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A 15-year national follow-up: legislation is not enough to reduce the use of seclusion and restraint.

https://arctichealth.org/en/permalink/ahliterature162773
Source
Soc Psychiatry Psychiatr Epidemiol. 2007 Sep;42(9):747-52
Publication Type
Article
Date
Sep-2007
Author
Alice Keski-Valkama
Eila Sailas
Markku Eronen
Anna-Maija Koivisto
Jouko Lönnqvist
Riittakerttu Kaltiala-Heino
Author Affiliation
Vanha Vaasa Hospital, PO Box 13, Vaasa, 65381 Finland. alice.keski-valkama@vvs.fi
Source
Soc Psychiatry Psychiatr Epidemiol. 2007 Sep;42(9):747-52
Date
Sep-2007
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Coercion
Female
Finland - epidemiology
Follow-Up Studies
Humans
Male
Mental Disorders - epidemiology
Mental Health Services - legislation & jurisprudence - standards
Middle Aged
Patient Discharge - statistics & numerical data
Prevalence
Registries
Restraint, Physical - legislation & jurisprudence - utilization
Abstract
Seclusion and restraint are frequent but controversial coercive measures used in psychiatric treatment. Legislative efforts have started to emerge to control the use of these measures in many countries. In the present study, the nationwide trends in the use of seclusion and restraint were investigated in Finland over a 15-year span which was characterised by legislative changes aiming to clarify and restrict the use of these measures.
The data were collected during a predetermined week in 1990, 1991, 1994, 1998 and 2004, using a structured postal survey of Finnish psychiatric hospitals. The numbers of inpatients during the study weeks were obtained from the National Hospital Discharge Register.
The total number of the secluded and restrained patients declined as did the number of all inpatients during the study weeks, but the risk of being secluded or restrained remained the same over time when compared to the first study year. The duration of the restraint incidents did not change, but the duration of seclusion increased. A regional variation was found in the use of coercive measures.
Legislative changes solely cannot reduce the use of seclusion and restraint or change the prevailing treatment cultures connected with these measures. The use of seclusion and restraint should be vigilantly monitored and ethical questions should be under continuous scrutiny.
PubMed ID
17598058 View in PubMed
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30-Day Survival Probabilities as a Quality Indicator for Norwegian Hospitals: Data Management and Analysis.

https://arctichealth.org/en/permalink/ahliterature273361
Source
PLoS One. 2015;10(9):e0136547
Publication Type
Article
Date
2015
Author
Sahar Hassani
Anja Schou Lindman
Doris Tove Kristoffersen
Oliver Tomic
Jon Helgeland
Source
PLoS One. 2015;10(9):e0136547
Date
2015
Language
English
Publication Type
Article
Keywords
Comorbidity
Diagnosis-Related Groups
Episode of Care
Hospital Mortality
Hospital records
Hospitals - standards - statistics & numerical data
Humans
Length of Stay
Norway - epidemiology
Patient Admission - statistics & numerical data
Patient Discharge - statistics & numerical data
Patient transfer
Probability
Quality Improvement
Quality Indicators, Health Care
Survival Analysis
Abstract
The Norwegian Knowledge Centre for the Health Services (NOKC) reports 30-day survival as a quality indicator for Norwegian hospitals. The indicators have been published annually since 2011 on the website of the Norwegian Directorate of Health (www.helsenorge.no), as part of the Norwegian Quality Indicator System authorized by the Ministry of Health. Openness regarding calculation of quality indicators is important, as it provides the opportunity to critically review and discuss the method. The purpose of this article is to describe the data collection, data pre-processing, and data analyses, as carried out by NOKC, for the calculation of 30-day risk-adjusted survival probability as a quality indicator.
