Introduction: Multiple case studies were conducted using a public school and a private school to understand why the prevalence of dental caries was high among primary school children despite previous oral health strategies. The study is aimed to inform the refinement of current dental caries prevention behavioural strategies in Qatar for school children in both public and private settings. Methods: Purposive sampling was used to select 5 pupils, 5 parents, 5 teachers and 2 school nursese for the case study. A semi-structured in-depth interview was conducted with the participants to understand issues relating to prevalence and control of dental caries among school pupils. Results: The study found that home context plays a crucial role in terms of oral health motivation in Qatar. It was found that children are taught the most basic daily oral hygiene-related behaviours at home, including tooth brushing and dental flossing. Discussion: The study revealed the role of parents at home in supporting oral health activities to motivate and empower children to take part in such behaviours. Also, parents and teachers work in collaboration to enhance oral health behaviours in children.
{"title":"Assessing behavioural prevention strategies to reduce dental caries in the primary schools of the state of qatar-case study","authors":"","doi":"10.33140/mcr.06.12.04","DOIUrl":"https://doi.org/10.33140/mcr.06.12.04","url":null,"abstract":"Introduction: Multiple case studies were conducted using a public school and a private school to understand why the prevalence of dental caries was high among primary school children despite previous oral health strategies. The study is aimed to inform the refinement of current dental caries prevention behavioural strategies in Qatar for school children in both public and private settings. Methods: Purposive sampling was used to select 5 pupils, 5 parents, 5 teachers and 2 school nursese for the case study. A semi-structured in-depth interview was conducted with the participants to understand issues relating to prevalence and control of dental caries among school pupils. Results: The study found that home context plays a crucial role in terms of oral health motivation in Qatar. It was found that children are taught the most basic daily oral hygiene-related behaviours at home, including tooth brushing and dental flossing. Discussion: The study revealed the role of parents at home in supporting oral health activities to motivate and empower children to take part in such behaviours. Also, parents and teachers work in collaboration to enhance oral health behaviours in children.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82371432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The excision of secondary lymphoid organs might not be harmless. Although the procedure itself, is less and less performed presently, infectious sequels in total splenectomy might occur and are possibly fatal. Among further complications, thromboembolic and immune alterations should also be expected. The most debatable of consequences, probably associated with an immune adjustment, concerns the development of malignancies. Considering post-splenectomy tumors, discrepancies emerge between their occurrence in humans, and their consequent protective effect in experimental animals. It is recommended that surgeons aspire at preserving as much of lymphoid tissues a feasible, when performing such resections.
{"title":"Tonsillectomy, appendectomy and splenectomy: sequels and malignant evolution","authors":"","doi":"10.33140/mcr.06.12.01","DOIUrl":"https://doi.org/10.33140/mcr.06.12.01","url":null,"abstract":"The excision of secondary lymphoid organs might not be harmless. Although the procedure itself, is less and less performed presently, infectious sequels in total splenectomy might occur and are possibly fatal. Among further complications, thromboembolic and immune alterations should also be expected. The most debatable of consequences, probably associated with an immune adjustment, concerns the development of malignancies. Considering post-splenectomy tumors, discrepancies emerge between their occurrence in humans, and their consequent protective effect in experimental animals. It is recommended that surgeons aspire at preserving as much of lymphoid tissues a feasible, when performing such resections.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83956036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Over the last two decades, there has been a significant evolution of the complex treatment of the invasive bladder carcinoma (BC), including both surgery methods and high-tech radiotherapy (RT), often combined with chemotherapy (Ch). Different protocols supporting multimodal treatment and the concept of the bladder preservation are currently developed. New high-tech radiation methods were presented combined with Ch to preserve the bladder as a healing alternative to radical cystectomy. The purpose of this overview is to present the place and healing effect of high-tech RT in the contemporary treatment approach to invasive BC. The expected contributions from this research project are: 1) For the first time in Bulgaria, modern bladder-sparing strategies combine maximal transurethral resection of bladder tumor (TURBT) followed by an induction course of concurrent radiation therapy (RT) and sensitizing chemotherapy will be held. 2) Disease-free survival, overall survival, local control and early radical toxicity in two patient groups after self intensity modulated radiation therapy (IMRT) and after concurrent chemoradiotherapy (CChRT) with VMAT will be analyzed. It is important to improve the quality of life by preserving the bladder in the invasive bladder carcinoma.
