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Agreement among pediatric health care professionals with the pediatric Canadian triage and acuity scale guidelines.

https://arctichealth.org/en/permalink/ahliterature178934
Source
Pediatr Emerg Care. 2004 Aug;20(8):514-8
Publication Type
Article
Date
Aug-2004
Author
Sylvie Bergeron
Serge Gouin
Benoit Bailey
Devendra K Amre
Hema Patel
Author Affiliation
Division of Emergency Medicine, Department of Paediatrics, Hôpital Ste-Justine, Université de Montréal, Montreal, Canada. liber@videotron.ca
Source
Pediatr Emerg Care. 2004 Aug;20(8):514-8
Date
Aug-2004
Language
English
Publication Type
Article
Keywords
Acute Disease
Adolescent
Attitude of Health Personnel
Canada
Child
Child, Preschool
Cross-Sectional Studies
Emergency medical services
Emergency Service, Hospital
Female
Humans
Infant
Infant, Newborn
Male
Nurses - psychology
Pediatrics
Physicians - psychology
Practice Guidelines as Topic
Questionnaires
Severity of Illness Index
Triage
Abstract
To compare triage level assignment, using case scenarios, in a pediatric emergency department between registered nurses (RNs) and pediatric emergency physicians (PEPs) based on the Pediatric Canadian Triage and Acuity Scale (P-CTAS) guidelines. To compare triage level assignment of the RNs and PEPs to that done by a panel of experts using the same P-CTAS guidelines.
A cross-sectional questionnaire survey (55 case scenarios) was sent to all RNs and PEPs working in the emergency department after the P-CTAS was implemented. Participants were instructed to assign a triage level for each case. A priori, all cases were assigned a triage level by a panel of experts using the P-CTAS guidelines. Kappa statistics and the mean number (+/-1SD) of correct responses were calculated.
A response rate of 85% was achieved (29 RNs, 15 PEPs). The kappa level of agreement (95% CI) among RNs was 0.51 (0.50-0.52) and was 0.39 (0.38-0.41) among PEPs (P
PubMed ID
15295246 View in PubMed
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The Canadian Triage and Acuity Scale for children: a prospective multicenter evaluation.

https://arctichealth.org/en/permalink/ahliterature127335
Source
Ann Emerg Med. 2012 Jul;60(1):71-7.e3
Publication Type
Article
Date
Jul-2012
Author
Jocelyn Gravel
Serge Gouin
Ran D Goldman
Martin H Osmond
Eleanor Fitzpatrick
Kathy Boutis
Chantal Guimont
Gary Joubert
Kelly Millar
Sarah Curtis
Douglas Sinclair
Devendra Amre
Author Affiliation
Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada. graveljocelyn@hotmail.com
Source
Ann Emerg Med. 2012 Jul;60(1):71-7.e3
Date
Jul-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Canada
Child
Child, Preschool
Emergency Service, Hospital
Female
Health Resources - utilization
Hospitalization - statistics & numerical data
Hospitals, Pediatric
Hospitals, University
Humans
Infant
Length of Stay - statistics & numerical data
Male
Multivariate Analysis
Nurses
Observer Variation
Prospective Studies
Regression Analysis
Reproducibility of Results
Single-Blind Method
Trauma Severity Indices
Triage - methods
Abstract
The aims of the study are to measure both the interrater agreement of nurses using the Canadian Triage and Acuity Scale in children and the validity of the scale as measured by the correlation between triage level and proxy markers of severity.
This was a prospective multicenter study of the reliability and construct validity of the Canadian Triage and Acuity Scale in 9 tertiary care pediatric emergency departments (EDs) across Canada during 2009 to 2010. Participants were a sample of children initially triaged as Canadian Triage and Acuity Scale level 2 (emergency) to level 5 (nonurgent). Participants were recruited immediately after their initial triage to undergo a second triage assessment by the research nurse. Both triages were performed blinded to the other. The primary outcome measures were the interrater agreement between the 2 nurses and the association between triage level and hospitalization. Secondary outcome measures were the association between triage level and health resource use and length of stay in the ED.
