Lineamientos del Colegio Colombiano de Terapia Ocupacional para la atención hospitalaria aguda y subaguda de pacientes con COVID-19
DOI:
https://doi.org/10.25214/25907816.951Palabras clave:
Terapia Ocupacional, cuidado intensivo, COVID-19, hospital, servicios de rehabilitaciónResumen
El amplio espectro clínico de la enfermedad COVID-19 tiene importantes implicaciones funcionales para el cuidado hospitalario agudo y subagudo en unidades de cuidado intensivo. Ante la emergencia sanitaria desencadenada por esta enfermedad, el Colegio Colombiano de Terapia Ocupacional convocó a un grupo de profesionales expertas en el área para proveer lineamientos para terapeutas ocupacionales que participan en la rehabilitación temprana de pacientes con COVID-19 en Colombia. Se realizó una revisión de literatura sobre la clasificación y las manifestaciones clínicas de la enfermedad, la efectividad de la rehabilitación temprana adulta, pediátrica y neonatal, y el rol y la experiencia de profesionales en Terapia Ocupacional en el uso de guías de salud existentes. Un consenso de expertas determinó la aplicabilidad de los lineamientos al contexto colombiano. Terapia Ocupacional, como parte del equipo de rehabilitación temprana, juega un papel fundamental en la restauración y el mantenimiento de la independencia funcional; la adaptación del ambiente y el acondicionamiento holístico gradual de las funciones respiratorias, cardiovasculares, sensoriomotoras y cognitivas durante las actividades básicas cotidianas, y la prevención del deterioro físico, mental, espiritual y social de la persona hospitalizada y su familia. Estos lineamientos constituyen un recurso técnico y educativo relevante para la Terapia Ocupacional hospitalaria.
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Referencias bibliográficas
Acosta, M., Ariza, M., Arribas, A.M., Blásquez, V., Fernández, J., Gómez, C., Herrera, D., Incio, M.J., Lastres, A., Martín, M., Martínez, N., Martínez, S., Moreno, M., Muñoz, V., Pérez, J. y Sancho, C. (2020). Guía clínica de intervención de terapia ocupacional en pacientes con COVID-19. Colegio Profesional de Terapeutas Ocupacionales de la Comunidad de Madrid [COPTOCAM]. https://coptocam.org/wp-content/uploads/2020/05/Gu%C3%ADa-cl%C3%ADnica-de-TO-covid-19-.pdf
Algeo, N. y Aitken, L. M. (2019). The evolving role of occupational therapists in adult critical care in England. Irish Journal of Occupational Therapy, 42(7), 74-94. http://doi.org/10.1108/IJOT-04-2019-0005
Álvarez, E. A., Garrido, M. A., Tobar, E. A., Prieto, S. A., Vergara, S. O., Briceño, C. D. y González, F. J. (2017). Occupational therapy for delirium management in elderly patients without mechanical ventilation in an intensive care unit: A pilot randomized clinical trial. Journal of critical care, 37, 85-90. https://doi.org/10.1016/j.jcrc.2016.09.002
Anekwe, D. E., Biswas, S., Bussières, A. y Spahija, J. (2019). Early rehabilitation reduces the likelihood of developing intensive care unit-acquired weakness: A systematic review and meta-analysis. Physiotherapy, 107, 1-10. https://doi.org/10.1016/j.physio.2019.12.004
Benavides, A., Castillo, G., Landauro, M. y Vásquez, G. (2006). Factores que prolongan la estancia hospitalaria en el Hospital Nacional PNP Luis N. Sáenz. Revista de Medicina Humana-Universidad Ricardo Palma, 6(2), 3-12.
