Nadroparin versus dalteparin anticoagulation in high-volume, continuous venovenous hemofiltration: A double-blind, randomized, crossover study
OBJECTIVES:To compare filter survival times during high-volume, continuous venovenous hemofiltration in patients with normal coagulation variables, using anti-factor Xa bioequivalent doses of nadroparin and dalteparin. To evaluate which other factors influence filter survival time. DESIGN:Randomized...
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| Veröffentlicht in: | Critical care medicine 2000-02, Vol.28 (2), p.421-425 |
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| creator | de Pont, Anne-Cornélie J. M Oudemans-van Straaten, Heleen M Roozendaal, Klaas J Zandstra, Durk F |
| description | OBJECTIVES:To compare filter survival times during high-volume, continuous venovenous hemofiltration in patients with normal coagulation variables, using anti-factor Xa bioequivalent doses of nadroparin and dalteparin. To evaluate which other factors influence filter survival time.
DESIGN:Randomized, prospective, double-blind, crossover study.
SETTING:An 18-bed intensive care unit in a 530-bed teaching hospital.
PATIENTS:Thirty-two critically ill patients with renal failure, treated with high-volume, continuous venovenous hemofiltration.
INTERVENTIONS:High-volume, postdilutional continuous venovenous hemofiltration, with a standard blood flow rate of 200 mL/min and an ultrafiltrate volume of 100 L in 24 hrs, was performed with a highly permeable, large-surface cellulose triacetate membrane. Anticoagulation with anti-Xa bioequivalent doses of nadroparin and dalteparin was administered in the extracorporeal line before the filter. Blood was sampled for determination of coagulation variables before hemofiltration, 0.5, 2, 4, 6, and 12 hrs after starting the treatment, and at the end of the hemofiltration run.
MEASUREMENTS AND MAIN RESULTS:Anti-Xa peak activity, time of anti-Xa peak activity, area under the curve for 0-3 hrs and filter survival time were not significantly different using nadroparin or dalteparin. When analyzing the patients according to the length of filter survival time, no relationship among anti-Xa peak activity, area under the curve for 0-3 hrs, and filter survival time was found. However, there was a strong trend toward a negative correlation between baseline platelet count and filter survival time (r = .11; p = .07). Mean blood urea nitrogen decreased from 81.0 ± 31.9 to 41.1 ± 21.2 mg/dL (p < .01) and mean creatinine decreased from 3.4 ± 1.8 to 1.9 ± 1.2 mg/dL (p < .01). There were no clinically important bleeding complications.
CONCLUSIONS:Nadroparin and dalteparin are bioequivalent with respect to their anti-Xa activities. Using either drug, we did not find a difference in filter survival time during high-volume, continuous venovenous hemofiltration. No relationship between anti-Xa activity and filter survival time could be found. However, there is a strong trend toward a negative correlation between baseline platelet count and filter survival time. This suggests that during high-volume, continuous venovenous hemofiltration, patients with a higher baseline platelet count might need a different anticoagulation regimen to obtain longer |
| doi_str_mv | 10.1097/00003246-200002000-00022 |
| format | Article |
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DESIGN:Randomized, prospective, double-blind, crossover study.
SETTING:An 18-bed intensive care unit in a 530-bed teaching hospital.
PATIENTS:Thirty-two critically ill patients with renal failure, treated with high-volume, continuous venovenous hemofiltration.
INTERVENTIONS:High-volume, postdilutional continuous venovenous hemofiltration, with a standard blood flow rate of 200 mL/min and an ultrafiltrate volume of 100 L in 24 hrs, was performed with a highly permeable, large-surface cellulose triacetate membrane. Anticoagulation with anti-Xa bioequivalent doses of nadroparin and dalteparin was administered in the extracorporeal line before the filter. Blood was sampled for determination of coagulation variables before hemofiltration, 0.5, 2, 4, 6, and 12 hrs after starting the treatment, and at the end of the hemofiltration run.
MEASUREMENTS AND MAIN RESULTS:Anti-Xa peak activity, time of anti-Xa peak activity, area under the curve for 0-3 hrs and filter survival time were not significantly different using nadroparin or dalteparin. When analyzing the patients according to the length of filter survival time, no relationship among anti-Xa peak activity, area under the curve for 0-3 hrs, and filter survival time was found. However, there was a strong trend toward a negative correlation between baseline platelet count and filter survival time (r = .11; p = .07). Mean blood urea nitrogen decreased from 81.0 ± 31.9 to 41.1 ± 21.2 mg/dL (p < .01) and mean creatinine decreased from 3.4 ± 1.8 to 1.9 ± 1.2 mg/dL (p < .01). There were no clinically important bleeding complications.
