Assessment of the Quality of Chronic Anticoagulation Control With Time in Therapeutic Range in Atrial Fibrillation Patients Treated With Vitamin K Antagonists by Hemostasis Specialists: The TERRA Registry: Tiempo en rango en la República Argentina
Background: Oral anticoagulation therapy with vitamin K antagonists (VKA) such as warfarin and acenocoumarol is recommended in patients with atrial fibrillation (AF) and risk factors for embolism. The quality of anticoagulation control with VKA may be assessed by the time in therapeutic range (TTR)....
Gespeichert in:
| Veröffentlicht in: | Clinical and applied thrombosis/hemostasis 2017-07, Vol.23 (5), p.445-453 |
|---|---|
| Hauptverfasser: | , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext bestellen |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 453 |
|---|---|
| container_issue | 5 |
| container_start_page | 445 |
| container_title | Clinical and applied thrombosis/hemostasis |
| container_volume | 23 |
| creator | Tajer, Carlos Ceresetto, José Bottaro, Federico Jorge Martí, Alejandra Casey, Marcelo |
| description | Background:
Oral anticoagulation therapy with vitamin K antagonists (VKA) such as warfarin and acenocoumarol is recommended in patients with atrial fibrillation (AF) and risk factors for embolism. The quality of anticoagulation control with VKA may be assessed by the time in therapeutic range (TTR). In our country, there are no data available about the quality of anticoagulation in patients with AF. The primary goal of our study was to assess the level of effective anticoagulation in a multicenter network of anticoagulation clinics in Argentina, which included patients with nonvalvular AF (NVAF) treated with VKA oral anticoagulants.
Methods:
The TERRA trial is a multicenter, cross-sectional study involving 14 anticoagulation clinics that were invited to participate and recruit 100 consecutive patients with NVAF treated with VKA for more than 1 year. The international normalized ratio (INR) values were retrospectively obtained from patient charts, and TTR was calculated using the Rosendaal method.
Results:
A total of 1190 patients were included in the analysis. Mean age was 74.9 ± 9.9 years, and 52.5% of the patients were male. Median TTR was 67.5% (interquartile interval 54-80). During 55% of the TTR, INR was >3. Interinstitution variability was substantial, with a range of 57.7% ± 17% to 87.7% ± 17%, P < .001. The 10th percentile of TTR was 41%, the 20th percentile was 50%, the 30th was 58%, and the 35th percentile was 60%. In 40% of patients, TTR was |
| doi_str_mv | 10.1177/1076029615623378 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_AFRWT</sourceid><recordid>TN_cdi_proquest_miscellaneous_1826647680</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_1076029615623378</sage_id><sourcerecordid>1826647680</sourcerecordid><originalsourceid>FETCH-LOGICAL-c407t-791b6d5b6b44a53c26069817df063a9d6b347005ea1dadd01f3fc38b59c7886a3</originalsourceid><addsrcrecordid>eNp1Us1u1DAQjhCIlsKdE7LEhUvAjhM75hatWoqoBCwLHKNJMsm6SuzUdg77alx5KY443QJSJU4znu9vZE2SPGf0NWNSvmFUCpopwQqRcS7LB8kpU7xMM5nxh7GPcLriJ8kT768pZUoo8Tg5yYTkqsiz0-RX5T16P6EJxPYk7JF8XmDU4bA-N3tnjW5JZYJuLQzLCEFbQzbWBGdH8l2HPdnpCYk2ZLdHBzMukUq2YIbbYRWchpFc6Mbp8U79KZaY58nOIQTsjjbfdIApKj6saTDEXB8pzYFc4mR9AK89-TJjG-1W5O2aR3bn221FtjjEkTvEmcZptgQNcXGD22aEiM8_fzSjboFUbojR2sDT5FEPo8dnd_Us-Xpxvttcplcf373fVFdpm1MZUqlYI7qiEU2eQ8HbTFChSia7ngoOqhMNzyWlBQLroOso63nf8rIpVCvLUgA_S14dfWdnbxb0oZ60bzH-hUG7-JqVmRC5FCWN1Jf3qNd2cSZuV2c8zzOaF0pFFj2yWme9d9jXs9MTuEPNaL1eRX3_KqLkxZ3x0kzY_RX8OYNISI8EDwP-S_2v4W_MIsNG</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2344204599</pqid></control><display><type>article</type><title>Assessment of the Quality of Chronic Anticoagulation Control With Time in Therapeutic Range in Atrial Fibrillation Patients Treated With Vitamin K Antagonists by Hemostasis Specialists: The TERRA Registry: Tiempo en rango en la República Argentina</title><source>SAGE Open Access Journals</source><creator>Tajer, Carlos ; Ceresetto, José ; Bottaro, Federico Jorge ; Martí, Alejandra ; Casey, Marcelo</creator><creatorcontrib>Tajer, Carlos ; Ceresetto, José ; Bottaro, Federico Jorge ; Martí, Alejandra ; Casey, Marcelo ; TERRA Trial investigators</creatorcontrib><description>Background:
