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Access to outreach specialist palliative care teams among cancer patients in Denmark.

https://arctichealth.org/en/permalink/ahliterature114285
Source
J Palliat Med. 2013 Aug;16(8):951-7
Publication Type
Article
Date
Aug-2013
Author
Mette Asbjoern Neergaard
Anders Bonde Jensen
Frede Olesen
Peter Vedsted
Author Affiliation
The Palliative Team, Aarhus University Hospital, Aarhus, Denmark. mettneer@rm.dk
Source
J Palliat Med. 2013 Aug;16(8):951-7
Date
Aug-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Aged
Community-Institutional Relations
Cross-Sectional Studies
Denmark
Female
Health Services Accessibility - statistics & numerical data
Humans
Male
Middle Aged
Multivariate Analysis
Neoplasms - physiopathology - therapy
Palliative Care - manpower - organization & administration
Patient Care Team - organization & administration - standards
Registries
Sex Distribution
Socioeconomic Factors
Specialization
Terminal Care - manpower - organization & administration
Young Adult
Abstract
Equal access to end-of-life care is important. However, social inequality has been found in relation to place-of-death. The question is whether social and economic factors play a role in access to specialist palliative care services.
The study analyzed the association between access to outreach specialist palliative care teams (SPCTs) and socioeconomic characteristics of Danish cancer patients who died of their cancer.
The study was a population-based, cross-sectional register study. We identified 599 adults who had died of cancer from March 1 to November 30, 2006, in Aarhus County, Denmark. Data from health registers were retrieved and linked based on the unique personal identifier number.
Multivariate analysis with adjustment for age, gender, and general practitioner (GP) involvement showed a higher probability of contact with an SPCT among immigrants and descendants of immigrants than among people of Danish origin (prevalence ratio [PR]: 1.55; 95% confidence interval (CI): 1.04;2.31) and among married compared to unmarried patients (PR: 1.25; 95% CI: 1.01;1.54). The trends were most marked among women.
We found an association between females, married patients, and female immigrants and their descendants and access to an SPCT in Denmark. However, no association with the examined economic factor was found. Need for specialized health care, which is supposed to be the main reason for access to an SPCT, may be related to economic imbalance; and despite the relative equality found, SPCT access may not be equal for all Danish residents. Further research into social and economic consequences in palliative care services is warranted.
PubMed ID
23631614 View in PubMed
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Adaptation, data quality and confirmatory factor analysis of the Danish version of the PACIC questionnaire.

https://arctichealth.org/en/permalink/ahliterature138823
Source
Eur J Public Health. 2012 Feb;22(1):31-6
Publication Type
Article
Date
Feb-2012
Author
Helle Terkildsen Maindal
Ineta Sokolowski
Peter Vedsted
Author Affiliation
Section of General Practice, School of Public Health, Aarhus University, Aarhus, Denmark. htm@alm.au.dk
Source
Eur J Public Health. 2012 Feb;22(1):31-6
Date
Feb-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cross-Sectional Studies
Denmark
Diabetes mellitus, type 2 - therapy
Factor Analysis, Statistical
Female
Humans
Male
Middle Aged
Patient Participation
Patient satisfaction
Psychometrics
Quality of Health Care
Questionnaires - standards
Abstract
The Patient Assessment of Chronic Illness Care (PACIC) 20-item questionnaire measures how chronic care patients perceive their involvement in care. We aimed to adapt the measure into Danish and to assess data quality, internal consistency and the proposed factorial structure.
The PACIC was translated by a standardised forward-backward procedure, and filled in by 560 patients receiving type 2 diabetes care. Data quality was assessed by mean, median, item response, missing values, floor and ceiling effects, internal consistency (Cronbach's a and average inter-item correlation), item-rest correlations and factorial structure was assessed by confirmatory factor analysis (CFA).
