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Adombire S, Baiden D, Puts M, Puchalski Ritchie LM, Ani-Amponsah M, Cranley L. Knowledge, skills, attitudes, beliefs, and implementation of evidence-based practice among nurses in low- and middle-income countries: A scoping review. Worldviews Evid Based Nurs 2024; 21:542-553. [PMID: 38853345 DOI: 10.1111/wvn.12734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 03/25/2024] [Accepted: 05/05/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Over the past three decades, research studies on nurses' engagement in evidence-based practice (EBP) have been widely reported, particularly in high-income countries, with studies from these countries dominating literature reviews. As low- and middle-income countries (LMICs) continue to join the EBP movement, primary research has emerged over the past decade about nurses' engagement with EBP. AIMS The aim of this scoping review was to identify the types and extent of published research regarding nurses' knowledge, skills, attitudes, beliefs, and implementation of EBP in LMICs. METHODS The JBI scoping review methodology was used. Eight databases were searched up to November 2023. The review included primary studies (quantitative, qualitative, and mixed methods) that reported the knowledge, skills, attitudes, beliefs, or implementation of EBP among nurses in LMICs. Included studies focused on registered nurses in all healthcare settings within LMICs. Studies published in English were included with no limit on publication date. Two independent reviewers screened titles, abstracts, and full-text articles of published studies. Data were analyzed quantitatively using frequencies and counts. Textual data from qualitative studies were analyzed using descriptive content analysis. RESULTS Fifty-three publications were included, involving 20 LMICs. Studies were published between 2007 and 2023, with over 60% published in the past 7 years. Studies that evaluated familiarity/awareness of EBP showed that in general, nurses had low familiarity with or awareness of EBP. Most studies (60%) described nurses' attitudes toward EBP as positive, favorable, or high, and 31% as moderate. However, over 60% of studies described nurses' EBP knowledge/skills as moderate, low, or insufficient. Approximately 84% of studies described EBP implementation in healthcare settings as moderate, low, poor, or suboptimal. LINKING EVIDENCE TO ACTION Studies on nursing EBP have been increasing in LMICs for the past two decades, with findings highlighting opportunities for advancing EBP in nursing within LMICs. Health systems and healthcare organization leaders in LMICs should equip nurses with EBP knowledge and skills while providing the needed resources and support to ensure consistent implementation of EBP to improve health outcomes.
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Affiliation(s)
- Stephen Adombire
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Deborah Baiden
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Lisa M Puchalski Ritchie
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute-St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Lisa Cranley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Wudu MA, Tarekegn SM, Wondifraw EB, Birhanu TA, Hailu MK, Bekalu YE, Yosef ST, Belete MA. Uptake of evidence-based practice and its predictors among nurses in Ethiopia: a systematic review and meta-analysis. Front Pharmacol 2024; 15:1421690. [PMID: 39092215 PMCID: PMC11291372 DOI: 10.3389/fphar.2024.1421690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 06/17/2024] [Indexed: 08/04/2024] Open
Abstract
Background: While evidence-based practice has demonstrated its capacity to enhance healthcare quality and bolster clinical outcomes, the translation of research into clinical practice encounters persistent challenges. In Ethiopia, there remains a dearth of comprehensive and nationally representative data concerning the extent of Evidence-based practice adoption among nurses. Thus, this systematic review and meta-analysis endeavors to assess the overall prevalence of Evidence-based practice implementation and delve into its determinants among Ethiopian nurses. Methods: A systematic review and meta-analysis were conducted following the PRISMA guidelines. In order to identify pertinent studies, a search was conducted across PubMed, Scopus, Google Scholar, and EMBASE databases. A weighted inverse variance random-effects model was employed to estimate the pooled prevalence. Cochrane's Q-test and I2 statistics were calculated to assess heterogeneity among studies. Funnel plots and Egger's test were utilized to evaluate publication bias. Pooled implementation rates and meta-regression analysis were carried out using STATA 17. Results: Of the total 1,590 retrieved articles, twelve studies including 4,933 nurses were included in the final analysis. The pooled prevalence of Evidence-based practice uptake among nurses in Ethiopia is 53% (95% CI: 46%-60%). Having knowledge about Evidence-based practice (AOR = 2.29; 95% CI: 1.90, 2.69; I2 = 70.95%), holding a favorable attitude towards Evidence-based practice (AOR = 2.56; 95% CI: 1.63, 3.49; I2 = 88.39%), occupying a head nurse position (AOR = 3.15; 95% CI: 1.85, 4.46; I2 = 87.42%), possessing effective communication skills (AOR = 4.99; 95% CI: 1.47, 8.51; I2 = 99.86%), and having access to Evidence-based practice guidelines (AOR = 1.90; 95% CI: 1.55, 2.24; I2 = 57.24%) were identified as predictors of the uptake of Evidence-based practice. Conclusion: Only half of Ethiopia's nurses exhibit a strong embrace of Evidence-Based Practice within clinical settings, underscoring the urgent necessity for coordinated endeavors to cultivate this essential practice. Possessing knowledge, effective communication skills, access to updated guidelines, maintaining a positive attitude towards Evidence-Based Practice, and holding a position as head nurse emerged as predictors of successful implementation of Evidence-Based Practice. Hence, policymakers must prioritize capacity-building initiatives, disseminate the latest EBP guidelines widely, and strengthen mentorship roles for head nurses. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/#searchadvanced, identifier CRD42023488943.
