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Different patient-reported outcomes in immigrants and patients born in Sweden: 18,791 patients with 1 year follow-up in the Swedish Hip Arthroplasty Registry.

https://arctichealth.org/en/permalink/ahliterature256752
Source
Acta Orthop. 2014 Jun;85(3):221-8
Publication Type
Article
Date
Jun-2014
Author
Ferid Krupic
Göran Garellick
Max Gordon
Johan Kärrholm
Author Affiliation
Department of Orthopaedics , Institute of Clinical Sciences, Sahlgrenska Academy , University of Gothenburg.
Source
Acta Orthop. 2014 Jun;85(3):221-8
Date
Jun-2014
Language
English
Publication Type
Article
Keywords
Aged
Arthroplasty, Replacement, Hip
Emigrants and Immigrants
Female
Follow-Up Studies
Humans
Male
Middle Aged
Osteoarthritis, Hip - surgery
Pain Measurement
Patient satisfaction
Population Groups
Questionnaires
Registries
Regression Analysis
Retrospective Studies
Self Report
Sweden
Treatment Outcome
Abstract
Some patients have persistent symptoms after total hip arthroplsty (THA). We investigated whether the proportions of inferior clinical results after total hip arthroplasty-according to the 5 dimensions in the EQ-5D form, and pain and satisfaction according to a visual analog scale (VAS)-are the same in immigrants to Sweden as observed in those born in Sweden.
Records of total hip arthroplasties performed between 1992 and 2007 were retrieved from the Swedish Hip Arthroplasty Register (SHAR) and cross-matched with data from the National Board of Health and Welfare and also Statistics, Sweden. 18,791 operations (1,451 in immigrants, 7.7%) were eligible for analysis. Logistic and linear regression models including age, sex, diagnosis, type of fixation, comorbidity, surgical approach, marital status, and education level were analyzed. Outcomes were the 5 dimensions in EQ-5D, EQ-VAS, VAS pain, and VAS satisfaction. Preoperative data and data from 1 year postoperatively were studied.
Preoperatively (and after inclusion of covariates in the regression models), all immigrant groups had more negative interference concerning self-care. Immigrants from the Nordic countries outside Sweden and Europe tended to have more problems with their usual activities and patients from Europe and outside Europe more often reported problems with anxiety/depression. Patients born abroad showed an overall tendency to report more pain on the VAS than patients born in Sweden. After the operation, the immigrant groups reported more problems in all the EQ-5D dimensions. After adjustment for covariates including the preoperative baseline value, most of these differences remained except for pain/discomfort and-concerning immigrants from the Nordic countries-also anxiety/depression. After the operation, pain according to VAS had decreased substantially in all groups. The immigrant groups indicated more pain than those born in Sweden, both before and after adjustment for covariates.
The frequency of patients who reported moderate to severe problems, both before and 1 year after the operation, differed for most of the dimensions in EQ-5D between patients born in Sweden and those born outside Sweden.
Notes
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PubMed ID
24803309 View in PubMed
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Difficulties in using interpreters in clinical encounters as experienced by immigrants living in Sweden.

