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Abukmail E, Bakhit M, Hoffmann TC. Evaluation of natural history communication and shared decision making for self-limiting conditions: Analysis of UK primary care consultations. PATIENT EDUCATION AND COUNSELING 2024; 129:108409. [PMID: 39216148 DOI: 10.1016/j.pec.2024.108409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 08/08/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To analyse communication about the natural course of self-limiting illnesses, as part of shared decision-making (SDM), in general practice consultations. METHODS Natural history communication and SDM (using Observing Patient Involvement in Decision-Making (OPTION-12) and Assessing Communication about Evidence and Patient Preferences (ACEPP) items) were rated by two raters using transcripts from the UK 'One in a Million' database. RESULTS Of 55 eligible consultations, a 'wait and see' option was mentioned in 27 consultations (49 %), using varying terminology, with a general recovery timeframe provided in 21. Mean OPTION-12 score (of 100) was 25.2 (SD=7.4), indicating a low level of SDM. Mean ACEPP score (out of 5) was 1.2 (SD=0.5), indicating minimal communication about the options' benefits and harms. Recovery likelihood was quantified in only two consultations, while harms were quantified in none. CONCLUSION Communication about the natural history of self-limiting illnesses was generally limited. The 'wait and see' approach, along with its benefits and harms, was typically not explicitly presented as an option for patients to consider. PRACTICE IMPLICATIONS Improving clinicians' awareness of the importance of and skills for communicating the natural history of self-limiting illnesses, as part of SDM, may facilitate informed decision-making in managing these conditions.
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Affiliation(s)
- Eman Abukmail
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia.
| | - Mina Bakhit
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia.
| | - Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia.
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Juay L, Bhupendrabhai MN, Ahmad SHB, Wong HC, Chong JWM, Tan WH, Chandran NS. Prevalence of dermatoses in geriatric singaporeans in the community - a cross-sectional study. BMC PRIMARY CARE 2024; 25:290. [PMID: 39123111 PMCID: PMC11312226 DOI: 10.1186/s12875-024-02525-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 07/15/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Little is known about the prevalence of dermatoses in "skin-well" geriatric Singaporeans. We aim to identify the prevalence of dermatoses and their associations within the geriatric population in Singapore, and to understand the distribution of dermatological encounters presenting to primary care physicians, and the resultant referral behaviour. METHODS A joint quantitative-qualitative study was performed across 8 months. Patients aged 65 years and above who visited a local polyclinic for management of non-dermatological chronic diseases were recruited. They were administered questionnaires, and underwent full skin examinations. Online surveys were disseminated to polyclinic physicians under the same healthcare cluster. RESULTS 201 patients and 53 physicians were recruited. The most common dermatoses identified in patients were benign tumours and cysts (97.5%), and asteatosis (81.6%). For every 1-year increase in age, the odds of having asteatosis increased by 13.5% (95% CI 3.4-24.7%, p = 0.008), and urticarial disorders by 14.6% (95% CI 0.3-30.9%, p = 0.045). Patients who used any form of topical preparations on a daily basis had higher odds of having eczema and inflammatory dermatoses (OR 2.51, 95% CI 1.38 to 4.56, p = 0.003). Physicians reported dermatological conditions involving 20% of all clinical encounters. Eczema represented the most commonly reported dermatosis within the first visit. 50% of dermatology referrals were done solely at the patient's own request. CONCLUSION The prevalence of dermatoses in the elderly in Singapore is high, especially asteatosis. Prompt recognition by the primary healthcare provider potentially prevents future morbidity. Outreach education for both primary care physicians and the general public will be key. ETHICS APPROVAL National Healthcare group (NHG) Domain Specific Review Board (DSRB), Singapore, under Trial Registration Number 2020/00239, dated 11 August 2020.
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Affiliation(s)
- Lester Juay
- Division of Dermatology, National University Hospital, 5 Lower Kent Ridge Road, Singapore city, 119074, Singapore.
