Patient-reported outcomes and mobile applications. A review of their impact on patients’ health outcomes
To review the evidence of the mobile apps in collection patient-reported outcomes and their impact on health outcomes. A review was conducted of the literature on apps aimed at collecting patient-reported outcomes. Selected articles were required to consider the apps’ impact on patients’ health outc...
Gespeichert in:
Veröffentlicht in: | Farmacia hospitalaria 2022-05, Vol.46 (3), p.173-181 |
---|---|
Hauptverfasser: | , , , , , |
Format: | Artikel |
Sprache: | eng ; por ; spa |
Schlagworte: | |
Online-Zugang: | Volltext |
Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
container_end_page | 181 |
---|---|
container_issue | 3 |
container_start_page | 173 |
container_title | Farmacia hospitalaria |
container_volume | 46 |
creator | Collado-Borrell, Roberto Escudero-Vilaplana, Vicente Narrillos-Moraza, Álvaro Villanueva-Bueno, Cristina Herranz-Alonso, Ana Sanjurjo-Sáez, María |
description | To review the evidence of the mobile apps in collection patient-reported outcomes and their impact on health outcomes.
A review was conducted of the literature on apps aimed at collecting patient-reported outcomes. Selected articles were required to consider the apps’ impact on patients’ health outcomes. The search was carried out during April 2021 in Pubmed and Embase using the search terms “app”, “mobile applications”, “patient-reported outcomes”, “outcome assessment, health care”, and “quality of life”, To be included articles had to be written in English or Spanish and they were required to dwell on apps used by patients, family members and/or caregivers that measured at least one health outcome. No time restrictions were applied.
Of the 26 articles reviewed, 19 (73.1%) were clinical trials, 4 (15.4%) were quasi-experimental studies, and 3 (11.5%) were observational studies. A pharmacy department was involved in 4 studies (15.4%), and 3 (11.5%), were carried out in Spain. The sample size ranged from 14 to 411. Depending on the study population, the most frequent studies included cancer patients (42.3%) and patients with cardiovascular diseases (26.9%). Most of the studies focused on measuring the impact of the app on the patients’ quality of life (50.0%), control of clinical parameters (46.2%), adherence (38.5%), and management of symptoms and/or reduction of complications (26.9%). Overall efficacy in terms of the percentage of studies where apps were found to result in a significant improvement was 73.1%. The most heavily impacted patient-reported outcomes were adherence, health-related quality of life and satisfaction.
There is emerging evidence that apps have a positive impact on patients’ health outcomes. These tools have shown to lead to an improvement in the management of different conditions, with results showing a reduction in complications rates and in the consumption of resources as well as better adherence to medication and enhanced patient quality of life.
Realizar una revisión sobre la evidencia de las aplicaciones móviles en el registro de los patient-reported outcomes y su impacto en los resultados en salud.