A total of 1,564 patients were approached and 1,464 consented. The overall interrater agreement was good, as demonstrated by a quadratic weighted ? score of 0.74 (95% confidence interval 0.71 to 0.76). Hospitalization proportions were 30%, 8.3%, 2.3%, and 2.2% for patients triaged at levels 2, 3, 4, and 5, respectively. There was also a strong association between triage levels and use of health care resources and length of stay.
The Canadian Triage and Acuity Scale demonstrates a good interrater agreement between nurses across multiple pediatric EDs and is a valid triage tool, as demonstrated by its good association with markers of severity.
PubMed ID
22305329 View in PubMed
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Ceftriaxone for refractory acute otitis media: impact of a clinical practice guideline.

https://arctichealth.org/en/permalink/ahliterature147679
Source
Pediatr Emerg Care. 2009 Nov;25(11):739-43
Publication Type
Article
Date
Nov-2009
Author
Marie Gauthier
Isabelle Chevalier
Serge Gouin
Valérie Lamarre
Anthony Abela
Author Affiliation
Department of Pediatrics, CHU Sainte-Justine, 3175 Côte Sainte-Catherine, Université de Montréal, Montreal H3T1C5, Canada. marie.gauthier.hsj@ssss.gouv.qc.ca
Source
Pediatr Emerg Care. 2009 Nov;25(11):739-43
Date
Nov-2009
Language
English
Publication Type
Article
Keywords
Acute Disease
Anti-Bacterial Agents - administration & dosage
Canada
Ceftriaxone - administration & dosage
Child, Preschool
Dose-Response Relationship, Drug
Female
Follow-Up Studies
Guideline Adherence
Hospitals, Pediatric
Humans
Infant
Injections, Intravenous
Male
Otitis Media - drug therapy
Practice Guidelines as Topic
Retrospective Studies
Treatment Outcome
Abstract
To determine the effect of a clinical practice guideline (CPG) on the use of ceftriaxone for the treatment of refractory acute otitis media (AOM) at a tertiary care pediatric hospital.
Charts of all patients aged 3 to 60 months referred from an emergency department to a day treatment center for management of refractory AOM with ceftriaxone were reviewed. Data were collected during two 18-month periods before and after implementation of a CPG developed by a local group of experts. Ceftriaxone was indicated for children with symptomatic AOM despite 48 hours of treatment with high-dosage amoxicillin or amoxicillin-clavulanate (>75 mg/kg per day) or despite receiving 1 of these 2 antibiotics over the previous month. Overall treatment was considered adequate if patients met these indications for ceftriaxone, if at least 3 daily doses had been prescribed, and if all doses were within the 40- to 60-mg/kg range.
Thirty-two emergency physicians referred 127 patients to the day treatment center (60 preimplementation and 67 postimplementation of the CPG). The mean (SD) patient ages were 16.7 (7.4) and 19.7 (12.4) months in the preimplementation and postimplementation groups, respectively. Indications for prescription of ceftriaxone were adequate in 16.7% of the preguideline and 22.4% of the postguideline groups (P = 0.4). Physicians were twice as likely to use ceftriaxone adequately after the guideline's implementation, but this result was not statistically significant (crude odds ratio, 2.2; 95% confidence interval, 0.5-9.0).
Implementation of a CPG for the treatment of refractory AOM with ceftriaxone did not improve indications for its use.
PubMed ID
19864968 View in PubMed
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Cost-effectiveness of epinephrine and dexamethasone in children with bronchiolitis.

https://arctichealth.org/en/permalink/ahliterature140430
Source
Pediatrics. 2010 Oct;126(4):623-31
Publication Type
Article
Date
Oct-2010
Author
Amanda Sumner
Douglas Coyle
Craig Mitton
David W Johnson
Hema Patel
Terry P Klassen
Rhonda Correll
Serge Gouin
Maala Bhatt
Gary Joubert
Karen J L Black
Troy Turner
Sandra Whitehouse
Amy C Plint
Author Affiliation
Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, and Department of Epidemiology and Community Medicine, University of Ottawa, 401 Smyth Ave, Ottawa, Ontario, Canada K1H 8L1.
