Outcome of nonsurgical intervention in patients with perforated peptic ulcers
Abstract Background Although surgical intervention is the favorable treatment modality for perforated peptic ulcer, nonsurgical treatment is another option. The aim of this study is to analyze the results of conservative treatment for perforated peptic ulcer. Methods Between 2003 and 2014, 403 patie...
Gespeichert in:
| Veröffentlicht in: | The American journal of emergency medicine 2016-08, Vol.34 (8), p.1556-1560 |
|---|---|
| Hauptverfasser: | , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 1560 |
|---|---|
| container_issue | 8 |
| container_start_page | 1556 |
| container_title | The American journal of emergency medicine |
| container_volume | 34 |
| creator | Lay, Ping-Lien, MD Huang, Hsin-Hung, MD Chang, Wei-Kuo, MD, PhD Hsieh, Tsai-Yuan, MD, PhD Huang, Tien-Yu, MD, PhD Lin, Hsuan-Hwai, MD, PhD |
| description | Abstract Background Although surgical intervention is the favorable treatment modality for perforated peptic ulcer, nonsurgical treatment is another option. The aim of this study is to analyze the results of conservative treatment for perforated peptic ulcer. Methods Between 2003 and 2014, 403 patients were admitted to our hospital for perforated peptic ulcer, and 383 patients underwent surgery, whereas 20 were allocated to conservative treatment. The results of nonsurgical intervention in these patients were analyzed retrospectively. Results The overall mortality rate of conservative treatment was 40%. Eleven patients remained hospitalized less than 2 weeks; among them, patients with a high (≥ IV) American Society of Anesthesiologists class at admission had higher mortality than those with a low (< IV) American Society of Anesthesiologists class (83.3% vs 0%, P = .015). However, when patients remained hospitalized longer than 2 weeks, the mortality rates did not differ between patients with the low and high American Society of Anesthesiologists classes. Eight patients presented with a high American Society of Anesthesiologists class, of which 3 received early enteral feeding, and all of them survived. In contrast, the survival of patients without early enteral feeding was 0%, suggesting that early enteral feeding improved survival of patients with the high American Society of Anesthesiologists class ( P = .018). Conclusions A higher American Society of Anesthesiologists class correlated with mortality in patients undergoing conservative treatment during the first 2 weeks of hospitalization. Early enteral feeding might improve the outcome of conservative treatment in patients with high American Society of Anesthesiologists class. |
| doi_str_mv | 10.1016/j.ajem.2016.05.045 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1807080697</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0735675716301784</els_id><sourcerecordid>4134379491</sourcerecordid><originalsourceid>FETCH-LOGICAL-c439t-7f50aa7be3af2b787250fff5ab0881f4146dae62ffaacf4cdc84de2fbf16aaa93</originalsourceid><addsrcrecordid>eNp9kUGL1jAQhoMo7rerf8CDFLx4aZ2kSdOCCMuiq7CyB_Uc0nSiqW1Tk3Rl_72p36qwB0-ZgecdMs8Q8oxCRYE2r8ZKjzhXLNcViAq4eEAOVNSsbKmkD8kBZC3KRgp5Qk5jHAEo5YI_JidMso41QA_k4_WWjJ-x8LZY_BK38NUZPRVuSRhucEnOL7kpVp1c7mLx06VvxYrB-qATDrlckzPFNhkM8Ql5ZPUU8ende0a-vHv7-eJ9eXV9-eHi_Ko0vO5SKa0ArWWPtbasl61kAqy1QvfQttRyyptBY8Os1dpYbgbT8gGZ7S1ttNZdfUZeHueuwf_YMCY1u2hwmvSCfouKtiChhaaTGX1xDx39Fpb8u99UJwGgyRQ7Uib4GANatQY363CrKKhdthrVLlvtshUIlWXn0PO70Vs_4_A38sduBl4fAcwubhwGFU22aHBwAU1Sg3f_n__mXtxMbtnP8x1vMf7bQ0WmQH3az71fmzY1UNny-hcO36am</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1807970006</pqid></control><display><type>article</type><title>Outcome of nonsurgical intervention in patients with perforated peptic ulcers</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><source>ProQuest Central UK/Ireland</source><creator>Lay, Ping-Lien, MD ; Huang, Hsin-Hung, MD ; Chang, Wei-Kuo, MD, PhD ; Hsieh, Tsai-Yuan, MD, PhD ; Huang, Tien-Yu, MD, PhD ; Lin, Hsuan-Hwai, MD, PhD</creator><creatorcontrib>Lay, Ping-Lien, MD ; Huang, Hsin-Hung, MD ; Chang, Wei-Kuo, MD, PhD ; Hsieh, Tsai-Yuan, MD, PhD ; Huang, Tien-Yu, MD, PhD ; Lin, Hsuan-Hwai, MD, PhD</creatorcontrib><description>Abstract Background Although surgical intervention is the favorable treatment modality for perforated peptic ulcer, nonsurgical treatment is another option. The aim of this study is to analyze the results of conservative treatment for perforated peptic ulcer. Methods Between 2003 and 2014, 403 patients were admitted