{"title":"Trimodal bladder-preserving treatment including high-tech radiotherapy in invasive bladder carcinoma-dissertation project with literature review","authors":"Vaska Vassileva, V. Petrov, L. Marinova","doi":"10.33140/mcr.06.11.01","DOIUrl":"https://doi.org/10.33140/mcr.06.11.01","url":null,"abstract":"Over the last two decades, there has been a significant evolution of the complex treatment of the invasive bladder carcinoma (BC), including both surgery methods and high-tech radiotherapy (RT), often combined with chemotherapy (Ch). Different protocols supporting multimodal treatment and the concept of the bladder preservation are currently developed. New high-tech radiation methods were presented combined with Ch to preserve the bladder as a healing alternative to radical cystectomy. The purpose of this overview is to present the place and healing effect of high-tech RT in the contemporary treatment approach to invasive BC. The expected contributions from this research project are: 1) For the first time in Bulgaria, modern bladder-sparing strategies combine maximal transurethral resection of bladder tumor (TURBT) followed by an induction course of concurrent radiation therapy (RT) and sensitizing chemotherapy will be held. 2) Disease-free survival, overall survival, local control and early radical toxicity in two patient groups after self intensity modulated radiation therapy (IMRT) and after concurrent chemoradiotherapy (CChRT) with VMAT will be analyzed. It is important to improve the quality of life by preserving the bladder in the invasive bladder carcinoma.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76832642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fluoropyrimidine is commonly used to treat unresectable cases of metastatic colorectal cancer or as an adjuvant therapy for colorectal cancer. Dihydropyrimidine dehydrogenase (DPD) is an enzyme encoded by the DPYD gene, which is responsible for the rate-limiting step in pyrimidine catabolism and breaks down >80% of standard doses of 5-fluorouracil (5-FU). Reductions in DPD activity increase the half-life of 5-FU, resulting in excess 5-FU accumulation and toxicity, which can lead to life-threatening side effects. There have been several published case reports about DPD deficiency in colorectal cancer patients from Western countries. However, case reports of DPD deficiency in Japanese colorectal cancer patients are rare because the measurement of DPD activity is not covered by the public medical insurance system in Japan, and DPD activity is not currently measured in daily clinical practice. Furthermore, there have not been any reports about anticancer drug therapy for Japanese patients with DPD deficiency. In this report, we describe a case in which a Japanese patient with colorectal cancer was diagnosed with DPD deficiency. The DPD deficiency arose as a severe adverse effect of mFOLFOX6/CapOX treatment for recurrent colorectal cancer, and the patient was subsequently treated with TAS-102, without experiencing any severe adverse effects. We report this case along with a review of the literature.
{"title":"A case in which TAS-102 produced disease control without severe adverse events in a patient with recurrent colorectal cancer and dihydropyrimidine dehydrogenase deficiency","authors":"","doi":"10.33140/mcr.06.11.02","DOIUrl":"https://doi.org/10.33140/mcr.06.11.02","url":null,"abstract":"Fluoropyrimidine is commonly used to treat unresectable cases of metastatic colorectal cancer or as an adjuvant therapy for colorectal cancer. Dihydropyrimidine dehydrogenase (DPD) is an enzyme encoded by the DPYD gene, which is responsible for the rate-limiting step in pyrimidine catabolism and breaks down >80% of standard doses of 5-fluorouracil (5-FU). Reductions in DPD activity increase the half-life of 5-FU, resulting in excess 5-FU accumulation and toxicity, which can lead to life-threatening side effects. There have been several published case reports about DPD deficiency in colorectal cancer patients from Western countries. However, case reports of DPD deficiency in Japanese colorectal cancer patients are rare because the measurement of DPD activity is not covered by the public medical insurance system in Japan, and DPD activity is not currently measured in daily clinical practice. Furthermore, there have not been any reports about anticancer drug therapy for Japanese patients with DPD deficiency. In this report, we describe a case in which a Japanese patient with colorectal cancer was diagnosed with DPD deficiency. The DPD deficiency arose as a severe adverse effect of mFOLFOX6/CapOX treatment for recurrent colorectal cancer, and the patient was subsequently treated with TAS-102, without experiencing any severe adverse effects. We report this case along with a review of the literature.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84801165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Pembrolizumab is a monoclonal antibody-based chemotherapy infusion, recently approved for unresectable or metastatic solid tumors with certain genetic anomalies. Discussion: Pembrolizumab is an IV infusion therapy for treating non-surgical or metastatic melanoma and non-small cell lung cancer. Multiple cardiac complications have been related to this drug, the mechanism is not precise, but a possibility is immune events involving the cytotoxic T-cell resulting in fibrosis of the cardiac cells. Conclusion: New oncologic medications have emerged with a potential reversible or irreversible cytotoxicity, including inflammation, dysfunction, or apoptosis that could represent a life-threatening condition. There is not enough data to establish proper therapy to avoid cardiotoxicity on monoclonal therapies, but an early approach and immunosuppressive therapy are thought to improve the outcome.
