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Ehrlich O, Vallerand AH. Patient Goals in Hospice Cancer Pain Management: A Total Pain Case Scenario. J Hosp Palliat Nurs 2023; 25:75-81. [PMID: 36525651 DOI: 10.1097/njh.0000000000000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Evidence-based clinical practice guidelines and hospice agency policies and procedures direct nursing assessment and interventions for the care of persons with cancer-related pain. Guidelines assert that pain should be assessed from a holistic perspective that considers physical, psychological, social, and spiritual aspects. In addition, guidelines maintain that hospice nurses should ascertain patient goals for pain management. Assessment and documentation of goals other than pain intensity goals is an area of nursing practice that has not been developed. Without inclusion of personally meaningful goals in pain assessment instruments, such goals cannot be routinely or consistently included in the hospice care plan. To address the assessment of pain and patient goals for pain management, this scenario-based article merges theoretical knowledge about pain from concept analyses with clinical guideline recommendations. Although research is needed to develop pain goal assessment tools, nurses can use this empirically based approach for asking about goals and integrating them into the plan of care.
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Azizoddin DR, Adam R, Kessler D, Wright AA, Kematick B, Sullivan C, Zhang H, Hassett MJ, Cooley ME, Ehrlich O, Enzinger AC. Leveraging mobile health technology and research methodology to optimize patient education and self-management support for advanced cancer pain. Support Care Cancer 2021; 29:5741-5751. [PMID: 33738594 PMCID: PMC8410657 DOI: 10.1007/s00520-021-06146-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/08/2021] [Indexed: 01/09/2023]
Abstract
PURPOSE Patient education is critical for management of advanced cancer pain, yet the benefits of psychoeducational interventions have been modest. We used mobile health (mHealth) technology to better meet patients' needs. METHODS Using the Agile and mHealth Development and Evaluation Frameworks, a multidisciplinary team of clinicians, researchers, patients, and design specialists followed a four-phase iterative process to develop comprehensive, tailored, multimedia cancer pain education for a patient-facing smartphone application. The target population reviewed the content and provided feedback. RESULTS The resulting application provides comprehensive cancer pain education spanning pharmacologic and behavioral aspects of self-management. Custom graphics, animated videos, quizzes, and audio-recorded relaxations complemented written content. Computable algorithms based upon daily symptom surveys were used to deliver brief, tailored motivational messages that linked to more comprehensive teaching. Patients found the combination of pharmacologic and behavioral support to be engaging and helpful. CONCLUSION Digital technology can be used to provide cancer pain education that is engaging and tailored to individual needs. A replicable interdisciplinary and patient-centered approach to intervention development was advantageous. mHealth interventions may be a scalable approach to improve cancer pain. Frameworks that merge software and research methodology can be useful in developing interventions.
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Affiliation(s)
- Desiree R Azizoddin
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA. .,Department of Emergency Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St, Thorn Building, Boston, MA, 13-1303, USA.
| | - Rosalind Adam
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Daniela Kessler
- Division of Population Sciences, Dana Farber Cancer Institute, Boston, MA, USA
| | - Alexi A Wright
- Harvard Medical School, Boston, MA, USA.,Division of Population Sciences, Dana Farber Cancer Institute, Boston, MA, USA
| | - Benjamin Kematick
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA
| | - Clare Sullivan
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA
| | - Haipeng Zhang
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Brigham Digital Innovation Hub, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael J Hassett
- Harvard Medical School, Boston, MA, USA.,Division of Population Sciences, Dana Farber Cancer Institute, Boston, MA, USA
| | - Mary E Cooley
- Harvard Medical School, Boston, MA, USA.,Phyllis F. Cantor Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Olga Ehrlich
- Phyllis F. Cantor Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Andrea C Enzinger
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Division of Population Sciences, Dana Farber Cancer Institute, Boston, MA, USA
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Ehrlich O, Brandoff D, Gorman DP, Berry DL. Nurse-Led Motivational Interviewing for Setting Functional Cancer Pain Goals. Pain Manag Nurs 2021; 22:716-723. [PMID: 33962871 DOI: 10.1016/j.pmn.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 03/07/2021] [Accepted: 03/11/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Persons with advanced cancers experience high rates of pain. Nursing interventions for pain, which are tailored to the individual patient, may support motivation to engage in self-management and should include setting of realistic functional goals. For patients with advanced cancer, functional pain goals include personally important activities, measurable across clinical encounters. However, limited evidence exists regarding nursing assessment of functional pain goals. To address this gap, we piloted use of a motivational interviewing intervention. Motivational interviewing is a clinical technique for clarifying goals and related impediments, such as cognitive and emotional factors underlying pain management behaviors. DESIGN Pilot feasibility testing. METHODS Palliative care patients with cancer-related pain completed up to four intervention sessions, the Pain Self-Efficacy Questionnaire, and an author-developed acceptability questionnaire. Feasibility success was determined by 60% of participants completing at least two interventions. Fidelity to the intervention was assessed using the Motivational Interviewing Skills for Healthcare Encounters tool. RESULTS Sixty-seven percent completed two interventions. Participants reported that interventions were helpful, worthwhile, and recommended. Mean pain self-efficacy scores (0-60 possible) rose from 31.5 (SD = 11.2) at intervention 1 to 35.5 (SD = 13) after intervention 4. Intervention fidelity was maintained. CONCLUSIONS Participants were willing to engage in multiple motivational interviewing conversations focused on pain management behaviors related to functional goals. Based on these findings about motivational interviewing for functional goals and patient willingness to set them, these conversations may have a place in clinical care as an element of pain assessment and intervention tailoring.
