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Boaden E, Burnell J, Hives L, Dey P, Clegg A, Lyons MW, Lightbody CE, Hurley MA, Roddam H, McInnes E, Alexandrov A, Watkins CL. Screening for aspiration risk associated with dysphagia in acute stroke. Cochrane Database Syst Rev 2021; 10:CD012679. [PMID: 34661279 PMCID: PMC8521523 DOI: 10.1002/14651858.cd012679.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Stroke can affect people's ability to swallow, resulting in passage of some food and drink into the airway. This can cause choking, chest infection, malnutrition and dehydration, reduced rehabilitation, increased risk of anxiety and depression, longer hospital stay, increased likelihood of discharge to a care home, and increased risk of death. Early identification and management of disordered swallowing reduces risk of these difficulties. OBJECTIVES Primary objective • To determine the diagnostic accuracy and the sensitivity and specificity of bedside screening tests for detecting risk of aspiration associated with dysphagia in people with acute stroke Secondary objectives • To assess the influence of the following sources of heterogeneity on the diagnostic accuracy of bedside screening tools for dysphagia - Patient demographics (e.g. age, gender) - Time post stroke that the study was conducted (from admission to 48 hours) to ensure only hyperacute and acute stroke swallow screening tools are identified - Definition of dysphagia used by the study - Level of training of nursing staff (both grade and training in the screening tool) - Low-quality studies identified from the methodological quality checklist - Type and threshold of index test - Type of reference test SEARCH METHODS: In June 2017 and December 2019, we searched CENTRAL, MEDLINE, Embase, CINAHL, and the Health Technology Assessment (HTA) database via the Centre for Reviews and Dissemination; the reference lists of included studies; and grey literature sources. We contacted experts in the field to identify any ongoing studies and those potentially missed by the search strategy. SELECTION CRITERIA We included studies that were single-gate or two-gate studies comparing a bedside screening tool administered by nurses or other healthcare professionals (HCPs) with expert or instrumental assessment for detection of aspiration associated with dysphagia in adults with acute stroke admitted to hospital. DATA COLLECTION AND ANALYSIS Two review authors independently screened each study using the eligibility criteria and then extracted data, including the sensitivity and specificity of each index test against the reference test. A third review author was available at each stage to settle disagreements. The methodological quality of each study was assessed using the Quality Assessment of Studies of Diagnostic Accuracy (QUADAS-2) tool. We identified insufficient studies for each index test, so we performed no meta-analysis. Diagnostic accuracy data were presented as sensitivities and specificities for the index tests. MAIN RESULTS Overall, we included 25 studies in the review, four of which we included as narratives (with no accuracy statistics reported). The included studies involved 3953 participants and 37 screening tests. Of these, 24 screening tests used water only, six used water and other consistencies, and seven used other methods. For index tests using water only, sensitivity and specificity ranged from 46% to 100% and from 43% to 100%, respectively; for those using water and other consistencies, sensitivity and specificity ranged from 75% to 100% and from 69% to 90%, respectively; and for those using other methods, sensitivity and specificity ranged from 29% to 100% and from 39% to 86%, respectively. Twenty screening tests used expert assessment or the Mann Assessment of Swallowing Ability (MASA) as the reference, six used fibreoptic endoscopic evaluation of swallowing (FEES), and 11 used videofluoroscopy (VF). Fifteen screening tools had an outcome of aspiration risk, 20 screening tools had an outcome of dysphagia, and two narrative papers did not report the outcome. Twenty-one screening tests were carried out by nurses, and 16 were carried out by other HCPs (not including speech and language therapists (SLTs)). We assessed a total of six studies as low risk across all four QUADAS-2 risk of bias domains, and we rated 15 studies as low concern across all three applicability domains. No single study demonstrated 100% sensitivity and specificity with low risk of bias for all domains. The best performing combined water swallow and instrumental tool was the Bedside Aspiration test (n = 50), the best performing water plus other consistencies tool was the Gugging Swallowing Screen (GUSS; n = 30), and the best water only swallow screening tool was the Toronto Bedside Swallowing Screening Test (TOR-BSST; n = 24). All tools demonstrated combined highest sensitivity and specificity and low risk of bias for all domains. However, clinicians should be cautious in their interpretation of these findings, as these tests are based on single studies with small sample sizes, which limits the estimates of reliability of screening tests. AUTHORS' CONCLUSIONS We were unable to identify a single swallow screening tool with high and precisely estimated sensitivity and specificity based on at least one trial with low risk of bias. However, we were able to offer recommendations for further high-quality studies that are needed to improve the accuracy and clinical utility of bedside screening tools.