CONCLUSIONS:Nadroparin and dalteparin are bioequivalent with respect to their anti-Xa activities. Using either drug, we did not find a difference in filter survival time during high-volume, continuous venovenous hemofiltration. No relationship between anti-Xa activity and filter survival time could be found. However, there is a strong trend toward a negative correlation between baseline platelet count and filter survival time. This suggests that during high-volume, continuous venovenous hemofiltration, patients with a higher baseline platelet count might need a different anticoagulation regimen to obtain longer filter survival times.</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/00003246-200002000-00022</identifier><identifier>PMID: 10708177</identifier><identifier>CODEN: CCMDC7</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins, Inc</publisher><subject>Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Anticoagulants - pharmacology ; Anticoagulants - therapeutic use ; Biological and medical sciences ; Blood Flow Velocity ; Cross-Over Studies ; Dalteparin - pharmacology ; Dalteparin - therapeutic use ; Double-Blind Method ; Emergency and intensive care: renal failure. Dialysis management ; Equipment Design ; Factor Xa Inhibitors ; Female ; Hemofiltration - instrumentation ; Hemofiltration - methods ; Humans ; Intensive care medicine ; Male ; Medical sciences ; Middle Aged ; Nadroparin - pharmacology ; Nadroparin - therapeutic use ; Prospective Studies ; Renal Insufficiency - blood ; Renal Insufficiency - physiopathology ; Renal Insufficiency - therapy ; Survival Analysis ; Therapeutic Equivalency ; Time Factors</subject><ispartof>Critical care medicine, 2000-02, Vol.28 (2), p.421-425</ispartof><rights>2000 Lippincott Williams & Wilkins, Inc.</rights><rights>2000 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4512-9e59e9f8d199b024f8997675ecc63476bfdf11c08a659c633a6c76b13c6ad91a3</citedby><cites>FETCH-LOGICAL-c4512-9e59e9f8d199b024f8997675ecc63476bfdf11c08a659c633a6c76b13c6ad91a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1325125$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10708177$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>de Pont, Anne-Cornélie J. M</creatorcontrib><creatorcontrib>Oudemans-van Straaten, Heleen M</creatorcontrib><creatorcontrib>Roozendaal, Klaas J</creatorcontrib><creatorcontrib>Zandstra, Durk F</creatorcontrib><title>Nadroparin versus dalteparin anticoagulation in high-volume, continuous venovenous hemofiltration: A double-blind, randomized, crossover study</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>OBJECTIVES:To compare filter survival times during high-volume, continuous venovenous hemofiltration in patients with normal coagulation variables, using anti-factor Xa bioequivalent doses of nadroparin and dalteparin. To evaluate which other factors influence filter survival time.
DESIGN:Randomized, prospective, double-blind, crossover study.
SETTING:An 18-bed intensive care unit in a 530-bed teaching hospital.
PATIENTS:Thirty-two critically ill patients with renal failure, treated with high-volume, continuous venovenous hemofiltration.
INTERVENTIONS:High-volume, postdilutional continuous venovenous hemofiltration, with a standard blood flow rate of 200 mL/min and an ultrafiltrate volume of 100 L in 24 hrs, was performed with a highly permeable, large-surface cellulose triacetate membrane. Anticoagulation with anti-Xa bioequivalent doses of nadroparin and dalteparin was administered in the extracorporeal line before the filter. Blood was sampled for determination of coagulation variables before hemofiltration, 0.5, 2, 4, 6, and 12 hrs after starting the treatment, and at the end of the hemofiltration run.
MEASUREMENTS AND MAIN RESULTS:Anti-Xa peak activity, time of anti-Xa peak activity, area under the curve for 0-3 hrs and filter survival time were not significantly different using nadroparin or dalteparin. When analyzing the patients according to the length of filter survival time, no relationship among anti-Xa peak activity, area under the curve for 0-3 hrs, and filter survival time was found. However, there was a strong trend toward a negative correlation between baseline platelet count and filter survival time (r = .11; p = .07). Mean blood urea nitrogen decreased from 81.0 ± 31.9 to 41.1 ± 21.2 mg/dL (p < .01) and mean creatinine decreased from 3.4 ± 1.8 to 1.9 ± 1.2 mg/dL (p < .01). There were no clinically important bleeding complications.