Revisión de la literatura sobre los estudios de aplicaciones orientadas al registro de patient-reported outcomes y que analizaran su impacto en los resultados en salud de los pacientes. La búsqueda se realizó en abril de 2021 en Pubmed y Embase con los términos “App”, “Mobile Applications”; “Patient Reported Outcomes”; “Outcome Asses |
doi_str_mv | 10.7399/fh.11830 |
format | Article |
fullrecord | <record><control><sourceid>elsevier</sourceid><recordid>TN_cdi_elsevier_sciencedirect_doi_10_7399_fh_11830</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S113063432300154X</els_id><sourcerecordid>S113063432300154X</sourcerecordid><originalsourceid>FETCH-LOGICAL-e167t-a05449702bf01232a6e7b89f47bb14024118a9937da7c526e23cf6eb581d4f4f3</originalsourceid><addsrcrecordid>eNo9kElOwzAYhb0AiVKQOIIvkOIpcbKsKiapEixgbXn4rbhK4sg2sOUaXI-TEChi9TZP3xsQuqJkI3nXXft-Q2nLyQlaUcpJ1XDBz9B5zgdCaiYZXaHDky4BplIlmGMq4HB8LTaOkLGeHB6jCQNgPc9DsIszTnmDtzjBW4B3HD0uPYSEwzhrW3Cc8HzE5a-PT9yDHkr_D7xAp14PGS7_dI1ebm-ed_fV_vHuYbfdV0AbWSpNaiE6SZjxhDLOdAPStJ0X0hgqCBPLJN11XDotbc0aYNz6BkzdUie88HyN2JELS8jSM6lsl04WXEhgi3IxKErUz0PK9-r3If4N82pdvQ</addsrcrecordid><sourcetype>Publisher</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Patient-reported outcomes and mobile applications. A review of their impact on patients’ health outcomes</title><source>DOAJ Directory of Open Access Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Access via ScienceDirect (Elsevier)</source><source>Alma/SFX Local Collection</source><creator>Collado-Borrell, Roberto ; Escudero-Vilaplana, Vicente ; Narrillos-Moraza, Álvaro ; Villanueva-Bueno, Cristina ; Herranz-Alonso, Ana ; Sanjurjo-Sáez, María</creator><creatorcontrib>Collado-Borrell, Roberto ; Escudero-Vilaplana, Vicente ; Narrillos-Moraza, Álvaro ; Villanueva-Bueno, Cristina ; Herranz-Alonso, Ana ; Sanjurjo-Sáez, María</creatorcontrib><description>To review the evidence of the mobile apps in collection patient-reported outcomes and their impact on health outcomes.
A review was conducted of the literature on apps aimed at collecting patient-reported outcomes. Selected articles were required to consider the apps’ impact on patients’ health outcomes. The search was carried out during April 2021 in Pubmed and Embase using the search terms “app”, “mobile applications”, “patient-reported outcomes”, “outcome assessment, health care”, and “quality of life”, To be included articles had to be written in English or Spanish and they were required to dwell on apps used by patients, family members and/or caregivers that measured at least one health outcome. No time restrictions were applied.
Of the 26 articles reviewed, 19 (73.1%) were clinical trials, 4 (15.4%) were quasi-experimental studies, and 3 (11.5%) were observational studies. A pharmacy department was involved in 4 studies (15.4%), and 3 (11.5%), were carried out in Spain. The sample size ranged from 14 to 411. Depending on the study population, the most frequent studies included cancer patients (42.3%) and patients with cardiovascular diseases (26.9%). Most of the studies focused on measuring the impact of the app on the patients’ quality of life (50.0%), control of clinical parameters (46.2%), adherence (38.5%), and management of symptoms and/or reduction of complications (26.9%). Overall efficacy in terms of the percentage of studies where apps were found to result in a significant improvement was 73.1%. The most heavily impacted patient-reported outcomes were adherence, health-related quality of life and satisfaction.
There is emerging evidence that apps have a positive impact on patients’ health outcomes. These tools have shown to lead to an improvement in the management of different conditions, with results showing a reduction in complications rates and in the consumption of resources as well as better adherence to medication and enhanced patient quality of life.
Realizar una revisión sobre la evidencia de las aplicaciones móviles en el registro de los patient-reported outcomes y su impacto en los resultados en salud.
Revisión de la literatura sobre los estudios de aplicaciones orientadas al registro de patient-reported outcomes y que analizaran su impacto en los resultados en salud de los pacientes. La búsqueda se realizó en abril de 2021 en Pubmed y Embase con los términos “App”, “Mobile Applications”; “Patient Reported Outcomes”; “Outcome Assessment, Health Care”; “Quality of Life”. Se incluyeron artículos publicados en inglés o español sin límite de tiempo y que incluyeran aplicaciones cuyos participantes fueran pacientes, familiares y/o cuidadores y que midieran algún tipo de resultado en salud.