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Affiliation(s)
- Olga Ehrlich
- University of Massachusetts Amherst, College of Nursing, Amherst, Massachusetts; Phyllis F. Cantor Center for Research in Nursing and Patient Care, Dana-Farber Cancer Institute, Boston, Massachusetts.
| | - Douglas Brandoff
- Schwartz Center Rounds, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Daniel P Gorman
- Adult Palliative Care Clinic, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Donna L Berry
- University of Washington School of Nursing, Seattle, Washington
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Chua IS, Ransohoff JR, Ehrlich O, Katznelson E, Virk ZM, Demetriou CA, Petrides AK, Orav EJ, Schiff GD, Melanson SEF. Laboratory-Generated Urine Toxicology Interpretations: A Mixed Methods Study. Pain Physician 2021; 24:E191-E201. [PMID: 33740356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Clinicians frequently order urine drug testing (UDT) for patients on chronic opioid therapy (COT), yet often have difficulty interpreting test results accurately. OBJECTIVES To evaluate the implementation and effectiveness of a laboratory-generated urine toxicology interpretation service for clinicians prescribing COT. STUDY DESIGN Type II hybrid-convergent mixed methods design (implementation) and pre-post prospective cohort study with matched controls (effectiveness). SETTING Four ambulatory sites (2 primary care, 1 pain management, 1 palliative care) within 2 US academic medical institutions. METHODS Interpretative reports were generated by the clinical chemistry laboratory and were provided to UDT ordering providers via inbox message in the electronic health record (EHR). The Partners Institutional Review Board approved this study.Participants were primary care, pain management, and palliative care clinicians who ordered liquid chromatography-mass spectrometry UDT for COT patients in clinic. Intervention was a laboratory-generated interpretation service that provided an individualized interpretive report of UDT results based on the patient's prescribed medications and toxicology metabolites for clinicians who received the intervention (n = 8) versus matched controls (n = 18).Implementation results included focus group and survey feedback on the interpretation service's usability and its impact on workflow, clinical decision making, clinician-patient relationships, and interdisciplinary teamwork. Effectiveness outcomes included UDT interpretation concordance between the clinician and laboratory, documentation frequency of UDT results interpretation and communication of results to patients, and clinician prescribing behavior at follow-up. RESULTS Among the 8 intervention clinicians (median age 58 [IQR 16.5] years; 2 women [25%]) on a Likert scale from 1 ("strongly disagree") to 5 ("strongly agree"), 7 clinicians reported at 6 months postintervention that the interpretation service was easy to use (mean 5 [standard deviation {SD}, 0]); improved results comprehension (mean 5 [SD, 0]); and helped them interpret results more accurately (mean 5 [SD, 0]), quickly (mean 4.67 [SD, 0.52]), and confidently (mean 4.83 [SD, 0.41]). Although there were no statistically significant differences in outcomes between cohorts, clinician-laboratory interpretation concordance trended toward improvement (intervention 22/32 [68.8%] to 29/33 [87.9%] vs. control 21/25 [84%] to 23/30 [76.7%], P = 0.07) among cases with documented interpretations. LIMITATIONS This study has a low sample size and was conducted at 2 large academic medical institutions and may not be generalizable to community settings. CONCLUSIONS Interpretations were well received by clinicians but did not significantly improve laboratory-clinician interpretation concordance, interpretation documentation frequency, or opioid-prescribing behavior.