CONCLUSIONS:Nadroparin and dalteparin are bioequivalent with respect to their anti-Xa activities. Using either drug, we did not find a difference in filter survival time during high-volume, continuous venovenous hemofiltration. No relationship between anti-Xa activity and filter survival time could be found. However, there is a strong trend toward a negative correlation between baseline platelet count and filter survival time. This suggests that during high-volume, continuous venovenous hemofiltration, patients with a higher baseline platelet count might need a different anticoagulation regimen to obtain longer filter survival times.</description><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Anticoagulants - pharmacology</subject><subject>Anticoagulants - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Blood Flow Velocity</subject><subject>Cross-Over Studies</subject><subject>Dalteparin - pharmacology</subject><subject>Dalteparin - therapeutic use</subject><subject>Double-Blind Method</subject><subject>Emergency and intensive care: renal failure. Dialysis management</subject><subject>Equipment Design</subject><subject>Factor Xa Inhibitors</subject><subject>Female</subject><subject>Hemofiltration - instrumentation</subject><subject>Hemofiltration - methods</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nadroparin - pharmacology</subject><subject>Nadroparin - therapeutic use</subject><subject>Prospective Studies</subject><subject>Renal Insufficiency - blood</subject><subject>Renal Insufficiency - physiopathology</subject><subject>Renal Insufficiency - therapy</subject><subject>Survival Analysis</subject><subject>Therapeutic Equivalency</subject><subject>Time Factors</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2000</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1Uk2P1SAUJUbjPEf_gunCuJoqlLYUd5PJ-JFMdKNrQuF2itLyhPIm44_wN3v7-vzYSAL3cnIOcO-BkILRV4xK8Zri4FXdltWarUu5xuoB2bGG46aS_CHZUSppyWvJz8iTlL5SyupG8MfkjFFBOybEjvz8qG0Mex3dXBwgppwKq_0CG6LnxZmgb7PXiwtzgdDobsfyEHye4KIwAQlzDqg6wBzWiekIUxicX-JR9Ka4LGzIvYey9262F0XUsw2T-wGYmxhSQmEs0pLt_VPyaNA-wbNTPCdf3l5_vnpf3nx69-Hq8qY0dcOqUkIjQQ6dZVL2tKqHTkrRigaMaXkt2n6wA2OGdrptJEJctwZRxk2rrWSan5OX27n7GL5nSIuaXDLgvZ4BS1CCypYKzpDYbcTjQyMMah_dpOO9YlStXqjfXqg_XqijFyh9froj9xPYf4Rb85Hw4kTQyWg_YF-MS395vMJaG6TVG-0uoDExffP5DqIaAX0a1f--Av8FQaqkCw</recordid><startdate>200002</startdate><enddate>200002</enddate><creator>de Pont, Anne-Cornélie J. M</creator><creator>Oudemans-van Straaten, Heleen M</creator><creator>Roozendaal, Klaas J</creator><creator>Zandstra, Durk F</creator><general>Lippincott Williams & Wilkins, Inc</general><general>Lippincott</general><scope>IQODW</scope><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>7X8</scope></search><sort><creationdate>200002</creationdate><title>Nadroparin versus dalteparin anticoagulation in high-volume, continuous venovenous hemofiltration: A double-blind, randomized, crossover study</title><author>de Pont, Anne-Cornélie J. M ; Oudemans-van Straaten, Heleen M ; Roozendaal, Klaas J ; Zandstra, Durk F</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4512-9e59e9f8d199b024f8997675ecc63476bfdf11c08a659c633a6c76b13c6ad91a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2000</creationdate><topic>Aged</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Anticoagulants - pharmacology</topic><topic>Anticoagulants - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Blood Flow Velocity</topic><topic>Cross-Over Studies</topic><topic>Dalteparin - pharmacology</topic><topic>Dalteparin - therapeutic use</topic><topic>Double-Blind Method</topic><topic>Emergency and intensive care: renal failure. Dialysis management</topic><topic>Equipment Design</topic><topic>Factor Xa Inhibitors</topic><topic>Female</topic><topic>Hemofiltration - instrumentation</topic><topic>Hemofiltration - methods</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nadroparin - pharmacology</topic><topic>Nadroparin - therapeutic use</topic><topic>Prospective Studies</topic><topic>Renal Insufficiency - blood</topic><topic>Renal Insufficiency - physiopathology</topic><topic>Renal Insufficiency - therapy</topic><topic>Survival Analysis</topic><topic>Therapeutic Equivalency</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>de Pont, Anne-Cornélie J. M</creatorcontrib><creatorcontrib>Oudemans-van Straaten, Heleen M</creatorcontrib><creatorcontrib>Roozendaal, Klaas J</creatorcontrib><creatorcontrib>Zandstra, Durk F</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>de Pont, Anne-Cornélie J. M</au><au>Oudemans-van Straaten, Heleen M</au><au>Roozendaal, Klaas J</au><au>Zandstra, Durk F</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Nadroparin versus dalteparin anticoagulation in high-volume, continuous venovenous hemofiltration: A double-blind, randomized, crossover study</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2000-02</date><risdate>2000</risdate><volume>28</volume><issue>2</issue><spage>421</spage><epage>425</epage><pages>421-425</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><coden>CCMDC7</coden><abstract>OBJECTIVES:To compare filter survival times during high-volume, continuous venovenous hemofiltration in patients with normal coagulation variables, using anti-factor Xa bioequivalent doses of nadroparin and dalteparin. To evaluate which other factors influence filter survival time.