Three diagnosis-specific 30-day survival indicators (first time acute myocardial infarction (AMI), stroke and hip fracture) are estimated based on all-cause deaths, occurring in-hospital or out-of-hospital, within 30 days counting from the first day of hospitalization. Furthermore, a hospital-wide (i.e. overall) 30-day survival indicator is calculated. Patient administrative data from all Norwegian hospitals and information from the Norwegian Population Register are retrieved annually, and linked to datasets for previous years. The outcome (alive/death within 30 days) is attributed to every hospital by the fraction of time spent in each hospital. A logistic regression followed by a hierarchical Bayesian analysis is used for the estimation of risk-adjusted survival probabilities. A multiple testing procedure with a false discovery rate of 5% is used to identify hospitals, hospital trusts and regional health authorities with significantly higher/lower survival than the reference. In addition, estimated risk-adjusted survival probabilities are published per hospital, hospital trust and regional health authority. The variation in risk-adjusted survival probabilities across hospitals for AMI shows a decreasing trend over time: estimated survival probabilities for AMI in 2011 varied from 80.6% (in the hospital with lowest estimated survival) to 91.7% (in the hospital with highest estimated survival), whereas it ranged from 83.8% to 91.2% in 2013.
Since 2011, several hospitals and hospital trusts have initiated quality improvement projects, and some of the hospitals have improved the survival over these years. Public reporting of survival/mortality indicators are increasingly being used as quality measures of health care systems. Openness regarding the methods used to calculate the indicators are important, as it provides the opportunity of critically reviewing and discussing the methods in the literature. In this way, the methods employed for establishing the indicators may be improved.
Notes
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Cites: Am J Epidemiol. 2011 Mar 15;173(6):676-8221330339
PubMed ID
26352600 View in PubMed
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The ability to achieve complete revascularization is associated with improved in-hospital survival in cardiogenic shock due to myocardial infarction: Manitoba cardiogenic SHOCK Registry investigators.

https://arctichealth.org/en/permalink/ahliterature134718
Source
Catheter Cardiovasc Interv. 2011 Oct 1;78(4):540-8
Publication Type
Article
Date
Oct-1-2011
Author
Farrukh Hussain
Roger K Philipp
Robin A Ducas
Jason Elliott
Vladimír D┼żavík
Davinder S Jassal
James W Tam
Daniel Roberts
Philip J Garber
John Ducas
Author Affiliation
Section of Cardiology Dept. of Cardiac Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. fhussain@sbgh.mb.ca
Source
Catheter Cardiovasc Interv. 2011 Oct 1;78(4):540-8
Date
Oct-1-2011
Language
English
Publication Type
Article
Keywords
Aged
Angioplasty, Balloon, Coronary - adverse effects - mortality
Cardiovascular Agents - adverse effects - therapeutic use
Catheterization, Swan-Ganz
Coronary Angiography
Coronary Artery Bypass - adverse effects - mortality
Female
Hospital Mortality
Humans
Logistic Models
Male
Manitoba
Middle Aged
Myocardial Infarction - complications - diagnosis - mortality - therapy
Odds Ratio
Patient Discharge - statistics & numerical data
Registries
Retrospective Studies
Risk assessment
Risk factors
Shock, Cardiogenic - diagnosis - etiology - mortality - therapy
Survival Analysis
Survival Rate
Time Factors
Treatment Outcome
Abstract
To identify predictors of survival in a retrospective multicentre cohort of patients with cardiogenic shock undergoing coronary angiography and to address whether complete revascularization is associated with improved survival in this cohort.
Early revascularization is the standard of care for cardiogenic shock. Coronary bypass grafting and percutaneous intervention have complimentary roles in achieving this revascularization.
A total of 210 consecutive patients (mean age 66 ± 12 years) at two tertiary centres from 2002 to 2006 inclusive with a diagnosis of cardiogenic shock were evaluated. Univariate and multivariate predictors of in-hospital survival were identified utilizing logistic regression.
