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Beserra VDS, Brito C. [Difficult situations and feelings in palliative oncology care]. CAD SAUDE PUBLICA 2024; 40:e00116823. [PMID: 38359275 PMCID: PMC10876151 DOI: 10.1590/0102-311xpt116823] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/28/2023] [Accepted: 09/29/2023] [Indexed: 02/17/2024] Open
Abstract
The act of caring for people in pain, shortness of breath, and imminent death on a daily basis can intensify difficult situations for health professionals. However, difficult situations are rarely discussed in the services and in the professional training process. This study aimed to analyze difficult situations and feelings that emerge from healthcare. This is a phenomenological and qualitative study based on 30 difficult situations of health professionals who work exclusively in palliative oncological care. The interviews were conducted from August to February 2020. The results show that the main difficulties were motivated by identification (when the professional recognizes similarities in the patient they are caring for), a bad death (with suffering), caring for young patients, the death of a mother with a small child, and when there was a divergence between what the professional proposed and the patient's choice. There was a relationship between types of difficult situations and professional category. The professionals expressed both unpleasant feelings (sadness, impotence, anguish, fear) and pleasant feelings (compassion, gratitude). The results show that the concealment of the dying process throughout the societies' development turned it into a taboo, causing distress even in those who work in palliative care. They also show an important subjective dimension of care, usually neglected, which generates suffering, but also resignification. To properly provide care, health professionals must find meaning in the work, made possible by the modification of the their internal mindset via experience, which generates transformation, new meaning, and knowledge from praxis.
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Affiliation(s)
| | - Claudia Brito
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Pinto SOSA, Pereira MA, Ribeiro Junior U, D'Albuquerque LAC, Ramos MFKP. PALLIATIVE GASTRECTOMY VERSUS GASTRIC BYPASS FOR SYMPTOMATIC CLINICAL STAGE IV GASTRIC CANCER: A PROPENSITY SCORE MATCHING ANALYSIS. Arq Bras Cir Dig 2024; 36:e1790. [PMID: 38324851 PMCID: PMC10841491 DOI: 10.1590/0102-672020230072e1790] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/15/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Patients with clinical stage IV gastric cancer may require palliative procedures to manage complications such as obstruction. However, there is no consensus on whether performing palliative gastrectomy compared to gastric bypass brings benefits in terms of survival. AIMS To compare the overall survival of patients with distal obstructive gastric cancer undergoing palliative surgical treatment, using propensity score matching analysis. METHODS Patients who underwent palliative bypass surgery (gastrojejunostomy or partitioning) and resection between the years 2009 and 2023 were retrospectively selected. Initial and postoperative clinicopathological variables were collected. RESULTS 150 patients were initially included. The derived group (n=91) presented more locally invasive disease (p<0.01), greater degree of obstruction (p<0.01), and worse clinical status (p<0.01), while the resected ones (n= 59) presented more distant metastasis (p<0.01). After matching, 35 patients remained in each group. There was no difference in the incidence of postoperative complications, but the derived group had higher 90-day mortality (p<0.01). Overall survival was 16.9 and 4.5 months for the resected and derived groups, respectively (p<0.01). After multivariate analysis, hypoalbuminemia (hazard ratio - HR=2.02, 95% confidence interval - 95%CI 1.17-3.48; p=0.01), absence of adjuvant chemotherapy (HR=5.97; 95%CI 3.03-11.7; p<0.01), and gastric bypass (HR=3,28; 95%CI 1.8-5.95; p<0.01) were associated with worse survival. CONCLUSIONS Palliative gastrectomy was associated with greater survival and lower postoperative morbidity compared to gastric bypass. This may be due to better local control of the disease, with lower risks of complications and better effectiveness of chemotherapy.