The item response was high (missing answers: 0.5-2.9%). Floor effect was 2.7-69.2%, above 15% for 17 items. Ceiling effect was 4.0-40.4%, above 15% for 12 items. The subscales had average inter-item correlations over 0.30 and CFA showed high factor loadings (range 0.67-0.77). All had a over 0.7 and included items with both high and low loadings. The CFA model fit was good for two indices out of six (TLI and SRMR).
Danish PACIC is now available and validated in primary care in a type 2 diabetes population. The psychometric properties were satisfactory apart from ceiling and floor effects. We endorse the proposed five scale structure. All the subscales showed good model fit, and may be used for separate sum scores.
PubMed ID
21134901 View in PubMed
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Agreement between patients and general practitioners on quality deviations during the cancer diagnostic pathway and associations with time to diagnosis.

https://arctichealth.org/en/permalink/ahliterature270236
Source
Fam Pract. 2015 Jun;32(3):329-35
Publication Type
Article
Date
Jun-2015
Author
Henry Jensen
Cecilie Sperling
Mette Sandager
Peter Vedsted
Source
Fam Pract. 2015 Jun;32(3):329-35
Date
Jun-2015
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Cross-Sectional Studies
Delayed Diagnosis - adverse effects - statistics & numerical data
Denmark
Early Detection of Cancer - statistics & numerical data
Female
General Practitioners - statistics & numerical data
Humans
Male
Middle Aged
Neoplasms - diagnosis
Patient Satisfaction - statistics & numerical data
Prognosis
Quality Assurance, Health Care - methods - statistics & numerical data
Quality of Life
Registries
Surveys and Questionnaires
Young Adult
Abstract
High quality and minimal delay are crucial and anticipated elements in the diagnostic cancer pathway as delay in the diagnosis may worsen the prognosis and cause lower patient satisfaction.
The aim of this study was to describe agreement in reported quality deviations (QDs) between general practitioners (GPs) and cancer patients during the diagnostic pathway in primary care and to estimate the association between length of diagnostic interval and level of agreement on reported QDs.
The study was carried out as a Danish cross-sectional study of incident cancer patients identified in the Danish National Patient Registry. Data were collected by independent questionnaires from patients (response rate: 53.0%) and their GPs (response rate: 73.8%), and 2177 pairs of questionnaires were subsequently combined. Agreement between GP- and patient-reported QDs was estimated using Cohen's Kappa, whereas the association between level of agreement and time to diagnosis was estimated using quantile regression.
Patients reported QDs in 29.0% and GPs in 28.5% of the cases, but agreed only slightly on QD presence (Kappas between -0.08 and 0.26). Agreement on 'QD presence' was associated with a 54-day (95%CI: 44-64) longer time to diagnosis than agreement on 'no QD presence'. The association with a longer diagnostic interval was stronger when only GP reported a QD the association than when only patient reported a QD.
Included GPs and patients agreed only slightly on QD presence although they reported the same amount of QDs; this suggests that GPs and patients see QDs as two different concepts. QD presence had a stronger impact on time to diagnosis when reported by the GP (alone or in agreement with the patient) than when reported by the patient alone. The GP may thus be the most important source of information on QD and diagnostic interval, while the patient information tends to underpin this assessment.
PubMed ID
25888583 View in PubMed
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Alarm symptoms of soft-tissue and bone sarcoma in patients referred to a specialist center.

https://arctichealth.org/en/permalink/ahliterature260959
Source
Acta Orthop. 2014 Dec;85(6):657-62
Publication Type
Article
Date
Dec-2014
Author
Heidi B Dyrop
Peter Vedsted
Akmal Safwat
Katja Maretty-Nielsen
Bjarne H Hansen
Peter H Jørgensen
Thomas Baad-Hansen
Johnny Keller
Source
Acta Orthop. 2014 Dec;85(6):657-62
Date
Dec-2014
Language
English
Publication Type
Article
Keywords
Adult
Bone Neoplasms - diagnosis - epidemiology
Cancer Care Facilities - utilization
Critical Pathways - utilization
Denmark - epidemiology
Female
General Practice - statistics & numerical data
Humans
Incidental Findings
Male
Middle Aged
Neoplasms - diagnosis - epidemiology
Osteosarcoma - diagnosis - epidemiology
Predictive value of tests
Prevalence
Referral and Consultation - utilization
Sarcoma - diagnosis - epidemiology
Sensitivity and specificity
Soft Tissue Neoplasms - diagnosis - epidemiology
Young Adult
Abstract
The Danish Cancer Patient Pathway for sarcoma defines a set of alarm symptoms as criteria for referral to a sarcoma center. This may exclude cancer patients without alarm symptoms, so we investigated the presence of alarm symptoms (defined as being indicative of a sarcoma) in patients who had been referred to the Aarhus Sarcoma Center.