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Affiliation(s)
- Elizabeth Boaden
- Faculty of Health and Care , University of Central Lancashire , Preston, UK
| | - Jane Burnell
- Faculty of Health and Care, University of Central Lancashire , Preston, UK
| | - Lucy Hives
- Faculty of Health and Care, University of Central Lancashire , Preston, UK
| | - Paola Dey
- Faculty of Health and Social Care, Edge Hill University, Ormskirk, UK
| | - Andrew Clegg
- Faculty of Health and Care, University of Central Lancashire , Preston, UK
| | - Mary W Lyons
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Margaret A Hurley
- Faculty of Health and Care, University of Central Lancashire , Preston, UK
| | - Hazel Roddam
- Faculty of Allied Health and Well-being, University of Central Lancashire, Preston, UK
| | - Elizabeth McInnes
- Nursing Research Institute, Australian Catholic University, Sydney, Australia
| | - Anne Alexandrov
- University of Tennessee Health Science Center (UTHSC), Memphis, Tennessee, USA
| | - Caroline L Watkins
- Faculty of Health and Care, University of Central Lancashire, Preston, UK
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Lee BJ, Eo H, Park D. Usefulness of the Modified Videofluoroscopic Dysphagia Scale in Evaluating Swallowing Function among Patients with Amyotrophic Lateral Sclerosis and Dysphagia. J Clin Med 2021; 10:jcm10194300. [PMID: 34640316 PMCID: PMC8509220 DOI: 10.3390/jcm10194300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The videofluoroscopic dysphagia scale (VDS) is used to predict the long-term prognosis of dysphagia among patients with the condition. Previously, a modified version of the VDS (mVDS) was established to overcome the relatively low inter-rater reliability of VDS, and was verified in patients with dysphagia, such as stroke patients. However, the validity of mVDS in patients with amyotrophic lateral sclerosis (ALS) has never been proved. Therefore, in this study, we attempted to seek the validity of the mVDS score in patients with ALS suffering from dysphagia. METHOD Data from the videofluoroscopic swallowing study (VFSS) of 34 patients with ALS and dysphagia were retrospectively collected. We investigated the presence of aspiration pneumonia and the selected feeding method based on the VFSS. We also evaluated the correlations between the mVDS and the selected feeding method, and between the mVDS and the presence of aspiration pneumonia. Multivariate logistic regression and receiver operating characteristic (ROC) analyses were performed during the data analysis. RESULTS In patients with ALS and dysphagia, the mVDS scores were statistically correlated with the selected feeding method (p < 0.05) and the presence of aspiration pneumonia (p < 0.05). In the ROC curve analysis, the area under the ROC curve values for the selected feeding method and the presence of aspiration pneumonia were 0.886 (95% confidence interval (CI), 0.730-0.969; p < 0.0001) and 0.886 (95% CI, 0.730-0.969; p < 0.0001), respectively. CONCLUSION The mVDS can be a useful tool for quantifying the severity of dysphagia and interpreting the VFSS findings in patients with ALS and dysphagia. However, further studies involving a more general population of patients with ALS are needed to elucidate a more accurate cut-off value for the allowance of oral feeding and the presence of aspiration pneumonia.
