THU0198 Patient Evaluations of Autoinjectors for Delivery of Subcutaneous Golimumab for Treatment of Rheumatoid Arthritis
Background Self-injection of subcutaneous (SC) golimumab (GLM) using an autoinjector device may be useful for patients with rheumatoid arthritis (RA), especially if they have functional impairment in the joints of the hand and fingers. An autoinjector designed to account for RA patient disability ma...
Gespeichert in:
Veröffentlicht in: | Annals of the rheumatic diseases 2013-06, Vol.72 (Suppl 3), p.A230-A231 |
---|---|
Hauptverfasser: | , , , , , , , , |
Format: | Artikel |
Sprache: | eng |
Online-Zugang: | Volltext |
Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
container_end_page | A231 |
---|---|
container_issue | Suppl 3 |
container_start_page | A230 |
container_title | Annals of the rheumatic diseases |
container_volume | 72 |
creator | Schulze-Koops, H. Giacomelli, R. Samborski, W. Rednic, S. Herold, M. Yao, R. Govoni, M. Vastesaeger, N. Weng, H. H. |
description | Background Self-injection of subcutaneous (SC) golimumab (GLM) using an autoinjector device may be useful for patients with rheumatoid arthritis (RA), especially if they have functional impairment in the joints of the hand and fingers. An autoinjector designed to account for RA patient disability may improve patient satisfaction. Objectives To measure the acceptability, ease of use, and preferences for use of a SmartJect autoinjector for SC GLM administration; effects of patient age and functional impairment were evaluated. Methods GO-MORE was an open-label, multinational, prospective study in biologic-naïve patients with active RA (DAS28-ESR ≥3.2). Patients self-injected 50-mg SC GLM once monthly for 6 months. At months 4 and 6, patients reported their use preferences and opinions of the autoinjector device on a questionnaire. Responses were analyzed descriptively. Effects of patient age and functional impairment on responses were evaluated. Results Overall, the vast majority of patients found the autoinjector to be easy to use, to cause mild or no discomfort, and to cause mild or no pain (table). At month 6, most of the efficacy-evaluable patients reported they preferred to self-inject in the thigh (75.2%; 1563/2077), followed by the abdomen (17.5%; 363/2077) and the upper arm (7.3%; 151/2077). More than 85% of patients indicated that they used their right hand for self-injection. More than 95% of patients were sure or very sure that when they used the autoinjector, the treatment had been fully injected; and 92.1% were satisfied or very satisfied with the monthly autoinjection frequency. Responses did not differ by patient age group. Patients with minimal or no functional impairment (HAQ-DI ≤0.5) at baseline tended to have more favorable responses, including greater ease of injection and less pain with injection, than those with functional impairment. At month 6, the overall self-injection experience was considered extremely favorable by 53.7% and favorable by 39.5% of patients without impairment and extremely favorable by 42.5% and favorable by 49.1% of patients with impairment. Conclusions Most patients had very favorable evaluations of the SmartJect autoinjector device for GLM, reporting it to be easy to use, with minimal pain or discomfort upon injection and satisfactory administration frequency. Disclosure of Interest H. Schulze-Koops Consultant for: Abbott, Actelion, Biotest, BMS, Chugai, Essex, GSK, MSD, Medac, Merck, Mundai Pharma, Novartis, Nyco |
doi_str_mv | 10.1136/annrheumdis-2013-eular.726 |
format | Article |
fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_1777912777</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>4008733601</sourcerecordid><originalsourceid>FETCH-LOGICAL-b2207-ad9ecc6910d6791ad154846ad5c40f55a87d86509504127f14bc78e5b2dde1543</originalsourceid><addsrcrecordid>eNqVkL1OwzAUhS0EEqXwDhHMATuJ7YStKrRFKj-CwsBiObEjXJIY_IOoWFh4UZ4EhyLEymL7-n7n3KsDwD6Chwil5Ih3nXmQvhXKxglEaSx9w80hTcgGGKCM5OGXwE0wgBCmcVYQug12rF2GEuYoH4C3xewWoiL_fP-44k7JzkWnL7zx4a07G-k6GnmnVbeUldPGRrU20Yls1Is0q75748vKO95J7W001Y1qfcvLb2xhJHdt7xi4635LHpxENDLuwSin7C7Yqnlj5d7PPQS3k9PFeBbPL6dn49E8LpME0piLQlYVKRAUhBaIC4SzPCNc4CqDNcY8pyInGBYYZiihNcrKiuYSl4kQMrDpEBysfZ-MfvbSOrbU3nRhJEOUBssknIE6XlOV0dYaWbMno1puVgxB1ofN_oTN-rDZd9gshB3E8VqsrJOvv0puHhmhKcXs4m7MyPXF5B5nkJ0HHq_5sl3-Z84Xm_WcEQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1777912777</pqid></control><display><type>article</type><title>THU0198 Patient Evaluations of Autoinjectors for Delivery of Subcutaneous Golimumab for Treatment of Rheumatoid Arthritis</title><source>BMJ Journals - NESLi2</source><creator>Schulze-Koops, H. ; Giacomelli, R. ; Samborski, W. ; Rednic, S. ; Herold, M. ; Yao, R. ; Govoni, M. ; Vastesaeger, N. ; Weng, H. H.</creator><creatorcontrib>Schulze-Koops, H. ; Giacomelli, R. ; Samborski, W. ; Rednic, S. ; Herold, M. ; Yao, R. ; Govoni, M. ; Vastesaeger, N. ; Weng, H. H.</creatorcontrib><description>Background Self-injection of subcutaneous (SC) golimumab (GLM) using an autoinjector device may be useful for patients with rheumatoid arthritis (RA), especially if they have functional impairment in the joints of the hand and fingers. An autoinjector designed to account for RA patient disability may improve patient satisfaction. Objectives To measure the acceptability, ease of use, and preferences for use of a SmartJect autoinjector for SC GLM administration; effects of patient age and functional impairment were evaluated. Methods GO-MORE was an open-label, multinational, prospective study in biologic-naïve patients with active RA (DAS28-ESR ≥3.2). Patients self-injected 50-mg SC GLM once monthly for 6 months. At months 4 and 6, patients reported their use preferences and opinions of the autoinjector device on a questionnaire. Responses were analyzed descriptively. Effects of patient age and functional impairment on responses were evaluated. Results Overall, the vast majority of patients found the autoinjector to be easy to use, to cause mild or no discomfort, and to cause mild or no pain (table). At month 6, most of the efficacy-evaluable patients reported they preferred to self-inject in the thigh (75.2%; 1563/2077), followed by the abdomen (17.5%; 363/2077) and the upper arm (7.3%; 151/2077). More than 85% of patients indicated that they used their right hand for self-injection. More than 95% of patients were sure or very sure that when they used the autoinjector, the treatment had been fully injected; and 92.1% were satisfied or very satisfied with the monthly autoinjection frequency. Responses did not differ by patient age group. Patients with minimal or no functional impairment (HAQ-DI ≤0.5) at baseline tended to have more favorable responses, including greater ease of injection and less pain with injection, than those with functional impairment. At month 6, the overall self-injection experience was considered extremely favorable by 53.7% and favorable by 39.5% of patients without impairment and extremely favorable by 42.5% and favorable by 49.1% of patients with impairment. Conclusions Most patients had very favorable evaluations of the SmartJect autoinjector device for GLM, reporting it to be easy to use, with minimal pain or discomfort upon injection and satisfactory administration frequency. Disclosure of Interest H. Schulze-Koops Consultant for: Abbott, Actelion, Biotest, BMS, Chugai, Essex, GSK, MSD, Medac, Merck, Mundai Pharma, Novartis, Nycomed, Pfizer, Roche, UCB., R. Giacomelli: None Declared, W. Samborski: None Declared, S. Rednic: None Declared, M. Herold: None Declared, R. Yao Employee of: Merck, M. Govoni Employee of: Merck, N. Vastesaeger Employee of: Merck, H. Weng Employee of: Merck</description><identifier>ISSN: 0003-4967</identifier><identifier>EISSN: 1468-2060</identifier><identifier>DOI: 10.1136/annrheumdis-2013-eular.726</identifier><identifier>CODEN: ARDIAO</identifier><language>eng</language><publisher>London: BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><ispartof>Annals of the rheumatic diseases, 2013-06, Vol.72 (Suppl 3), p.A230-A231</ispartof><rights>2013, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><rights>Copyright: 2013 (c) 2013, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b2207-ad9ecc6910d6791ad154846ad5c40f55a87d86509504127f14bc78e5b2dde1543</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://ard.bmj.com/content/72/Suppl_3/A230.3.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttp://ard.bmj.com/content/72/Suppl_3/A230.3.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,780,784,3196,23571,27924,27925,77600,77631</link.rule.ids></links><search><creatorcontrib>Schulze-Koops, H.</creatorcontrib><creatorcontrib>Giacomelli, R.</creatorcontrib><creatorcontrib>Samborski, W.</creatorcontrib><creatorcontrib>Rednic, S.</creatorcontrib><creatorcontrib>Herold, M.</creatorcontrib><creatorcontrib>Yao, R.</creatorcontrib><creatorcontrib>Govoni, M.</creatorcontrib><creatorcontrib>Vastesaeger, N.</creatorcontrib><creatorcontrib>Weng, H. H.</creatorcontrib><title>THU0198 Patient Evaluations of Autoinjectors for Delivery of Subcutaneous Golimumab for Treatment of Rheumatoid Arthritis</title><title>Annals of the rheumatic diseases</title><addtitle>Ann Rheum Dis</addtitle><description>Background Self-injection of subcutaneous (SC) golimumab (GLM) using an autoinjector device may be useful for patients with rheumatoid arthritis (RA), especially if they have functional impairment in the joints of the hand and fingers. An autoinjector designed to account for RA patient disability may improve patient satisfaction. Objectives To measure the acceptability, ease of use, and preferences for use of a SmartJect autoinjector for SC GLM administration; effects of patient age and functional impairment were evaluated. Methods GO-MORE was an open-label, multinational, prospective study in biologic-naïve patients with active RA (DAS28-ESR ≥3.2). Patients self-injected 50-mg SC GLM once monthly for 6 months. At months 4 and 6, patients reported their use preferences and opinions of the autoinjector device on a questionnaire. Responses were analyzed descriptively. Effects of patient age and functional impairment on responses were evaluated. Results Overall, the vast majority of patients found the autoinjector to be easy to use, to cause mild or no discomfort, and to cause mild or no pain (table). At month 6, most of the efficacy-evaluable patients reported they preferred to self-inject in the thigh (75.2%; 1563/2077), followed by the abdomen (17.5%; 363/2077) and the upper arm (7.3%; 151/2077). More than 85% of patients indicated that they used their right hand for self-injection. More than 95% of patients were sure or very sure that when they used the autoinjector, the treatment had been fully injected; and 92.1% were satisfied or very satisfied with the monthly autoinjection frequency. Responses did not differ by patient age group. Patients with minimal or no functional impairment (HAQ-DI ≤0.5) at baseline tended to have more favorable responses, including greater ease of injection and less pain with injection, than those with functional impairment. At month 6, the overall self-injection experience was considered extremely favorable by 53.7% and favorable by 39.5% of patients without impairment and extremely favorable by 42.5% and favorable by 49.1% of patients with impairment. Conclusions Most patients had very favorable evaluations of the SmartJect