We reviewed the medical records of all 1,126 patients who had been referred, with suspected sarcoma, from other hospitals in the period 2007-2010 for information on symptoms, clinical findings, and diagnosis. Alarm symptoms were analyzed for predictive values in diagnosing sarcoma.
179 (69%) of 258 sarcoma patients were referred with alarm symptoms (soft-tissue tumor>5 cm or deep-seated, fast-growing soft-tissue tumor, palpable bone tumor, or deep persisting bone pain). The remaining 79 sarcomas were found accidentally. "Size over 5 cm" for soft-tissue tumors, and "deep persisting bone pain" for bone tumors had the highest sensitivity and positive predictive value. Of the 79 sarcoma patients who were referred without alarm symptoms, 7 were found accidentally on imaging, 5 were referred with suspected recurrence of a sarcoma, 64 were referred with a confirmed histological diagnosis, and 3 were referred for other reasons.
Defined alarm symptoms are predictive of sarcoma, but one-third of the patients were found accidentally. Further studies on presenting symptoms in primary care are needed to assess the true value of alarm symptoms.
Notes
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PubMed ID
25175662 View in PubMed
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Alcohol and drug use among Danish physicians. A nationwide cross-sectional study in 2014.

https://arctichealth.org/en/permalink/ahliterature273192
Source
Dan Med J. 2015 Sep;62(9)
Publication Type
Article
Date
Sep-2015
Author
Johanne Korsdal Sørensen
Anette Fischer Pedersen
Niels Henrik Bruun
Bo Christensen
Peter Vedsted
Source
Dan Med J. 2015 Sep;62(9)
Date
Sep-2015
Language
English
Publication Type
Article
Keywords
Adult
Alcohol drinking - epidemiology
Alcoholism - epidemiology
Cross-Sectional Studies
Denmark - epidemiology
Emergency Medicine - statistics & numerical data
Female
General Practice - statistics & numerical data
Humans
Internal Medicine - statistics & numerical data
Male
Middle Aged
Physician Impairment
Physicians - psychology - statistics & numerical data
Risk-Taking
Self Report
Substance-Related Disorders - epidemiology
Young Adult
Abstract
The aims of this study were to describe Danish physicians' use of alcohol and drugs, their self-reported assessment of their use of alcohol and drugs, and their management of colleagues with substance use disorder in physician workplaces.
During the spring of 2014, a nationwide cross-sectional study was conducted as an anonymous, electronic survey among a randomly weighted sample of 1) consultants and practicing specialists, 2) younger physicians (trainees) and 3) general practitioners in Denmark. A total of 4,000 physicians (approx. 1,333 from each group) were sampled and 1,943 responded (49%). The survey included the Alcohol Use Disorders Identification Test on alcohol use and the Drug Use Disorders Identification Test on drug use and related questions on health and psychological issues.
The three groups had an almost equal share of risky alcohol use (comprising hazardous, harmful and dependent use) of 17.2-20.3%. The highest proportion (24%) of risky alcohol use was found for both internal medicine and emergency medicine and the lowest for general practice (16%). Significantly more male physicians (25.1%) than female physicians (14.4%) reported risky alcohol use. Among physicians with risky substance use, 23.1% recognised their risky use.