Source
Pediatrics. 2010 Oct;126(4):623-31
Date
Oct-2010
Language
English
Publication Type
Article
Keywords
Administration, Oral
Bronchiolitis - drug therapy - economics
Bronchodilator Agents - administration & dosage - economics
Cost-Benefit Analysis
Dexamethasone - administration & dosage - economics
Drug Therapy, Combination
Epinephrine - administration & dosage - economics
Glucocorticoids - administration & dosage - economics
Hospitalization - economics
Humans
Infant
Nebulizers and Vaporizers
Ontario
Randomized Controlled Trials as Topic
Abstract
Using data from the Canadian Bronchiolitis Epinephrine Steroid Trial we assessed the cost-effectiveness of treatments with epinephrine and dexamethasone for infants between 6 weeks and 12 months of age with bronchiolitis.
An economic evaluation was conducted from both the societal and health care system perspectives including all costs during 22 days after enrollment. The effectiveness of therapy was measured by the duration of symptoms of feeding problems, sleeping problems, coughing, and noisy breathing. Comparators were nebulized epinephrine plus oral dexamethasone, nebulized epinephrine alone, oral dexamethasone alone, and no active treatment. Uncertainty around estimates was assessed through nonparametric bootstrapping.
The combination of nebulized epinephrine plus oral dexamethasone was dominant over the other 3 comparators in that it was both the most effective and least costly. Average societal costs were $1115 (95% credible interval [CI]: 919-1325) for the combination therapy, $1210 (95% CI: 1004-1441) for no active treatment, $1322 (95% CI: 1093-1571) for epinephrine alone, and $1360 (95% CI: 1124-1624) for dexamethasone alone. The average time to curtailment of all symptoms was 12.1 days (95% CI: 11-13) for the combination therapy, 12.7 days (95% CI: 12-13) for no active treatment, 13.0 days (95% CI: 12-14) for epinephrine alone, and 12.6 days (95% CI: 12-13) for dexamethasone alone.
Treating infants with bronchiolitis with a combination of nebulized epinephrine plus oral dexamethasone is the most cost-effective treatment option, because it is the most effective in controlling symptoms and is associated with the least costs.
Notes
Comment In: Pediatrics. 2011 Feb;127(2):e513-4; author reply e515-621285330
Comment In: Pediatrics. 2011 Feb;127(2):e514-5; author reply e515-621285331
Comment In: Pediatrics. 2011 Feb;127(2):e514; author reply e515-621285332
PubMed ID
20876171 View in PubMed
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Development and pretesting of an electronic learning module to train health care professionals on the use of the Pediatric Respiratory Assessment Measure to assess acute asthma severity.

https://arctichealth.org/en/permalink/ahliterature107163
Source
Can Respir J. 2013 Nov-Dec;20(6):435-41
Publication Type
Article
Author
Anab R Lehr
Martha L McKinney
Serge Gouin
Jean-Guy Blais
Martin V Pusic
Francine M Ducharme
Source
Can Respir J. 2013 Nov-Dec;20(6):435-41
Language
English
Publication Type
Article
Keywords
Acute Disease
Adolescent
Allied Health Occupations - education
Asthma - diagnosis
Audiovisual Aids
Canada
Child
Child, Preschool
Clinical Competence
Computer-Assisted Instruction - methods
Education, Medical - methods
Education, Nursing, Continuing - methods
Female
Humans
Infant
Learning Curve
Male
Pilot Projects
Psychometrics
Severity of Illness Index
Abstract
Severity-specific guidelines based on the Pediatric Respiratory Assessment Measure (PRAM), a validated clinical score, reduce pediatric asthma hospitalization rates.
To develop, pretest the educational value of and revise an electronic learning module to train health care professionals on the use of the PRAM.