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Affiliation(s)
- Muluken Amare Wudu
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Setegn Mihret Tarekegn
- Department of Pediatrics and Child Health Nursing, School of Nursing and Midwifery, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Endalk Birrie Wondifraw
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tarikua Afework Birhanu
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Molla Kassa Hailu
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yemane Eshetu Bekalu
- Department of Public Health, ALKAN Health Sciences and Business College, Dessie, Ethiopia
| | - Selamyhun Tadesse Yosef
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Woldiya University, Woldiya, Ethiopia
| | - Melaku Ashagrie Belete
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Diriba DC, Tilahun T. Nurses' perception of the hospitals' culture and readiness of evidence-based practise integration in the hospital's system in western Ethiopia. BMC Nurs 2024; 23:103. [PMID: 38321447 PMCID: PMC10848357 DOI: 10.1186/s12912-024-01741-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 01/16/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Evidence-based practise is a method by which healthcare professionals integrate the best available evidence, individual expertise and patient preferences to improve patient safety and utilise quality healthcare. No study was conducted in Ethiopia to assess the nurses' perception of the hospitals' culture and readiness for evidence-based practice integration into the hospital's system. Hence, this study aimed to assess the perception of nurses on the hospitals' culture and readiness of evidence-based practise integration in hospitals' systems in Western Ethiopia. METHODS A cross-sectional study involving 412 nurses in six hospitals in western Ethiopia was conducted between December 2022 and February 2023. A 25-item Organisational Culture and Readiness of System-Wide Integration of EBP scale was used, with a Cronbach's alpha of 0.94. While 25 is the minimum score, 125 is the maximum; higher scores indicate better hospital culture and readiness for system-wide integration of evidence-based practice. A self-administered data collection technique was used. Descriptive statistics were computed using Statistical Package for the Social Sciences version 25 software. RESULTS Four hundred and twelve nurses participated in the study. The majority (85.9%) were bachelor's degree holders and over a third (34.7%) worked in primary hospitals. Only a quarter (26.5%) had ever received mentorship from their leader on implementing evidence-based practice. The overall hospital culture and readiness score for system-wide integration of evidence-based practice among nurses in six hospitals was 70.3 ± 17.3. CONCLUSION The nurses' perception of the hospitals' culture and readiness score for system-wide integration of evidence-based practice in six hospitals in Western Ethiopia was equivocal. There is a need to engage all resources and increase leadership commitment to make evidence-based practice a hospital culture. Further research is warranted to understand the national hospitals' status in establishing and sustaining evidence-based practise culture.
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Affiliation(s)
- Dereje Chala Diriba
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Temesgen Tilahun
- School of Medicine, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
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Shibabaw AA, Chereka AA, Walle AD, Demsash AW, Kebede SD, Gebeyehu AS, Tizie SB, Mamo DN, Kassie SY. Evidence-Based Practice and Its Associated Factors among Health Professionals Working at Public Hospitals in Southwest Ethiopia. BIOMED RESEARCH INTERNATIONAL 2023; 2023:4083442. [PMID: 38125070 PMCID: PMC10732803 DOI: 10.1155/2023/4083442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 10/22/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023]
Abstract
Introduction "Evidence-based practice" (EBP) is the process of incorporating clinical expertise and taking patient values and preferences into consideration when making clinical decisions. It is used to describe the provision of high-quality patient care. Objective This study is aimed at assessing evidence-based practice and associated factors among health professionals working at public hospitals in Illu Aba Bora and Buno Bedele Zones, Oromia Region, Southwest Ethiopia, in 2022. Methods An institution-based cross-sectional study design was conducted from May 8 to June 20 at public hospitals in Illu Aba Bora and Buno Bedele Zones, Oromia Region, Southwest Ethiopia. A total of 423 health professionals were included, using proportional allocation and simple random sampling. The data were collected using a self-administered questionnaire. Data was entered using EpiData version 4.6, and the collected data was cleared, arranged, coded, and then analyzed using Statistical Package for the Social Sciences version 26. Descriptive statistics and bivariable and multivariable analyses of logistic regression with AOR (95% CI) were performed at p < 0.05. Result The study revealed that 36.2% of health professionals had good evidence-based practice. The factors found to be significantly associated with good EBP include having training in EBP (AOR = 5.43; 95% CI: 4.323, 9.532), good knowledge (AOR = 1.91; 95% CI: 1.065, 3.541), a favorable attitude (AOR = 1.91; 95% CI: 1.884, 2.342), and work experience greater than 5 years (AOR = 1.58; 95% CI: 1.482, 2.437). Conclusion The evidence-based practice of health professionals was poor. Evidence-based practice should included in the curriculum, and also planned trainings need to be delivered to all health professionals, inorder to enhancing their knowledge as well as their attitudes by motivating them to increase evidence-based practice.