ST elevation infarction occurred in 67% of patients. Thrombolysis was administered in 34%, PCI was attempted in 62% (88% stented, 76% TIMI 3 flow), CABG was performed in 22% (2.7 grafts, 14 valve procedures), and medical therapy alone was administered to the remainder. The overall survival to discharge was 59% (CABG 68%, PCI 57%, medical 48%). Independent predictors of mortality included complete revascularization (P = 0.013, OR = 0.26 (95% CI: 0.09-0.76), hyperlactatemia (P = 0.046, OR = 1.14 (95% CI: 1.002-1.3) per mmol increase), baseline renal insufficiency (P = 0.043, OR = 3.45, (95% CI: 1.04-11.4), and the presence of anoxic brain injury (P = 0.008, OR = 8.22 (95% CI: 1.73-39.1). Within the STEMI with concomitant multivessel coronary disease subgroup of this population (N = 101), independent predictors of survival to discharge included complete revascularization (P = 0.03, OR = 2.5 (95% CI: 1.1-6.2)) and peak lactate (P = 0.02).
The ability to achieve complete revascularization may be strongly associated with improved in-hospital survival in patients with cardiogenic shock.
Notes
Comment In: Catheter Cardiovasc Interv. 2011 Oct 1;78(4):549-5021953751
PubMed ID
21547996 View in PubMed
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[Accelerated versus conventional hospital stay in total hip and knee arthroplasty III: patient satisfaction]

https://arctichealth.org/en/permalink/ahliterature81877
Source
Ugeskr Laeger. 2006 May 29;168(22):2148-51
Publication Type
Article
Date
May-29-2006
Author
Husted Henrik
Hansen Hans Christian
Holm Gitte
Bach-Dal Charlotte
Rud Kirsten
Andersen Kristoffer Lande
Kehlet Henrik
Author Affiliation
H:S Hvidovre Hospital, Ortopaedkirurgisk Afdeling, Hvidovre. henrikhusted@dadlnet.dk
Source
Ugeskr Laeger. 2006 May 29;168(22):2148-51
Date
May-29-2006
Language
Danish
Publication Type
Article
Keywords
Age Factors
Arthroplasty, Replacement, Hip - rehabilitation - statistics & numerical data
Arthroplasty, Replacement, Knee - rehabilitation - statistics & numerical data
Comorbidity
Denmark
Early Ambulation
Female
Humans
Length of Stay - statistics & numerical data
Male
Patient Discharge - statistics & numerical data
Patient satisfaction
Questionnaires
Registries
Abstract
INTRODUCTION: The goal of this study was to evaluate patient satisfaction with the hospital stay in relation to the length of stay for patients operated on with primary total hip- and knee-arthroplasty (THA and TKA). MATERIALS AND METHODS: According to the National Register on Patients, the three departments with the shortest and the three departments with the longest postoperative hospital stay at the end of 2003 were chosen for evaluation. The patients, operated on with THA or TKA from September 2004 to April 2005, from the selected departments answered a questionnaire regarding satisfaction with elected parts of their stay, co-morbidity, sex and age. RESULTS: The patients from the departments with the shortest stay were not younger nor had they less co-morbidities than patients from departments with longer stays. Apart from staying a significantly shorter time, they were either as satisfied--or sometimes more satisfied--with all parts of their stay compared to patients from the departments with longer hospital stay. CONCLUSION: Patients in accelerated stays are not less satisfied with their hospital stay (or any part of it) compared to patients with longer and more conventional hospital stays. These results support the implementation of fast-track total hip- and knee arthroplasty.
PubMed ID
16768952 View in PubMed
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[Accelerated versus conventional hospital stay in total hip and knee arthroplasty II: organizational and clinical differences].

https://arctichealth.org/en/permalink/ahliterature168857
Source
Ugeskr Laeger. 2006 May 29;168(22):2144-8
Publication Type
Article
Date
May-29-2006
Author
Henrik Husted
Hans Christian Hansen
Gitte Holm
Charlotte Bach-Dal
Kirsten Rud
Kristoffer Lande Andersen
Henrik Kehlet
Author Affiliation
H:S Hvidovre Hospital, Ortopaedkirurgisk Afdeling, Hvidovre. henrikhusted@dadlnet.dk
Source
Ugeskr Laeger. 2006 May 29;168(22):2144-8
Date
May-29-2006
Language
Danish
Publication Type
Article
Keywords
Arthroplasty, Replacement, Hip - nursing - rehabilitation - statistics & numerical data
Arthroplasty, Replacement, Knee - nursing - rehabilitation - statistics & numerical data
Denmark
Early Ambulation - statistics & numerical data
Focus Groups
Hospital Departments - organization & administration - statistics & numerical data
Humans
Interviews as Topic
Length of Stay
Orthopedics - organization & administration - statistics & numerical data
Patient Discharge - statistics & numerical data
Physician's Practice Patterns
Registries
Abstract
The goal of this study was to evaluate hospital stays for patients operated on with primary total hip- and knee-arthroplasty (THA and TKA) in order to identify important logistical and clinical areas for the duration of the hospital stay.