The proportion of physicians with a risky use of alcohol and drugs was 19% and 3.0%, respectively. Significantly more male than female physicians reported risky alcohol use. Among physicians with a risky substance use, only one in four recognised this as problematic.
PubMed ID
26324083 View in PubMed
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An investigation of routes to cancer diagnosis in 10 international jurisdictions, as part of the International Cancer Benchmarking Partnership: survey development and implementation.

https://arctichealth.org/en/permalink/ahliterature288091
Source
BMJ Open. 2016 07 25;6(7):e009641
Publication Type
Article
Date
07-25-2016
Author
David Weller
Peter Vedsted
Chantelle Anandan
Alina Zalounina
Evangelia Ourania Fourkala
Rakshit Desai
William Liston
Henry Jensen
Andriana Barisic
Anna Gavin
Eva Grunfeld
Mats Lambe
Rebecca-Jane Law
Martin Malmberg
Richard D Neal
Jatinderpal Kalsi
Donna Turner
Victoria White
Martine Bomb
Usha Menon
Source
BMJ Open. 2016 07 25;6(7):e009641
Date
07-25-2016
Language
English
Publication Type
Article
Keywords
Analysis of Variance
Antineoplastic Combined Chemotherapy Protocols
Australia - epidemiology
Benchmarking
Breast Neoplasms - diagnosis - epidemiology
Canada - epidemiology
Colorectal Neoplasms - diagnosis - epidemiology
Cross-Sectional Studies
Denmark - epidemiology
Early Detection of Cancer - standards
Female
Humans
Lung Neoplasms - diagnosis - epidemiology
Norway - epidemiology
Ovarian Neoplasms - diagnosis - epidemiology
Pilot Projects
Practice Patterns, Physicians' - organization & administration - statistics & numerical data
Primary Health Care - standards
Registries
Reproducibility of Results
Survival Rate
Sweden - epidemiology
United Kingdom - epidemiology
Abstract
This paper describes the methods used in the International Cancer Benchmarking Partnership Module 4 Survey (ICBPM4) which examines time intervals and routes to cancer diagnosis in 10 jurisdictions. We present the study design with defining and measuring time intervals, identifying patients with cancer, questionnaire development, data management and analyses.
Recruitment of participants to the ICBPM4 survey is based on cancer registries in each jurisdiction. Questionnaires draw on previous instruments and have been through a process of cognitive testing and piloting in three jurisdictions followed by standardised translation and adaptation. Data analysis focuses on comparing differences in time intervals and routes to diagnosis in the jurisdictions.
Our target is 200 patients with symptomatic breast, lung, colorectal and ovarian cancer in each jurisdiction. Patients are approached directly or via their primary care physician (PCP). Patients' PCPs and cancer treatment specialists (CTSs) are surveyed, and 'data rules' are applied to combine and reconcile conflicting information. Where CTS information is unavailable, audit information is sought from treatment records and databases.
Reliability testing of the patient questionnaire showed that agreement was complete (?=1) in four items and substantial (?=0.8, 95% CI 0.333 to 1) in one item. The identification of eligible patients is sufficient to meet the targets for breast, lung and colorectal cancer. Initial patient and PCP survey response rates from the UK and Sweden are comparable with similar published surveys. Data collection was completed in early 2016 for all cancer types.
An international questionnaire-based survey of patients with cancer, PCPs and CTSs has been developed and launched in 10 jurisdictions. ICBPM4 will help to further understand international differences in cancer survival by comparing time intervals and routes to cancer diagnosis.
Notes
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PubMed ID
27456325 View in PubMed
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Antibiotic prescribing patterns in out-of-hours primary care: a population-based descriptive study.