Oral anticoagulation therapy with vitamin K antagonists (VKA) such as warfarin and acenocoumarol is recommended in patients with atrial fibrillation (AF) and risk factors for embolism. The quality of anticoagulation control with VKA may be assessed by the time in therapeutic range (TTR). In our country, there are no data available about the quality of anticoagulation in patients with AF. The primary goal of our study was to assess the level of effective anticoagulation in a multicenter network of anticoagulation clinics in Argentina, which included patients with nonvalvular AF (NVAF) treated with VKA oral anticoagulants.
Methods:
The TERRA trial is a multicenter, cross-sectional study involving 14 anticoagulation clinics that were invited to participate and recruit 100 consecutive patients with NVAF treated with VKA for more than 1 year. The international normalized ratio (INR) values were retrospectively obtained from patient charts, and TTR was calculated using the Rosendaal method.
Results:
A total of 1190 patients were included in the analysis. Mean age was 74.9 ± 9.9 years, and 52.5% of the patients were male. Median TTR was 67.5% (interquartile interval 54-80). During 55% of the TTR, INR was >3. Interinstitution variability was substantial, with a range of 57.7% ± 17% to 87.7% ± 17%, P < .001. The 10th percentile of TTR was 41%, the 20th percentile was 50%, the 30th was 58%, and the 35th percentile was 60%. In 40% of patients, TTR was <70%.
Conclusion:
In this multicenter study, mean TTR values in patients with AF under VKA were similar to those in international therapeutic clinical trials (55%-65%). Marked variations among institutions were observed and, although average results obtained were high, one third of the patients exhibited a TTR below 60%. This cutoff value is conservative according to current recommendations, and guidelines suggest that when management with VKA cannot be improved, patients should be switched to direct oral anticoagulants. The addition of TTR calculation to clinical practice may help improve the quality of oral anticoagulation in patients with AF, thus improving anticoagulation outcomes.</description><identifier>ISSN: 1076-0296</identifier><identifier>EISSN: 1938-2723</identifier><identifier>DOI: 10.1177/1076029615623378</identifier><identifier>PMID: 26739542</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Aged ; Aged, 80 and over ; Anticoagulants ; Anticoagulants - administration & dosage ; Anticoagulants - adverse effects ; Argentina ; Atrial Fibrillation - blood ; Atrial Fibrillation - drug therapy ; Atrial Fibrillation - epidemiology ; Cardiac arrhythmia ; Cross-Sectional Studies ; Female ; Humans ; International Normalized Ratio ; Male ; Middle Aged ; Quality Control ; Registries ; Vitamin K - antagonists & inhibitors</subject><ispartof>Clinical and applied thrombosis/hemostasis, 2017-07, Vol.23 (5), p.445-453</ispartof><rights>The Author(s) 2016</rights><rights>The Author(s) 2016. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the associated terms available at: https://uk.sagepub.com/en-gb/eur/reusing-open-access-and-sage-choice-content</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c407t-791b6d5b6b44a53c26069817df063a9d6b347005ea1dadd01f3fc38b59c7886a3</citedby><cites>FETCH-LOGICAL-c407t-791b6d5b6b44a53c26069817df063a9d6b347005ea1dadd01f3fc38b59c7886a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/1076029615623378$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/1076029615623378$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21945,27830,27901,27902,44921,45309</link.rule.ids><linktorsrc>$$Uhttps://journals.sagepub.com/doi/full/10.1177/1076029615623378?utm_source=summon&utm_medium=discovery-provider$$EView_record_in_SAGE_Publications$$FView_record_in_$$GSAGE_Publications</linktorsrc><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26739542$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tajer, Carlos</creatorcontrib><creatorcontrib>Ceresetto, José</creatorcontrib><creatorcontrib>Bottaro, Federico