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Affiliation(s)
- Byung Joo Lee
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu 41133, Korea or (B.J.L.); (H.E.)
| | - Hyoshin Eo
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu 41133, Korea or (B.J.L.); (H.E.)
| | - Donghwi Park
- Department of Physical Medicine and Rehabilitation, College of Medicine, Ulsan University Hospital, University of Ulsan, Ulsan 44033, Korea
- Correspondence: ; Tel.: +82-52-250-7222; Fax: +82-52-250-7228
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Bolton L, Mills C, Wallace S, Brady MC. Aerosol generating procedures, dysphagia assessment and COVID-19: A rapid review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2020; 55:629-636. [PMID: 32478950 PMCID: PMC7300802 DOI: 10.1111/1460-6984.12544] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 05/08/2023]
Affiliation(s)
- Lee Bolton
- Speech & Language Therapy ServiceImperial College Healthcare NHS TrustLondonUK
| | - Claire Mills
- Speech & Language Therapy DepartmentLeeds Teaching Hospitals NHS TrustLeedsUK
- Academic Unit of Health EconomicsUniversity of LeedsLeedsUK
| | - Sarah Wallace
- Speech & Language Therapy Department, Wythenshawe HospitalManchester University NHS Foundation TrustManchesterUK
| | - Marian C. Brady
- Nursing, Midwifery and Allied Health Professions Research UnitGlasgow Caledonian UniversityGlasgowUK
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Abstract
Stroke medicine has seen rapid developments in diagnosis and management, and consequently improved prognosis. Management of ischaemic stroke, in particular, has benefited from these advances. The approach to management has evolved from one of historical passivity to active intervention with time of the essence following stroke onset. The last decade has seen the comparative effectiveness of several pharmacological agents being tested, creating significant randomised controlled trial evidence to support the management of common clinical problems following acute stroke. While several of these interventions are widely available, some remain less accessible. This review will discuss the latest developments in clinical stroke medicine, based on a symposium presentation at the Royal College of Physicians of Edinburgh, and reference key randomised controlled trial evidence in an effort to provide a balanced perspective on our current understanding of acute ischaemic and haemorrhagic stroke.
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Affiliation(s)
- J S Minhas
- TG Robinson, Department of Cardiovascular Sciences, University of Leicester, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester LE3 9QP, UK.
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Abu-Snieneh HM, Saleh MYN. Registered Nurse's Competency To Screen Dysphagia Among Stroke Patients: Literature Review. Open Nurs J 2018; 12:184-194. [PMID: 30258508 PMCID: PMC6128015 DOI: 10.2174/1874434601812010184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/30/2018] [Accepted: 07/15/2018] [Indexed: 01/25/2023] Open
Abstract
Background An increased number of elderly people in the world may lead to an increase in the incidence of stroke, which creates a burden on the country's healthcare system. Dysphagia is the most common post stroke. Screening of dysphagia in stroke patients is serious to prevent complication linked to aspiration and inadequate hydration/nutrition. Objective This literature review aimed to discuss registered nurses' competency to screen dysphagia among stroke patients. Methods The keywords used were nurse's competency; dysphagia; dysphagia screening; and stroke. These keywords were entered into multiple electronic databases including CINAHL, Medline, Science Direct, Pro Quest, Pub Med, and Wiley Online Library. Aliterature search was conducted for the period2005 to 2016.Results:Seventeen studies were identified by a systematic search ofthe literature.Two parts created the body of this literature review. The first part covers the literature on the training nurses in screening dysphagia among stroke patients and benefits of screening. The second part covers nurse's competency in terms of knowledge and skills of screening dysphagia among stroke patients. Conclusion Because the nurses have more contact with the patient, they are most likely to observe dysphagia. It is important that formal dysphagia screening protocols are routine nursing care that requires special training to practice. Trained nurses should assess their competency in terms of knowledge and skills via well-developed tool.
