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Mishuk AU, Chen L, Li C, Huo N, Hansen RA, Harris I, Kiptanui Z, Qian J. Patient factors associated with oral generic olanzapine initiation and substitution among Medicaid beneficiaries: a new user cohort study. Curr Med Res Opin 2021; 37:655-664. [PMID: 33507825 DOI: 10.1080/03007995.2021.1882413] [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: 10/22/2022]
Abstract
OBJECTIVE Generic drugs typically are less expensive than branded products; however, several factors can limit generic drug utilization. This study assesses the associations of patient factors with generic olanzapine initiation and substitution. METHODS A retrospective new user cohort study was conducted using the 2011-2012 Medicaid administrative claims data. Beneficiaries continuously enrolled during the 6 month washout period prior to their initial oral brand or generic olanzapine prescription were included and followed up to 12 months. Among brand olanzapine new users, time to generic substitution and competing risk outcomes was estimated using the Fine-Gray cumulative incidence function. Patient demographic and health service utilization factors were assessed in the multivariate cause-specific hazards model. RESULTS Among olanzapine new users, 70.7% patients initiated generic treatment. Beneficiaries aged ≥21, and living in the Midwest and West regions were more likely to initiate generic olanzapine. Among brand new users, 28.2% switched to generic olanzapine, 23.6% switched to an alternative atypical antipsychotic treatment and 38.0% discontinued within 12 months. Beneficiaries who resided in urban areas (adjusted hazard ratio [AHR) = 0.53, 95% CI = 0.37-0.75) and had prior hospitalizations (AHR = 0.85, 95% CI = 0.75-0.96) had lower rates of generic substitution, whereas those with emergency department (ED) visits (AHR = 1.06, 95% CI = 1.02-1.10) had a higher rate of generic substitution. In addition, beneficiaries in different age subgroups also had different rates of generic substitution in different regions. CONCLUSION Medicaid beneficiaries' age, geographic region, prior hospitalization and ED utilization were associated with generic olanzapine initiation and substitution. Tailored educational outreach targeting these patient subgroups might improve generic olanzapine utilization.
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Affiliation(s)
| | - Li Chen
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Chao Li
- Auburn University Harrison School of Pharmacy, Auburn, AL, USA
| | - Nan Huo
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Jingjing Qian
- Auburn University Harrison School of Pharmacy, Auburn, AL, USA
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Hamada Y, Uchida M, Arai S, Yamazaki K, Takeda M, Arai K, Nakamura T, Suzuki T, Ishii I. Analysis of patients’ request to switch from a generic drug to the original drug in external prescriptions. J Pharm Health Care Sci 2020; 6:27. [PMID: 33292744 PMCID: PMC7716439 DOI: 10.1186/s40780-020-00180-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/26/2020] [Indexed: 12/04/2022] Open
Abstract
Background Generic drugs are heavily promoted in Japan. The aim of this retrospective single-center study was to clarify whether the frequency and reason that patients request a switch from a generic drug to the original drug differ according to therapeutic category and dosage form. Methods This study was performed at Chiba University Hospital. Prescription inquiries about 121 generic drugs from community pharmacies over a 3-year period (from July 2014 to June 2017) were analyzed. Results Approximately 30% of the requests were related to the efficacy, safety, and comfort of the generic drug. The most cited motive was “patient’s desire with no reason given” at 44.5%. According to multiple logistic regression analysis, therapeutic categories and dosage forms were associated with the requests. The median request frequency differed according to therapeutic category and dosage form. The frequency was highest for “agents affecting the central nervous system” and “tablets and capsules”, respectively. Among the therapeutic categories, “agents affecting the central nervous system” had the highest median number of requests related to “decreased effectiveness”; “cardiovascular agents” had the highest median number of requests related to “physician’s instruction”; and “agents for the epidermis” had the highest median number of requests related to “uncomfortable to use”. Among dosage forms, the odds ratio for patients’ original drug request for “liniment and patch” was about 1.5 times that for “tablets and capsules”. “Liniment and patch” had the highest median frequency of requests related to “decreased effectiveness”, “uncomfortable to use”, and “patient’s desire with no reason given”. Conclusions The request frequency and reason differed according to therapeutic category and dosage form. Pharmacists should advise each patient properly about the choice and switching of drug brands, taking into account the therapeutic category and dosage form, especially liniments and patches.