De los 26 artículos revisados, 19 (73,1%) fueron ensayos clínicos, 4 (15,4%) estudios cuasiexperimentales y 3 (11,5%) estudios observacionales. En 4 estudios (15,4%) estaba implicado un servicio de farmacia y en 3 (11,5%) el estudio fue realizado en España. El tamaño muestral varió de 14 a 411. En función de la población de estudio, los más frecuentes incluyeron pacientes oncológicos (11 [42,3%] estudios) y pacientes con patologías cardiovasculares (7 [26,9%] estudios). La mayoría de los estudios se centraron en la medición del impacto de las aplicaciones en términos de calidad de vida (50,0%), control de parámetros clínicos (46,2%), adherencia (38,5%) y manejo de los síntomas y/o reducción de complicaciones (26,9%). La eficacia global en términos del porcentaje en los que se observó una mejoría significativa con el uso de las aplicaciones fue del 73,1%. Los patient-reported outcomes en los que se observó un mayor impacto fueron la adherencia, la calidad de vida relacionada con la salud y la satisfacción.
Existe evidencia emergente de que las aplicaciones tienen un impacto positivo en los resultados en salud de los pacientes. Estas herramientas están demostrando una mejora en el manejo de diferentes patologías, con resultados que muestran una reducción de complicaciones y consumo de recursos y mejoras en la adherencia y calidad de vida de los pacientes.</description><identifier>ISSN: 1130-6343</identifier><identifier>DOI: 10.7399/fh.11830</identifier><language>eng ; por ; spa</language><publisher>Elsevier España, S.L.U</publisher><subject>Adherence ; Adherencia ; Aplicaciones móviles ; Calidad de vida ; Health outcomes ; Mhealth apps ; Patient-reported outcomes ; Quality of life ; Resultados en salud ; Telefarmacia ; Telemedicina ; Telemedicine ; Telepharmacy</subject><ispartof>Farmacia hospitalaria, 2022-05, Vol.46 (3), p.173-181</ispartof><rights>2022 Sociedad Española de Farmacia Hospitalaria</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.7399/fh.11830$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>315,781,785,865,3551,27926,27927,45997</link.rule.ids></links><search><creatorcontrib>Collado-Borrell, Roberto</creatorcontrib><creatorcontrib>Escudero-Vilaplana, Vicente</creatorcontrib><creatorcontrib>Narrillos-Moraza, Álvaro</creatorcontrib><creatorcontrib>Villanueva-Bueno, Cristina</creatorcontrib><creatorcontrib>Herranz-Alonso, Ana</creatorcontrib><creatorcontrib>Sanjurjo-Sáez, María</creatorcontrib><title>Patient-reported outcomes and mobile applications. A review of their impact on patients’ health outcomes</title><title>Farmacia hospitalaria</title><description>To review the evidence of the mobile apps in collection patient-reported outcomes and their impact on health outcomes.
A review was conducted of the literature on apps aimed at collecting patient-reported outcomes. Selected articles were required to consider the apps’ impact on patients’ health outcomes. The search was carried out during April 2021 in Pubmed and Embase using the search terms “app”, “mobile applications”, “patient-reported outcomes”, “outcome assessment, health care”, and “quality of life”, To be included articles had to be written in English or Spanish and they were required to dwell on apps used by patients, family members and/or caregivers that measured at least one health outcome. No time restrictions were applied.
Of the 26 articles reviewed, 19 (73.1%) were clinical trials, 4 (15.4%) were quasi-experimental studies, and 3 (11.5%) were observational studies. A pharmacy department was involved in 4 studies (15.4%), and 3 (11.5%), were carried out in Spain. The sample size ranged from 14 to 411. Depending on the study population, the most frequent studies included cancer patients (42.3%) and patients with cardiovascular diseases (26.9%). Most of the studies focused on measuring the impact of the app on the patients’ quality of life (50.0%), control of clinical parameters (46.2%), adherence (38.5%), and management of symptoms and/or reduction of complications (26.9%). Overall efficacy in terms of the percentage of studies where apps were found to result in a significant improvement was 73.1%. The most heavily impacted patient-reported outcomes were adherence, health-related quality of life and satisfaction.