| | - Monil Nagad Bhupendrabhai
- Division of Dermatology, National University Hospital, 5 Lower Kent Ridge Road, Singapore city, 119074, Singapore
| | | | - Hung Chew Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore city, Singapore
| | - Justin Wee-Min Chong
- National University Polyclinics, National University Health System, Singapore city, Singapore
| | - Wee Hian Tan
- National University Polyclinics, National University Health System, Singapore city, Singapore
| | - Nisha Suyien Chandran
- Division of Dermatology, National University Hospital, 5 Lower Kent Ridge Road, Singapore city, 119074, Singapore
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3
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Burke C, Reidy K, Ryan P, Jennings AA. GPs' attitudes towards and experiences of using the Dermabuddy health app for the management of patients with dermatological conditions: a descriptive cross-sectional study. BJGP Open 2024:BJGPO.2024.0038. [PMID: 38580390 DOI: 10.3399/bjgpo.2024.0038] [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: 02/06/2024] [Revised: 03/07/2024] [Accepted: 03/25/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Dermatological presentations are common in primary care. The digital health space is growing in investment, revenue, and in usership numbers. Doctors utilise mobile health apps for referencing, communicating, and for clinical decision making. Dermabuddy is a secure mobile health app by which information and expertise around skin problems can be shared among a group of medical professionals with the aim of finding the best treatment and management plan. AIM To assess the utility of the Dermabuddy health app for GPs and associated trainees in the Republic of Ireland. DESIGN & SETTING This is a descriptive cross-sectional study, which involved a survey link distributed by email to GPs with Irish Medical Council membership. METHOD GPs were surveyed on their experiences of using the dermatology mobile application, Dermabuddy. RESULTS In total, 203 members took this questionnaire (13.5% response rate). Ninety-six per cent who responded to the statement, 'The app was easy to use', agreed it was 'easy' or 'very easy'. Eighty-seven per cent of those who responded to the statement, 'I would use this app again', agreed they 'definitely would'. Fifty-eight per cent of those who responded to the statement, 'The app is useful for my healthcare practice', gave it a five-star rating. The content of 36 comments included advice for improvement and positive feedback. CONCLUSION The Dermabuddy app was well received by participants in this study. Across all sections of the questionnaire looking at aspects of the app, including ease of use, interface and satisfaction, and usefulness, there was a positive response. Mobile health apps, such as Dermabuddy, may provide alternative solutions to meet the rising challenge of managing patients with dermatological conditions in primary care.
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Affiliation(s)
- Caroline Burke
- Department of General Practice, University College Cork, Cork, Republic of Ireland
| | - Karen Reidy
- Department of Dermatology, University Hospital Galway, Galway, Republic of Ireland
| | - Paul Ryan
- Department of General Practice, University College Cork, Cork, Republic of Ireland
| | - Aisling A Jennings
- Department of General Practice, University College Cork, Cork, Republic of Ireland
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4
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Ntessalen M, Krasniqi A, Murchie P. Development and piloting of an online course to improve knowledge, confidence and attitudes towards triaging images of skin lesions submitted online in primary care. BMC MEDICAL EDUCATION 2024; 24:839. [PMID: 39103798 DOI: 10.1186/s12909-024-05840-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/30/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Melanoma is the 5th commonest cancer in the UK and survivors require frequent and thorough skin checks. During the Achieving Self-directed Integrated Cancer Aftercare (ASICA) trial, melanoma survivors used an app to submit images of concerning lesions for assessment by a dermatology nurse. In the past, online courses have been used to train non-specialist primary care practitioners (PCPs) in this skill. OBJECTIVES This study aimed to determine whether an online course could increase knowledge, confidence, and attitudes towards skin image triage in PCPs in the Grampian area. METHODS Preliminary discussions were held with PCPs to determine the need for an online course. The course was designed at the University of Aberdeen and included an introduction to the skin, case studies and quizzes on a variety of skin conditions based on melanoma survivors' submissions via the ASICA app. Two pre- and post-course questionnaires were administered to all participants to (1) assess knowledge gained and (2) assess any improvements in confidence and attitudes towards triaging skin lesions that could be indicative of skin cancer. All PCPs in the Grampian area were invited to participate with almost 70 medical practices contacted. Results were analysed using a paired sample T-test. RESULTS The course was advertised to all GP practices in the Grampian area and 38 PCPs completed all its stages. Undertaking the course improved all PCPs' confidence and attitudes towards triaging (p < 0.001). It also improved knowledge in all non-GP PCPs (p = 0.01). Most participants found the course useful; thought it was at the right level of difficulty, right format and thought the design was good. CONCLUSIONS Our online course in triaging skin lesions submitted digitally to PCPs was able to improve knowledge, confidence, and attitudes towards triaging. The course was acceptable in its design and was deemed useful and applicable to practice. Further research should investigate the effect the course has on secondary care referral numbers.
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Affiliation(s)
- Maria Ntessalen
- Academic Primary Care Research Group, Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, AB25 2ZD, Aberdeen, Scotland
| | - Albana Krasniqi
- Academic Primary Care Research Group, Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, AB25 2ZD, Aberdeen, Scotland
| | - Peter Murchie
- Academic Primary Care Research Group, Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, AB25 2ZD, Aberdeen, Scotland.
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Milavec Kapun M, Rajkovič V, Šušteršič O, Rajkovič U. A self-care process model for patients with chronic noncommunicable diseases. Health Serv Manage Res 2024; 37:189-197. [PMID: 37699151 DOI: 10.1177/09514848231201405] [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] [Indexed: 09/14/2023]
Abstract
Self-care of patients with chronic noncommunicable diseases is an essential component of contemporary healthcare. The purpose of this paper is to present a novel self-care process model and place it in the broader context of professional care. The extended Event-driven Process Chain approach to process modelling was used, focusing on a detailed overview of sequences of events, connections and activities and other elements/building blocks. A self-care process model was designed. The model is divided into two parts. The first part represents the self-care process when patients are able to manage their symptoms and be independent. The second part includes the process when patients are unable to perform self-care and/or need professional support. By identifying the essential elements of this process and incorporating them into the patients' care process, we can ensure that professional support for self-care creates a dynamic balance in the patients' ecosystems. Patients with chronic noncommunicable diseases need to make timely decisions about individual aspects of their health and seek professional help. In this way, an optimal level of health and well-being of patients can be achieved. Focusing on the patients' self-care process could also reduce treatment costs and improve the quality of life of patients. The novel designed model of the process of self-care, with all its essential elements, can be supported by digital technology, especially in the decision-making process and needs to become an important part of healthcare and long-term care systems.