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Howard JN, Harris I, Frank G, Kiptanui Z, Qian J, Hansen R. Influencers of generic drug utilization: A systematic review. Res Social Adm Pharm 2018; 14:619-627. [PMID: 28814375 PMCID: PMC5910277 DOI: 10.1016/j.sapharm.2017.08.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/23/2017] [Accepted: 08/01/2017] [Indexed: 02/08/2023]
Abstract
INTRODUCTION With an increase in prescription drug spending and rising drug costs there is a need to encourage the use of generic prescription drugs. However, maximizing generic drug use is not possible without the public's positive perception and meeting their informational needs about generic drugs. Thus, improving the public's confidence in, and knowledge of generic drugs on the market is critical. The objective of this systematic review is to examine and evaluate the studies focusing on the nature and extent of key factors influencing generic drug use in the United States in order to help guide policy, education and practice interventions. MATERIALS AND METHODS Using multiple search engines and key word screening criteria, empirical studies published in English between January 1, 2005 and December 31, 2015 were identified. A qualitative synthesis of the evidence identified domains of key factors that influenced generic drug use across studies. RESULTS Over 3000 citations met the key word screening criteria; 67 of these met inclusion criteria for the systematic review. Seven domains of factors that influence generic drug utilization were identified: 1) patient-related factors, 2) formulary management or cost containment, 3) healthcare policies, 4) promotional activities, 5) educational initiatives, 6) technology, and 7) physician-related factors. CONCLUSION Patients, physicians, pharmacists, formulary managers, and policymakers play an important role in generic drug use. Understanding the factors influencing generic drug use can help guide future policy, education, and practice interventions to increase generic drug use.
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Affiliation(s)
- Jennifer N Howard
- IMPAQ International, LLC, 10420 Little Patuxent Parkway, Suite 300, Columbia, MD, 21044, USA.
| | - Ilene Harris
- IMPAQ International, LLC, 10420 Little Patuxent Parkway, Suite 300, Columbia, MD, 21044, USA.
| | - Gavriella Frank
- IMPAQ International, LLC, 10420 Little Patuxent Parkway, Suite 300, Columbia, MD, 21044, USA.
| | - Zippora Kiptanui
- IMPAQ International, LLC, 10420 Little Patuxent Parkway, Suite 300, Columbia, MD, 21044, USA.
| | - Jingjing Qian
- Auburn University Harrison School of Pharmacy, 038 James E. Foy Hall, Auburn, AL, 36849, USA.
| | - Richard Hansen
- Auburn University Harrison School of Pharmacy, 038 James E. Foy Hall, Auburn, AL, 36849, USA.
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Cusack L, Del Mar CB, Chalmers I, Gibson E, Hoffmann TC. Educational interventions to improve people's understanding of key concepts in assessing the effects of health interventions: a systematic review. Syst Rev 2018; 7:68. [PMID: 29716639 PMCID: PMC5930693 DOI: 10.1186/s13643-018-0719-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 03/23/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Health information is readily accessible but is of variable quality. General knowledge about how to assess whether claims about health interventions are trustworthy is not common, so people's health decisions can be ill-informed, unnecessarily costly and even unsafe. This review aims to identify and evaluate studies of educational interventions designed to improve people's understanding of key concepts for evaluating claims about the effects of health interventions. METHODS/DESIGN We searched multiple electronic databases and sources of grey literature. Inclusion criteria included all study types that included a comparison, any participants (except health professionals or health professional students) and educational interventions aimed at improving people's understanding of one or more of the key concepts considered necessary for assessing health intervention claims. Knowledge and/or understanding of concepts or skills relevant to evaluating health information were our primary outcome measures. Secondary outcomes included behaviour, confidence, attitude and satisfaction with the educational interventions. Two authors independently screened search results, assessed study eligibility and risk of bias and extracted data. Results were summarised using descriptive synthesis. RESULTS Among 24 eligible studies, 14 were randomised trials and 10 used other study designs. There was heterogeneity across study participants, settings and educational intervention type, content and delivery. The risk of bias was high in at least one domain for all randomised studies. Most studies measured outcomes immediately after the educational intervention, with few measuring later. In most of the comparisons, measures of knowledge and skills were better among those who had received educational interventions than among controls, and some of these differences were statistically significant. The effects on secondary outcomes were inconsistent. CONCLUSIONS Educational interventions to improve people's understanding of key concepts for evaluating health intervention claims can improve people's knowledge and skills, at least in the short term. Effects on confidence, attitude and behaviour are uncertain. Many of the studies were at moderate or greater risk of bias. Improvements in study quality, consistency of outcome measures and measures of longer-term effects are needed to improve confidence in estimates of the effects of educational interventions to improve people's understanding of key concepts for evaluating health intervention claims. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016033103.