The respiratory efforts of 32 children with acute asthma were videotaped and pulmonary auscultation was recorded. A pilot module, composed of a tutorial and 18 clinical cases, was developed in French and English. Health care professionals completed the module and provided feedback. The performance of participants, case quality and difficulty, and learning curve were assessed using the Rasch test; quantitative and qualitative feedback served to revise the module.
Seventy-two participants (19 physicians, 22 nurses, four respiratory therapists and 27 health care trainees) with a balanced distribution across self-declared expertise (26% beginner, 35% competent and 39% expert) were included. The accuracy of experts was superior to beginners (OR 1.79, 1.15 and 2.79, respectively). Overall performance significantly improved between the first and latter half of cases (P
PubMed ID
24046819 View in PubMed
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Evaluation of the Paediatric Canadian Triage and Acuity Scale in a pediatric ED.

https://arctichealth.org/en/permalink/ahliterature174610
Source
Am J Emerg Med. 2005 May;23(3):243-7
Publication Type
Article
Date
May-2005
Author
Serge Gouin
Jocelyn Gravel
Devendra K Amre
Sylvie Bergeron
Author Affiliation
Division of Emergency Medicine, Department of Paediatrics, Ste-Justine Hospital, Montreal University, Quebec, Canada. sergegouin@aol.com
Source
Am J Emerg Med. 2005 May;23(3):243-7
Date
May-2005
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Canada
Child
Child, Preschool
Emergency Service, Hospital - organization & administration
Hospitalization - statistics & numerical data
Humans
Infant
Infant, Newborn
Pediatrics
Prospective Studies
Severity of Illness Index
Triage - methods
Abstract
The aim of this study was to compare the performance of the Paediatric Canadian Triage and Acuity Scale (Paed CTAS) to a previous triage tool with respect to the percentage of admissions, the diagnostic and therapeutic interventions, and the mean pediatric risk of admission (PRISA) score in a pediatric tertiary center emergency department. Data were prospectively collected for 4 months before the Paed CTAS introduction (PRE group) and for 4 months after its implementation (Paed CTAS group). Both groups were similar in chief complaints, distribution of triage levels, and mean PRISA score. In the Paed CTAS group, more patients were triaged in the higher acuity levels (53% vs 36%, P
PubMed ID
15915392 View in PubMed
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Evaluation of the pediatric risk of admission score in a pediatric emergency department.

https://arctichealth.org/en/permalink/ahliterature185704
Source
Ann Emerg Med. 2003 May;41(5):630-8
Publication Type
Article
Date
May-2003
Author
Jocelyn Gravel
Serge Gouin
Devendra Amre
Sylvie Bergeron
Jacques Lacroix
Author Affiliation
Division of Emergency Medicine, Department of Pediatrics, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec, Canada. Graveljocelyn@hotmail.com
Source
Ann Emerg Med. 2003 May;41(5):630-8
Date
May-2003
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Chi-Square Distribution
Child
Child, Preschool
Emergency Service, Hospital - statistics & numerical data
Female
Hospitalization - statistics & numerical data
Hospitals, Pediatric - statistics & numerical data
Humans
Infant
Infant, Newborn
Logistic Models
Male
Patient Admission - statistics & numerical data
Predictive value of tests
Prospective Studies
Quebec
ROC Curve
Risk assessment
Severity of Illness Index
Abstract
The pediatric risk of admission (PRISA) score was developed to predict the risk for hospitalization for pediatric emergency department patients. We sought to evaluate prospectively the predictive value of the PRISA score with respect to the risk for hospitalization in a pediatric ED.
A prospective cohort study was conducted in a pediatric tertiary center ED. From November 1, 2000, to October 31, 2001, 3 periods of 8 hours each were randomly chosen monthly. During these periods, all patients triaged to the ED were evaluated. Data collection was performed by an investigator uninvolved in the patients' treatment. Data were recorded before the decision regarding hospitalization was made. Odds ratios for the risk of hospitalization related to individual criteria and PRISA scores were calculated. Discrimination and calibration of the score were assessed.