https://arctichealth.org/en/permalink/ahliterature281583
Source
J Clin Nurs. 2016 Jun;25(11-12):1721-8
Publication Type
Article
Date
Jun-2016
Author
Ferid Krupic
Mikael Hellström
Mirza Biscevic
Sahmir Sadic
Nabi Fatahi
Source
J Clin Nurs. 2016 Jun;25(11-12):1721-8
Date
Jun-2016
Language
English
Publication Type
Article
Keywords
Communication
Communication Barriers
Cultural Competency
Emigrants and Immigrants - statistics & numerical data
Female
Focus Groups
Humans
Male
Middle Aged
Multilingualism
Physician-Patient Relations
Primary Health Care
Qualitative Research
Sweden
Translating
Abstract
To study a group of immigrants' experiences regarding interactions with primary health care through an interpreter.
Approximately, 230 million people are resettled outside of their own home country. Thus, more than 3% of the world's population are migrants. It is a major challenge for health care providers to satisfy immigrants' needs for individualised health care services.
Qualitative study.
Focus group interviews were conducted with four groups of immigrants (n = 24) from Bosnia and Herzegovina, Croatia, Kosovo and Somalia. The group interviews were audio recorded, transcribed and analysed, and the text was categorised using the content analysis method.
Participants' expectations of the interpreter-mediated consultations were high, but not always fulfilled. Interpreters being late, lacking professionalism or lacking knowledge in medical terminology and the use of health care professionals or relatives as interpreters were some of the problems raised.
A well-organised, disciplined interpreter service with professional and competent interpreters is needed to overcome problems regarding clinical consultations involving interpreters. A satisfactory language bridge has a significant impact on the quality of communications.
Interpreter services should be well organised, and interpreters should be linguistically, culturally and socially competent, as these factors may have a significant impact on consultation outcomes. Using relatives or staff as interpreters can sometimes be a solution but often results in an unsatisfactory clinical consultation.
PubMed ID
26879885 View in PubMed
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The effect of changing one's country of residence on the decision to become an organ donor: the experience of religious immigrant women living in Sweden.

https://arctichealth.org/en/permalink/ahliterature295858
Source
Med Glas (Zenica). 2018 Aug 01; 15(2):192-198
Publication Type
Journal Article
Date
Aug-01-2018
Author
Ferid Krupic
Sahmir Šadic
Svemir Custovic
Mahir Jašarevic
Mirsad Fazlic
Kristian Samuelsson
Author Affiliation
Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg; Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal; Department of Anaesthesiology, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg; Department of Orthopaedics, Sahlgrenska University Hospital Östra, Gothenburg, Sweden; University Clinical Centre Tuzla, Clinic for Orthopaedics and Traumatology, Bosnia and Herzegovina.
Source
Med Glas (Zenica). 2018 Aug 01; 15(2):192-198
Date
Aug-01-2018
Language
English
Publication Type
Journal Article
Keywords
Adult
Culture
Decision Making
Emigrants and Immigrants
Emigration and Immigration
Ethnic Groups
Europe, Eastern
Female
Health Knowledge, Attitudes, Practice
Humans
Male
Middle Aged
Qualitative Research
Religion
Sweden
Tissue Donors
Tissue and Organ Procurement
Abstract
Aim To explore and elucidate women's knowledge of and willingness to take part in organ donation, and to explore if their opinions were changed by coming to Sweden. Methods The study was designed as a qualitative study using data from interviews with women from Bosnia and Herzegovina, Macedonia, Croatia and Kosovo. The inclusion criteria were women who were immigrants in Sweden and have lived in Sweden for more than 10 years. Five groups including forty-five women were invited to participate in the study and 39 agreed. The women were aged 29 to 73 years (mean 52.5 years). Results Regarding knowledge and information about organ donation, most women found it very important to be able to talk about such things. However, the knowledge and information about organ donation of almost all the women was at a very low level. None of the women changed their opinion on the organ donation and attitudes from their countries of origin. All women firmly emphasized and explained that by coming to another state they do not become a different person and retain all values they had and with which were born in home country. Conclusion It is important to study how to find new ways to communicate and work with minorities and vulnerable groups in order to discuss organ donation with all those who could be potential donors in the Swedish health care system.
PubMed ID
29790483 View in PubMed
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Equivalent Knee Injury and Osteoarthritis Outcome Scores 12 and 24 Months After Anterior Cruciate Ligament Reconstruction: Results From the Swedish National Knee Ligament Register.