autoinjector device for GLM, reporting it to be easy to use, with minimal pain or discomfort upon injection and satisfactory administration frequency. Disclosure of Interest H. Schulze-Koops Consultant for: Abbott, Actelion, Biotest, BMS, Chugai, Essex, GSK, MSD, Medac, Merck, Mundai Pharma, Novartis, Nycomed, Pfizer, Roche, UCB., R. Giacomelli: None Declared, W. Samborski: None Declared, S. Rednic: None Declared, M. Herold: None Declared, R. Yao Employee of: Merck, M. Govoni Employee of: Merck, N. Vastesaeger Employee of: Merck, H. Weng Employee of: Merck</description><issn>0003-4967</issn><issn>1468-2060</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNqVkL1OwzAUhS0EEqXwDhHMATuJ7YStKrRFKj-CwsBiObEjXJIY_IOoWFh4UZ4EhyLEymL7-n7n3KsDwD6Chwil5Ih3nXmQvhXKxglEaSx9w80hTcgGGKCM5OGXwE0wgBCmcVYQug12rF2GEuYoH4C3xewWoiL_fP-44k7JzkWnL7zx4a07G-k6GnmnVbeUldPGRrU20Yls1Is0q75748vKO95J7W001Y1qfcvLb2xhJHdt7xi4635LHpxENDLuwSin7C7Yqnlj5d7PPQS3k9PFeBbPL6dn49E8LpME0piLQlYVKRAUhBaIC4SzPCNc4CqDNcY8pyInGBYYZiihNcrKiuYSl4kQMrDpEBysfZ-MfvbSOrbU3nRhJEOUBssknIE6XlOV0dYaWbMno1puVgxB1ofN_oTN-rDZd9gshB3E8VqsrJOvv0puHhmhKcXs4m7MyPXF5B5nkJ0HHq_5sl3-Z84Xm_WcEQ</recordid><startdate>201306</startdate><enddate>201306</enddate><creator>Schulze-Koops, H.</creator><creator>Giacomelli, R.</creator><creator>Samborski, W.</creator><creator>Rednic, S.</creator><creator>Herold, M.</creator><creator>Yao, R.</creator><creator>Govoni, M.</creator><creator>Vastesaeger, N.</creator><creator>Weng, H. H.</creator><general>BMJ Publishing Group Ltd and European League Against Rheumatism</general><general>BMJ Publishing Group LTD</general><scope>BSCLL</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9-</scope><scope>K9.</scope><scope>LK8</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>M7P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope></search><sort><creationdate>201306</creationdate><title>THU0198 Patient Evaluations of Autoinjectors for Delivery of Subcutaneous Golimumab for Treatment of Rheumatoid Arthritis</title><author>Schulze-Koops, H. ; Giacomelli, R. ; Samborski, W. ; Rednic, S. ; Herold, M. ; Yao, R. ; Govoni, M. ; Vastesaeger, N. ; Weng, H. H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b2207-ad9ecc6910d6791ad154846ad5c40f55a87d86509504127f14bc78e5b2dde1543</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schulze-Koops, H.</creatorcontrib><creatorcontrib>Giacomelli, R.</creatorcontrib><creatorcontrib>Samborski, W.</creatorcontrib><creatorcontrib>Rednic, S.</creatorcontrib><creatorcontrib>Herold, M.</creatorcontrib><creatorcontrib>Yao, R.</creatorcontrib><creatorcontrib>Govoni, M.</creatorcontrib><creatorcontrib>Vastesaeger, N.</creatorcontrib><creatorcontrib>Weng, H. H.</creatorcontrib><collection>Istex</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>Biological Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><jtitle>Annals of the rheumatic diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schulze-Koops, H.</au><au>Giacomelli, R.</au><au>Samborski, W.</au><au>Rednic, S.</au><au>Herold, M.</au><au>Yao, R.</au><au>Govoni, M.</au><au>Vastesaeger, N.</au><au>Weng, H. H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>THU0198 Patient Evaluations of Autoinjectors for Delivery of Subcutaneous Golimumab for Treatment of Rheumatoid Arthritis</atitle><jtitle>Annals of the rheumatic diseases</jtitle><addtitle>Ann Rheum Dis</addtitle><date>2013-06</date><risdate>2013</risdate><volume>72</volume><issue>Suppl 3</issue><spage>A230</spage><epage>A231</epage><pages>A230-A231</pages><issn>0003-4967</issn><eissn>1468-2060</eissn><coden>ARDIAO</coden><abstract>Background Self-injection of subcutaneous (SC) golimumab (GLM) using an autoinjector device may be useful for patients with rheumatoid arthritis (RA), especially if they have functional impairment in