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Affiliation(s)
| | - Vladislav Rajkovič
- Faculty of Organizational Sciences, University of Maribor, Kranj, Slovenia
| | - Olga Šušteršič
- Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Uroš Rajkovič
- Faculty of Organizational Sciences, University of Maribor, Kranj, Slovenia
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Harvey J, Shariff Z, Anderson C, Boyd MJ, Ridd MJ, Santer M, Thomas KS, Maidment I, Leighton P. How can community pharmacists be supported to manage skin conditions? A multistage stakeholder research prioritisation exercise. BMJ Open 2024; 14:e071863. [PMID: 38167282 PMCID: PMC10773317 DOI: 10.1136/bmjopen-2023-071863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 11/16/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE To establish research priorities which will support the development and delivery of community pharmacy initiatives for the management of skin conditions. DESIGN An iterative, multistage stakeholder consultation consisting of online survey, participant workshops and prioritisation meeting. SETTING All data collection took place online with participants completing a survey (delivered via the JISC Online Survey platform, between July 2021 and January 2022) and participating in online workshops and meetings (hosted on Microsoft Teams between April and July 2022). PARTICIPANTS 174 community pharmacists and pharmacy staff completed the online survey.53 participants participated in the exploratory workshops (19 community pharmacists, 4 non-pharmacist members of pharmacy staff and 30 members of the public). 4 healthcare professionals who were unable to attend a workshop participated in a one-to-one interview.29 participants from the workshops took part in the prioritisation meeting (5 pharmacists/pharmacy staff, 1 other healthcare professional and 23 members of the public). RESULTS Five broad areas of potential research need were identified in the online survey: (1) identifying and diagnosing skin conditions; (2) skin conditions in skin of colour; (3) when to refer skin conditions; (4) disease-specific concerns and (5) product-specific concerns.These were explored and refined in the workshops to establish 10 potential areas for research, which will support pharmacists in managing skin conditions. These were ranked in the prioritisation meeting. Among those prioritised were topics which consider how pharmacists work with other healthcare professionals to identify and manage skin conditions. CONCLUSIONS Survey responses and stakeholder workshops all recognised the potential for community pharmacists to play an active role in the management of common skin conditions. Future research may support this in the generation of resources for pharmacists, in encouraging public take-up of pharmacy services, and in evaluating the most effective provision for dealing with skin conditions.
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Affiliation(s)
- Jane Harvey
- Centre for Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Zakia Shariff
- Aston Pharmacy School, Aston University School of Life and Health Sciences, Birmingham, UK
| | - Claire Anderson
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Matthew J Boyd
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Matthew J Ridd
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Miriam Santer
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Kim Suzanne Thomas
- Centre for Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Ian Maidment
- Aston Pharmacy School, Aston University School of Life and Health Sciences, Birmingham, UK
| | - Paul Leighton
- Centre for Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
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7
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Richard MA, Paul C, Nijsten T, Gisondi P, Salavastru C, Taieb C, Stratigos A, Trakatelli M, Puig L. The journey of patients with skin diseases from the first consultation to the diagnosis in a representative sample of the European general population from the EADV burden of skin diseases study. J Eur Acad Dermatol Venereol 2023; 37 Suppl 7:17-24. [PMID: 37806003 DOI: 10.1111/jdv.18916] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/09/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND The journey of patients with skin diseases through healthcare has been scarcely investigated. OBJECTIVE To analyse the journey of people with skin diseases in the different healthcare environment in Europe. METHODS This multinational, cross-sectional, European study was conducted on a representative sample of the adult general population of 27 European countries. The prevalence of the most frequent skin diseases was determined. Information was collected on the patient journey from the first medical consultation to the diagnosis, and the reasons for not consulting a healthcare professional. RESULTS On a total of 44,689 individuals, 30.3% reported to have consulted a dermatologist during the previous 2 years. Participants consulted mainly for mole control or skin cancer screening (22.3%), followed by chronic skin diseases (16.2%). The diagnoses of acne, atopic dermatitis, psoriasis and rosacea were made most frequently by a dermatologist, while fungal skin infections were diagnosed more often by a general practitioner (GP), and sexually transmitted diseases (STD) by other specialists. The diagnosis was not always definitive at the first consultation, in particular for STD. The percentage of people who did not consult a healthcare professional for their skin disease was particularly high for acne (36.4%), alopecia (44.7%) and fungal infection (30.0%). Moreover, 17.7% of respondents with psoriasis did not consult. A high percentage of participants with alopecia thought that the disease was not worrying, while patients with psoriasis often answered that they were able to manage the disease since they had already consulted a doctor. Many patients with acne (41.1%) and fungal infection (48.2%) thought that they were able to handle the disease by themselves. CONCLUSION The analysis of the self-reported medical journey of patients with common skin diseases may allow to understand the unmet needs of patients, thus improving outcomes and reducing expenses.