There is emerging evidence that apps have a positive impact on patients’ health outcomes. These tools have shown to lead to an improvement in the management of different conditions, with results showing a reduction in complications rates and in the consumption of resources as well as better adherence to medication and enhanced patient quality of life.
Realizar una revisión sobre la evidencia de las aplicaciones móviles en el registro de los patient-reported outcomes y su impacto en los resultados en salud.
Revisión de la literatura sobre los estudios de aplicaciones orientadas al registro de patient-reported outcomes y que analizaran su impacto en los resultados en salud de los pacientes. La búsqueda se realizó en abril de 2021 en Pubmed y Embase con los términos “App”, “Mobile Applications”; “Patient Reported Outcomes”; “Outcome Assessment, Health Care”; “Quality of Life”. Se incluyeron artículos publicados en inglés o español sin límite de tiempo y que incluyeran aplicaciones cuyos participantes fueran pacientes, familiares y/o cuidadores y que midieran algún tipo de resultado en salud.
De los 26 artículos revisados, 19 (73,1%) fueron ensayos clínicos, 4 (15,4%) estudios cuasiexperimentales y 3 (11,5%) estudios observacionales. En 4 estudios (15,4%) estaba implicado un servicio de farmacia y en 3 (11,5%) el estudio fue realizado en España. El tamaño muestral varió de 14 a 411. En función de la población de estudio, los más frecuentes incluyeron pacientes oncológicos (11 [42,3%] estudios) y pacientes con patologías cardiovasculares (7 [26,9%] estudios). La mayoría de los estudios se centraron en la medición del impacto de las aplicaciones en términos de calidad de vida (50,0%), control de parámetros clínicos (46,2%), adherencia (38,5%) y manejo de los síntomas y/o reducción de complicaciones (26,9%). La eficacia global en términos del porcentaje en los que se observó una mejoría significativa con el uso de las aplicaciones fue del 73,1%. Los patient-reported outcomes en los que se observó un mayor impacto fueron la adherencia, la calidad de vida relacionada con la salud y la satisfacción.
Existe evidencia emergente de que las aplicaciones tienen un impacto positivo en los resultados en salud de los pacientes. Estas herramientas están demostrando una mejora en el manejo de diferentes patologías, con resultados que muestran una reducción de complicaciones y consumo de recursos y mejoras en la adherencia y calidad de vida de los pacientes.</description><subject>Adherence</subject><subject>Adherencia</subject><subject>Aplicaciones móviles</subject><subject>Calidad de vida</subject><subject>Health outcomes</subject><subject>Mhealth apps</subject><subject>Patient-reported outcomes</subject><subject>Quality of life</subject><subject>Resultados en salud</subject><subject>Telefarmacia</subject><subject>Telemedicina</subject><subject>Telemedicine</subject><subject>Telepharmacy</subject><issn>1130-6343</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNo9kElOwzAYhb0AiVKQOIIvkOIpcbKsKiapEixgbXn4rbhK4sg2sOUaXI-TEChi9TZP3xsQuqJkI3nXXft-Q2nLyQlaUcpJ1XDBz9B5zgdCaiYZXaHDky4BplIlmGMq4HB8LTaOkLGeHB6jCQNgPc9DsIszTnmDtzjBW4B3HD0uPYSEwzhrW3Cc8HzE5a-PT9yDHkr_D7xAp14PGS7_dI1ebm-ed_fV_vHuYbfdV0AbWSpNaiE6SZjxhDLOdAPStJ0X0hgqCBPLJN11XDotbc0aYNz6BkzdUie88HyN2JELS8jSM6lsl04WXEhgi3IxKErUz0PK9-r3If4N82pdvQ</recordid><startdate>20220501</startdate><enddate>20220501</enddate><creator>Collado-Borrell, Roberto</creator><creator>Escudero-Vilaplana, Vicente</creator><creator>Narrillos-Moraza, Álvaro</creator><creator>Villanueva-Bueno, Cristina</creator><creator>Herranz-Alonso, Ana</creator><creator>Sanjurjo-Sáez, María</creator><general>Elsevier España, S.L.U</general><scope>6I.