Betters, K. A., Hebbar, K. B., Farthing, D., Griego, B., Easley, T., Turman, H., Perrino, L., Sparacino, S.y deAlmeida, M. L. (2017). Development and implementation of an early mobility program for mechanically ventilated pediatric patients. Journal of critical care, 41, 303-308. https://doi.org/10.1016/j.jcrc.2017.08.004
Berrios, S. G., Álvarez, J. C., Gimpel, V. E., Bolaño, G. F. y Toro, K. S. (2019). Rol del terapeuta ocupacional en el tratamiento de niños con delirium hospitalario infantil en unidades hospitalarias de Chile. Revista Chilena de Terapia Ocupacional, 19(1), 69-82. https://ultimadecada.uchile.cl/index.php/RTO/article/view/53685
Bouyer-Ferullo, S. (2013). Preventing perioperative peripheral nerve injuries. AORN journal, 97(1), 110-124. https://doi.org/10.1016/j.aorn.2012.10.013
Borges Nery, P., Snider, L., Camelo, J. S., Boychuck, Z., Khodary, F., Goldschleger, J. y Majnemer, A. (2019). The role of rehabilitation specialists in Canadian nicus: a 21st century perspective. Physical & occupational therapy in pediatrics, 39(1), 33-47. https://doi.org/10.1080/01942638.2018.1490846
Cascella, M., Rajnik, M., Cuomo, A., Dulebohn, S. C. y Di Napoli, R. (2020). Features, evaluation and treatment coronavirus (COVID-19). En Statpearls [internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK554776/
Castagnoli, R., Votto, M., Licari, A., Brambilla, I., Bruno, R., Perlini, S., Rovida, F., Baldanti, F. y Marseglia, G. L. (2020). Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in children and adolescents: A systematic review. JAMA pediatrics. https://doi.org/10.1001/jamapediatrics.2020.1467
Colegio Colombiano de Terapia Ocupacional [CCTO] (2020, 29 de abril). Pronunciamiento sobre el rol de la Terapia Ocupacional en la atención hospitalaria durante la pandemia por COVID-19. https://6e05f2cf-f3fc-4799-b443-264a49ac10ee.filesusr.com/ugd/7ce81a_c46fe1c221294fc68f41b90fa7d808b5.pdf
Chen, A., Huang, J., Liao, Y., Liu, Z., Chen, D., Yang, C., Yang, R. y Wei, X. (2020). Differences in Clinical and Imaging Presentation of Pediatric Patients with COVID-19 in Comparison with Adults. Radiology: Cardiothoracic Imaging, 2(2), e200117. https://doi.org/10.1148/ryct.2020200117
Coelho Filho, J. M. (2000). Modelos de serviços hospitalares para casos agudos em idosos. Revista de Saúde Pública, 34(6), 666-671. https://doi.org/10.1590/S0034-89102000000600017
Corcoran, J.R., Herbsman, J. M., Bushnik, T., Van Lew, S., Stolfi, A., Parkin, K., McKenzie, A., Hall, G., Joseph, W., Whiteson, J. y Flanagan, S.R. (2017). Early rehabilitation in the medical and surgical intensive care units for patients with and without mechanical ventilation: an interprofessional performance improvement project. PM&R, 9(2), 113-119. https://doi.org/10.1016/j.pmrj.2016.06.015
Costigan, F. A., Duffett, M., Harris, J. E., Baptiste, S. y Kho, M. E. (2019). Occupational therapy in the ICU: A scoping review of 221 documents. Critical care medicine, 47(12), e1014-e1021. https://doi.org/10.1097/CCM.0000000000003999
Critchley, H. D., Wiens, S., Rotshtein, P., Öhman, A. y Dolan, R. J. (2004). Neural systems supporting interoceptive awareness. Nature neuroscience, 7(2), 189-195. https://doi.org/10.1038/nn1176
Cuevas-Lara, C., Izquierdo, M., Gutiérrez-Valencia, M., Marín-Epelde, I., Zambom-Ferrasi, F., Contreras-Escámez, B. y Martínez-Velilla, N. (2019). Effectiveness of occupational therapy interventions in acute geriatric wards: a systematic review. Maturitas, 127, 43-50. https://doi.org/10.1016/j.maturitas.2019.06.005
Cuello-Garcia, C. A., Mai, S. H. C., Simpson, R., Al-Harbi, S. y Choong, K. (2018). Early mobilization in critically ill children: a systematic review. The Journal of pediatrics, 203, 25-33. https://doi.org/10.1016/j.jpeds.2018.07.037
Cui, L. R., LaPorte, M., Civitello, M., Stanger, M., Orringer, M., Casey III, F., Kuch, B., Beers, S., Valenta, C., Kochanek, P., Houtrow, A. y Fink, E. (2017). Physical and occupational therapy utilization in a pediatric intensive care unit. Journal of critical care, 40, 15-20. https://doi.org/10.1016/j.jcrc.2017.03.003
Dong, Y., Mo, X., Hu, Y., Qi, X., Jiang, F., Jiang, Z. y Tong, S. (2020). Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics [pre-print]. https://doi.org/10.1542/peds.2020-0702
Durocher, E. (2017). Occupational justice: A fine balance for occupational therapists. In D. Sakellariou y N. Pollard (Eds.). Occupational Therapies Without Borders. Integrating Justice with Practice (pp. 9-18). Elsevier.