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Affiliation(s)
- Marie Aleth Richard
- CEReSS-EA 3279, Research Center in Health Services and Quality of Life Aix Marseille University, Dermatology Department, University Hospital Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Carle Paul
- INSERM Infinity U1291, Université de Toulouse et CHU, Toulouse, France
| | - Tamar Nijsten
- Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Carmen Salavastru
- Department of Pediatric Dermatology, Carol Davila University of Medicine and Pharmacy, Colentina Clinical Hospital, Bucharest, Romania
| | | | - Alex Stratigos
- Department of Dermatology, Andreas Syggros Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Myrto Trakatelli
- Second Dermatology Department, Faculty of Medicine, Aristotle University, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Luis Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Alotaibi HM, Alruwaili ZM, Dilli AA, Altaleb AA, Asiri MM, Alwadani OJ, Alshaalan ZM, Dar UF. Assessment of Primary Care Physicians' Expertise of Common Dermatological Conditions in the Jouf Region, Saudi Arabia: A Mixed Methods Study. Healthcare (Basel) 2023; 11:1705. [PMID: 37372823 DOI: 10.3390/healthcare11121705] [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: 04/08/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
Primary care physicians (PCPs) are the first line of defense for the management of common dermatological conditions (DCs). This study aimed to assess how dermatological diseases are identified, managed, and referred to in primary healthcare centers (PHCs). This was a mixed methods study comprising a cross-sectional survey and semi-structured interviews recruited through PHCs across the Jouf region of Saudi Arabia. Sixty-one PCPs completed the data, and eight participants were interviewed. A survey based on a sample of 22 photographs of common DCs in the Kingdom was administered to the participants to answer questions about the correct diagnosis, appropriate management, referral strategy, and encounter rate. In our sampled population, the mean overall knowledge level on a scale of 10 was 7.08 (±1.3). Among participants that had good to acceptable scores, 51 (83.6%) were in the overall knowledge parameter, 46 (75.4%) in the diagnosis parameter, and 49 (80.3%) in the management parameter. PCPs with five years or more of experience were found to have significantly higher overall knowledge and management scores. Most of our PCPs demonstrated sufficient knowledge of common DCs and had good to acceptable scores in all parameters. However, educational and regulatory aspects of PCPs' clinical management were identified. Focused training, provision of workshops, and improving medical school curricula regarding common DCs are recommended.
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Affiliation(s)
- Hatem M Alotaibi
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
| | | | - Ahmed A Dilli
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
| | | | - Mohanad M Asiri
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
| | - Osama J Alwadani
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
| | - Ziad M Alshaalan
- Division of Dermatology, Department of Medicine, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
| | - Umar-Farooq Dar
- Department of Family & Community Medicine, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
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9
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Thandi CS, Constantinou S, Vincent R, Ridd MJ. Where and how have written action plans for atopic eczema/dermatitis been developed and evaluated? Systematic review. SKIN HEALTH AND DISEASE 2023; 3:e213. [PMID: 37275422 PMCID: PMC10233085 DOI: 10.1002/ski2.213] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 06/07/2023]
Abstract
Background Atopic eczema/dermatitis is a common inflammatory condition which affects 15%-30% of children and 2%-10% of adults. It can have a significant impact and its management can be challenging. It is important for patients, parents, and caregivers to know how to look after their skin. Objectives To identify and review written eczema action plans (WAPs) that are available internationally for use by patients, parents, and caregivers. Methods We followed Preferred Reporting Items for Systematic reviews and Meta-analysis guidelines. We searched relevant databases (MEDLINE, Embase, COCHRANE) from inception until March 2022. We sought grey literature via Google searches and professional networks. Database search results were independently reviewed by two different reviewers. With identified WAPs, we assessed length, appearance, content, how it was developed and whether it had been evaluated. Results From 312 abstracts, supplemented by other searches, we identified 20 unique eczema WAPs. From nine countries, all were written in English with 18 were designed for children. For the majority, it was unclear whether any development work preceded their creation or the intended clinical setting for use. Nineteen had a stepwise approach, 17 advised when to seek help, 6 were visually appealing and 6 had a rationale behind treatment documented in the WAP. Only three had been evaluated in clinical trials. Conclusion Further evaluation is needed to assess the effectiveness of the WAPs that currently exist, prior to creating further WAPs. Patient and caregiver involvement is needed in any future work.