https://arctichealth.org/en/permalink/ahliterature290380
Source
Am J Sports Med. 2017 Jul; 45(9):2085-2091
Publication Type
Journal Article
Date
Jul-2017
Author
Kristian Samuelsson
Robert A Magnussen
Eduard Alentorn-Geli
Ferid Krupic
Kurt P Spindler
Christer Johansson
Magnus Forssblad
Jón Karlsson
Author Affiliation
Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden.
Source
Am J Sports Med. 2017 Jul; 45(9):2085-2091
Date
Jul-2017
Language
English
Publication Type
Journal Article
Keywords
Activities of Daily Living
Adolescent
Adult
Anterior Cruciate Ligament - surgery
Anterior Cruciate Ligament Injuries - surgery
Anterior Cruciate Ligament Reconstruction - methods
Cohort Studies
Female
Follow-Up Studies
Humans
Knee Injuries - surgery
Knee Joint - surgery
Male
Middle Aged
Osteoarthritis, Knee - surgery
Quality of Life
Sweden
Treatment Outcome
Young Adult
Abstract
It is not clear whether Knee injury and Osteoarthritis Outcome Score (KOOS) results will be different 1 or 2 years after anterior cruciate ligament (ACL) reconstruction.
To investigate within individual patients enrolled in the Swedish National Knee Ligament Register whether there is equivalence between KOOS at 1 and 2 years after primary ACL reconstruction.
Cohort study; Level of evidence, 2.
This cohort study was based on data from the Swedish National Knee Ligament Register during the period January 1, 2005, through December 31, 2013. The longitudinal KOOS values for each individual at the 1- and 2-year follow-up evaluations were assessed through the two one-sided test (TOST) procedure with an acceptance criterion of 4. Subset analysis was performed with patients classified by sex, age, graft type, and type of injury (meniscal and/or cartilage injury).
A total of 23,952 patients were eligible for analysis after exclusion criteria were applied (10,116 women, 42.2%; 13,836 men, 57.8%). The largest age group was between 16 and 20 years of age (n = 6599; 27.6%). The most common ACL graft was hamstring tendon (n = 22,504; 94.0%), of which the combination of semitendinosus and gracilis was the most common. A total of 7119 patients reported on the KOOS Pain domain at both 1- and 2-year follow-ups, with a mean difference of 0.21 (13.1 SD, 0.16 SE [90% CI, -0.05 to 0.46], P
PubMed ID
28714793 View in PubMed
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Factors Beyond the Language Barrier in Providing Health Care to Immigrant Patients.

https://arctichealth.org/en/permalink/ahliterature290461
Source
Med Arch. 2016 Feb; 70(1):61-5
Publication Type
Journal Article
Date
Feb-2016
Author
Nabi Fatahi
Ferid Krupic
Author Affiliation
Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
Source
Med Arch. 2016 Feb; 70(1):61-5
Date
Feb-2016
Language
English
Publication Type
Journal Article
Keywords
Adult
Communication Barriers
Delivery of Health Care - ethnology
Emigrants and Immigrants - statistics & numerical data
Europe
Female
Focus Groups
Health Knowledge, Attitudes, Practice
Health Services Accessibility - statistics & numerical data
Healthcare Disparities - ethnology
Humans
Iraq
Male
Middle Aged
Patient Acceptance of Health Care - ethnology
Social Perception
Sweden - ethnology
Abstract
Due to the enormous migration as the result of war and disasters during the last decades, health systems in Europe are faced with various cultural traditions and both healthcare systems and healthcare professionals are challenged by human rights and values. In order to minimize difficulties in providing healthcare services to patients with different cultural backgrounds, cultural competence healthcare professionals are needed.
Four focus group interviews, were conducted with Kurdish immigrants in Scandinavian countries (N=26). The majority were males (n=18) aged between 33-61 years (M= 51.6 years) and a few were (n=8) females aged 41-63 years (M=50.7 years). The data were analyzed by using qualitative content analysis method.
According to the study results participants experienced that diversities both in culture and healthcare routines create a number of difficulties regarding contact with healthcare services. Though culture related aspects influenced the process of all contact with health care services, the obstacles were more obvious in the case of psychological issues. The results of the study showed that cultural diversities were an obvious reason for immigrants' attitudes regarding healthcare services in resettlement countries.
The results of the study revealed a number of difficulties beyond linguistic problems regarding immigrants' contact with healthcare services in Scandinavian countries. Problems were rooted both in diversities in healthcare services and cultural aspects. Immigrants' views of healthcare systems and healthcare professionals' approach in providing healthcare were some of the problems mentioned.
Notes
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PubMed ID
26980935 View in PubMed
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[Foreign-born report more problems after total hip arthroplasty than Swedish-born. Unclear why, but better informed and educated interpreters may be needed].