https://arctichealth.org/en/permalink/ahliterature263171
Source
Scand J Prim Health Care. 2014 Dec;32(4):200-7
Publication Type
Article
Date
Dec-2014
Author
Linda Huibers
Grete Moth
Morten Bondo Christensen
Peter Vedsted
Source
Scand J Prim Health Care. 2014 Dec;32(4):200-7
Date
Dec-2014
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
After-Hours Care - trends
Anti-Bacterial Agents - therapeutic use
Child
Child, Preschool
Denmark
Drug Prescriptions - statistics & numerical data
Female
Humans
Infant
Infant, Newborn
Male
Middle Aged
Observational Study as Topic
Physician's Practice Patterns
Primary Health Care
Retrospective Studies
Young Adult
Abstract
To describe the frequency and characteristics of antibiotic prescribing for different types of contacts with the Danish out-of-hours (OOH) primary care service.
Population-based observational registry study using routine registry data from the OOH registration system on patient contacts and ATC-coded prescriptions.
The OOH primary care service in the Central Denmark Region.
All contacts with OOH primary care during a 12-month period (June 2010-May 2011).
Descriptive analyses of antibiotic prescription proportions stratified for type of antibiotic, patient age and gender, contact type, and weekdays or weekend.
Of the 644 777 contacts registered during the study period, 15.0% received an antibiotic prescription: 26.1% resulted from clinic consultations, 10.7% from telephone consultations, and 10.9% from home visits. The prescription proportion was higher for weekends (17.6%) than for weekdays (10.6%). The most frequently prescribed antibiotic drugs were beta-lactamase sensitive penicillins (34.9%), antibiotic eye drops (21.2%), and broad-spectrum penicillins (21.0%). Most antibiotic eye drops (73%) were prescribed in a telephone consultation. Most antibiotics were prescribed at 4-6 p.m. on weekdays. Young infants received most antibacterial eye drops (41.3%), patients aged 5-17 years and 18-60 years received most beta-lactamase sensitive penicillins (44.6% and 38.9%, respectively), while patients aged 60 + years received most broad-spectrum penicillins (32.9% of all antibiotic prescriptions).
Antibiotics were most often prescribed in clinic consultations, but, in absolute terms, many were also prescribed by telephone. The high prescription proportion, particularly antibacterial eye drops for young infants, suggests room for improvement in rational antibiotic use.
Notes
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PubMed ID
25350313 View in PubMed
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Association between general practice referral rates and patients' socioeconomic status and access to specialised health care a population-based nationwide study.

https://arctichealth.org/en/permalink/ahliterature151333
Source
Health Policy. 2009 Oct;92(2-3):180-6
Publication Type
Article
Date
Oct-2009
Author
Torben Højmark Sørensen
Kim Rose Olsen
Peter Vedsted
Author Affiliation
Danish Institute for Health Services Research (DSI), Dampfaergevej 27-29, DK-2100 København Ø, Denmark. ths@dsi.dk
Source
Health Policy. 2009 Oct;92(2-3):180-6
Date
Oct-2009
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Denmark
Female
General Practice - statistics & numerical data
Health Services Accessibility - economics
Humans
Infant
Infant, Newborn
Male
Medicine
Middle Aged
Physician's Practice Patterns - statistics & numerical data
Referral and Consultation - statistics & numerical data
Socioeconomic Factors
Young Adult
Abstract
To explore the association between patients' socioeconomic status and their referral from general practice to specialised health care.
Multiple regression analysis was used on cross-sectional data on general practice referral rates for all Danish general practices in year 2006.
Our models explained between 26% and 45% of the variation in general practice referral to specialised care. Adjusting for access to specialised care (local supply of hospitals and practicing specialists) reduced the association between socioeconomic factors and referral rates. The results suggest that persons with high socioeconomic status are referred more to practicing specialist than persons with low socioeconomic status and that the latter are referred more to hospital care than the former.
Our results indicate that the influence of socioeconomic factors may be overstated failing to control for access to specialised care. Still, a socioeconomic gradient was observed in GPs' referral pattern to different sorts of health care after adjusting for access. The association between socioeconomic status and referral pattern can both be rooted in morbidity variation and to the ability of persons with high socioeconomic status to influence general practitioners' (GPs') decision making.