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Affiliation(s)
- Charankumal Singh Thandi
- Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
- Department of DermatologyBristol Royal InfirmaryBristolUK
| | | | - Rosie Vincent
- Department of DermatologyBristol Royal InfirmaryBristolUK
| | - Matthew J. Ridd
- Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
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Golembiewski EH, Espinoza Suarez NR, Maraboto Escarria AP, Yang AX, Kunneman M, Hassett LC, Montori VM. Video-based observation research: A systematic review of studies in outpatient health care settings. PATIENT EDUCATION AND COUNSELING 2023; 106:42-67. [PMID: 36207219 DOI: 10.1016/j.pec.2022.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 09/13/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To examine the use of video-based observation research in outpatient health care encounter research. METHODS We conducted a systematic search of MEDLINE, Scopus, Cochrane and other databases from database inception to October 2020 for reports of studies that used video recording to investigate ambulatory patient-clinician interactions. Two authors independently reviewed all studies for eligibility and extracted information related to study setting and purpose, participant recruitment and consent processes, data collection procedures, method of analysis, and participant sample characteristics. RESULTS 175 articles were included. Most studies (65%) took place in a primary care or family practice setting. Study objectives were overwhelmingly focused on patient-clinician communication (81%). Reporting of key study elements was inconsistent across included studies. CONCLUSION Video recording has been used as a research method in outpatient health care in a limited number and scope of clinical contexts and research domains. In addition, reporting of study design, methodological characteristics, and ethical considerations needs improvement. PRACTICE IMPLICATIONS Video recording as a method has been relatively underutilized within many clinical and research contexts. This review will serve as a practical resource for health care researchers as they plan and execute future video-based studies.
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Affiliation(s)
| | - Nataly R Espinoza Suarez
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Department of Family Medicine and Emergency Medicine Laval University Quebec, Canada.
| | - Andrea P Maraboto Escarria
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Department of Obstetrics and Gynecology Hospital Angeles Lomas Mexico City, Mexico.
| | - Andrew X Yang
- Mayo Clinic Alix School of Medicine Rochester, MN, USA.
| | - Marleen Kunneman
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Medical Decision Making, Department of Biomedical Data Sciences Leiden University Medical Center Leiden, the Netherlands.
| | - Leslie C Hassett
- Division of Endocrinology, Diabetes, Metabolism and Nutrition Department of Medicine Mayo Clinic, Rochester, MN, USA.
| | - Victor M Montori
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Mayo Clinic Libraries Mayo Clinic, Rochester, MN, USA.
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Valentin J, Niemetzky F, Gaillet M, Michaud C, Carbunar A, Demar M, Couppie P, Blaizot R. Spectrum of skin diseases in Maroon villages of the Maroni area, French Guiana. Int J Dermatol 2022; 61:1137-1144. [PMID: 35767188 PMCID: PMC9543587 DOI: 10.1111/ijd.16324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/08/2022] [Accepted: 06/12/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Due to their genetic characteristics and their high exposure to infectious diseases, Maroons are likely to suffer from a specific spectrum of skin diseases. However, skin disorders have never been explored in this population. We aimed to describe all skin diseases in Maroon villages of the Maroni region in French Guiana. METHODS This retrospective study concerned all patients who consulted in the remote health centers of Apatou, Grand-Santi, Papaichton, and Maripasoula between October 5, 2017, and June 30, 2020. We included all patients registered with a skin disorder (International Classification of Diseases) in the medical database. We excluded patients whose diagnosis was invalidated after cross-checking by a dermatologist. RESULTS A total of 4741 patients presented at least one skin disease, for 6058 different disorders. Nonsexually transmitted infections represented 71.6% of all diagnoses, followed by inflammatory diseases (9.8%) and bites/envenomations (4.6%). The three most frequent conditions were scabies, abscesses, and impetigo. Besides scabies, neglected tropical diseases (NTDs) were still prevalent as we reported 13 cases of leprosy and 63 cutaneous leishmaniasis. Atopic dermatitis (AD) represented only 2.5% of our diagnoses. CONCLUSIONS With the exception of AD, which was less frequent among Maroons, these results are similar to those previously reported in Amerindians. Therefore, a common exposure to rainforest pathogens seems to induce a common spectrum of skin diseases dominated by infections. The high prevalence of NTDs requires specific public health actions.