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Affiliation(s)
| | - Mohammad Y N Saleh
- Clinical Nursing Department, The University of Jordan, Faculty of Nursing, Amman-Jordan
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Su C, Gao Y, Xie Y, Xue Y, Ge L, Li H. A hybrid classifier based on nonlinear-PCA and deep belief networks with applications in dysphagia diagnosis. Comput Assist Surg (Abingdon) 2017; 22:135-147. [PMID: 29095063 DOI: 10.1080/24699322.2017.1389391] [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: 10/18/2022] Open
Abstract
Traditional dysphagia prescreening diagnostic methods require doctors specialists to give patients a total score based on a water swallow test scale. This method is limited by the high dimensionality of the diagnostic elements in the water swallow test scale with heavy workload (Towards each patient, the scale requires the doctors give score for 18 diagnostic elements respectively) as well as the difficulties of extracting and using the diagnostic scale data's non-linear features and hidden expertise information (Even with the scale scores, specific diagnostic conclusions are still given by expert doctors under the expertise). In this paper, a hybrid classifier model based on Nonlinear-Principal Component Analysis (NPCA) and Deep Belief Networks (DBN) is proposed in order to effectively extract the diagnostic scale data's nonlinear features and hidden information and to provide the key scale elements' locating methods towards the diagnostic results (The key scale elements that affect different diagnostic conclusions are given to improve the efficiency and pertinence of diagnosis and reduce the workload of diagnosis). We demonstrate the effectiveness of the proposed method using the frame of 'information entropy theory'. Real dysphagia diagnosis examples from the China-Japanese Friendship Hospital are used to demonstrate applications of the proposed methods. The examples show satisfactory results compared to the traditional classifier.
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Affiliation(s)
- Chong Su
- a School of Information Science and Technology , Beijing University of Chemical Technology , Beijing , China
| | - Yue Gao
- a School of Information Science and Technology , Beijing University of Chemical Technology , Beijing , China
| | - Yuxiao Xie
- b Department of Rehabilitation , China-Japanese Friendship Hospital , Beijing , China
| | - Yong Xue
- b Department of Rehabilitation , China-Japanese Friendship Hospital , Beijing , China
| | - Lijun Ge
- b Department of Rehabilitation , China-Japanese Friendship Hospital , Beijing , China
| | - Hongguang Li
- a School of Information Science and Technology , Beijing University of Chemical Technology , Beijing , China
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Baijens LW, Clavé P, Cras P, Ekberg O, Forster A, Kolb GF, Leners JC, Masiero S, Mateos-Nozal J, Ortega O, Smithard DG, Speyer R, Walshe M. European Society for Swallowing Disorders - European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging 2016. [PMID: 27785002 DOI: 10.2147/cia.s107750.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, and invited experts. It consists of 12 sections that cover all aspects of clinical management of oropharyngeal dysphagia (OD) related to geriatric medicine and discusses prevalence, quality of life, and legal and ethical issues, as well as health economics and social burden. OD constitutes impaired or uncomfortable transit of food or liquids from the oral cavity to the esophagus, and it is included in the World Health Organization's classification of diseases. It can cause severe complications such as malnutrition, dehydration, respiratory infections, aspiration pneumonia, and increased readmissions, institutionalization, and morbimortality. OD is a prevalent and serious problem among all phenotypes of older patients as oropharyngeal swallow response is impaired in older people and can cause aspiration. Despite its prevalence and severity, OD is still underdiagnosed and untreated in many medical centers. There are several validated clinical and instrumental methods (videofluoroscopy and fiberoptic endoscopic evaluation of swallowing) to diagnose OD, and treatment is mainly based on compensatory measures, although new treatments to stimulate the oropharyngeal swallow response are under research. OD matches the definition of a geriatric syndrome as it is highly prevalent among older people, is caused by multiple factors, is associated with several comorbidities and poor prognosis, and needs a multidimensional approach to be treated. OD should be given more importance and attention and thus be included in all standard screening protocols, treated, and regularly monitored to prevent its main complications. More research is needed to develop and standardize new treatments and management protocols for older patients with OD, which is a challenging mission for our societies.