According to the National Register on Patients, the three departments with the shortest and the three departments with the longest postoperative hospital stay at the end of 2003 were chosen for evaluation. This took place from late 2004 to mid 2005, and all written material and 25 journals from each department were evaluated, and interviews with the heads of the departments as well as the staff were conducted. The logistical set-up and the clinical treatment/pathway were examined in an attempt to identify logistical and clinical factors acting as improvements or barriers for quick rehabilitation and subsequent discharge.
Departments with short hospital stay were characterised by both logistical (homogenous entities, regular staff, high continuity, using more time on and up-to-date information including expectations of a short stay, functional discharge criteria) and clinical features (multi-modal pain treatment, early mobilization and discharge when criteria were met) facilitating quick rehabilitation and discharge.
Implementation of logistical and clinical features, as shown in this study in all departments, are expected to increase rehabilitation and reduce the length of hospital stay.
PubMed ID
16768951 View in PubMed
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Accidents in Canada: mortality and hospitalization.

https://arctichealth.org/en/permalink/ahliterature231964
Source
Health Rep. 1989;1(1):23-50
Publication Type
Article
Date
1989
Author
R. Riley
P. Paddon
Source
Health Rep. 1989;1(1):23-50
Date
1989
Language
English
French
Publication Type
Article
Keywords
Accident prevention
Accidental Falls - mortality - statistics & numerical data
Accidents - mortality - statistics & numerical data - trends
Accidents, Traffic - statistics & numerical data
Adolescent
Adult
Aged
Canada - epidemiology
Cause of Death
Child, Preschool
Cross-Cultural Comparison
Female
Hospitalization - statistics & numerical data
Humans
Infant
Length of Stay - statistics & numerical data
Male
Patient Discharge - statistics & numerical data
United States - epidemiology
Abstract
For Canadians under 45, accidents are the leading cause of both death and hospitalization. For the Canadian population as a whole, accidents rank fourth as a cause of death, after cardiovascular disease (CVD), cancer and respiratory disease. This article analyzes accident mortality and hospitalization in Canada using age-specific rates, age-standardized mortality rates (ASMR), and potential years of life lost (PYLL). The six major causes of accidental death for men are motor vehicle traffic accidents (MVTA), falls, drowning, fires, suffocation and poisoning. For women, the order is slightly different: MVTA, falls, fires, suffocation, poisoning and drowning. From 1971 to 1986, age-standardized mortality rates (ASMR) for accidents decreased by 44% for men and 39% for women. The largest decrease occurred in the under 15 age group. Accidents accounted for 11.5% of total hospital days in 1985, and 8% of hospital discharges. Because young people have the highest rates of accidental death, potential years of life lost (PYLL) are almost as high for accidents as for cardiovascular disease, although CVD deaths outnumbered accidental deaths by almost five to one in 1985.
PubMed ID
2491351 View in PubMed
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The accuracy of administrative data for identifying the presence and timing of admission to intensive care units in a Canadian province.