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Affiliation(s)
- Julie Valentin
- Dermatology Department, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Florence Niemetzky
- Centres Délocalisés de Prévention et de Soins, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Melanie Gaillet
- Centres Délocalisés de Prévention et de Soins, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Celine Michaud
- Centres Délocalisés de Prévention et de Soins, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Aurel Carbunar
- Centres Délocalisés de Prévention et de Soins, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Magalie Demar
- Tropical Biome and Immunophysiopathology (TBIP), Université de Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, Centre Hospitalier de Cayenne, Université de Guyane, Cayenne, French Guiana.,Laboratory of Parasitology, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Pierre Couppie
- Dermatology Department, Centre Hospitalier de Cayenne, Cayenne, French Guiana.,Tropical Biome and Immunophysiopathology (TBIP), Université de Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, Centre Hospitalier de Cayenne, Université de Guyane, Cayenne, French Guiana
| | - Romain Blaizot
- Dermatology Department, Centre Hospitalier de Cayenne, Cayenne, French Guiana.,Tropical Biome and Immunophysiopathology (TBIP), Université de Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, Centre Hospitalier de Cayenne, Université de Guyane, Cayenne, French Guiana
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12
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Sutton E, Shaw AR, Ridd MJ, Santer M, Roberts A, Baxter H, Williams HC, Banks J. How parents and children evaluate emollients for childhood eczema: a qualitative study. Br J Gen Pract 2022; 72:e390-e397. [PMID: 35606161 PMCID: PMC9172216 DOI: 10.3399/bjgp.2021.0630] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/06/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Eczema affects one in five children in the UK. Regular application of emollients is routinely recommended for children with eczema. There are four main emollient types, but no clear evidence of which is best. The current 'trial and error' approach to find suitable emollients can be frustrating for parents, children, and clinicians. AIM To identify how parents and children experience and evaluate emollients. DESIGN AND SETTING Qualitative interview study, nested within a primary care trial of emollients (Best Emollients for Eczema [BEE] trial). METHOD Semi-structured interviews with children with eczema and their parents were conducted. Participants were purposively sampled on emollient type (lotion, cream, gel, or ointment), age, and eczema severity. RESULTS Forty-four parents were interviewed, with children participating in 24 of those interviews. There was no clear preference for any one emollient type. The strongest theme was the variation of experience in each of the four types. Participants focused on thickness and absorbency, both positively and negatively, to frame their evaluations. Effectiveness and acceptability were both considered when evaluating an emollient but effectiveness was the primary driver for continued use. For some, participating in the trial had changed their knowledge and behaviour of emollients, resulting in use that was more regular and for a longer duration. CONCLUSION There is no one emollient that is suitable for everyone, and parents/children prioritise different aspects of emollients. Future research could evaluate decision aids and/or tester pots of different types, which could enable clinicians and parents/children to work collaboratively to identify the best emollient for them.
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Affiliation(s)
- Eileen Sutton
- Bristol Population Health Sciences Institute, University of Bristol, Bristol
| | - Alison Rg Shaw
- Bristol Population Health Sciences Institute, University of Bristol, Bristol
| | - Matthew J Ridd
- Bristol Population Health Sciences Institute, University of Bristol, Bristol
| | - Miriam Santer
- Primary Care Research Centre, University of Southampton, Southampton
| | - Amanda Roberts
- Nottingham Support Group for Parents of Children with Eczema, Nottingham
| | - Helen Baxter
- Bristol Population Health Sciences Institute, University of Bristol, Bristol
| | - Hywel C Williams
- Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham
| | - Jonathan Banks
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol
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13
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Grada A, Muddasani S, Fleischer AB, Feldman SR, Peck GM. Trends in Office Visits for the Five Most Common Skin Diseases in the United States. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2022; 15:E82-E86. [PMID: 35642232 PMCID: PMC9122273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective We sought to determine the outpatient visit rates for the five most common skin conditions among dermatologists and non-dermatologists. Methods We conducted a population-based, cross-sectional analysis using the National Ambulatory Medical Care Survey between 2007 and 2016, the most recent years available. Results The five most common skin diagnoses among all medical specialties were contact dermatitis, acne vulgaris, actinic keratosis, benign neoplasm of the skin, and epidermoid cyst, respectively. Actinic keratosis followed by acne vulgaris and benign neoplasm of skin were the three most common visit diagnoses among dermatologists, whereas contact dermatitis, acne vulgaris, and epidermoid cyst were the most common among non-dermatologists. Overall, visits for the five most common skin conditions seen by dermatologists and non-dermatologists remained constant over the study interval. Limitations Misclassification bias could be impacting the results of this study. Additionally, the NAMCS samples only non-hospital based outpatient clinicians, and thus cannot describe hospital-based outpatient visits or inpatient hospital care. Conclusion Visits for contact dermatitis, acne, actinic keratosis, benign neoplasm of the skin, and epidermoid cysts have remained constant over the last ten years. These conditions represent the most common diagnoses of the skin at both dermatologists and non-dermatologists outpatient visits. Non-dermatologists continue to see almost half of visits for the five most common skin diagnoses. Patients are often referred from the primary care setting for growths of skin and skin lesions; thus, it is not surprising that actinic keratosis has remained the most common diagnosis among dermatologist and benign neoplasm the third most common dermatologic diagnosis.