the joints of the hand and fingers. An autoinjector designed to account for RA patient disability may improve patient satisfaction. Objectives To measure the acceptability, ease of use, and preferences for use of a SmartJect autoinjector for SC GLM administration; effects of patient age and functional impairment were evaluated. Methods GO-MORE was an open-label, multinational, prospective study in biologic-naïve patients with active RA (DAS28-ESR ≥3.2). Patients self-injected 50-mg SC GLM once monthly for 6 months. At months 4 and 6, patients reported their use preferences and opinions of the autoinjector device on a questionnaire. Responses were analyzed descriptively. Effects of patient age and functional impairment on responses were evaluated. Results Overall, the vast majority of patients found the autoinjector to be easy to use, to cause mild or no discomfort, and to cause mild or no pain (table). At month 6, most of the efficacy-evaluable patients reported they preferred to self-inject in the thigh (75.2%; 1563/2077), followed by the abdomen (17.5%; 363/2077) and the upper arm (7.3%; 151/2077). More than 85% of patients indicated that they used their right hand for self-injection. More than 95% of patients were sure or very sure that when they used the autoinjector, the treatment had been fully injected; and 92.1% were satisfied or very satisfied with the monthly autoinjection frequency. Responses did not differ by patient age group. Patients with minimal or no functional impairment (HAQ-DI ≤0.5) at baseline tended to have more favorable responses, including greater ease of injection and less pain with injection, than those with functional impairment. At month 6, the overall self-injection experience was considered extremely favorable by 53.7% and favorable by 39.5% of patients without impairment and extremely favorable by 42.5% and favorable by 49.1% of patients with impairment. Conclusions Most patients had very favorable evaluations of the SmartJect autoinjector device for GLM, reporting it to be easy to use, with minimal pain or discomfort upon injection and satisfactory administration frequency. Disclosure of Interest H. Schulze-Koops Consultant for: Abbott, Actelion, Biotest, BMS, Chugai, Essex, GSK, MSD, Medac, Merck, Mundai Pharma, Novartis, Nycomed, Pfizer, Roche, UCB., R. Giacomelli: None Declared, W. Samborski: None Declared, S. Rednic: None Declared, M. Herold: None Declared, R. Yao Employee of: Merck, M. Govoni Employee of: Merck, N. Vastesaeger Employee of: Merck, H. Weng Employee of: Merck</abstract><cop>London</cop><pub>BMJ Publishing Group Ltd and European League Against Rheumatism</pub><doi>10.1136/annrheumdis-2013-eular.726</doi></addata></record> |
fulltext | fulltext |
identifier | ISSN: 0003-4967 |
ispartof | Annals of the rheumatic diseases, 2013-06, Vol.72 (Suppl 3), p.A230-A231 |
issn | 0003-4967 1468-2060 |
language | eng |
recordid | cdi_proquest_journals_1777912777 |
source | BMJ Journals - NESLi2 |
title | THU0198 Patient Evaluations of Autoinjectors for Delivery of Subcutaneous Golimumab for Treatment of Rheumatoid Arthritis |
url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-05T13%3A42%3A06IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=THU0198%E2%80%85Patient%20Evaluations%20of%20Autoinjectors%20for%20Delivery%20of%20Subcutaneous%20Golimumab%20for%20Treatment%20of%20Rheumatoid%20Arthritis&rft.jtitle=Annals%20of%20the%20rheumatic%20diseases&rft.au=Schulze-Koops,%20H.&rft.date=2013-06&rft.volume=72&rft.issue=Suppl%203&rft.spage=A230&rft.epage=A231&rft.pages=A230-A231&rft.issn=0003-4967&rft.eissn=1468-2060&rft.coden=ARDIAO&rft_id=info:doi/10.1136/annrheumdis-2013-eular.726&rft_dat=%3Cproquest_cross%3E4008733601%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1777912777&rft_id=info:pmid/&rfr_iscdi=true |