{"title":"Pembrolizumab induced cardiotoxicity","authors":"","doi":"10.33140/mcr.06.10.002","DOIUrl":"https://doi.org/10.33140/mcr.06.10.002","url":null,"abstract":"Background: Pembrolizumab is a monoclonal antibody-based chemotherapy infusion, recently approved for unresectable or metastatic solid tumors with certain genetic anomalies. Discussion: Pembrolizumab is an IV infusion therapy for treating non-surgical or metastatic melanoma and non-small cell lung cancer. Multiple cardiac complications have been related to this drug, the mechanism is not precise, but a possibility is immune events involving the cytotoxic T-cell resulting in fibrosis of the cardiac cells. Conclusion: New oncologic medications have emerged with a potential reversible or irreversible cytotoxicity, including inflammation, dysfunction, or apoptosis that could represent a life-threatening condition. There is not enough data to establish proper therapy to avoid cardiotoxicity on monoclonal therapies, but an early approach and immunosuppressive therapy are thought to improve the outcome.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82673212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Non healing foot ulcers are a major debilitating condition in diabetic patients which leads to limb amputation.In this study we discuss the use ofMERISISTM Supercell plus Platelet Rich Fibrin Matrix (PRFM) kitfor point of care treatments towards limb salvation. Method: We selected diabetic mellitus patients havingDiabetic foot ulcer (DFU) grade 1 or higher. Use of MERISISTM Supercell plus PRFM is a biological matrix of extracellular matrix (ECM) protein plus growth factors derived from peripheral blood to treat the DFU 45 days over. Result: Following treatment the patients showed quick recovery and complete healing of the ulcers. Conclusion: Supercellplus PRFM therapy promotes wound healing in patients suffering from chronic non-healing diabetes foot ulcers. Supercells plus PRFM dressing is a safe and effective treatment modality to promote wound contraction in patients suffering from non-healing diabetic foot ulcers.
{"title":"Treatment of diabetic neuropathy induced non healing foot ulcer using merisistm supercellplatelet rich fibrin matrix: a clinical study","authors":"","doi":"10.33140/mcr.06.10.05","DOIUrl":"https://doi.org/10.33140/mcr.06.10.05","url":null,"abstract":"Objective: Non healing foot ulcers are a major debilitating condition in diabetic patients which leads to limb amputation.In this study we discuss the use ofMERISISTM Supercell plus Platelet Rich Fibrin Matrix (PRFM) kitfor point of care treatments towards limb salvation. Method: We selected diabetic mellitus patients havingDiabetic foot ulcer (DFU) grade 1 or higher. Use of MERISISTM Supercell plus PRFM is a biological matrix of extracellular matrix (ECM) protein plus growth factors derived from peripheral blood to treat the DFU 45 days over. Result: Following treatment the patients showed quick recovery and complete healing of the ulcers. Conclusion: Supercellplus PRFM therapy promotes wound healing in patients suffering from chronic non-healing diabetes foot ulcers. Supercells plus PRFM dressing is a safe and effective treatment modality to promote wound contraction in patients suffering from non-healing diabetic foot ulcers.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85112683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Needle phobia is an extreme psychiatric disorder that includes visual avoidance of the phobic stimulus. The average age of onset is 5.5 years and its incidence decreases with age. This condition often is the main reason for inability to perform skin allergy tests. “Story of Allergens” for home education improves cooperation in doctor-patient- parent interaction.
{"title":"“Story of Allergens”-collection of rhymes as a tool for dealing with the fear of needles in children","authors":"","doi":"10.33140/mcr.06.10.06","DOIUrl":"https://doi.org/10.33140/mcr.06.10.06","url":null,"abstract":"Needle phobia is an extreme psychiatric disorder that includes visual avoidance of the phobic stimulus. The average age of onset is 5.5 years and its incidence decreases with age. This condition often is the main reason for inability to perform skin allergy tests. “Story of Allergens” for home education improves cooperation in doctor-patient- parent interaction.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91501652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Pembrolizumab is a monoclonal antibody-based chemotherapy infusion, recently approved for unresectable or metastatic solid tumors with certain genetic anomalies. Discussion: Pembrolizumab is an IV infusion therapy for treating non-surgical or metastatic melanoma and non-small cell lung cancer. Multiple cardiac complications have been related to this drug, the mechanism is not precise, but a possibility is immune events involving the cytotoxic T-cell resulting in fibrosis of the cardiac cells. Conclusion: New oncologic medications have emerged with a potential reversible or irreversible cytotoxicity, including inflammation, dysfunction, or apoptosis that could represent a life-threatening condition. There is not enough data to establish proper therapy to avoid cardiotoxicity on monoclonal therapies, but an early approach and immunosuppressive therapy are thought to improve the outcome.