During the study periods, 1,930 patients were evaluated. Among these, 203 hospitalizations were observed, and the PRISA score predicted 235. The goodness-of-fit test demonstrated that the score had good predictive ability (chi(2)=28.15; P =.78). Receiver operating characteristic curve analysis confirmed the latter findings (area under the curve 0.79 [95% confidence interval 0.72 to 0.86]). Some individual criteria of the score did not significantly predict risk for admission.
The PRISA score is a good predictor of the risk for hospitalization in a pediatric ED. It seems more accurate for the sicker patients. Some variables of the score could be deleted or modified to optimize its accuracy.
Notes
Comment In: Ann Emerg Med. 2003 May;41(5):639-4312712030
PubMed ID
12712029 View in PubMed
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Interrater agreement between nurses for the Pediatric Canadian Triage and Acuity Scale in a tertiary care center.

https://arctichealth.org/en/permalink/ahliterature154595
Source
Acad Emerg Med. 2008 Dec;15(12):1262-7
Publication Type
Article
Date
Dec-2008
Author
Jocelyn Gravel
Serge Gouin
Sergio Manzano
Michael Arsenault
Devendra Amre
Author Affiliation
Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada. Graveljocelyn@hotmail.com
Source
Acad Emerg Med. 2008 Dec;15(12):1262-7
Date
Dec-2008
Language
English
Publication Type
Article
Keywords
Canada
Child
Child, Preschool
Cohort Studies
Decision Support Systems, Clinical
Emergency Nursing - statistics & numerical data
Female
Hospitals, Pediatric
Humans
Industry
Infant
Male
Pediatric Nursing - statistics & numerical data
Prospective Studies
Reproducibility of Results
Severity of Illness Index
Triage - methods - statistics & numerical data
Abstract
The objective was to measure the interrater agreement between nurses assigning triage levels to children visiting a pediatric emergency departments (EDs) assisted by a computerized version of the Pediatric Canadian Triage and Acuity Scale (PedCTAS).
This was a prospective cohort study evaluating children triaged from Level 2 (emergent) to Level 5 (nonurgent). A convenience sample of patients triaged during 38 shifts from April to September 2007 in a tertiary care pediatric ED was evaluated. All patients were initially triaged by regular triage nurses using a computerized version of the PedCTAS. Research nurses performed a second evaluation blinded to the first evaluation using the same triage tool. These research nurses were regular ED nurses performing extra hours for research purposes exclusively. The primary outcome measure was the interrater agreement between the two nurses as measured by the linear weighted kappa score. Secondary outcomes included the proportion of patient for which nurses did not apply the triage level suggested by Staturg (override) and agreement for these overrides.
A total of 499 patients were recruited. The overall interrater agreement was moderate (linear weighted kappa score of 0.55 [95% confidence interval {CI} = 0.48 to 0.61] and quadratic weighted kappa score of 0.61 [95% CI = 0.42 to 0.80]). There was a discrepancy of more than one level in only 10 patients (2% of the study population). Overrides occurred in 23.2 and 21.8% for regular and research triage nurses, respectively. These overrides were equally distributed between increase and decrease in triage level.
Nurses using Staturg, which is a computerized version of the PedCTAS, demonstrated moderate interrater agreement for assignment of triage level to children presenting to a pediatric ED.
PubMed ID
18945238 View in PubMed
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Performance of the Canadian Triage and Acuity Scale for children: a multicenter database study.

https://arctichealth.org/en/permalink/ahliterature122168
Source
Ann Emerg Med. 2013 Jan;61(1):27-32.e3
Publication Type
Article
Date
Jan-2013
Author
Jocelyn Gravel
Eleanor Fitzpatrick
Serge Gouin
Kelly Millar
Sarah Curtis
Gary Joubert
Kathy Boutis
Chantal Guimont
Ran D Goldman
Alexander S Dubrovsky
Robert Porter
Darcy Beer
Quynh Doan
Martin H Osmond
Author Affiliation
Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada. graveljocelyn@hotmail.com
Source
Ann Emerg Med. 2013 Jan;61(1):27-32.e3
Date
Jan-2013
Language
English
Geographic Location
Canada
Publication Type
Article
Keywords
Adolescent
Canada
Child
Child, Preschool
Databases, Factual
Emergency Service, Hospital - statistics & numerical data
Female
Hospitalization - statistics & numerical data
Hospitals, Pediatric
Hospitals, University
Humans
Infant
Intensive Care Units - statistics & numerical data
Male
Outcome Assessment (Health Care)
Patient Acuity
Retrospective Studies
Tertiary Care Centers
Triage - methods - statistics & numerical data
Abstract
We evaluate the association between triage levels assigned using the Canadian Triage and Acuity Scale and surrogate markers of validity for real-life children triaged in multiple emergency departments (EDs).