DESIGN:Randomized, prospective, double-blind, crossover study.
SETTING:An 18-bed intensive care unit in a 530-bed teaching hospital.
PATIENTS:Thirty-two critically ill patients with renal failure, treated with high-volume, continuous venovenous hemofiltration.
INTERVENTIONS:High-volume, postdilutional continuous venovenous hemofiltration, with a standard blood flow rate of 200 mL/min and an ultrafiltrate volume of 100 L in 24 hrs, was performed with a highly permeable, large-surface cellulose triacetate membrane. Anticoagulation with anti-Xa bioequivalent doses of nadroparin and dalteparin was administered in the extracorporeal line before the filter. Blood was sampled for determination of coagulation variables before hemofiltration, 0.5, 2, 4, 6, and 12 hrs after starting the treatment, and at the end of the hemofiltration run.
MEASUREMENTS AND MAIN RESULTS:Anti-Xa peak activity, time of anti-Xa peak activity, area under the curve for 0-3 hrs and filter survival time were not significantly different using nadroparin or dalteparin. When analyzing the patients according to the length of filter survival time, no relationship among anti-Xa peak activity, area under the curve for 0-3 hrs, and filter survival time was found. However, there was a strong trend toward a negative correlation between baseline platelet count and filter survival time (r = .11; p = .07). Mean blood urea nitrogen decreased from 81.0 ± 31.9 to 41.1 ± 21.2 mg/dL (p < .01) and mean creatinine decreased from 3.4 ± 1.8 to 1.9 ± 1.2 mg/dL (p < .01). There were no clinically important bleeding complications.
CONCLUSIONS:Nadroparin and dalteparin are bioequivalent with respect to their anti-Xa activities. Using either drug, we did not find a difference in filter survival time during high-volume, continuous venovenous hemofiltration. No relationship between anti-Xa activity and filter survival time could be found. However, there is a strong trend toward a negative correlation between baseline platelet count and filter survival time. This suggests that during high-volume, continuous venovenous hemofiltration, patients with a higher baseline platelet count might need a different anticoagulation regimen to obtain longer filter survival times.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins, Inc</pub><pmid>10708177</pmid><doi>10.1097/00003246-200002000-00022</doi><tpages>5</tpages></addata></record> |
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| ispartof | Critical care medicine, 2000-02, Vol.28 (2), p.421-425 |
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| language | eng |
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| subjects | Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anticoagulants - pharmacology Anticoagulants - therapeutic use Biological and medical sciences Blood Flow Velocity Cross-Over Studies Dalteparin - pharmacology Dalteparin - therapeutic use Double-Blind Method Emergency and intensive care: renal failure. Dialysis management Equipment Design Factor Xa Inhibitors Female Hemofiltration - instrumentation Hemofiltration - methods Humans Intensive care medicine Male Medical sciences Middle Aged Nadroparin - pharmacology Nadroparin - therapeutic use Prospective Studies Renal Insufficiency - blood Renal Insufficiency - physiopathology Renal Insufficiency - therapy Survival Analysis Therapeutic Equivalency Time Factors |
| title | Nadroparin versus dalteparin anticoagulation in high-volume, continuous venovenous hemofiltration: A double-blind, randomized, crossover study |
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