{"title":"Pembrolizumabinducedcardiotoxicity","authors":"","doi":"10.33140/mcr.06.10.02","DOIUrl":"https://doi.org/10.33140/mcr.06.10.02","url":null,"abstract":"Background: Pembrolizumab is a monoclonal antibody-based chemotherapy infusion, recently approved for unresectable or metastatic solid tumors with certain genetic anomalies. Discussion: Pembrolizumab is an IV infusion therapy for treating non-surgical or metastatic melanoma and non-small cell lung cancer. Multiple cardiac complications have been related to this drug, the mechanism is not precise, but a possibility is immune events involving the cytotoxic T-cell resulting in fibrosis of the cardiac cells. Conclusion: New oncologic medications have emerged with a potential reversible or irreversible cytotoxicity, including inflammation, dysfunction, or apoptosis that could represent a life-threatening condition. There is not enough data to establish proper therapy to avoid cardiotoxicity on monoclonal therapies, but an early approach and immunosuppressive therapy are thought to improve the outcome.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81250491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aneurysmal bone cysts (ABCs) are benign, highly vascular osseous lesions characterized by cystic, blood-filled spaces surrounded by thin perimeters of expanded bone. Children and young adults are most often affected by spinal ABCs; more than 75% of patients are younger than 20 years old at the time of presentation. Although ABCs have been documented in all areas of the axial and appendicular skeleton, ABCs of the spine present unique challenges due to the risk of vertebral destabilization, pathological fracture, and vertebral body (VB) collapse with neurological compromise. We describe here a case of a 12-year-old child who presented with cervical pain and gait disturbances starting a few weeks prior to his admission with acute paraparesis at the time of admission. Subsequently he was found to have a Thoracic ABC involving T1-T3.This was accompanied by T2 vertebral body collapse and spinal cord compression. He was investigated and treated promptly by resection of the aneurysmal bone cyst with posterior Cervical-thoracic instrumentation. There was full post-operative neurological resolution.
{"title":"Spinal cord compression with acute para-paresis due to thoracic aneurysmal bone cyst (ABC): a case report and review of the literature","authors":"","doi":"10.33140/mcr.06.10.04","DOIUrl":"https://doi.org/10.33140/mcr.06.10.04","url":null,"abstract":"Aneurysmal bone cysts (ABCs) are benign, highly vascular osseous lesions characterized by cystic, blood-filled spaces surrounded by thin perimeters of expanded bone. Children and young adults are most often affected by spinal ABCs; more than 75% of patients are younger than 20 years old at the time of presentation. Although ABCs have been documented in all areas of the axial and appendicular skeleton, ABCs of the spine present unique challenges due to the risk of vertebral destabilization, pathological fracture, and vertebral body (VB) collapse with neurological compromise. We describe here a case of a 12-year-old child who presented with cervical pain and gait disturbances starting a few weeks prior to his admission with acute paraparesis at the time of admission. Subsequently he was found to have a Thoracic ABC involving T1-T3.This was accompanied by T2 vertebral body collapse and spinal cord compression. He was investigated and treated promptly by resection of the aneurysmal bone cyst with posterior Cervical-thoracic instrumentation. There was full post-operative neurological resolution.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90440216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
After several manufacturers announced COVID-19 vaccine efficacy in clinical trials for disease, a comprehensive post-efficacy strategy for the following steps to ensure vaccination of the global population is now required. These considerations should include: how to manufacture billions of doses of high-quality vaccines, support for vaccine purchase, coordination of supply, the equitable distribution of vaccines, and the logistics of global vaccine delivery, all of which are a prelude to a massive vaccination campaign targeting people of all ages. Furthermore, additional scientific questions about the vaccines remain, and that should be answered to improve vaccine efficacy, including questions regarding the optimization of vaccination regimens, booster doses, the correlates of protection, vaccine effectiveness, safety, and enhanced surveillance. The timely and coordinated execution of these post-efficacy tasks will bring the pandemic effective and efficient [1].
{"title":"Third Shot vaccination for COVID-19 in Israel","authors":"","doi":"10.33140/mcr.06.033","DOIUrl":"https://doi.org/10.33140/mcr.06.033","url":null,"abstract":"After several manufacturers announced COVID-19 vaccine efficacy in clinical trials for disease, a comprehensive post-efficacy strategy for the following steps to ensure vaccination of the global population is now required. These considerations should include: how to manufacture billions of doses of high-quality vaccines, support for vaccine purchase, coordination of supply, the equitable distribution of vaccines, and the logistics of global vaccine delivery, all of which are a prelude to a massive vaccination campaign targeting people of all ages. Furthermore, additional scientific questions about the vaccines remain, and that should be answered to improve vaccine efficacy, including questions regarding the optimization of vaccination regimens, booster doses, the correlates of protection, vaccine effectiveness, safety, and enhanced surveillance. The timely and coordinated execution of these post-efficacy tasks will bring the pandemic effective and efficient [1].","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76396055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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