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Affiliation(s)
- Leila Cusack
- Centre for Research in Evidence-Based Practice (CREBP), Faculty of Health Sciences and Medicine, Bond University, 14 University Drive, Robina, QLD, 4229, Australia.
| | - Chris B Del Mar
- Centre for Research in Evidence-Based Practice (CREBP), Faculty of Health Sciences and Medicine, Bond University, 14 University Drive, Robina, QLD, 4229, Australia
| | | | - Elizabeth Gibson
- Centre for Research in Evidence-Based Practice (CREBP), Faculty of Health Sciences and Medicine, Bond University, 14 University Drive, Robina, QLD, 4229, Australia
| | - Tammy C Hoffmann
- Centre for Research in Evidence-Based Practice (CREBP), Faculty of Health Sciences and Medicine, Bond University, 14 University Drive, Robina, QLD, 4229, Australia
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Matheson D, Matheson-Monnet C. Wikipedia as Informal Self-Education for Clinical Decision-Making in Medical Practice. ACTA ACUST UNITED AC 2017. [DOI: 10.2174/1874220301704010015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:For almost any topic, a Wikipedia page will appear among the first ten items of a search online. Wikipedia is also a site whose quality and reliability has been called into question.Methods:In this paper, we aim to discuss medical practitioners’ use of Wikipedia, what this consists of and what it might be. We consider the context and history of Wikipedia before discussing the relationship between Wikipedia and the medical profession. In so doing, we will consider Wikipedia as a means of informal self-education and the extent to which it might inform clinical decision-making. We compare with the existing literature results from our two small-scale empirical studies of Wikipedia and clinical decision-making.Results:Notwithstanding issues over quality and reliability, Wikipedia’s rules on verifiability are such that its articles are very heavily referenced, and this is just as true of health-related articles. The Cochrane/Wikipedia Initiative in improving the quality and reliability of medical and health pages in Wikipedia is significant in increasing reliability. Our respondents largely concurred with the results from earlier studies on the use of Wikipedia by medical practitioners.Conclusion:Perhaps the very doubt over Wikipedia’s accuracy is its greatest strength as a means of informal education of doctors. That medical and health articles on Wikipedia can be so fully referenced and still be doubted is arguably a good thing and one whose effects may be spread into other, more trusted, publications. Hence, one might envisage a future where no one source is taken automatically on trust.
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Houser SH, Au DW, Miller MJ, Chen L, Outman RC, Ray MN, Saag KG, Weech-Maldonado R. Socio-demographic differences in risk information seeking sources for non-steroidal anti-inflammatory drugs (NSAIDS). Int J Med Inform 2016; 94:222-7. [PMID: 27573330 DOI: 10.1016/j.ijmedinf.2016.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 07/29/2016] [Accepted: 07/30/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed for musculoskeletal pain and inflammatory conditions. A better understanding of patient information seeking behavior can help bridge the gap between patient knowledge and health care resources. This study examines the primary sources of NSAID risk information and the associations with patient socio-demographic factors. METHODS A cross-sectional survey analysis of patients on prescription NSAIDs (n=220) seen by primary care physicians in Alabama. Bivariate and multivariable, multinomial logistic regression analyses were conducted to evaluate the associations among primary NSAID risk information sources used with patient socio-demographic factors. RESULTS The primary patient source of information on NSAID risks was physician (57.3%), followed by internet (16.8%), pharmacist (16.4%), and other sources, such as nurses and family/friends (9.6%). Compared to people who use the internet as a primary source of NSAID risk information, patients who were Black/African-American (p=0.002) and 65 years of age or older (p=0.009) were more likely to use a physician. Older patients were also more likely to use a pharmacist (p=0.008) than the internet. In contrast, females (p=0.032) were less likely to use the pharmacist compared to the internet (p=0.032). CONCLUSIONS Patients obtain information from a variety of sources, but primarily from health care providers. While the internet is a fast growing source of health information, socio-demographic disparities in internet use for seeking information exist. Health care providers should be aware of their patient preferences for information sources on medication risks to meet the age, race, and gender need differences of all patients.