</scope><scope>AAFTH</scope></search><sort><creationdate>20220501</creationdate><title>Patient-reported outcomes and mobile applications. A review of their impact on patients’ health outcomes</title><author>Collado-Borrell, Roberto ; Escudero-Vilaplana, Vicente ; Narrillos-Moraza, Álvaro ; Villanueva-Bueno, Cristina ; Herranz-Alonso, Ana ; Sanjurjo-Sáez, María</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-e167t-a05449702bf01232a6e7b89f47bb14024118a9937da7c526e23cf6eb581d4f4f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng ; por ; spa</language><creationdate>2022</creationdate><topic>Adherence</topic><topic>Adherencia</topic><topic>Aplicaciones móviles</topic><topic>Calidad de vida</topic><topic>Health outcomes</topic><topic>Mhealth apps</topic><topic>Patient-reported outcomes</topic><topic>Quality of life</topic><topic>Resultados en salud</topic><topic>Telefarmacia</topic><topic>Telemedicina</topic><topic>Telemedicine</topic><topic>Telepharmacy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Collado-Borrell, Roberto</creatorcontrib><creatorcontrib>Escudero-Vilaplana, Vicente</creatorcontrib><creatorcontrib>Narrillos-Moraza, Álvaro</creatorcontrib><creatorcontrib>Villanueva-Bueno, Cristina</creatorcontrib><creatorcontrib>Herranz-Alonso, Ana</creatorcontrib><creatorcontrib>Sanjurjo-Sáez, María</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><jtitle>Farmacia hospitalaria</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Collado-Borrell, Roberto</au><au>Escudero-Vilaplana, Vicente</au><au>Narrillos-Moraza, Álvaro</au><au>Villanueva-Bueno, Cristina</au><au>Herranz-Alonso, Ana</au><au>Sanjurjo-Sáez, María</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Patient-reported outcomes and mobile applications. A review of their impact on patients’ health outcomes</atitle><jtitle>Farmacia hospitalaria</jtitle><date>2022-05-01</date><risdate>2022</risdate><volume>46</volume><issue>3</issue><spage>173</spage><epage>181</epage><pages>173-181</pages><issn>1130-6343</issn><abstract>To review the evidence of the mobile apps in collection patient-reported outcomes and their impact on health outcomes.
A review was conducted of the literature on apps aimed at collecting patient-reported outcomes. Selected articles were required to consider the apps’ impact on patients’ health outcomes. The search was carried out during April 2021 in Pubmed and Embase using the search terms “app”, “mobile applications”, “patient-reported outcomes”, “outcome assessment, health care”, and “quality of life”, To be included articles had to be written in English or Spanish and they were required to dwell on apps used by patients, family members and/or caregivers that measured at least one health outcome. No time restrictions were applied.
Of the 26 articles reviewed, 19 (73.1%) were clinical trials, 4 (15.4%) were quasi-experimental studies, and 3 (11.5%) were observational studies. A pharmacy department was involved in 4 studies (15.4%), and 3 (11.5%), were carried out in Spain. The sample size ranged from 14 to 411. Depending on the study population, the most frequent studies included cancer patients (42.3%) and patients with cardiovascular diseases (26.9%). Most of the studies focused on measuring the impact of the app on the patients’ quality of life (50.0%), control of clinical parameters (46.2%), adherence (38.5%), and management of symptoms and/or reduction of complications (26.9%). Overall efficacy in terms of the percentage of studies where apps were found to result in a significant improvement was 73.1%. The most heavily impacted patient-reported outcomes were adherence, health-related quality of life and satisfaction.