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Affiliation(s)
- Ayman Grada
- Dr. Grada is with Grada Dermatology Research in Chesterbrook, Pennsylvania
| | - Suraj Muddasani
- Dr. Muddasani is with the College of Medicine at University of Cincinnati in Cincinnati, Ohio
| | - Alan B Fleischer
- Dr. Fleischer is with the Department of Dermatology at the University of Cincinnati in Cincinnati, Ohio
| | - Steven R Feldman
- Dr. Feldman is with the Department of Dermatology at Wake Forest School of Medicine, in Winston-Salem, North Carolina
| | - Gabrielle M Peck
- Ms. Peck is with the College of Medicine at the University of Cincinnati in Cincinnati, Ohio
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14
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Magin PJ, Tng ETV. Specialists and generalists in skin disease management: educational, clinical and research imperatives. Br J Dermatol 2022; 186:1-2. [PMID: 34988983 DOI: 10.1111/bjd.20575] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 11/30/2022]
Affiliation(s)
- P J Magin
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,NSW & ACT Research and Evaluation Unit, GP Synergy Regional Training Organisation, Mayfield West, NSW, Australia
| | - E T V Tng
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Department of Dermatology, John Hunter Hospital, New Lambton Heights, NSW, Australia
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15
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Willems A, Tapley A, Fielding A, Tng ETV, Holliday EG, van Driel ML, Ball JI, Davey AR, Patsan I, FitzGerald K, Spike NA, Magin PJ. Prevalence and Associations of General Practice Registrars' Management of Atopic Dermatitis: A Cross-Sectional Analysis from the Registrar Clinical Encounters in Training Study. Dermatol Pract Concept 2021; 11:e2021128. [PMID: 34631271 DOI: 10.5826/dpc.1104a128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2021] [Indexed: 10/31/2022] Open
Abstract
Introduction Atopic dermatitis (AD) is a chronic inflammatory condition which imposes substantial burden upon patients and their families. As a frequent primary care presentation, general practice (GP) trainees must develop adequate skills in AD diagnosis and management. Objectives We aimed to explore the prevalence and associations of GP registrars' management of patients with AD. Methods This study used data from the Registrar Clinical Encounters in Training (ReCEnT) project, an ongoing cohort study of the clinical and educational experience of Australian GP registrars. Registrar, patient, and consultation factors were independent variables in multivariable logistic regression with outcome factor 'diagnosis/problem being AD'. Results From 2010-2019, 2,783 registrars (96% response rate) provided data from 381,180 consultations. AD was encountered in 0.6% of consults. AD was more likely to be seen in patients aged 0-1 years and patients from a non-English speaking background. AD was less likely to be seen in Aboriginal or Torres Strait Islander patients. Learning goals were more likely to be generated for AD and these consultations were associated with registrars seeking information or assistance. AD was strongly associated with a medication being prescribed, of which the most prescribed medications were mild or moderate potency topical corticosteroids. Conclusions Our findings suggest that, similar to other dermatological presentations, registrars find AD challenging to manage. There may be some gaps in AD management knowledge and application.
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Affiliation(s)
- Anneliese Willems
- Eastern Victoria General Practice Training, Regional Training Organisation, Hawthorn, Victoria, Australia.,University of Melbourne, Department of General Practice and Primary Health Care, Berkeley Street, Carlton, Victoria, Australia
| | - Amanda Tapley
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, Newcastle, NSW, Australia.,GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, 20 Mclntosh Drive, Mayfield West, NSW, Australia
| | - Alison Fielding
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, Newcastle, NSW, Australia.,GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, 20 Mclntosh Drive, Mayfield West, NSW, Australia
| | - Er Tsing Vivian Tng
- Department of Dermatology, John Hunter Hospital, Newcastle, New Lambton Heights, NSW, Australia
| | - Elizabeth G Holliday
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, Newcastle, NSW, Australia
| | - Mieke L van Driel
- The University of Queensland Faculty of Medicine, Primary Care Clinical Unit, Faculty of Medicine, Level 8 Health Sciences Building, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | - Jean I Ball
- Hunter Medical Research Institute, Clinical Research Design, IT and Statistical Support Unit (CReDITSS), New Lambton, NSW, Australia
| | - Andrew R Davey
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, Newcastle, NSW, Australia.,GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, 20 Mclntosh Drive, Mayfield West, NSW, Australia
| | - Irena Patsan
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, Newcastle, NSW, Australia.,GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, 20 Mclntosh Drive, Mayfield West, NSW, Australia
| | - Kristen FitzGerald
- University of Tasmania Tasmanian School of Medicine, Hobart, TAS, Australia.,General Practice Training Tasmania, Regional Training Organisation, Hobart, TAS, Australia
| | - Neil A Spike
- Eastern Victoria General Practice Training, Regional Training Organisation, Hawthorn, Victoria, Australia.,University of Melbourne, Department of General Practice and Primary Health Care, Berkeley Street, Carlton, Victoria, Australia
| | - Parker J Magin
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, Newcastle, NSW, Australia.,GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, 20 Mclntosh Drive, Mayfield West, NSW, Australia
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16
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Salava A, Oker-Blom A, Remitz A. The spectrum of skin-related conditions in primary care during 2015-2019-A Finnish nationwide database study. SKIN HEALTH AND DISEASE 2021; 1:e53. [PMID: 35663141 PMCID: PMC9060089 DOI: 10.1002/ski2.53] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 12/18/2022]
Abstract
Background Skin‐related conditions are the frequent cause of doctors’ consultations in primary care. Methods Based on nationwide data bank information of the Finnish Institute for Health and Welfare, we analysed the 20 most frequent main diagnoses for each ICD‐10 category of all general practitioners’ visits in the public health care in Finland over the years 2015–2019. Results The total amount of doctor’s visits was 19 204 613 of which 1 489 228 consultations (7.80%) had a skin‐related condition as the main diagnosis. The most frequent skin‐related conditions were eczematous eruptions, bacterial skin infections and benign skin neoplasms accounting for 749 351 consultations (50.32%). The spectrum of skin‐related conditions was diverse, with a large quantity of rarer diagnoses. Some diagnoses showed significant proportional changes. Conclusions The results demonstrate that a limited amount of conditions comprises most of the skin‐related consultations in primary care in Finland. Undergraduate education in dermatology should concentrate on the most frequent conditions seen by general practitioners, but also address the wide range of skin problems.