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Affiliation(s)
| | - Marina Alessandra Pereira
- Universidade de Sao Paulo, Faculty of Medicina, Cancer Institute, Hospital de Clinicas, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Ulysses Ribeiro Junior
- Universidade de Sao Paulo, Faculty of Medicina, Cancer Institute, Hospital de Clinicas, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Luiz Augusto Carneiro D'Albuquerque
- Universidade de Sao Paulo, Faculty of Medicina, Cancer Institute, Hospital de Clinicas, Department of Gastroenterology - São Paulo (SP), Brazil
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Rodrigues AC, David F, Guedes R, Rocha C, Oliveira HM. Dying with end stage kidney disease: factors associated with place of death on a palliative care program. J Bras Nefrol 2024; 46:93-97. [PMID: 37870397 PMCID: PMC10962416 DOI: 10.1590/2175-8239-jbn-2023-0015en] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 07/25/2023] [Indexed: 10/24/2023] Open
Abstract
INTRODUCTION End of life care of patients with end-stage kidney disease (ESKD) may be particularly challenging and requires the intervention of a specialized palliative care team (PCT). OBJECTIVE To characterize the population of ESKD patients referred to a PCT and evaluate the determinants of planned dying at home. METHODS We performed a retrospective observational cohort study of all patients with ESKD referred to our PCT between January 2014 and December 2021 (n = 60) and further characterized those with previously known ESKD regarding place of death (n = 53). RESULTS The majority of the patients were female and the median age was 84 years. Half of the patients were on conservative treatment, 43% were on chronic hemodialysis, and the remainder underwent hemodialysis on a trial basis and were subsequently suspended. Of those with previously known ESKD, 18% died at home and neither gender, age, cognition, performance status, comorbidities, CKD etiology, or treatment modality were associated with place of death. Anuria was significantly associated with dying at the hospital as was shorter time from dialysis suspension and death. Although not reaching statistical significance, we found a tendency towards a longer duration of palliative care follow-up in those dying at home. CONCLUSION Dying at home is possible in a palliative domiciliary program regardless of age, gender, etiology of CKD, major comorbidities, and treatment modality. Anuria and shorter survival from RRT withdrawal may be limiting factors for planned dying at home. A longer follow-up by palliative care may favor dying at home.
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Affiliation(s)
| | | | - Rita Guedes
- Hospital Pedro Hispano, Equipa de Cuidados Paliativos, Matosinhos,
Portugal
| | - Céu Rocha
- Hospital Pedro Hispano, Equipa de Cuidados Paliativos, Matosinhos,
Portugal
| | - Hugo M. Oliveira
- Hospital Pedro Hispano, Equipa de Cuidados Paliativos, Matosinhos,
Portugal
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Marçola L, Zoboli I, Polastrini RTV, Barbosa SMDM, Falcão MC, Gaiolla PDV. Patau and Edwards Syndromes in a University Hospital: beyond palliative care. Rev Paul Pediatr 2023; 42:e2023053. [PMID: 38088680 PMCID: PMC10712940 DOI: 10.1590/1984-0462/2024/42/2023053] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 09/15/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE To describe the newborn population with Patau (T13) and Edwards Syndrome (T18) with congenital heart diseases that stayed in the Intensive Care Unit (ICU) of a quaternary care hospital complex, regarding surgical and non-surgical medical procedures, palliative care, and outcomes. METHODS Descriptive case series conducted from January/2014 to December/2018 through analysis of records of patients with positive karyotype for T13 or T18 who stayed in the ICU of a quaternary hospital. Descriptive statistics analysis was applied. RESULTS 33 records of eligible patients were identified: 27 with T18 (82%), and 6 T13 (18%); 64% female and 36% male. Eight were preterm infants with gestational age between 30-36 weeks (24%), and only 4 among the 33 infants had a birth weight >2500 g (12%). Four patients underwent heart surgery and one of them died. Intrahospital mortality was 83% for T13, and 59% for T18. The majority had other malformations and underwent other surgical procedures. Palliative care was offered to 54% of the patients. The median hospitalization time for T18 and T13 was 29 days (range: 2-304) and 25 days (13-58), respectively. CONCLUSIONS Patients with T13 and T18 have high morbidity and mortality, and long hospital and ICU stays. Multicentric studies are needed to allow the analysis of important aspects for creating protocols that, seeking therapeutic proportionality, may bring better quality of life for patients and their families.
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Affiliation(s)
- Ligia Marçola
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brazil
| | - Ivete Zoboli
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brazil
| | | | | | - Mário Cícero Falcão
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brazil
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Gonçalves RG, de Oliveira LPBA, Silva CJDA, Elias TMN, Nogueira ILA, de Menezes RMP. Palliative care in nursing training: higher education course coordinators' perception. Rev Bras Enferm 2023; 76:e20220222. [PMID: 37820159 PMCID: PMC10561922 DOI: 10.1590/0034-7167-2022-0222] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 02/12/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVES to analyze undergraduate nursing course coordinators' perception about nursing training in palliative care. METHODS a descriptive study, with a qualitative approach and thematic content analysis, carried out with coordinators of nursing courses in Higher Education Institutions in Rio Grande do Norte. RESULTS three thematic categories emerged: Nursing training in palliative care; Potentialities for teaching palliative care; and Challenges of teaching in palliative care. The coordinators described as potentialities: transversality, theoretical and practical approach, optional subject, university extensions, interdisciplinarity and transdisciplinary approach, and as challenges: biomedical model in health education and insufficient professor training. FINAL CONSIDERATIONS palliative care teaching in the researched institutions in the nursing education process is approached in an incipient and fragmented way, and almost always without having a specific curricular component on the subject, being present as one of its contents.