Ferrante, L. E., Murphy, T. E., Leo-Summers, L. S., Gahbauer, E. A., Pisani, M. A. y Gill, T. M. (2019). The combined effects of frailty and cognitive impairment on post-ICU disability among older ICU survivors. American journal of respiratory and critical care medicine, 200(1), 107-110. https://doi.org/10.1164/rccm.201806-1144LE
Fink, E., Beers, S., Houtrow, A.., Richichi, R., Burns, C., Doughty, L., Ortiz, R., Madurski, C., Valenta, C., Chrisman, M., Golightly, L., Kiger, M., Patrick, C., Treble, A., Pollon, D., Smith, C., Kochanek, P. (2019). Early protocolized versus usual care rehabilitation for pediatric neurocritical care patients: a randomized controlled trial. Pediatric Critical Care Medicine, 20(6), 540-550. https://doi.org/10.1097/PCC.0000000000001881
Gandhi, R. T., Lynch, J. B. y del Rio, C. (2020). Mild or moderate COVID-19. New England Journal of Medicine. https://doi.org/10.1056/NEJMcp2009249
Garfinkel, S. N., Seth, A. K., Barrett, A. B., Suzuki, K. y Critchley, H. D. (2015). Knowing your own heart: distinguishing interoceptive accuracy from interoceptive awareness. Biological psychology, 104, 65-74. https://doi.org/10.1016/j.biopsycho.2014.11.004
Gonçalo, T., Santos Nascimento, J., Barbieri Bombarda, T., Vieria Espalenza, G., Almeida Rodrigues, E.A., Ferreira, A.P. y Rodrigues dos Santos, Z. (2020). Terapia Ocupacional em cuidados paliativos na COVID-19. Comitê de Terapia Ocupacional da Academia Nacional de Cuidados Paliativos, ANCP.
Hanna, E.S., Zhao, S., Shannon, C.N. y Betters, K.A. (2020). Changes in provider perceptions regarding early mobility in the PICU. Pediatric Critical Care Medicine| Society of Critical Care Medicine, 21(1), e30-e38. https://doi.org/10.1097/PCC.0000000000002177
Hassan, S.A., Sheikh, F.N., Jamal, S., Ezeh, J.K. y Akhtar, A. (2020). Coronavirus (COVID-19): a review of clinical features, diagnosis, and treatment. Cureus, 12(3). https://doi.org/10.7759/cureus.7355
Herrup, E. A., Wieczorek, B. y Kudchadkar, S. R. (2017). Characteristics of postintensive care syndrome in survivors of pediatric critical illness: A systematic review. World journal of critical care medicine, 6(2), 124. https://doi.org/10.5492/wjccm.v6.i2.124
Hollinger, A., Gayat, E., Féliot, E., Paugam-Burtz, C., Fournier, M.C., Duranteau, J., Lefrant, J.Y., Leone, M., Jaber, S., Mebazaa, A. y Arrigo, M. (2019). Gender and survival of critically ill patients: results from the FROG-ICU study. Annals of intensive care, 9(1), 43. https://doi.org/10.1186/s13613-019-0514-y
Hopkins, R. O., Choong, K., Zebuhr, C. A. y Kudchadkar, S. R. (2015). Transforming PICU culture to facilitate early rehabilitation. Journal of Pediatric Intensive Care, 4(04), 204-211. https://doi.org/10.1055/s-0035-1563547
Hu, Z., Song, C., Xu, C., Jin, G., Chen, Y., Xu, X., Ma, H., Chen, Y., Lin, Y., Zheng, Y., Wang, J., Hu, Z., Yi, Y. y Shen, H. (2020). Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China. Science China Life Sciences, 1-6. https://doi.org/10.1007/s11427-020-1661-4