There is emerging evidence that apps have a positive impact on patients’ health outcomes. These tools have shown to lead to an improvement in the management of different conditions, with results showing a reduction in complications rates and in the consumption of resources as well as better adherence to medication and enhanced patient quality of life.
Realizar una revisión sobre la evidencia de las aplicaciones móviles en el registro de los patient-reported outcomes y su impacto en los resultados en salud.
Revisión de la literatura sobre los estudios de aplicaciones orientadas al registro de patient-reported outcomes y que analizaran su impacto en los resultados en salud de los pacientes. La búsqueda se realizó en abril de 2021 en Pubmed y Embase con los términos “App”, “Mobile Applications”; “Patient Reported Outcomes”; “Outcome Assessment, Health Care”; “Quality of Life”. Se incluyeron artículos publicados en inglés o español sin límite de tiempo y que incluyeran aplicaciones cuyos participantes fueran pacientes, familiares y/o cuidadores y que midieran algún tipo de resultado en salud.
De los 26 artículos revisados, 19 (73,1%) fueron ensayos clínicos, 4 (15,4%) estudios cuasiexperimentales y 3 (11,5%) estudios observacionales. En 4 estudios (15,4%) estaba implicado un servicio de farmacia y en 3 (11,5%) el estudio fue realizado en España. El tamaño muestral varió de 14 a 411. En función de la población de estudio, los más frecuentes incluyeron pacientes oncológicos (11 [42,3%] estudios) y pacientes con patologías cardiovasculares (7 [26,9%] estudios). La mayoría de los estudios se centraron en la medición del impacto de las aplicaciones en términos de calidad de vida (50,0%), control de parámetros clínicos (46,2%), adherencia (38,5%) y manejo de los síntomas y/o reducción de complicaciones (26,9%). La eficacia global en términos del porcentaje en los que se observó una mejoría significativa con el uso de las aplicaciones fue del 73,1%. Los patient-reported outcomes en los que se observó un mayor impacto fueron la adherencia, la calidad de vida relacionada con la salud y la satisfacción.
Existe evidencia emergente de que las aplicaciones tienen un impacto positivo en los resultados en salud de los pacientes. Estas herramientas están demostrando una mejora en el manejo de diferentes patologías, con resultados que muestran una reducción de complicaciones y consumo de recursos y mejoras en la adherencia y calidad de vida de los pacientes.</abstract><pub>Elsevier España, S.L.U</pub><doi>10.7399/fh.11830</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
fulltext | fulltext |
identifier | ISSN: 1130-6343 |
ispartof | Farmacia hospitalaria, 2022-05, Vol.46 (3), p.173-181 |
issn | 1130-6343 |
language | eng ; por ; spa |
recordid | cdi_elsevier_sciencedirect_doi_10_7399_fh_11830 |
source | DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Access via ScienceDirect (Elsevier); Alma/SFX Local Collection |
subjects | Adherence Adherencia Aplicaciones móviles Calidad de vida Health outcomes Mhealth apps Patient-reported outcomes Quality of life Resultados en salud Telefarmacia Telemedicina Telemedicine Telepharmacy |
title | Patient-reported outcomes and mobile applications. A review of their impact on patients’ health outcomes |
url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-18T06%3A14%3A57IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-elsevier&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Patient-reported%20outcomes%20and%20mobile%20applications.%20A%20review%20of%20their%20impact%20on%20patients%E2%80%99%20health%20outcomes&rft.jtitle=Farmacia%20hospitalaria&rft.au=Collado-Borrell,%20Roberto&rft.date=2022-05-01&rft.volume=46&rft.issue=3&rft.spage=173&rft.epage=181&rft.pages=173-181&rft.issn=1130-6343&rft_id=info:doi/10.7399/fh.11830&rft_dat=%3Celsevier%3ES113063432300154X%3C/elsevier%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_id=info:pmid/&rft_els_id=S113063432300154X&rfr_iscdi=true |