutical supply chain system” beginning with the manufacturer, continuing through distribution, and ending at the point of interest within the patient’s body.
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Affiliation(s)
- Erick Jones
- Industrial and Management Systems Engineering, University of Nebraska–Lincoln, 175 Nebraska Hall, Lincoln, NE 68588-0518
| | - Marcia Henry
- Department of Biochemistry, Tulane University Health Sciences Center, 1430 Tulane Avenue, New Orleans, LA 70112
| | - David Cochran
- Industrial and Management Systems Engineering, University of Nebraska–Lincoln, 181 Nebraska Hall, Lincoln, NE 68588-0518
| | - Tara Frailey
- Industrial and Management Systems Engineering, University of Nebraska–Lincoln, 175 Nebraska Hall, Lincoln, NE 68588-0518
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Fujii Y, Shibata Y, Miyata S, Inaba S, Asai T, Hoshi Y, Takamatsu J, Takahashi K, Ohto H, Juji T, Sagawa K. Consecutive national surveys of ABO-incompatible blood transfusion in Japan. Vox Sang 2009; 97:240-6. [PMID: 19476605 DOI: 10.1111/j.1423-0410.2009.01199.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Morbidity and mortality from ABO-incompatible transfusion persist as consequences of human error. Even so, insufficient attention has been given to improving transfusion safety within the hospital. MATERIALS AND METHODS National surveys of ABO-incompatible blood transfusions were conducted by the Japanese Society of Blood Transfusion, with support from the Ministry of Health, Labor and Welfare. Surveys concluded in 2000 and 2005 analysed ABO-incompatible transfusion data from the previous 5 years (January 1995 to December 1999 and January 2000 to December 2004, respectively). The first survey targeted 777 hospitals and the second, 1355 hospitals. Data were collected through anonymous questionnaires. RESULTS The first survey achieved a 77.4% response rate (578 of 777 hospitals). The second survey collected data from 251 more hospitals, but with a lower response rate (61.2%, or 829 of 1355 hospitals). The first survey analysed 166 incidents from 578 hospitals, vs. 60 incidents from 829 hospitals in the second survey. The main cause of ABO-incompatible transfusion was identification error between patient and blood product: 55% (91 of 166) in the first survey and 45% (27 of 60) in the second. Patient outcomes included nine preventable deaths from 1995 to 1999, and eight preventable deaths from 2000 to 2004. CONCLUSION Misidentification at the bedside persists as the main cause of ABO-incompatible transfusion.
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Affiliation(s)
- Y Fujii
- Department of Blood Transfusion, Yamaguchi University Hospital, Yamaguchi, Japan.
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A quality initiative to decrease pathology specimen-labeling errors using radiofrequency identification in a high-volume endoscopy center. Am J Gastroenterol 2009; 104:972-5. [PMID: 19259073 DOI: 10.1038/ajg.2008.170] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Our institution has had problems with mislabeling of tissue specimens in our gastrointestinal and colorectal surgery endoscopy units. Most labeling errors have been due to either the wrong patient label or no label being affixed to a specimen bottle. As a result, an initiative was created to reduce the number of specimen-labeling errors. This initiative involved the application of radiofrequency identification (RFID) technology to specimen bottles, moving to a paperless pathology requisition system and confirmation of the correct site and correct patient by both the endoscopy nursing staff and the endoscopist for each specimen bottle. METHODS We reviewed the number of specimen-labeling errors from our endoscopy unit for the first 3 months of 2007, before the implementation of the initiative, and for the first 3 months of 2008, 6 months after the initiation of RFID specimen labeling with paperless requisition and two-provider confirmation of correct site, correct patient specimen labeling. The RFID system we used was an off-the-shelf 3M (St. Paul, MN) Library Sciences RFID system modified and installed for our purposes. Specimen-labeling errors were categorized as Class 1 (only typographical with no potential clinical consequences), Class 2 (minor error, unlikely to have clinical consequences) or Class 3 (significant error that has the potential to detrimentally impact patient care). The Fischer's exact test was used to compare the rate of specimen-bottle labeling errors before and after the initiation of this new system. RESULTS In the first 3 months of 2007, our endoscopy unit sent 8,231 specimen bottles to our pathology laboratory for evaluation; 8,539 bottles were sent in the first 3 months of 2008. There were 646 (7.85%) Class 1 errors in the first quarter of 2007 and 35 (0.41%) in the first quarter of 2008 (P<0.001). There were 112 (1.36%) Class 2 errors in the first quarter of 2007 and 10 (0.12%) in the first quarter of 2008 (P<0.001). Finally, in the first quarter of 2007 there were seven (0.09%) Class 3 errors and in the first quarter of 2008, there were two (0.02%) Class 3 errors. However, with the new system in place, both Class 3 errors in the first quarter of 2008 were recognized and corrected before the processing of the specimens in the pathology laboratory (P=0.001). CONCLUSIONS These data confirm that the initiation of a new specimen-labeling system that uses RFID technology, a paperless requisition process, and confirmation of the correct site and correct patient by two health-care providers significantly decreased specimen-labeling errors at every level in a high-volume endoscopy center.
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Daurat G. Oui, il faut conserver le test d’agglutination ABO dans le contrôle ultime au lit du malade. Transfus Clin Biol 2008; 15:322-6. [DOI: 10.1016/j.tracli.2008.09.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Accepted: 09/05/2008] [Indexed: 10/21/2022]
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