https://arctichealth.org/en/permalink/ahliterature273202
Source
Lakartidningen. 2015;112
Publication Type
Article
Date
2015
Author
Ferid Krupic
Johan Kärrholm
Source
Lakartidningen. 2015;112
Date
2015
Language
Swedish
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip - psychology - statistics & numerical data
Emigrants and Immigrants - psychology - statistics & numerical data
Female
Humans
Male
Middle Aged
Pain - ethnology
Pain Measurement
Patient Education as Topic
Patient satisfaction
Registries
Self Care
Self Report
Socioeconomic Factors
Sweden - epidemiology - ethnology
Translating
Visual Analog Scale
Abstract
In 2013, 23.3% of the Swedish population of 9.7 million had foreign background and 15.4% were born outside the country. Immigrants, just as natives, suffer or will suffer from hip disease, which could involve surgery with total hip arthroplasty. Our aim was to explore the association between birthplace (in or outside Sweden), socio-economic factors and outcome after primary total hip arthroplasty. Records from the Swedish Hip Arthroplasty Register were cross-matched with population-based registers from the National Board of Health and Welfare and Statistics Sweden.  Preoperatively immigrants reported more problems with self-care (P=0.02), usual activities (P=0.05) and anxiety/depression (P=0.005) as well as higher levels of pain. Postoperatively immigrants reported more problems in all EQ-5D dimensions. Improved patient information, better training of medical staff and better access to interpreters could facilitate these patients' contacts with health care and also contribute to improved outcome.
PubMed ID
26284881 View in PubMed
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The impact of knowledge and religion on organ donation as seen by immigrants in Sweden.

https://arctichealth.org/en/permalink/ahliterature294244
Source
Scand J Caring Sci. 2017 Dec; 31(4):687-694
Publication Type
Journal Article
Date
Dec-2017
Author
Ferid Krupic
Arkan S Sayed-Noor
Nabi Fatahi
Author Affiliation
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Source
Scand J Caring Sci. 2017 Dec; 31(4):687-694
Date
Dec-2017
Language
English
Publication Type
Journal Article
Keywords
Adult
Aged
Child
Emigrants and Immigrants - psychology
Humans
Middle Aged
Religion
Sweden
Tissue and Organ Procurement
Abstract
Transplantation of organs is one of the most successful medical advances of the past 60 years and transplantation is the treatment of choice for severe organ failure worldwide. Despite this situation, and the general acknowledgement of organ donation as a global priority, demand for organs outstrips supply in virtually every country in the world.
The aim of the study was to elucidate factors that influence immigrant's decisions regarding organ donation.
Data were collected through three group interviews using open-ended questions and qualitative content analysis. 32 participants, 16 men and 16 women from Bosnia and Herzegovina, Somalia, Lebanon and Kosovo participated in focus group interviews (FGI).
Analysis of the collected data resulted in two main categories: 'Information about organ donation' and 'Religious aspects of organ donation and a number of subcategories'. Some of the influencing factors concerning organ donation were mainly related to limited information from society as well as limited information from healthcare professionals. Religious aspects, fear and prejudices about organ donation were other factors that mentioned by participants as hamper regarding organ donation.
In order to improve immigrants' attitude towards organ donation, information about this issue and identification of the hampering factors, particularly culturally related factors such as the religious aspect, is essential. In this context, different intervention studies are needed to increase monitories groups' attitude towards organ donations.
PubMed ID
27500584 View in PubMed
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The Impact of Religion and Provision of Information on Increasing Knowledge and Changing Attitudes to Organ Donation: An Intervention Study.