Kaur, S., Silver, G., Samuels, S., Rosen, A., Weiss, M., Mauer, E., Gerber, L., Greenwald, B. y Traube, C. (2020). Delirium and developmental disability: Improving specificity of a pediatric delirium screen. Pediatric Critical Care Medicine, 21(5), 409-414. https://doi.org/10.1097/PCC.0000000000002248
Kiekens, C., Boldrini, P., Andreoli, A., Avesani, R., Gamna, F., Grandi, M., Lombardi, F., Lusuardi, M., Molteni, F., Perboni, A. y Negrini, S. (2020). Rehabilitation and respiratory management in the acute and early post-acute phase." Instant paper from the field" on rehabilitation answers to the Covid-19 emergency. European Journal of Physical and Rehabilitation Medicine, 06305-4. https://doi.org/10.23736/S1973-9087.20.06305-4
Kho, M.E., Brooks, D., Namasivayam-MacDonald, A., Sangrar, R. y Vrkljan, B. (2020) Rehabilitation for patients with COVID-19. Guidance for occupational therapists, physical therapists, speech-language pathologists and assistants. School of Rehabilitation Science, McMaster University. https://srs-mcmaster.ca/covid-19/
Legg, L., Drummond, A. y Langhorne, P. (2006). Occupational therapy for patients with problems in activities of daily living after stroke. Cochrane Database of Systematic Reviews, (4). https://doi.org/10.1002/14651858.CD003585.pub2
Leisman, D. E., Deutschman, C. S. y Legrand, M. (2020). Facing COVID-19 in the ICU: vascular dysfunction, thrombosis, and dysregulated inflammation. Intensive Care Medicine. https://doi.org/10.1007/s00134-020-06059-6
Lima, E.M.F.D.A., Okuma, D.G. y Pastore, M.D.N. (2013). Atividade, ação, fazer e ocupação: a discussão dos termos na Terapia Ocupacional brasileira. Cadernos daTerapia Ocupacional UFSCar, 21(2), 243-254. https://doi.org/10.4322/cto.2013.026
Lu, X., Xiang, Y., Du, H. y Wing‐Kin Wong, G. (2020). SARS‐CoV‐2 infection in children–understanding the immune responses and controlling the pandemic. Pediatric Allergy and Immunology, 0, 1-5. https://doi.org/10.1111/pai.13267
Ludvigsson, J. F. (2020). Systematic review of COVID‐19 in children show milder cases and a better prognosis than adults. Acta Paediatrica, 109, 1088-1095. https://doi.org/10.1111/apa.15270
Marrugo-Arnedo, C. A., Arrieta-Arrieta, A., Herrera-Malambo, D., Díaz-Vargas, L. C., Pérez-Yepes, C., Dueñas-Castell, C., Flórez-Tanus, A., Gómez, F., Alvear-Pájaro, R. y Alvis-Guzmán, N. (2019). Determinantes de estancia prolongada de neonatos en una unidad de cuidados intensivos. Revista Ciencias de la Salud, 17(2), 259-275. https://doi.org/10.12804/revistas.urosario.edu.co/revsalud/a.7928
Martell, M., Burgueño, M., Arbón, G., Weinberger, M., Balbi, C., Munyo, A., Martinotti, L., Murillo, S., Keshishian, R., Pomi, A. y Alonso, R. (2007). Asociación entre morbilidad neonatal y desarrollo en pretérminos a la edad escolar. Archivos de Pediatría del Uruguay, 78(2), 99-109. https://www.sup.org.uy/archivos-de-pediatria/adp78-2/pdf/adp78-2_3.pdf