This was a retrospective cohort study evaluating the triage assessment and outcomes of all children presenting to 12 pediatric EDs, all of which are members of the Pediatric Emergency Research Canada group, during a 1-year period (2010 to 2011). Anonymous data were retrieved from the ED computerized databases. The primary outcome measure was the proportion of children hospitalized for each triage level. Other outcomes were ICU admission, proportion of patients who left without being seen by a physician, and length of stay in the ED. Evaluation of all children visiting these EDs during 1 year was expected to provide more than 1,000 patients in each triage category.
A total of 550,940 children were included. Pooled data demonstrated hospitalization proportions of 61%, 30%, 10%, 2%, and 0.9% for patients in Canadian Triage and Acuity Scale levels 1, 2, 3, 4, and 5, respectively. There was a strong association between triage level and admission to the ICU, probability of leaving without being seen by a physician, and length of stay.
The strong association between triage level and multiple markers of severity in 12 Canadian pediatric EDs suggests validity of the Canadian Triage and Acuity Scale for children.
Notes
Comment In: Ann Emerg Med. 2013 Mar;61(3):372-323433024
Comment In: Ann Emerg Med. 2013 Jan;61(1):33-422883682
PubMed ID
22841173 View in PubMed
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Practice patterns in asthma discharge pharmacotherapy in pediatric emergency departments: a pediatric emergency research Canada study.

https://arctichealth.org/en/permalink/ahliterature120704
Source
Acad Emerg Med. 2012 Sep;19(9):E1019-26
Publication Type
Article
Date
Sep-2012
Author
Suzanne Schuh
Roger Zemek
Amy Plint
Karen J L Black
Stephen Freedman
Robert Porter
Serge Gouin
David W Johnson
Author Affiliation
Department of Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada. suzanne.schuh@sickkids.ca
Source
Acad Emerg Med. 2012 Sep;19(9):E1019-26
Date
Sep-2012
Language
English
Publication Type
Article
Keywords
Administration, Inhalation
Administration, Oral
Adolescent
Adrenal Cortex Hormones - administration & dosage
Age Factors
Albuterol - administration & dosage
Anti-Asthmatic Agents - administration & dosage
Asthma - diagnosis - drug therapy
Canada
Child
Child, Preschool
Cohort Studies
Confidence Intervals
Continuity of Patient Care
Databases, Factual
Emergency Medicine - standards - trends
Emergency Service, Hospital
Female
Follow-Up Studies
Humans
Length of Stay
Male
Metered Dose Inhalers
Odds Ratio
Patient Discharge
Physician's Practice Patterns
Retrospective Studies
Risk assessment
Severity of Illness Index
Sex Factors
Treatment Outcome
Abstract
The objective was to examine utilization of ß2 agonists via metered dose inhalers with oral and inhaled corticosteroids (ICS) at discharge in children with acute asthma.
This was a retrospective medical record review at six pediatric emergency departments (EDs) of otherwise healthy children 2 to 17 years of age discharged with acute asthma. Data were extracted on history, disease severity, and pharmacotherapy used in the ED and at discharge. The primary outcome was the proportion of children prescribed "comprehensive therapy," i.e., albuterol via metered dose inhaler (MDI) with oral and ICS.
The overall rate of comprehensive therapy was 382 of 654 (58%), which varied from 30% to 84% (p
PubMed ID
22978728 View in PubMed
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13 records – page 1 of 2.