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Mesquita MGDR, Silva AE, Coelho LP, Martins MR, de Souza MT, Trotte LAC. Slum compassionate community: expanding access to palliative care in Brazil. Rev Esc Enferm USP 2023; 57:e20220432. [PMID: 37656988 PMCID: PMC10478829 DOI: 10.1590/1980-220x-reeusp-2022-0432en] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 06/16/2023] [Indexed: 09/03/2023] Open
Abstract
OBJECTIVE To describe the implementation of a compassionate community in Rocinha and Vidigal slums, located in the city of Rio de Janeiro. METHOD Report on the experience of implementing a Compassionate Community based on the World Health Organization conceptual bases, supported by university extension guidelines. RESULTS Initially, local leaders and residents were recruited and trained in palliative care. Subsequently, health professionals from different specialties engaged in the project through volunteering. Home visits were instituted in the form of interconsultation and "sponsorships" by residents and health professionals to people in palliative care and family members. Finally, the health care network in the territory was integrated in order to recognize the project as a support network. CONCLUSION We highlight the experience as living work in health, which involves relationships and creative processes, which mobilize structured technical knowledge and relationships between people and soft-hard and soft technologies, making it possible to recognize powers in the territory.
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Affiliation(s)
- Maria Gefé da Rosa Mesquita
- Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery, Departamento de Metodologia de Enfermagem, Rio de Janeiro, RJ, Brazil
| | - Alexandre Ernesto Silva
- Universidade Federal de São João del-Rei, Departamento de Enfermagem Fundamental, Divinópolis, MG, Brazil
| | | | - Matheus Rodrigues Martins
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem, Belo Horizonte, MG, Brazil
| | - Marcela Teixeira de Souza
- Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery, Programa de Pós-Graduação em Enfermagem, Rio de Janeiro, RJ, Brazil
| | - Liana Amorim Corrêa Trotte
- Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery, Departamento de Metodologia de Enfermagem, Rio de Janeiro, RJ, Brazil
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Rocha IEGM, Fonseca FLBDES, Silva J. The care of the patients with hipoplastic left heart syndrome in places of social and economic vulneability. An ethical analysis. Rev Col Bras Cir 2023; 50:e20233437. [PMID: 37075465 PMCID: PMC10508666 DOI: 10.1590/0100-6991e-20233437-en] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/22/2022] [Indexed: 04/21/2023] Open
Abstract
The birth of a child means hope and joy, particularly for the parents and the healthcare team. When this child is born with a severe malformation and a poor prognosis, as in the case of hypoplastic left heart syndrome, the scenario is one of great uncertainty and emotional suffering. The role of the health team becomes fundamental for the identification of conflicts of values and for the search for shared decisions that promote the best benefit to the child. When the diagnosis is made during fetal life, it is necessary to develop counseling strategies appropriate to the context of each family. In places with limited care resources, precarious prenatal care and short temporal conditions, the recommended counseling is compromised. Indication of treatment requires technical competence and a detailed analysis of ethical issues, and consultation with institutional clinical bioethics services or commissions is important. The article proposes to address the moral conflicts of two clinical cases and the respective bioethical analysis that involves principles and values in contexts of vulnerability and uncertainty, contrasting two situations where the indication of treatment was based on accessibility to treatment.
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Affiliation(s)
- Isaura Elaine Gonçalves Moreira Rocha
- - Universidade Federal de Pernambuco, Programa de Pós-graduação em Cirurgia - Recife - PE -Brasil
- - Universidade Federal do Cariri, Faculdade de Medicina - Barbalha - CE - Brasil
| | | | - Josimário Silva
- - Universidade Federal de Pernambuco, Programa de Pós-graduação em Cirurgia - Recife - PE -Brasil
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do Prado E, Camparoto CW, Takemoto AY, Ichisato SMT, Miguel MEGB, Marcon SS. Palliative care strategies in the management of people with serious cases of COVID-19. Rev Bras Enferm 2023; 76Suppl 1:e20220308. [PMID: 36888747 PMCID: PMC9987459 DOI: 10.1590/0034-7167-2022-0308] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/13/2022] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVES to analyze the assistance strategies in palliative care developed in the COVID-19 pandemic for critically ill patients and their families. METHODS an integrative review carried out in August 2021 and updated in April 2022 in the Base de Dados de Enfermagem (BDENF), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), US National Library of Medicine (PubMed), Web of Science databases, and presented in the PRISMA flowchart. RESULTS thirteen works were selected for reading and content analysis, from which emerged the two main themes that reflect the reality evidenced in this context: The sudden advent of COVID-19 with impacts on palliative care; and The strategies used in palliative care to mitigate these impacts. FINAL CONSIDERATIONS palliative care is the best strategy for providing health care, used as a comfort to bring relief and comfort to patients and families.