Moreno-Chaparro, J., Cubillos-Mesa, C. y Duarte-Torres, S. C. (2019). Rol de terapia ocupacional en la unidad de cuidado intensivo en Colombia. Revista Ciencias de la Salud, 17(1), 70-84. https://doi.org/10.12804/revistas.urosario.edu.co/revsalud/a.7614
Needham, D., Davidson, J., Cohen, H., Hopkins, R., Weinert, C., Wunsch, H., Zawistowski, C., Dougherty, A., Berney, S., Bienvenu, O., Brady, S., Brodsky, M., Denehy, L., Elliott, D., Flatley, C., Harabin, A., Jones, C., Louis, D. Meltzer, W.... y Brady, S. L. (2012). Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference. Critical care medicine, 40(2), 502-509. https://doi.org/10.1097/CCM.0b013e318232da75
Oficina del Alto Comisionado en Derechos Humanos de la ONU (2020, abril). COVID-19 and the rights of persons with disabilities: guidance. https://www.ohchr.org/Documents/Issues/Disability/COVID-19_and_The_Rights_of_Persons_with_Disabilities.pdf
Organización Mundial de la Salud [OMS] (2010, octubre). Sus 5 momentos para la higiene de las manos. Seguridad del Paciente. https://www.who.int/gpsc/information_centre/gpsc_5_momentos_poster_es.pdf?ua=1
Organización Mundial de la Salud [OMS] (2020, febrero). Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf
Pickens, N. D. y Pizur‐Barnekow, K. (2009). Co‐occupation: Extending the dialogue. Journal of Occupational Science, 16(3), 151-156. https://doi.org/10.1080/14427591.2009.9686656
Pierce, D. (2001). Untangling occupation and activity. American Journal of Occupational Therapy, 55(2), 138-146. https://doi.org/10.5014/ajot.55.2.138
Popovich, K. (2011). Chapter 2: The intensive care unit. En H. Smith-Gabai (Ed.) Occupational Therapy in Acute Care (pp. 41-74). AOTA Press.
Pozzi, C., Tatzer, V. C., Álvarez, E. A., Lanzoni, A. y Graff, M. J. (2020). The applicability and feasibility of occupational therapy in delirium care. European Geriatric Medicine, 1-8. https://doi.org/10.1007/s41999-020-00308-z
Price, C.J., y Hooven, C. (2018). Interoceptive awareness skills for emotion regulation: Theory and approach of mindful awareness in body-oriented therapy (MABT). Frontiers in psychology, 9, 798. https://doi.org/10.3389/fpsyg.2018.00798
Provancha-Romeo, A. F., Hoffman, A. L., Malcolm, M. P., Coatsworth, J. D., Laxton, L. R., Freeman, K. M. y Schmid, A. A. (2019). Mind-body interventions utilized by an occupational therapist in a medical intensive care unit: An exploratory case study. Work (Reading, Mass.), 63(2), 191. https://doi.org/10.3233/WOR-192920
Rajendran, K., Narayanasamy, K., Rangarajan, J., Rathinam, J., Natarajan, M. y Ramachandran, A. (2020). Convalescent plasma transfusion for the treatment of COVID‐19: Systematic review. Journal of Medical Virology, 1-9. https://doi.org/10.1002/jmv.25961
Reimer, C., y Slinger, P. (2019). Intraoperative patient positioning and neurological injuries. En Principles and Practice of Anesthesia for Thoracic Surgery (pp. 337-342). Springer, Cham.