https://arctichealth.org/en/permalink/ahliterature127694
Source
Med Care. 2012 Mar;50(3):e1-6
Publication Type
Article
Date
Mar-2012
Author
Allan Garland
Marina Yogendran
Kendiss Olafson
Damon C Scales
Kari-Lynne McGowan
Randy Fransoo
Author Affiliation
Department of Medicine, University of Manitoba, Winnipeg, MB, Canada. agarland@hsc.mb.ca
Source
Med Care. 2012 Mar;50(3):e1-6
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Critical Care - organization & administration - statistics & numerical data
Databases, Factual - standards
Hospital Information Systems - organization & administration - standards
Hospitalization - statistics & numerical data
Humans
Intensive Care Units - organization & administration - statistics & numerical data
Length of Stay - statistics & numerical data
Manitoba
Patient Admission - statistics & numerical data
Patient Discharge - statistics & numerical data
Time Factors
Abstract
A prerequisite for using administrative data to study the care of critically ill patients in intensive care units (ICUs) is that it accurately identifies such care. Only limited data exist on this subject.
To assess the accuracy of administrative data in the Canadian province of Manitoba for identifying the existence, number, and timing of admissions to adult ICUs.
For the period 1999 to 2008, we compared information about ICU care from Manitoba hospital abstracts, with the criterion standard of a clinical ICU database that includes all admissions to adult ICUs in its largest city of Winnipeg. Comparisons were made before and after a national change in administrative data requirements that mandated specific data elements identifying the existence and timing of ICU care.
In both time intervals, hospital abstracts were extremely accurate in identifying the presence of ICU care, with positive predictive values exceeding 98% and negative predictive values exceeding 99%. Administrative data correctly identified the number of separate ICU admissions for 93% of ICU-containing hospitalizations; inaccuracy increased with more ICU stays per hospitalization. Hospital abstracts were highly accurate for identifying the timing of ICU care, but only for hospitalizations containing a single ICU admission.
Under current national-reporting requirements, hospital administrative data in Canada can be used to accurately identify and quantify ICU care. The high accuracy of Manitoba administrative data under the previous reporting standards, which lacked standardized coding elements specific to ICU care, may not be generalizable to other Canadian jurisdictions.
PubMed ID
22270100 View in PubMed
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Accuracy of the ICD-10 discharge diagnosis for syncope.

https://arctichealth.org/en/permalink/ahliterature119178
Source
Europace. 2013 Apr;15(4):595-600
Publication Type
Article
Date
Apr-2013
Author
Martin Huth Ruwald
Morten Lock Hansen
Morten Lamberts
Søren Lund Kristensen
Mads Wissenberg
Anne-Marie Schjerning Olsen
Stefan Bisgaard Christensen
Michael Vinther
Lars Køber
Christian Torp-Pedersen
Jim Hansen
Gunnar Hilmar Gislason
Author Affiliation
Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark. mruwald@hotmail.com
Source
Europace. 2013 Apr;15(4):595-600
Date
Apr-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Chi-Square Distribution
Denmark - epidemiology
Emergency Service, Hospital - statistics & numerical data
Female
Humans
International Classification of Diseases - statistics & numerical data
Male
Middle Aged
Patient Discharge - statistics & numerical data
Predictive value of tests
Reproducibility of Results
Retrospective Studies
Risk factors
Syncope - diagnosis - epidemiology
Abstract
Administrative discharge codes are widely used in epidemiology, but the specificity and sensitivity of this coding is unknown and must be validated. We assessed the validity of the discharge diagnosis of syncope in administrative registers and reviewed the etiology of syncope after workup.
Two samples were investigated. One sample consisted of 5262 randomly selected medical patients. The other sample consisted of 750 patients admitted or seen in the emergency department (ED) for syncope (ICD-10: R55.9) in three hospitals in Denmark. All charts were reviewed for baseline characteristics and to confirm the presence/absence of syncope and to compare with the administrative coding. In a sample of 600 admitted patients 570 (95%) and of 150 patients from ED 140 (93%) had syncope representing the positive predictive values. Median age of the population was 69 years (IQR: ± 14). In the second sample of 5262 randomly selected medical patients, 75 (1.4%) had syncope, of which 47 were coded as R55.9 yielding a sensitivity of 62.7%, a negative predictive value of 99.5%, and a specificity of 99.9%.
ED and hospital discharge diagnostic coding for syncope has a positive predictive value of 95% and a sensitivity of 63%.