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Affiliation(s)
- A Salava
- Department of Dermatology and Allergology Helsinki University Hospital Helsinki Finland
| | - A Oker-Blom
- Department of Dermatology and Allergology Helsinki University Hospital Helsinki Finland
| | - A Remitz
- Department of Dermatology and Allergology Helsinki University Hospital Helsinki Finland
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17
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Nawaz S, Tapley A, Davey AR, van Driel ML, Fielding A, Holliday EG, Ball J, Patsan I, Berrigan A, Morgan S, Spike NA, FitzGerald K, Magin P. Management of a Chronic Skin Disease in Primary Care: An Analysis of Early-Career General Practitioners' Consultations Involving Psoriasis. Dermatol Pract Concept 2021; 11:e2021055. [PMID: 34123559 DOI: 10.5826/dpc.1103a55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 10/31/2022] Open
Abstract
Background The management of psoriasis by general practitioners (GPs) is vital, given its prevalence, chronicity, and associated physical and psychosocial co-morbidities. However, there is little information on how GPs (including early-career GPs) manage psoriasis. Objectives This study assessed the frequency with which Australian specialist GP vocational trainees ('registrars') provide psoriasis care and the associations of that clinical experience. Methods A cross-sectional analysis was done of data from the ReCEnT study, an ongoing multi-site cohort study of Australian GP registrars' experiences during vocational training. In ReCEnT, 60 consecutive consultations are recorded 3 times (6-monthly) during each registrar's training. The outcome factor for this analysis was a problem/diagnosis being psoriasis, and independent variables were related to registrar, patient, practice and consultation factors. This study analysed 17 rounds of data collection (2010-2017) using univariate and multivariable regression. Results Data from 1,741 registrars regarding 241,888 consultations and 377,980 problems/diagnoses were analysed. Psoriasis comprised 0.15% (n=550) of all problems/diagnoses (95% CI, 0.13-0.16). Significant patient multivariable associations of a problem/diagnosis being psoriasis included age, gender, being new to a practice or a registrar, and psoriasis being an existing problem rather than a new diagnosis. Significant registrar associations included seeking in-consultation information/assistance, not scheduling a follow-up appointment, prescribing medication, and generating learning goals. Conclusions Australian registrars have modest training exposure to psoriasis and may find psoriasis management challenging. Furthermore, continuity of care (essential for optimal chronic disease management) was modest. The findings have implications for GPs' approaches to the management of psoriasis more widely as well for general practice education and training policies.
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Affiliation(s)
- Sameerah Nawaz
- GP Synergy, Regional Training Organisation, Liverpool, NSW, Australia
| | - Amanda Tapley
- The University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, Australia.,GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Mayfield West, NSW, Australia
| | - Andrew R Davey
- The University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, Australia.,GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Mayfield West, NSW, Australia
| | - Mieke L van Driel
- The University of Queensland Faculty of Medicine, Primary Care Clinical Unit, Brisbane, QLD, Australia
| | - Alison Fielding
- The University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, Australia.,GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Mayfield West, NSW, Australia
| | - Elizabeth G Holliday
- The University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, Australia
| | - Jean Ball
- Hunter Medical Research Institute, Clinical Research Design, IT and Statistical Support Unit (CReDITSS), New Lambton, NSW, Australia
| | - Irena Patsan
- The University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, Australia.,GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Mayfield West, NSW, Australia
| | - Alyse Berrigan
- GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Mayfield West, NSW, Australia
| | - Simon Morgan
- GP Synergy, Regional Training Organisation, Liverpool, NSW, Australia
| | - Neil A Spike
- Eastern Victoria GP Training, General Practice Training Organisation, Melbourne, Australia.,The University of Melbourne, Department of General Practice, Melbourne, VIC, Australia
| | - Kristen FitzGerald
- University of Tasmania, School of Medicine, Hobart, TAS, Australia.,General Practice Training Tasmania (GPTT), Regional Training Organisation, Hobart, TAS, Australia
| | - Parker Magin
- The University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, Australia.,GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Mayfield West, NSW, Australia
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18
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Ochsendorf F, von Kiedrowski R. Vom Hörsaal in die Praxis – und zurück. J Dtsch Dermatol Ges 2021; 19:649-650. [PMID: 33979063 DOI: 10.1111/ddg.14536_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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