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Affiliation(s)
- Shannon H Houser
- University of Alabama at Birmingham, Department of Health Services Administration, Birmingham, AL, USA.
| | - David W Au
- Valdosta State University, Department of Management and Healthcare Administration, Valdosta, GA, USA
| | - Michael J Miller
- The University of Oklahoma School of Community Medicine, Department of Medical Informatics, Tulsa, OK, USA
| | - Lang Chen
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL, USA
| | - Ryan C Outman
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL, USA
| | - Midge N Ray
- University of Alabama at Birmingham, Department of Health Services Administration, Birmingham, AL, USA
| | - Kenneth G Saag
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL, USA
| | - Robert Weech-Maldonado
- University of Alabama at Birmingham, Department of Health Services Administration, Birmingham, AL, USA
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Information needs of Botswana health care workers and perceptions of wikipedia. Int J Med Inform 2016; 95:8-16. [PMID: 27697235 DOI: 10.1016/j.ijmedinf.2016.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/15/2016] [Accepted: 07/18/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Since the UN Human Rights Council's recognition on the subject in 2011, the right to access the Internet and information is now considered one of the most basic human rights of global citizens [1,2]. Despite this, an information gap between developed and resource-limited countries remains, and there is scant research on actual information needs of workers themselves. The Republic of Botswana represents a fertile ground to address existing gaps in research, policy, and practice, due to its demonstrated gap in access to information and specialists among rural health care workers (HCWs), burgeoning mHealth capacity, and a timely offer from Orange Telecommunications to access Wikipedia for free on mobile platforms for Botswana subscribers. OBJECTIVES In this study, we sought to identify clinical information needs of HCWs of Botswana and their perception of Wikipedia as a clinical tool. METHODS Twenty-eight facilitated focus groups, consisting of 113 HCWs of various cadres based at district hospitals, clinics, and health posts around Botswana, were employed. Transcription and thematic analysis were performed for those groups. RESULTS Access to the Internet is limited at most facilities. Most HCWs placed high importance upon using Botswana Ministry of Health (MoH) resources for obtaining credible clinical information. However, the clinical applicability of these materials was limited due to discrepancies amongst sources, potentially outdated information, and poor optimization for time-sensitive circumstances. As a result, HCWs faced challenges, such as loss of patient trust and compromises in patient care. Potential solutions posed by HCWs to address these issues included: multifaceted improvements in Internet infrastructure, access to up-to-date information, transfer of knowledge from MoH to HCW, and improving content and applicability of currently available information. Topics of clinical information needs were broad and encompassed: HIV, TB (Tuberculosis), OB/GYN (Obstetrics and Gynecology), and Pediatrics. HCW attitudes towards Wikipedia were variable; some trusted Wikipedia as a reliable point of care information resource whereas others thought that its use should be restricted and monitored by the MoH. CONCLUSIONS There is a demonstrated need for accessible, reliable, and up-to-date information to aid clinical practice in Botswana. Attitudes towards Wikipedia as an open information resource tool are at best, split. Therefore, future studies are necessary to determine the accuracy, currency, and relevancy of Wikipedia articles on the health topics identified by health care workers as areas of information need. More broadly speaking, future efforts should be dedicated to configure a quality-controlled, readily accessible mobile platform based clinical information application tool fitting for Botswana.