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Affiliation(s)
- Laura Wj Baijens
- Department of Otorhinolaryngology - Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataró, Autonomous University of Barcelona, Mataró; CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - Patrick Cras
- Department of Neurology, Antwerp University Hospital, University of Antwerp, Born Bunge Institute, Edegem, Belgium
| | - Olle Ekberg
- Department of Translational Medicine, Division of Medical Radiology, Skåne University Hospital, Malmö, Sweden
| | | | - Gerald F Kolb
- Department of Geriatrics and Physical Medicine, Bonifatius Hospital, Lingen, Germany
| | | | - Stefano Masiero
- Rehabilitation Unit, Department of Neuroscience, University of Padua, Padova, Italy
| | | | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataró, Autonomous University of Barcelona, Mataró; CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - David G Smithard
- Clinical Gerontology, Princess Royal University Hospital, King's College Hospital Foundation Trust, London, UK
| | - Renée Speyer
- College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
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Baijens LWJ, Clavé P, Cras P, Ekberg O, Forster A, Kolb GF, Leners JC, Masiero S, Mateos-Nozal J, Ortega O, Smithard DG, Speyer R, Walshe M. European Society for Swallowing Disorders - European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging 2016; 11:1403-1428. [PMID: 27785002 PMCID: PMC5063605 DOI: 10.2147/cia.s107750] [Citation(s) in RCA: 383] [Impact Index Per Article: 47.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, and invited experts. It consists of 12 sections that cover all aspects of clinical management of oropharyngeal dysphagia (OD) related to geriatric medicine and discusses prevalence, quality of life, and legal and ethical issues, as well as health economics and social burden. OD constitutes impaired or uncomfortable transit of food or liquids from the oral cavity to the esophagus, and it is included in the World Health Organization's classification of diseases. It can cause severe complications such as malnutrition, dehydration, respiratory infections, aspiration pneumonia, and increased readmissions, institutionalization, and morbimortality. OD is a prevalent and serious problem among all phenotypes of older patients as oropharyngeal swallow response is impaired in older people and can cause aspiration. Despite its prevalence and severity, OD is still underdiagnosed and untreated in many medical centers. There are several validated clinical and instrumental methods (videofluoroscopy and fiberoptic endoscopic evaluation of swallowing) to diagnose OD, and treatment is mainly based on compensatory measures, although new treatments to stimulate the oropharyngeal swallow response are under research. OD matches the definition of a geriatric syndrome as it is highly prevalent among older people, is caused by multiple factors, is associated with several comorbidities and poor prognosis, and needs a multidimensional approach to be treated. OD should be given more importance and attention and thus be included in all standard screening protocols, treated, and regularly monitored to prevent its main complications. More research is needed to develop and standardize new treatments and management protocols for older patients with OD, which is a challenging mission for our societies.
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Affiliation(s)
- Laura WJ Baijens
- Department of Otorhinolaryngology – Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataró, Autonomous University of Barcelona, Mataró
- CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - Patrick Cras
- Department of Neurology, Antwerp University Hospital, University of Antwerp, Born Bunge Institute, Edegem, Belgium
| | - Olle Ekberg
- Department of Translational Medicine, Division of Medical Radiology, Skåne University Hospital, Malmö, Sweden
| | | | - Gerald F Kolb
- Department of Geriatrics and Physical Medicine, Bonifatius Hospital, Lingen, Germany
| | | | - Stefano Masiero
- Rehabilitation Unit, Department of Neuroscience, University of Padua, Padova, Italy
| | | | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataró, Autonomous University of Barcelona, Mataró
- CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - David G Smithard
- Clinical Gerontology, Princess Royal University Hospital, King’s College Hospital Foundation Trust, London, UK
| | - Renée Speyer
- College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
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Pappas NW. Synthesize, evaluate, act: 2013 Speech Pathology Australia Conference. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2014; 16:191-192. [PMID: 24833424 DOI: 10.3109/17549507.2014.916350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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