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Affiliation(s)
- Isaac S Chua
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Jaime R Ransohoff
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Olga Ehrlich
- Phyllis Cantor Center for Research in Nursing and Patient Care Services, Dana Farber Cancer Institute, Boston, MA, USA
| | | | | | - Christiana A Demetriou
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus; The Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Athena K Petrides
- Department of Pathology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Endel J Orav
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Gordon D Schiff
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Stacy E F Melanson
- Department of Pathology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
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Hall TE, Wood AJ, Ehrlich O, Li M, Sonntag CS, Cole NJ, Huttner IG, Sztal TE, Currie PD. Cellular rescue in a zebrafish model of congenital muscular dystrophy type 1A. NPJ Regen Med 2019; 4:21. [PMID: 31754462 PMCID: PMC6858319 DOI: 10.1038/s41536-019-0084-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 10/11/2019] [Indexed: 01/11/2023] Open
Abstract
Laminins comprise structural components of basement membranes, critical in the regulation of differentiation, survival and migration of a diverse range of cell types, including skeletal muscle. Mutations in one muscle enriched Laminin isoform, Laminin alpha2 (Lama2), results in the most common form of congenital muscular dystrophy, congenital muscular dystrophy type 1A (MDC1A). However, the exact cellular mechanism by which Laminin loss results in the pathological spectrum associated with MDC1A remains elusive. Here we show, via live tracking of individual muscle fibres, that dystrophic myofibres in the zebrafish model of MDC1A maintain sarcolemmal integrity and undergo dynamic remodelling behaviours post detachment, including focal sarcolemmal reattachment, cell extension and hyper-fusion with surrounding myoblasts. These observations imply the existence of a window of therapeutic opportunity, where detached cells may be “re-functionalised” prior to their delayed entry into the cell death program, a process we show can be achieved by muscle specific or systemic Laminin delivery. We further reveal that Laminin also acts as a pro-regenerative factor that stimulates muscle stem cell-mediated repair in lama2-deficient animals in vivo. The potential multi-mode of action of Laminin replacement therapy suggests it may provide a potent therapeutic axis for the treatment for MDC1A.
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Affiliation(s)
- T E Hall
- 1Australian Regenerative Medicine Institute, Monash University, Level 1, 15 Innovation Walk, Victoria, 3800 Australia.,2Institute for Molecular Bioscience, University of Queensland, 306 Carmody Road, St Lucia, 4067 Australia
| | - A J Wood
- 1Australian Regenerative Medicine Institute, Monash University, Level 1, 15 Innovation Walk, Victoria, 3800 Australia
| | - O Ehrlich
- 1Australian Regenerative Medicine Institute, Monash University, Level 1, 15 Innovation Walk, Victoria, 3800 Australia
| | - M Li
- 1Australian Regenerative Medicine Institute, Monash University, Level 1, 15 Innovation Walk, Victoria, 3800 Australia
| | - C S Sonntag
- 1Australian Regenerative Medicine Institute, Monash University, Level 1, 15 Innovation Walk, Victoria, 3800 Australia
| | - N J Cole
- 3Victor Chang Cardiac Research Institute, 405 Liverpool Street, Darlinghurst, Sydney, New South Wales 2010 Australia.,4Anatomy & Histology, School of Medical Science, Anderson Stuart Building, Eastern Avenue, The University of Sydney, Sydney, New South Wales 2006 Australia
| | - I G Huttner
- 3Victor Chang Cardiac Research Institute, 405 Liverpool Street, Darlinghurst, Sydney, New South Wales 2010 Australia
| | - T E Sztal
- 1Australian Regenerative Medicine Institute, Monash University, Level 1, 15 Innovation Walk, Victoria, 3800 Australia.,5Department of Biological Sciences, Monash University, Victoria, 3800 Australia
| | - P D Currie
- 1Australian Regenerative Medicine Institute, Monash University, Level 1, 15 Innovation Walk, Victoria, 3800 Australia.,6EMBL Australia, Victorian Node, Monash University, Clayton, VIC 3800 Australia
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Walker RK, Ehrlich O, Berry DL. MALE BREAST CANCER SURVIVORS’ PERSPECTIVES ON THE ADEQUACY OF THEIR SURVIVORSHIP CARE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R K Walker
- University of Massachusetts-Amherst, Amherst, Massachusetts, United States
| | - O Ehrlich
- CHPN, Postdoctoral Fellow, Phyllis F. Cantor Center for Research in Nursing & Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - D L Berry
- Affiliate Professor, University of Washington, School of Nursing, Seattle, WA, USA
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Abstract