PubMed ID
19394106 View in PubMed
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The association between general practitioners' attitudes towards breast cancer screening and women's screening participation.

https://arctichealth.org/en/permalink/ahliterature123343
Source
BMC Cancer. 2012;12:254
Publication Type
Article
Date
2012
Author
Line Flytkjær Jensen
Thomas Ostersen Mukai
Berit Andersen
Peter Vedsted
Author Affiliation
The Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C, Denmark. line.jensen@alm.au.dk
Source
BMC Cancer. 2012;12:254
Date
2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Attitude of Health Personnel
Breast Neoplasms - diagnosis - prevention & control
Denmark
Early Detection of Cancer
Female
General Practitioners - psychology
Humans
Male
Mass Screening
Middle Aged
Patient Participation
Abstract
Breast cancer screening in Denmark is organised by the health services in the five regions. Although general practitioners (GPs) are not directly involved in the screening process, they are often the first point of contact to the health care system and thus play an important advisory role. No previous studies, in a health care setting like the Danish system, have investigated the association between GPs' attitudes towards breast cancer screening and women's participation in the screening programme.
Data on women's screening participation was obtained from the regional screening authorities. Data on GPs' attitudes towards breast cancer screening was taken from a previous survey among GPs in the Central Denmark Region. This study included women aged 50-69 years who were registered with a singlehanded GP who had participated in the survey.
The survey involved 67 singlehanded GPs with a total of 13,288 women on their lists. Five GPs (7%) had a negative attitude towards breast cancer screening. Among registered women, 81% participated in the first screening round. Multivariate analyses revealed that women registered with a GP with a negative attitude towards breast cancer screening were 17% (95% CI: 2-34%) more likely to be non-participants compared with women registered with a GP with a positive attitude towards breast cancer screening.
The GPs' attitudes may influence the participation rate even in a system where GPs are not directly involved in the screening process. However, further studies are needed to investigate this association.
Notes
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PubMed ID
22708828 View in PubMed
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Association between patients' recommendation of their GP and their evaluation of the GP.

https://arctichealth.org/en/permalink/ahliterature155179
Source
Scand J Prim Health Care. 2008;26(4):228-34
Publication Type
Article
Date
2008
Author
Peter Vedsted
Hanne N Heje
Author Affiliation
The Research Unit for General Practice, Institute of Public Health, University of Aarhus, Denmark. p.vedsted@alm.au.dk
Source
Scand J Prim Health Care. 2008;26(4):228-34
Date
2008
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Clinical Competence
Denmark
Empathy
Family Practice - organization & administration - standards
Female
Humans
Male
Middle Aged
Patient satisfaction
Physician-Patient Relations
Physicians, Family - standards
Questionnaires
Abstract
Patient priorities and patient evaluations indicate that accessibility should receive more attention to increase quality in general practice. The definition of family medicine emphasizes the patient-centred approach, communication skills, continuity, and clinical skills. We aimed to explore the associations between the 23 items in the Europep questionnaire measuring patient evaluation of general practice and the patients' recommendation of their general practitioner (GP) to friends and to study the relationship of these items with the core competences of family medicine.
Cross-sectional study where patients aged 18 years and over attending the practice were included. Patients completed the Danish version of the 23 item Europep questionnaire and an additional item about the degree to which they could recommend their GP to friends.
Danish general practice (the DanPEP study).
A total of 50 191 patients and 690 GPs were included in the analyses.
For each item, associations were calculated between a positive answer and the degree to which the patient could recommend the GP. Analyses were made at patient and GP levels.
We found 12 items that covered the 10 most strongly associated items from both analyses: four of six items from the "doctor-patient relationship", two of five items from "medical care", and all items from "information and support" and "organization of services". No items from "accessibility" were among the 12 items.
Recommending the GP to others was most strongly associated with the "emphatic", "patient-oriented", "informative and coordinating", and "competent/skilled" GP and to a lesser degree with accessibility to general practice.
Notes
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PubMed ID
18792855 View in PubMed
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