https://arctichealth.org/en/permalink/ahliterature307697
Source
J Relig Health. 2020 Aug; 59(4):2082-2095
Publication Type
Journal Article
Date
Aug-2020
Author
Ferid Krupic
Author Affiliation
Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborgsvägen 31, 431 80, Mölndal, Sweden. ferid.krupic@gu.se.
Source
J Relig Health. 2020 Aug; 59(4):2082-2095
Date
Aug-2020
Language
English
Publication Type
Journal Article
Keywords
Female
Health Knowledge, Attitudes, Practice
Humans
Male
Organ Transplantation - psychology - statistics & numerical data - trends
Religion
Surveys and Questionnaires
Sweden
Tissue Donors - psychology - statistics & numerical data
Tissue and Organ Procurement - statistics & numerical data - trends
Abstract
One of the most significant developments in recent history has probably been organ donation and organ transplantation. They are frequently the only treatment available in certain cases. However, there is an ever-increasing discrepancy between the number of people needing transplantation and the organs available, because the decision to donate an organ is up to each individual. The study aims to assess the impact of the intervention on knowledge, attitudes and practices on organ donation among religious immigrants in Sweden. Data were collected through three group interviews using open-ended questions and qualitative content analysis. Thirty-six participants, 18 males and 18 females from six countries, participated in the focus group interviews. The analysis of the collected data resulted in two main categories: "Religion in theory and practice" and "More information-more knowledge about organ donation" including seven subcategories. Understanding of religion and religiosity, happiness by taking the class, the practice of religion in everyday life, the overcoming the prejudices in religion, having more information about organ donation and the donations process, as well as that the increased information changes people's minds, were some of things the informants emphasised as predictors of the decision of organ donation. A class dealing with religion, the religious aspects of organ donation and the way the Swedish healthcare system is organised increased people's knowledge and changed their attitudes so they became potential organ donors. More intervention studies are needed in every field of medicine to build confidence and give time to educate and discuss issues with potential organ donors in Sweden.
PubMed ID
31838627 View in PubMed
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Migrant General Practitioners' Experiences of Using Interpreters in Health-care: a Qualitative Explorative Study.

https://arctichealth.org/en/permalink/ahliterature295090
Source
Med Arch. 2017 Feb; 71(1):42-47
Publication Type
Journal Article
Date
Feb-2017
Author
Ferid Krupic
Kristian Samuelsson
Nabi Fatahi
Olof Skoldenberg
Arkan S Sayed-Noor
Author Affiliation
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
Source
Med Arch. 2017 Feb; 71(1):42-47
Date
Feb-2017
Language
English
Publication Type
Journal Article
Keywords
Adult
Attitude of Health Personnel
Communication Barriers
Cultural Competency - organization & administration
Emigrants and Immigrants
Europe, Eastern
Female
Focus Groups
Foreign Medical Graduates
General practitioners
Humans
Male
Middle Aged
Physician-Patient Relations
Primary Health Care - methods
Qualitative Research
Sweden
Translating
Abstract
According to the UNHCR, 250 million people currently live outside their country of birth. The growing multicultural population poses a major challenge to healthcare professionals who aim to provide individualized, holistic care, which respects the individual's autonomy. To ensure basic rights, healthcare interventions should be guided by the value of benefiting others; individuals should be treated honestly, equally, and impartially.
To investigate immigrant doctors' experiences of using interpreters in the Swedish health-care system.
Twenty-eight doctors, 12 men and 16 women from Bosnia and Herzegovina, Croatia, Macedonia and Serbia participated in four focus group interviews (FGI). The interviews were audio recorded, transcribed and analyzed using content analysis method.
The best results in the present study were achieved in situations where a professional interpreter was involved. In some cases, the doctors were forced to use relatives or a colleague to interpret, which in many cases proved to be a mistake. The consequences of poor interpretation routines included payment by mistake, a patient paying an interpreter who refused to interpret, time spent waiting for another interpreter, as well as disturbances to the daily work schedule. Finding someone who could replace an interpreter who did not show up caused time shortage and increased stress.
Improved routines and more effective cooperation between interpreting services and health-care centers are needed in order to ensure that using professional interpreters guarantees appropriate, high quality care. Improvements are needed to provide satisfactory health-care to people with limited language skills. In order to achieve this, better education of interpreters is needed, especially regarding cultural diversity and medical terminology. These improvements present complex challenges, deserving empirical and critical reflection in order to improve the work situation for doctors.
Notes
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PubMed ID
28428673 View in PubMed
Less detail