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Affiliation(s)
- Adamu Ambachew Shibabaw
- Department of Health Informatics, College of Health Science, Mettu University, Mettu, Ethiopia
| | - Alex Ayenew Chereka
- Department of Health Informatics, College of Health Science, Mettu University, Mettu, Ethiopia
| | - Agmasie Damtew Walle
- Department of Health Informatics, College of Health Science, Mettu University, Mettu, Ethiopia
| | | | - Shimels Derso Kebede
- Department of Health Informatics, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Ayenew Sisay Gebeyehu
- Department of Health Informatics, School of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Sefefe Birhanu Tizie
- Department of Health Informatics, School of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Daniel Niguse Mamo
- Department of Health Informatics, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
| | - Sisay Yitayh Kassie
- Department of Health Informatics, College of Health Science, Mettu University, Mettu, Ethiopia
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Gartrell K, Warren JI, Fontelo P. PubMed4Hh: A Point-of-Care Mobile App for Evidence-Based Clinical Decision Support for Nurse Residents in Maryland. Comput Inform Nurs 2023; 41:983-992. [PMID: 38062547 PMCID: PMC10746293 DOI: 10.1097/cin.0000000000001063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Evidence-based clinical decision-making is considered a core competency for professional nurses. However, barriers such as lack of time in clinical practice; information overload; restricted access to resources; lack of evidence appraisal skills, awareness, and knowledge; and unreliable resources prevent them from adopting evidence-based practice. This study examined the usefulness of the PubMed4Hh (PubMed for Handhelds) mobile application for clinical decision-making at the point of care among Maryland newly licensed RNs. Using iOS and Android smartphones, 178 newly licensed RNs participated in a 6-month trial from November 2019 to April 2020. Nurses manually entered free-text queries or used voice inputs on the "Patient, Intervention, Comparison, Outcome" or "askMEDLINE" search engines. The results retrieved were presented as journal article abstracts or short summaries called "the bottom line," designed for quick reading at the point of care. Both Patient, Intervention, Comparison, Outcome and askMEDLINE were rated highly for their usefulness, and participants said they would continue using PubMed4Hh and recommend it to others. Newly licensed RNs had a significantly higher perception of the usefulness of PubMed4Hh when the results of "the bottom line" or abstracts confirmed, led, or modified their nursing skills, knowledge, or the patient's care plan.
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Affiliation(s)
- Kyungsook Gartrell
- Author Affiliations: Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore (Dr Gartrell); Maryland Organization of Nurse Leaders, Inc/Maryland Nurse Residency Collaborative, Ellicott City (Dr Warren); and Applied Clinical Informatics Branch, National Library of Medicine, Bethesda (Dr Fontelo), MD
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Zewdie A, Ayele M, Melis T, Kasahun AW. Determinants of evidence-based practice among health care professionals in Ethiopia: A systematic review and meta-analysis. PLoS One 2023; 18:e0293902. [PMID: 37943797 PMCID: PMC10635493 DOI: 10.1371/journal.pone.0293902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Evidence-based practice (EBP) is the art of using up-to-date information for clinical decision-making. Healthcare professionals at all levels are expected to use the latest research evidence for quality care. In Ethiopia inclusive and nationally representative summarized evidence regarding the level of EBP among health professionals is scarce. Therefore, this systematic review and meta-analysis aimed to assess the pooled prevalence of EBP utilization and its determinants among Ethiopian health professionals. METHOD A systematic review and meta-analysis were conducted using PRISMA guidelines. Comprehensive literature was searched in PubMed, Google Scholar, and African Online Journal databases. A weighted inverse variance random effect model was used to estimate pooled prevalence. Cochrane Q-test and I2 statistics were computed to assess heterogeneity among studies. Funnel plot and Eggers test were done to assess publication bias. Factors associated with EBP were identified using STATA v. 14. RESULT Overall, 846 articles were retrieved and finally 23 articles were included in this review. The pooled prevalence of good EBP among health professionals was 52.60% (95%CI; 48.15%-57.05%). Knowledge about EBP (AOR = 2.38, 95% CI: (2.08-2.72)), attitude (AOR = 2.09, 95% CI: (1.67-2.60)), educational status (AOR = 3.12, 95% CI: (2.18-4.47)), work experience (AOR = 2.59, 95% CI: (1.48-4.22)), EBP training (AOR = 2.26, 95% CI: (1.87-2.74)), presence of standard guideline (AOR = 1.94, 95% CI: (1.51-2.50)), internet access (AOR = 1.80, 95% CI: (1.47-2.20)), presence of enough time (AOR = 2.01, 95% CI: (1.56-2.60)) and marital status (AOR = 1.73, 95% CI: (1.32-2.28)) were determinants of EBP. CONCLUSION Around half of health professionals in Ethiopia have good EBP utilization which was low. Knowledge, attitude, educational status, work experience, EBP training, presence of standard guidelines, internet access, presence of enough time, and single marital status were positively associated with EBP. Therefore future interventions should focus on increasing their knowledge and changing their attitude through providing training and addressing organizational barriers like availing standard guidelines, accessing the internet, and minimizing professionals' workload that enables them to critically appraise and integrate the latest evidence for clinical decision-making to improve the quality of care.