to our hospital for perforated peptic ulcer, and 383 patients underwent surgery, whereas 20 were allocated to conservative treatment. The results of nonsurgical intervention in these patients were analyzed retrospectively. Results The overall mortality rate of conservative treatment was 40%. Eleven patients remained hospitalized less than 2 weeks; among them, patients with a high (≥ IV) American Society of Anesthesiologists class at admission had higher mortality than those with a low (< IV) American Society of Anesthesiologists class (83.3% vs 0%, P = .015). However, when patients remained hospitalized longer than 2 weeks, the mortality rates did not differ between patients with the low and high American Society of Anesthesiologists classes. Eight patients presented with a high American Society of Anesthesiologists class, of which 3 received early enteral feeding, and all of them survived. In contrast, the survival of patients without early enteral feeding was 0%, suggesting that early enteral feeding improved survival of patients with the high American Society of Anesthesiologists class ( P = .018). Conclusions A higher American Society of Anesthesiologists class correlated with mortality in patients undergoing conservative treatment during the first 2 weeks of hospitalization. Early enteral feeding might improve the outcome of conservative treatment in patients with high American Society of Anesthesiologists class.</description><identifier>ISSN: 0735-6757</identifier><identifier>EISSN: 1532-8171</identifier><identifier>DOI: 10.1016/j.ajem.2016.05.045</identifier><identifier>PMID: 27292601</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Age ; Aged ; Aged, 80 and over ; Antibiotics ; Blood pressure ; Conservative Treatment - methods ; Duodenal Ulcer - complications ; Duodenal Ulcer - diagnosis ; Duodenal Ulcer - therapy ; Emergency ; Emergency medical care ; Endoscopy ; Endoscopy, Gastrointestinal ; Enteral nutrition ; Female ; Heart rate ; Hospitals ; Humans ; Length of Stay - trends ; Male ; Medical prognosis ; Middle Aged ; Mortality ; Peptic Ulcer Perforation - diagnosis ; Peptic Ulcer Perforation - etiology ; Peptic Ulcer Perforation - therapy ; Radiography, Abdominal ; Retrospective Studies ; Statistical analysis ; Studies ; Surgery ; Treatment Outcome ; Ulcers</subject><ispartof>The American journal of emergency medicine, 2016-08, Vol.34 (8), p.1556-1560</ispartof><rights>Elsevier Inc.</rights><rights>2016 Elsevier Inc.</rights><rights>Copyright © 2016 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c439t-7f50aa7be3af2b787250fff5ab0881f4146dae62ffaacf4cdc84de2fbf16aaa93</citedby><cites>FETCH-LOGICAL-c439t-7f50aa7be3af2b787250fff5ab0881f4146dae62ffaacf4cdc84de2fbf16aaa93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1807970006?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>315,781,785,3551,27929,27930,46000,64390,64392,64394,72474</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27292601$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lay, Ping-Lien, MD</creatorcontrib><creatorcontrib>Huang, Hsin-Hung, MD</creatorcontrib><creatorcontrib>Chang, Wei-Kuo, MD, PhD</creatorcontrib><creatorcontrib>Hsieh, Tsai-Yuan, MD, PhD</creatorcontrib><creatorcontrib>Huang, Tien-Yu, MD, PhD</creatorcontrib><creatorcontrib>Lin, Hsuan-Hwai, MD, PhD</creatorcontrib><title>Outcome of nonsurgical intervention in patients with perforated peptic ulcers</title><title>The American journal of emergency medicine</title><addtitle>Am J Emerg Med</addtitle><description>Abstract Background Although surgical intervention is the favorable treatment modality for perforated peptic ulcer, nonsurgical treatment is another option. The aim of this study is to analyze the results of conservative treatment for perforated peptic ulcer. Methods Between 2003 and 2014, 403 patients were admitted to our hospital for perforated peptic ulcer, and 383 patients underwent surgery, whereas 20 were allocated to conservative treatment. The results of nonsurgical intervention in these patients were analyzed retrospectively. Results The overall mortality rate of conservative treatment was 40%. Eleven patients remained hospitalized less than 2 weeks; among them, patients with a high (≥ IV) American Society of Anesthesiologists class at admission had higher mortality than those with a low (< IV) American Society of Anesthesiologists class (83.3% vs 0%, P = .015). However, when patients remained hospitalized longer than 2 weeks, the mortality rates did