Jorge</creatorcontrib><creatorcontrib>Martí, Alejandra</creatorcontrib><creatorcontrib>Casey, Marcelo</creatorcontrib><creatorcontrib>TERRA Trial investigators</creatorcontrib><title>Assessment of the Quality of Chronic Anticoagulation Control With Time in Therapeutic Range in Atrial Fibrillation Patients Treated With Vitamin K Antagonists by Hemostasis Specialists: The TERRA Registry: Tiempo en rango en la República Argentina</title><title>Clinical and applied thrombosis/hemostasis</title><addtitle>Clin Appl Thromb Hemost</addtitle><description>Background:
Oral anticoagulation therapy with vitamin K antagonists (VKA) such as warfarin and acenocoumarol is recommended in patients with atrial fibrillation (AF) and risk factors for embolism. The quality of anticoagulation control with VKA may be assessed by the time in therapeutic range (TTR). In our country, there are no data available about the quality of anticoagulation in patients with AF. The primary goal of our study was to assess the level of effective anticoagulation in a multicenter network of anticoagulation clinics in Argentina, which included patients with nonvalvular AF (NVAF) treated with VKA oral anticoagulants.
Methods:
The TERRA trial is a multicenter, cross-sectional study involving 14 anticoagulation clinics that were invited to participate and recruit 100 consecutive patients with NVAF treated with VKA for more than 1 year. The international normalized ratio (INR) values were retrospectively obtained from patient charts, and TTR was calculated using the Rosendaal method.
Results:
A total of 1190 patients were included in the analysis. Mean age was 74.9 ± 9.9 years, and 52.5% of the patients were male. Median TTR was 67.5% (interquartile interval 54-80). During 55% of the TTR, INR was >3. Interinstitution variability was substantial, with a range of 57.7% ± 17% to 87.7% ± 17%, P < .001. The 10th percentile of TTR was 41%, the 20th percentile was 50%, the 30th was 58%, and the 35th percentile was 60%. In 40% of patients, TTR was <70%.
Conclusion:
In this multicenter study, mean TTR values in patients with AF under VKA were similar to those in international therapeutic clinical trials (55%-65%). Marked variations among institutions were observed and, although average results obtained were high, one third of the patients exhibited a TTR below 60%. This cutoff value is conservative according to current recommendations, and guidelines suggest that when management with VKA cannot be improved, patients should be switched to direct oral anticoagulants. The addition of TTR calculation to clinical practice may help improve the quality of oral anticoagulation in patients with AF, thus improving anticoagulation outcomes.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anticoagulants</subject><subject>Anticoagulants - administration & dosage</subject><subject>Anticoagulants - adverse effects</subject><subject>Argentina</subject><subject>Atrial Fibrillation - blood</subject><subject>Atrial Fibrillation - drug therapy</subject><subject>Atrial Fibrillation - epidemiology</subject><subject>Cardiac arrhythmia</subject><subject>Cross-Sectional Studies</subject><subject>Female</subject><subject>Humans</subject><subject>International Normalized Ratio</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Quality Control</subject><subject>Registries</subject><subject>Vitamin K - antagonists & inhibitors</subject><issn>1076-0296</issn><issn>1938-2723</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1Us1u1DAQjhCIlsKdE7LEhUvAjhM75hatWoqoBCwLHKNJMsm6SuzUdg77alx5KY443QJSJU4znu9vZE2SPGf0NWNSvmFUCpopwQqRcS7LB8kpU7xMM5nxh7GPcLriJ8kT768pZUoo8Tg5yYTkqsiz0-RX5T16P6EJxPYk7JF8XmDU4bA-N3tnjW5JZYJuLQzLCEFbQzbWBGdH8l2HPdnpCYk2ZLdHBzMukUq2YIbbYRWchpFc6Mbp8U79KZaY58nOIQTsjjbfdIApKj6saTDEXB8pzYFc4mR9AK89-TJjG-1W5O2aR3bn221FtjjEkTvEmcZptgQNcXGD22aEiM8_fzSjboFUbojR2sDT5FEPo8dnd_Us-Xpxvttcplcf373fVFdpm1MZUqlYI7qiEU2eQ8HbTFChSia7ngoOqhMNzyWlBQLroOso63nf8rIpVCvLUgA_S14dfWdnbxb0oZ60bzH-hUG7-JqVmRC5FCWN1Jf3qNd2cSZuV2c8zzOaF0pFFj2yWme9d9jXs9MTuEPNaL1eRX3_KqLkxZ3x0kzY_RX8OYNISI8EDwP-S_2v4W_MIsNG</recordid><startdate>201707</startdate><enddate>201707</enddate><creator>Tajer, Carlos</creator><creator>Ceresetto, José</creator><creator>Bottaro, Federico