No influence of immigrant background on the outcome of total hip arthroplasty. 140,299 patients born in Sweden and 11,539 immigrants in the Swedish Hip Arthroplasty Register.

https://arctichealth.org/en/permalink/ahliterature116977
Source
Acta Orthop. 2013 Feb;84(1):18-24
Publication Type
Article
Date
Feb-2013
Author
Ferid Krupic
Thomas Eisler
Tore Eliasson
Göran Garellick
Max Gordon
Johan Kärrholm
Author Affiliation
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden. ferid.krupic@vgregion.se
Source
Acta Orthop. 2013 Feb;84(1):18-24
Date
Feb-2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip - statistics & numerical data
Emigrants and Immigrants - statistics & numerical data
Female
Humans
Male
Middle Aged
Proportional Hazards Models
Registries - statistics & numerical data
Reoperation - statistics & numerical data
Sweden - epidemiology - ethnology
Time Factors
Treatment Outcome
Abstract
Total Hip Replacement (THA) is one of the most successful and cost-effective operations. Despite its benefits, marked ethnic differences in the utilization of THA are well documented. However, very little has been published on the influence of ethnicity on outcome. We investigate whether the outcome-in terms of reoperation within 2 years or revision up to 14 years after the primary operation-varies depending on ethnic background.
Records of total hip arthroplasties performed between 1992 and 2007 were retrieved from the Swedish Hip Arthropalsty Registry and integrated with data on ethnicity of patients from 2 demographical databases (i.e. Patient Register and Statistics Sweden). The first operated side in patients with THA recorded in the Swedish Hip Arthroplasty Register (SHAR) between 1992 and 2007 were generally included. We excluded patients with 1 Swedish and 1 non-Swedish parent and patients born abroad with 2 Swedish parents. After these exclusions 151,838 patients were left for analysis. There were 11,539 Swedish patients born outside Sweden. We used a Cox regression model including age, sex, diagnosis, type of fixation, whether or not there was comorbidity according to Elixhauser or not, marital status and educational level.
The mean age was lowest in the group of patient coming from outside Europe including the former Soviet Union (61 years), and highest in the Swedish population (70 years). Before adjustment, for covariates, patients born in Europe outside the Nordic countries showed a lower risk to undergo early reoperation (HR = 0.73, 95% CI: 0.56-0.97), which increased after adjustment to (HR = 0.76, 95% CI: 0.58-1.01). Before adjustment, patients born in the Nordic countries outside Sweden and those born outside Europe (including the former Soviet Union) showed a higher risk to undergo revision than patients born in Sweden (HR = 1.14, 95% CI: 1.02-1.27; HR = 1.49, 95% CI: 1.2-1.9), but this difference disappeared after adjustment for covariates.
We did not find any certain differences in reoperation within 2 years, or revision within 14 years, between patients born in Sweden and immigrants. Further studies are needed to determine whether our observations are biased by the attitude of health providers regarding performance of these procedures, or by a reluctance of certain patient groups to seek medical attention should any complications requiring reoperation or revision occur.
Notes
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PubMed ID
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