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Cusack L, Del Mar CB, Chalmers I, Hoffmann TC. Educational interventions to improve people's understanding of key concepts in assessing the effects of health interventions: a systematic review protocol. Syst Rev 2016; 5:37. [PMID: 26915734 PMCID: PMC4766603 DOI: 10.1186/s13643-016-0213-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 02/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health information has become readily accessible through mass media, and people are playing a more active and autonomous role in their health. Much of the health information that was previously only available to health professionals is now directly accessible to the public. Consequently, people often navigate vast amounts of health information on their own, typically with little knowledge about how to evaluate it or the need to do so. Health information remains essentially unregulated, and widespread problems and concerns with the quality of health information have been noted. In addition to the variable quality of health information, inconsistent and/or inappropriate use of related terminology (e.g. 'evidence-based' and 'clinically proven') can be confusing to the public, who are ill-prepared to critically examine claims. The general public are not trained in the fundamentals of health research and do not typically possess the knowledge and skills to evaluate the accuracy and completeness of information about health interventions. Without this, the public are vulnerable to acting on inaccurate or incomplete health information and making ill-informed health decisions. With this review, we intend to identify and assess educational interventions which have been designed to improve people's ability to understand key concepts relevant to evaluating claims about the effects of health interventions. METHODS/DESIGN This systematic review of the literature will use a search strategy that has been developed in conjunction with a Health Sciences Librarian who has expertise in systematic review searching to identify relevant studies. Databases to be searched include the following: the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and ERIC. Attempts to identify unpublished studies and ongoing trials will also be made. Two review authors will independently screen search results and assess studies for eligibility. Studies which aim to improve participants' understanding of the key concepts relevant to evaluating the effects (or the interpretation of results) of health interventions will be included. Randomised trials, non-randomised trials, controlled before and after studies, controlled studies with only post-test measures, and interrupted time series studies will be eligible for inclusion. We will contact study authors to clarify any missing details/data. Due to the nature of the systematic review question and the expectation of heterogeneity in study design, interventions, and outcomes, we intend to take a narrative approach to data synthesis. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016033103.
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Affiliation(s)
- Leila Cusack
- Faculty of Health Sciences and Medicine, Centre for Research in Evidence-Based Practice (CREBP), Bond University, Robina, QLD, 4229, Australia.
| | - Chris B Del Mar
- Faculty of Health Sciences and Medicine, Centre for Research in Evidence-Based Practice (CREBP), Bond University, Robina, QLD, 4229, Australia.
| | | | - Tammy C Hoffmann
- Faculty of Health Sciences and Medicine, Centre for Research in Evidence-Based Practice (CREBP), Bond University, Robina, QLD, 4229, Australia.
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Cerminara C, Santarone ME, Casarelli L, Curatolo P, El Malhany N. Use of the DISCERN tool for evaluating web searches in childhood epilepsy. Epilepsy Behav 2014; 41:119-21. [PMID: 25461201 DOI: 10.1016/j.yebeh.2014.09.053] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 09/17/2014] [Accepted: 09/19/2014] [Indexed: 11/25/2022]
Abstract
Epilepsy is an important cause of neurological disability in children. Nowadays, an increasing number of parents or caregivers use the Internet as a source of health information concerning symptoms, therapy, and prognosis of epilepsy occurring during childhood. Therefore, high-quality websites are necessary to satisfy this request. Using the DISCERN tool, we evaluated online information on childhood epilepsy provided by the first 50 links displayed on the Google search engine. The same links were evaluated by a team of pediatric neurologists (PNs) and by a lay subject (LS). The evaluation performed by the PNs found out that only 9.6% of the websites showed good reliability, that only 7.2% of the websites had a good quality of information on treatment choices, and that only 21.5% of the websites showed good overall quality of the content. With regard to the evaluation performed by the neutral subject, it was found that 21.4% of the websites showed good reliability, that 59.5% of the websites showed poor quality of information on treatment choices, and that only 2% of the websites showed good overall quality of the content. Our conclusion is that online information about childhood epilepsy still lacks reliability, accuracy, and relevance as well as fails to provide a thorough review of treatment choices.
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Affiliation(s)
- Caterina Cerminara
- Pediatric Neurology, Department of Neurosciences, Tor Vergata University of Rome, Viale Oxford 81, 00133 Rome, Italy.
| | - Marta Elena Santarone
- Pediatric Neurology, Department of Neurosciences, Tor Vergata University of Rome, Viale Oxford 81, 00133 Rome, Italy
| | - Livia Casarelli
- Pediatric Neurology, Department of Neurosciences, Tor Vergata University of Rome, Viale Oxford 81, 00133 Rome, Italy
| | - Paolo Curatolo
- Pediatric Neurology, Department of Neurosciences, Tor Vergata University of Rome, Viale Oxford 81, 00133 Rome, Italy
| | - Nadia El Malhany
- Pediatric Neurology, Department of Neurosciences, Tor Vergata University of Rome, Viale Oxford 81, 00133 Rome, Italy
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