Rengel, K.F., Hayhurst, C.J., Pandharipande, P.P. y Hughes, C.G. (2019). Long-term cognitive and functional impairments after critical illness. Anesthesia & Analgesia, 128(4), 772-780. https://doi.org/10.1213/ANE.0000000000004066
Riphagen, S., Gomez, X., Gonzalez-Martinez, C., Wilkinson, N. y Theocharis, P. (2020). Hyperinflammatory shock in children during COVID-19 pandemic. The Lancet. https://doi.org/10.1016/S0140-6736(20)31094-1
Ross, K., Heiny, E., Conner, S., Spener, P. y Pineda, R. (2017). Occupational therapy, physical therapy and speech-language pathology in the neonatal intensive care unit: Patterns of therapy usage in a level IV NICU. Research in developmental disabilities, 64, 108-117. https://doi.org/10.1016/j.ridd.2017.03.009
Rubio-Grillo, M. H. (2019). Desempeño profesional del terapeuta ocupacional en la unidad de cuidado intensivo neonatal. Colombia Médica, 50(1), 30-39. http://dx.doi.org/10.25100/cm.v50i1.2600
Sabartés, O., Sánchez, D. y Cervera, A. M. (2009). Unidades de subagudos. Revista Española de Geriatría y Gerontología, 44, 34-38. https://doi.org/10.1016/j.regg.2009.01.008
Smith, A., Karpf, M., Jow, M., Jardon, M., Yu, T. y Hutchins, B. (2019). Mothers’ experiences with infant co-occupations after NICU discharge. American Journal of Occupational Therapy, 73(4_Supplement_1), 7311505075p1-7311505075p1. https://doi.org/10.5014/ajot.2019.73S1-PO1014
Smith, H. A. y Williams, S. R. (2020). Pediatric delirium assessment, prevention, and management. En Delirium (pp. 73-92). Springer, Cham.
Spruce, L., y Van Wicklin, S. A. (2014). Back to basics: positioning the patient. AORN journal, 100(3), 298-305. https://doi.org/10.1016/j.aorn.2014.06.004
Sundaram, M., Ravikumar, N., Bansal, A., Nallasamy, K., Basavaraja, G. V., Lodha, R., Gupta, D., Odena, M., Ram, A., Jayashree, M. (2020). Novel coronavirus 2019 (2019-nCoV) infection: Part II-Respiratory support in the pediatric intensive care unit in resource-limited settings. Indian Pediatrics, 57, 335-342. https://doi.org/10.1007/s13312-020-1786-x
Scholten, E. L., Beitler, J. R., Prisk, G. K. y Malhotra, A. (2017). Treatment of ARDS with prone positioning. Chest, 151(1), 215-224. https://doi.org/10.1016/j.chest.2016.06.032
Schweickert, W., Pohlman, M., Pohlman, A., Nigos, C., Pawlik, A.., Esbrook, C., Spears, L., Miller, M., Franczyk, M., Deprizio, D., Schmidt, G., Bowman, A., Barr, R., McCallister, K., Hall, J. y Kress, J. (2009). Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. The Lancet, 373(9678), 1874-1882. https://doi.org/10.1016/S0140-6736(09)60658-9
Thomas, P., Baldwin, C., Bissett, B., Boden, I., Gosselink, R., Granger, C., Hodgson, C., Jones, A., Kho, M., Moses, R., Ntoumenopoulos, G., Parry, S., Patman, S. y Lee, L. (2020). Physiotherapy management for COVID-19 in the acute hospital setting: clinical practice recommendations. Journal of Physiotherapy, 66(2), 73-82. https://doi.org/10.1016/j.jphys.2020.03.011
Treyvaud, K., Lee, K. J., Doyle, L. W. y Anderson, P. J. (2014). Very preterm birth influences parental mental health and family outcomes seven years after birth. The Journal of pediatrics, 164(3), 515-521. https://doi.org/10.1016/j.jpeds.2013.11.001
Weinreich, M., Herman, J., Dickason, S. y Mayo, H. (2017). Occupational therapy in the intensive care unit: a systematic review. Occupational therapy in health care, 31(3), 205-213. https://doi.org/10.1080/07380577.2017.1340690
Whiteford, G. (2000). Occupational deprivation: Global challenge in the new millennium. British journal of occupational therapy, 63(5), 200-204. https://doi.org/10.1177/030802260006300503
Wieczorek, B., Ascenzi, J., Kim, Y., Lenker, H., Potter, C., Shata, N., Mitchel, L., Haut, C., Berkowitz, I., Pidcock, F., Hoch, J., Malamed, C., Kravitz, T. y Kudchadkar, S. (2016). PICU Up! Impact of a quality improvement intervention to promote early mobilization in critically ill children. Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 17(12), e559. https://doi.org/10.1097/PCC.0000000000000983
Yu, P., Wei, Q. y He, C. (2020). Early rehabilitation for critically ill patients with COVID-2019: More benefits than risks. American Journal of Physical Medicine & Rehabilitation. https://doi.org/10.1097/PHM.0000000000001445
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