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Prado RT, Leone DRR, Souza TDM, Werneck PV, Lacerda MR, de Castro EAB. Palliative care management by caregivers in home care: theoretical validation in a conversation circle. Rev Bras Enferm 2022; 75:e20210737. [PMID: 36102471 PMCID: PMC9728829 DOI: 10.1590/0034-7167-2021-0737] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 04/03/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES to present the validation process of a Grounded Theory on the management of palliative care at home by a caregiver of a family member who experiences a death/dying process. METHODS a qualitative, explanatory research, which validated a theoretical matrix through a conversation circle containing 15 family caregivers and nine healthcare professionals, in December 2018. RESULTS forty-six propositions were validated regarding family caregivers' contextual, causal, intervening conditions, consequences and action strategies to deal with the dying and death process of a family member. Conversation circles encouraged dialogue and (re)signification of the senses and knowledge of those involved, proving to be a way of educating and promoting the exercise of citizenship by participants. FINAL CONSIDERATIONS the conversation circle made it possible for participants to interact and share information and experiences regarding home care for palliative patients and their families.
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Affiliation(s)
- Roberta Teixeira Prado
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora. Juiz de Fora, Minas Gerais, Brazil
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da Silveira MRM, Forte DN. Palliative care and neurology: a path to neuropalliativism. Arq Neuropsiquiatr 2022; 80:328-335. [PMID: 35976309 PMCID: PMC9491435 DOI: 10.1590/0004-282x-anp-2022-s119] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
This article aims to expand the understanding of how it is possible to alleviate suffering and enable a dignified life trajectory for patients with progressive neurological diseases or with severe and permanent neurological impairment. The four most common disease trajectories described for people with chronic and progressive disease used to advance care planning, Brazilian normative ethical resolutions, evidence-based benefits of palliative care (PC), as well as particularities of PC in neurology, such as neurological symptom control, caring for existential and psychological suffering, care provider's needs and particularities of pediatric neurologic PC are reviewed.
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Affiliation(s)
- Mariana Ribeiro Marcondes da Silveira
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Neurologia, São Paulo SP, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, Unidade de Dor e Cuidados Paliativos, São Paulo SP, Brazil
| | - Daniel Neves Forte
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Emergências Clíncias, São Paulo SP, Brazil
- Hospital Sírio-Libanês, Núcleo de Cuidados Paliativos, São Paulo SP, Brazil
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Abstract
The world population is aging and diseases such as diabetes mellitus and systemic arterial hypertension are increasing the risk of patients developing chronic kidney disease, leading to an increase in the prevalence of patients on dialysis. The expansion of health services has made it possible to offer dialysis treatment to an increasing number of patients. At the same time, dialysis survival has increased considerably in the last two decades. Thus, patients on dialysis are becoming more numerous, older and with greater number of comorbidities. Although dialysis maintains hydroelectrolytic and metabolic balance, in several patients this is not associated with an improvement in quality of life. Therefore, despite the high social and financial cost of dialysis, patient recovery may be only partial. In these conditions, it is necessary to evaluate the patient individually in relation to the dialysis treatment. This implies reflections on initiating, maintaining or discontinuing treatment. The multidisciplinary team involved in the care of these patients should be familiar with these aspects in order to approach the patient and his/her relatives in an ethical and humanitarian way. In this study, we discuss dialysis in the final phase of life and present a systematic way to address this dilemma.
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Farré M, Hernández-López C, Peiró AM. [Medications of wellbeing]. Aten Primaria 2000; 26:275-6. [PMID: 11100592 PMCID: PMC7681513 DOI: 10.1016/s0212-6567(00)78661-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Bierge Valero A, Arruba Mombiela C. [Use of opioid drugs]. Aten Primaria 2000; 26:275. [PMID: 11100591 PMCID: PMC7681527 DOI: 10.1016/s0212-6567(00)78660-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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