BACKGROUND Qualitative pain research for hospice patients with cancer and their caregivers involves recruiting and retaining participants with multiple vulnerabilities and ethical and logistical challenges. These have been reported for studies of individuals or dyads. However, there are no reports of the related challenges and outcomes where the sampled population was a hospice triad. OBJECTIVES Qualitative research about pain management for home hospice patients with cancer contributes rich descriptive data and such studies are critical to improving cancer pain outcomes. We describe the ethical and pragmatic challenges we faced in a study of the hospice caring triad, operationalized as the patient, family caregiver, and nurse; how our study design anticipated them; and related outcomes. RESULTS We found that having an established relationship with the hospice agency at which we recruited participants, clearly identifying potential participants at the onset of hospice care, practice using a recruitment script, patient recruitment of caregivers, establishing rapport, and participants determining when interviews should end helped us recruit and retain our sample. We were unable to accrue our anticipated triad sample, partially because of nurse gatekeeping and the condition at admission of patient participants who enrolled but had physical decline or died prior to written consent. CONCLUSIONS Although researchers will always face challenges to enrolling individuals and groups in cancer pain studies, with careful study design, recruitment, and retention planning and research team-participant engagement, it is possible to gather a robust corpus of qualitative data.
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Affiliation(s)
- Olga Ehrlich
- 1 Dana-Farber Cancer Institute, The Phyllis F. Cantor Center for Research in Nursing and Patient Care Services/UMass Boston P54 Center for Cancer and Health Disparities, Boston, MA, USA
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Ehrlich O, Walker RK. Pain and social processes for hospice cancer patients: An integrative review. Eur J Oncol Nurs 2016; 25:83-89. [DOI: 10.1016/j.ejon.2016.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 09/25/2016] [Accepted: 10/05/2016] [Indexed: 12/01/2022]
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Perevolotsky A, Brosh A, Ehrlich O, Gutman M, Henkin Z, Holzer Z. Nutritional value of common oak (Quercus calliprinos) browse as fodder for goats: Experimental results in ecological perspective. Small Rumin Res 1993. [DOI: 10.1016/0921-4488(93)90143-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Abuelo DN, Ehrlich O, Schwartz A, Feingold M. Picture of the month: Frontometaphyseal dysplasia. Am J Dis Child 1983; 137:1017-8. [PMID: 6613928 DOI: 10.1001/archpedi.1983.02140360077021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Ehrlich O, Brem A. A Prospective Comparison of Urinary Tract Infections in Patients Treated with Either Clean Intermittent Catheterization or Urinary Diversion. J Urol 1983. [DOI: 10.1016/s0022-5347(17)52547-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- O. Ehrlich
- Department of Pediatrics, Rhode Island Hospital, Providence, Rhode Island
| | - A.S. Brem
- Department of Pediatrics, Rhode Island Hospital, Providence, Rhode Island
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Ehrlich O, Brem AS. A prospective comparison of urinary tract infections in patients treated with either clean intermittent catheterization or urinary diversion. Pediatrics 1982; 70:665-9. [PMID: 6752858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Clean intermittent catheterization (CIC) has replaced urinary diversion as the treatment of choice for patients with neurogenic bladder. Yet, no well controlled studies are available assessing the efficacy of CIC over ileal loop diversion (ILD). Consequently, a one-year pospective study was carried out comparing short-term patient morbidity, infection rates, and bacterial organisms in 33 children with meningomyelocele. Twenty-four of the children were treated with CIC whereas nine children had an ILD. A minimum of four cultures per year were obtained on each patient. Patients maintained on CIC had 36.8% of their cultures positive for bacteriuria whereas children with ILD had 61.8% of their cultures positive (P less than .001). The incidence of bacteriuria associated with clinical signs and symptoms was similar in both groups. Four of 24 children treated with CIC had sterile urine whereas none of the children with ILD were persistently free from bacteriuria. Only five of 24 children receiving CIC had 50% or more of their cultures positive as contrasted with seven of nine children with an ILD (P less than .01). Escherichia coli accounted for approximately one third of organisms recovered from infected urine in both groups. Although the short-term morbidity associated with both treatment modalities is similar, the incidence of asymptomatic bacteriuria in children maintained on CIC is significantly less than in children with ILD. Whether this factor plays a role in determining long-term morbidity is a subject for further study.
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