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Affiliation(s)
- Amare Zewdie
- Department of Public Health, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Mulat Ayele
- Department of Midwifery, College of Medicine and Health Science, Woldia University, Woldia, Ethiopia
| | - Tamirat Melis
- Department of Public Health, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Abebaw Wasie Kasahun
- Department of Public Health, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
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Ngusie HS, Ahmed MH, Mengiste SA, Kebede MM, Shemsu S, Kanfie SG, Kassie SY, Kalayou MH, Gullslett MK. The effect of capacity building evidence-based medicine training on its implementation among healthcare professionals in Southwest Ethiopia: a controlled quasi-experimental outcome evaluation. BMC Med Inform Decis Mak 2023; 23:172. [PMID: 37653419 PMCID: PMC10472735 DOI: 10.1186/s12911-023-02272-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 08/21/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Evidence-based medicine (EBM) bridges research and clinical practice to enhance medical knowledge and improve patient care. However, clinical decisions in many African countries don't base on the best available scientific evidence. Hence, this study aimed to determine the effect of training interventions on background knowledge and awareness of EBM sources, attitude, competence, and practice of EBM among healthcare professionals. METHOD We designed a controlled group quasi-experimental pre-post test study to evaluate the effect of capacity-building EBM training. A total of 192 healthcare professionals were recruited in the study (96 from the intervention and 96 from the control group). We used a difference-in-differences (DID) analysis to determine the effect of the training. Along the way, we used a fixed effect panel-data regression model to assess variables that could affect healthcare professionals' practice of EBM. The cut point to determine the significant effect of EBM training on healthcare professionals' background knowledge and awareness of EBM sources, attitude, and competence was at a P-value < 0.05. RESULT The DID estimator showed a significant net change of 8.0%, 17.1%, and 11.4% at P < 0.01 on attitude, competence, and practice of EBM, respectively, whereas no significant increment in the background knowledge and awareness of EBM sources. The fixed effect regression model showed that the attitude [OR = 2.288, 95% CI: (1.049, 4.989)], competence [OR = 4.174, 95% CI: 1.984, 8.780)], technical support [OR = 2.222, 95% CI: (1.043, 3.401)], and internet access [OR = 1.984, 95% CI: (1.073, 4.048)] were significantly affected EBM practice. CONCLUSION The capacity-building training improved attitude, competence, and EBM practice. Policymakers, government, and other concerned bodies recommended focusing on a well-designed training strategy to enhance the attitude, competence, and practice towards EBM among healthcare professionals. It was also recommended to enhance internet access and set mechanisms to provide technical support at health facilities.
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Affiliation(s)
- Habtamu Setegn Ngusie
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia.
| | - Mohammadjud Hasen Ahmed
- Department of Health Informatics, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | | | | | - Shuayib Shemsu
- Department of Public Health, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | - Shuma Gosha Kanfie
- Department of Health Informatics, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | - Sisay Yitayih Kassie
- Department of Health Informatics, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | - Mulugeta Hayelom Kalayou
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Shibabaw AA, Walle AD, Wubante SM, Butta FW, Demsash AW, Sisay MM, Kebede SD, Mengistie MB, Mamo DN. Knowledge and attitude toward evidence-based medicine and associated factors among health science students in Mettu University southwest Ethiopia: A cross-sectional study. INFORMATICS IN MEDICINE UNLOCKED 2023. [DOI: 10.1016/j.imu.2023.101228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
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