not differ between patients with the low and high American Society of Anesthesiologists classes. Eight patients presented with a high American Society of Anesthesiologists class, of which 3 received early enteral feeding, and all of them survived. In contrast, the survival of patients without early enteral feeding was 0%, suggesting that early enteral feeding improved survival of patients with the high American Society of Anesthesiologists class ( P = .018). Conclusions A higher American Society of Anesthesiologists class correlated with mortality in patients undergoing conservative treatment during the first 2 weeks of hospitalization. Early enteral feeding might improve the outcome of conservative treatment in patients with high American Society of Anesthesiologists class.</description><subject>Adult</subject><subject>Age</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antibiotics</subject><subject>Blood pressure</subject><subject>Conservative Treatment - methods</subject><subject>Duodenal Ulcer - complications</subject><subject>Duodenal Ulcer - diagnosis</subject><subject>Duodenal Ulcer - therapy</subject><subject>Emergency</subject><subject>Emergency medical care</subject><subject>Endoscopy</subject><subject>Endoscopy, Gastrointestinal</subject><subject>Enteral nutrition</subject><subject>Female</subject><subject>Heart rate</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Length of Stay - trends</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Peptic Ulcer Perforation - diagnosis</subject><subject>Peptic Ulcer Perforation - etiology</subject><subject>Peptic Ulcer Perforation - therapy</subject><subject>Radiography, Abdominal</subject><subject>Retrospective Studies</subject><subject>Statistical analysis</subject><subject>Studies</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><subject>Ulcers</subject><issn>0735-6757</issn><issn>1532-8171</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kUGL1jAQhoMo7rerf8CDFLx4aZ2kSdOCCMuiq7CyB_Uc0nSiqW1Tk3Rl_72p36qwB0-ZgecdMs8Q8oxCRYE2r8ZKjzhXLNcViAq4eEAOVNSsbKmkD8kBZC3KRgp5Qk5jHAEo5YI_JidMso41QA_k4_WWjJ-x8LZY_BK38NUZPRVuSRhucEnOL7kpVp1c7mLx06VvxYrB-qATDrlckzPFNhkM8Ql5ZPUU8ende0a-vHv7-eJ9eXV9-eHi_Ko0vO5SKa0ArWWPtbasl61kAqy1QvfQttRyyptBY8Os1dpYbgbT8gGZ7S1ttNZdfUZeHueuwf_YMCY1u2hwmvSCfouKtiChhaaTGX1xDx39Fpb8u99UJwGgyRQ7Uib4GANatQY363CrKKhdthrVLlvtshUIlWXn0PO70Vs_4_A38sduBl4fAcwubhwGFU22aHBwAU1Sg3f_n__mXtxMbtnP8x1vMf7bQ0WmQH3az71fmzY1UNny-hcO36am</recordid><startdate>20160801</startdate><enddate>20160801</enddate><creator>Lay, Ping-Lien, MD</creator><creator>Huang, Hsin-Hung, MD</creator><creator>Chang, Wei-Kuo, MD, PhD</creator><creator>Hsieh, Tsai-Yuan, MD, PhD</creator><creator>Huang, Tien-Yu, MD, PhD</creator><creator>Lin, Hsuan-Hwai, MD, PhD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20160801</creationdate><title>Outcome of nonsurgical intervention in patients with perforated peptic ulcers</title><author>Lay, Ping-Lien, MD ; Huang, Hsin-Hung, MD ; Chang, Wei-Kuo, MD, PhD ; Hsieh, Tsai-Yuan, MD, PhD ; Huang, Tien-Yu, MD, PhD ; Lin, Hsuan-Hwai, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c439t-7f50aa7be3af2b787250fff5ab0881f4146dae62ffaacf4cdc84de2fbf16aaa93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Age</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antibiotics</topic><topic>Blood pressure</topic><topic>Conservative Treatment - methods</topic><topic>Duodenal Ulcer - complications</topic><topic>Duodenal Ulcer - diagnosis</topic><topic>Duodenal Ulcer - therapy</topic><topic>Emergency</topic><topic>Emergency medical care</topic><topic>Endoscopy</topic><topic>Endoscopy, Gastrointestinal</topic><topic>Enteral nutrition</topic><topic>Female</topic><topic>Heart rate</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Length of Stay - trends</topic><topic>Male</topic><topic>Medical prognosis</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Peptic Ulcer Perforation - diagnosis</topic><topic>Peptic Ulcer Perforation - etiology</topic><topic>Peptic Ulcer Perforation - therapy</topic><topic>Radiography, Abdominal</topic><topic>Retrospective Studies</topic><topic>Statistical analysis</topic><topic>Studies</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><topic>Ulcers</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lay, Ping-Lien, MD</creatorcontrib><creatorcontrib>Huang, Hsin-Hung, MD</creatorcontrib><creatorcontrib>Chang, Wei-Kuo, MD, PhD</creatorcontrib><creatorcontrib>Hsieh, Tsai-Yuan, MD, PhD</creatorcontrib><creatorcontrib>Huang, Tien-Yu, MD, PhD</creatorcontrib><creatorcontrib>Lin, Hsuan-Hwai, MD, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</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>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</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 Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lay, Ping-Lien, MD</au><au>Huang, Hsin-Hung, MD</au><au>Chang, Wei-Kuo, MD, PhD</au><au>Hsieh, Tsai-Yuan, MD, PhD</au><au>Huang, Tien-Yu, MD, PhD</au><au>Lin, Hsuan-Hwai, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcome of nonsurgical intervention in patients with perforated peptic ulcers</atitle><jtitle>The American journal of emergency medicine</jtitle><addtitle>Am J Emerg Med</addtitle><date>2016-08-01</date><risdate>2016</risdate><volume>34</volume><issue>8</issue><spage>1556</spage><epage>1560</epage><pages>1556-1560</pages><issn>0735-6757</issn><eissn>1532-8171</eissn><abstract>Abstract Background Although surgical intervention is the favorable treatment modality for perforated peptic ulcer, nonsurgical treatment is another option. The aim of this study is to analyze the results of conservative treatment for perforated peptic ulcer. Methods Between 2003 and 2014, 403 patients were admitted to our hospital for perforated peptic ulcer, and 383 patients underwent surgery, whereas 20 were allocated to conservative treatment. The results of nonsurgical intervention in these patients were analyzed retrospectively. Results The overall mortality rate of conservative treatment was 40%. Eleven patients remained hospitalized less than 2 weeks; among them, patients with a high (≥ IV) American Society of Anesthesiologists class at admission had higher mortality than those with a low (< IV) American Society of Anesthesiologists class (83.3% vs 0%, P = .015). However, when patients remained hospitalized longer than 2 weeks, the mortality rates did not differ between patients with the low and high American Society of Anesthesiologists classes. Eight patients presented with a high American Society of Anesthesiologists class, of which 3 received early enteral feeding, and all of them survived. In contrast, the survival of patients without early enteral feeding was 0%, suggesting that early enteral feeding improved survival of patients with the high American Society of Anesthesiologists class ( P = .018). Conclusions A higher American Society of Anesthesiologists class correlated with mortality in patients undergoing conservative treatment during the first 2 weeks of hospitalization. Early enteral feeding might improve the outcome of conservative treatment in patients with high American Society of Anesthesiologists class.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27292601</pmid><doi>10.1016/j.ajem.2016.05.045</doi><tpages>5</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0735-6757 |
| ispartof | The American journal of emergency medicine, 2016-08, Vol.34 (8), p.1556-1560 |
| issn | 0735-6757 1532-8171 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1807080697 |
| source | MEDLINE; Access via ScienceDirect (Elsevier); ProQuest Central UK/Ireland |
| subjects | Adult Age Aged Aged, 80 and over Antibiotics Blood pressure Conservative Treatment - methods Duodenal Ulcer - complications Duodenal Ulcer - diagnosis Duodenal Ulcer - therapy Emergency Emergency medical care Endoscopy Endoscopy, Gastrointestinal Enteral nutrition Female Heart rate Hospitals Humans Length of Stay - trends Male Medical prognosis Middle Aged Mortality Peptic Ulcer Perforation - diagnosis Peptic Ulcer Perforation - etiology Peptic Ulcer Perforation - therapy Radiography, Abdominal Retrospective Studies Statistical analysis Studies Surgery Treatment Outcome Ulcers |
| title | Outcome of nonsurgical intervention in patients with perforated peptic ulcers |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-12T23%3A21%3A18IST&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=Outcome%20of%20nonsurgical%20intervention%20in%20patients%20with%20perforated%20peptic%20ulcers&rft.jtitle=The%20American%20journal%20of%20emergency%20medicine&rft.au=Lay,%20Ping-Lien,%20MD&rft.date=2016-08-01&rft.volume=34&rft.issue=8&rft.spage=1556&rft.epage=1560&rft.pages=1556-1560&rft.issn=0735-6757&rft.eissn=1532-8171&rft_id=info:doi/10.1016/j.ajem.2016.05.045&rft_dat=%3Cproquest_cross%3E4134379491%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=1807970006&rft_id=info:pmid/27292601&rft_els_id=1_s2_0_S0735675716301784&rfr_iscdi=true |