Jorge</creator><creator>Martí, Alejandra</creator><creator>Casey, Marcelo</creator><general>SAGE Publications</general><general>SAGE PUBLICATIONS, INC</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>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</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>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>201707</creationdate><title>Assessment of the Quality of Chronic Anticoagulation Control With Time in Therapeutic Range in Atrial Fibrillation Patients Treated With Vitamin K Antagonists by Hemostasis Specialists: The TERRA Registry: Tiempo en rango en la República Argentina</title><author>Tajer, Carlos ; Ceresetto, José ; Bottaro, Federico Jorge ; Martí, Alejandra ; Casey, Marcelo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c407t-791b6d5b6b44a53c26069817df063a9d6b347005ea1dadd01f3fc38b59c7886a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anticoagulants</topic><topic>Anticoagulants - administration & dosage</topic><topic>Anticoagulants - adverse effects</topic><topic>Argentina</topic><topic>Atrial Fibrillation - blood</topic><topic>Atrial Fibrillation - drug therapy</topic><topic>Atrial Fibrillation - epidemiology</topic><topic>Cardiac arrhythmia</topic><topic>Cross-Sectional Studies</topic><topic>Female</topic><topic>Humans</topic><topic>International Normalized Ratio</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Quality Control</topic><topic>Registries</topic><topic>Vitamin K - antagonists & inhibitors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tajer, Carlos</creatorcontrib><creatorcontrib>Ceresetto, José</creatorcontrib><creatorcontrib>Bottaro, Federico Jorge</creatorcontrib><creatorcontrib>Martí, Alejandra</creatorcontrib><creatorcontrib>Casey, Marcelo</creatorcontrib><creatorcontrib>TERRA Trial investigators</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>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</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)</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</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content (ProQuest)</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>MEDLINE - Academic</collection><jtitle>Clinical and applied thrombosis/hemostasis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext_linktorsrc</fulltext></delivery><addata><au>Tajer, Carlos</au><au>Ceresetto, José</au><au>Bottaro, Federico Jorge</au><au>Martí, Alejandra</au><au>Casey, Marcelo</au><aucorp>TERRA Trial investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Assessment of the Quality of Chronic Anticoagulation Control With Time in Therapeutic Range in Atrial Fibrillation Patients Treated With Vitamin K Antagonists by Hemostasis Specialists: The TERRA Registry: Tiempo en rango en la República Argentina</atitle><jtitle>Clinical and applied thrombosis/hemostasis</jtitle><addtitle>Clin Appl Thromb Hemost</addtitle><date>2017-07</date><risdate>2017</risdate><volume>23</volume><issue>5</issue><spage>445</spage><epage>453</epage><pages>445-453</pages><issn>1076-0296</issn><eissn>1938-2723</eissn><abstract>Background:
Oral anticoagulation therapy with vitamin K antagonists (VKA) such as warfarin and acenocoumarol is recommended in patients with atrial fibrillation (AF) and risk factors for embolism. The quality of anticoagulation control with VKA may be assessed by the time in therapeutic range (TTR). In our country, there are no data available about the quality of anticoagulation in patients with AF. The primary goal of our study was to assess the level of effective anticoagulation in a multicenter network of anticoagulation clinics in Argentina, which included patients with nonvalvular AF (NVAF) treated with VKA oral anticoagulants.