PubMed ID
23129545 View in PubMed
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Acute care alternate-level-of-care days due to delayed discharge for traumatic and non-traumatic brain injuries.

https://arctichealth.org/en/permalink/ahliterature114257
Source
Healthc Policy. 2012 May;7(4):41-55
Publication Type
Article
Date
May-2012
Author
Chen Amy
Brandon Zagorski
Vincy Chan
Daria Parsons
Rika Vander Laan
Angela Colantonio
Author Affiliation
Toronto Rehabilitation Institute, UHN, Toronto, ON.
Source
Healthc Policy. 2012 May;7(4):41-55
Date
May-2012
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Aged, 80 and over
Brain diseases
Brain Injuries - epidemiology - therapy
Comorbidity
Female
Health Services Misuse
Humans
Length of Stay - statistics & numerical data
Male
Mental disorders
Ontario
Patient Discharge - statistics & numerical data
Young Adult
Abstract
Alternate-level-of-care (ALC) days represent hospital beds that are taken up by patients who would more appropriately be cared for in other settings. ALC days have been found to be costly and may result in worse functional outcomes, reduced motor skills and longer lengths of stay in rehabilitation. This study examines the factors that are associated with acute care ALC days among patients with acquired brain injury (ABI). We used the Discharge Abstract Database to identify patients with ABI using International Classification of Disease-10 codes. From fiscal years 2007/08 to 2009/10, 17.5% of patients with traumatic and 14% of patients with non-traumatic brain injury had at least one ALC day. Significant predictors include having a psychiatric co-morbidity, increasing age and length of stay in acute care. These findings can inform planning for care of people with ABI in a publicly funded healthcare system.
Notes
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PubMed ID
23634162 View in PubMed
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Acute global outcome in patients with mild uncomplicated and complicated traumatic brain injury.

https://arctichealth.org/en/permalink/ahliterature116563
Source
Brain Inj. 2013;27(2):189-99
Publication Type
Article
Date
2013
Author
Jehane H Dagher
Andreane Richard-Denis
Julie Lamoureux
Elaine de Guise
Mitra Feyz
Author Affiliation
Physical Medicine and Rehabilitation Department, McGill University Health Centre-Montreal General Hospital, Montreal, Quebec, Canada.
Source
Brain Inj. 2013;27(2):189-99
Date
2013
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Aged
Brain Injuries - epidemiology - rehabilitation
Canada - epidemiology
Cohort Studies
Cross-Sectional Studies
Disability Evaluation
Female
Glasgow Coma Scale
Glasgow Outcome Scale
Humans
Length of Stay
Male
Middle Aged
Outcome Assessment (Health Care)
Patient Care Planning
Patient Discharge - statistics & numerical data
Recovery of Function
Retrospective Studies
Treatment Outcome
United States - epidemiology
Abstract
This study assesses the influence of socio-demographic, psychosocial, clinical and radiological variables on the outcome of patients with mild traumatic brain injury (MTBI) in an acute care inpatient setting.
Retrospective cohort study.
A total of 2127 inpatients with MTBI were included. Outcomes measured were Extended Glasgow Outcome Scale (GOS-E), the FIM® instrument, length of stay (LOS) and discharge destination.
Fifty-four per cent of patients with MTBI with a median GOS-E of 2 were discharged home with no need for further follow-up. Age, LOS, lower Glasgow score (GCS) at admission, insurance coverage and positive CT scans were associated with rehabilitation referrals on discharge. Age, LOS, alcohol and drug abuse, motor vehicle collision and lower GCS at admission were associated with greater physical disabilities and functional impairment at discharge. FIM® cognitive functional scores were higher in women, younger patients and patients without psychiatric disorders. Brain lesions were correlated with longer LOS. CT scan findings in patients with MTBI may help clinicians predict the final outcome and resources required for patient care during their hospitalization and on discharge.
This study can help healthcare professionals in treating and planning future care of patients with MTBI.
PubMed ID
23384216 View in PubMed
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392 records – page 1 of 40.