Methods:
The TERRA trial is a multicenter, cross-sectional study involving 14 anticoagulation clinics that were invited to participate and recruit 100 consecutive patients with NVAF treated with VKA for more than 1 year. The international normalized ratio (INR) values were retrospectively obtained from patient charts, and TTR was calculated using the Rosendaal method.
Results:
A total of 1190 patients were included in the analysis. Mean age was 74.9 ± 9.9 years, and 52.5% of the patients were male. Median TTR was 67.5% (interquartile interval 54-80). During 55% of the TTR, INR was >3. Interinstitution variability was substantial, with a range of 57.7% ± 17% to 87.7% ± 17%, P < .001. The 10th percentile of TTR was 41%, the 20th percentile was 50%, the 30th was 58%, and the 35th percentile was 60%. In 40% of patients, TTR was <70%.
Conclusion:
In this multicenter study, mean TTR values in patients with AF under VKA were similar to those in international therapeutic clinical trials (55%-65%). Marked variations among institutions were observed and, although average results obtained were high, one third of the patients exhibited a TTR below 60%. This cutoff value is conservative according to current recommendations, and guidelines suggest that when management with VKA cannot be improved, patients should be switched to direct oral anticoagulants. The addition of TTR calculation to clinical practice may help improve the quality of oral anticoagulation in patients with AF, thus improving anticoagulation outcomes.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>26739542</pmid><doi>10.1177/1076029615623378</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext_linktorsrc |
| identifier | ISSN: 1076-0296 |
| ispartof | Clinical and applied thrombosis/hemostasis, 2017-07, Vol.23 (5), p.445-453 |
| issn | 1076-0296 1938-2723 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1826647680 |
| source | SAGE Open Access Journals |
| subjects | Aged Aged, 80 and over Anticoagulants Anticoagulants - administration & dosage Anticoagulants - adverse effects Argentina Atrial Fibrillation - blood Atrial Fibrillation - drug therapy Atrial Fibrillation - epidemiology Cardiac arrhythmia Cross-Sectional Studies Female Humans International Normalized Ratio Male Middle Aged Quality Control Registries Vitamin K - antagonists & inhibitors |
| title | Assessment of the Quality of Chronic Anticoagulation Control With Time in Therapeutic Range in Atrial Fibrillation Patients Treated With Vitamin K Antagonists by Hemostasis Specialists: The TERRA Registry: Tiempo en rango en la República Argentina |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-07T19%3A59%3A17IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_AFRWT&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Assessment%20of%20the%20Quality%20of%20Chronic%20Anticoagulation%20Control%20With%20Time%20in%20Therapeutic%20Range%20in%20Atrial%20Fibrillation%20Patients%20Treated%20With%20Vitamin%20K%20Antagonists%20by%20Hemostasis%20Specialists:%20The%20TERRA%20Registry:%20Tiempo%20en%20rango%20en%20la%20Rep%C3%BAblica%20Argentina&rft.jtitle=Clinical%20and%20applied%20thrombosis/hemostasis&rft.au=Tajer,%20Carlos&rft.aucorp=TERRA%20Trial%20investigators&rft.date=2017-07&rft.volume=23&rft.issue=5&rft.spage=445&rft.epage=453&rft.pages=445-453&rft.issn=1076-0296&rft.eissn=1938-2723&rft_id=info:doi/10.1177/1076029615623378&rft_dat=%3Cproquest_AFRWT%3E1826647680%3C/proquest_AFRWT%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2344204599&rft_id=info:pmid/26739542&rft_sage_id=10.1177_1076029615623378&rfr_iscdi=true |