Use of Cytomegalovirus Intravenous Immune Globulin for the Adjunctive Treatment of Cytomegalovirus in Hematopoietic Stem Cell Transplant Recipients
Study Objective. To describe the characteristics and clinical outcomes of hematopoietic stem cell transplant (HSCT) recipients who received adjunctive cytomegalovirus intravenous immune globulin (CMV‐IVIG) for probable or proven CMV disease. Design. Retrospective cohort study. Setting. Large, univer...
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| Veröffentlicht in: | Pharmacotherapy 2010-06, Vol.30 (6), p.554-561 |
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| creator | Alexander, Bryan T. Hladnik, Lindsay M. Augustin, Kristan M. Casabar, Ed McKinnon, Peggy S. Reichley, Richard M. Ritchie, David J. Westervelt, Peter Dubberke, Erik R. |
| description | Study Objective. To describe the characteristics and clinical outcomes of hematopoietic stem cell transplant (HSCT) recipients who received adjunctive cytomegalovirus intravenous immune globulin (CMV‐IVIG) for probable or proven CMV disease.
Design. Retrospective cohort study.
Setting. Large, university‐affiliated, tertiary‐care medical center.
Patients. Thirty‐five adult HSCT recipients who received at least one dose of CMV‐IVIG for adjunctive treatment of probable or proven CMV disease between January 1, 1999, and December 31, 2007.
Measurements and Main Results. All‐cause mortality at hospital discharge was the primary outcome. All patients received an allogeneic HSCT. Twenty‐six patients (74%) had pneumonitis, nine (26%) had enteritis, and 29 (83%) had CMV viremia. All patients received concomitant antiviral therapy; 31 (89%) received ganciclovir, and 14 (40%) received foscarnet. All‐cause mortality at hospital discharge was 49% (17 patients). Patient characteristics associated with mortality included requiring intubation for CMV pneumonia (11 [79%] of 14 nonsurvivors vs 3 (25%) of 12 survivors, p=0.016) and earlier disease onset after HSCT (median 48 days for nonsurvivors vs 106 days for survivors, p |
| doi_str_mv | 10.1592/phco.30.6.554 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_733119532</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>733119532</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5428-d13e378b9acc3f92d2227770929bf6948bbb9a88e4dbc434c7eddf26e9942f533</originalsourceid><addsrcrecordid>eNp9kUtv1DAUhSMEotPCki3KBsEmg9-Ol6MRzLQqD5VWsLMc54a6JHEaO1Pmd_CH8WiGdoO6suX7nXPv9cmyVxjNMVfk_XBt_ZyiuZhzzp5kM1xKXiiM2dNshoiUBUKoPMqOQ7hBiGDByPPsiCCenhmfZX-uAuS-yZfb6Dv4aVq_ceMU8tM-jmYDvd_du27qIV-1vppa1-eNH_N4Dfmivpl6G90G8ssRTOygj__zSpI1dCb6wTuIzubfInT5Eto26UwfhtYk4QVYN7hkEV5kzxrTBnh5OE-yq48fLpfr4vzL6nS5OC8sZ6QsakyByrJSxlraKFITkvaVSBFVNUKxsqpSrSyB1ZVllFkJdd0QAUox0nBKT7K3e99h9LcThKg7F2way_SQ9taSUowVpySR7x4lseBMCCmJSmixR-3oQxih0cPoOjNuNUZ6l5jeJaYp0kKnxBL_-mA9VR3U9_S_iBLw5gCYYE3bpB-zLjxwpGSEiF1juufuXAvbx7vqr-vFBWGyfBjXhQi_71Vm_KWFpJLr759Xmp9hcfbpB9OE_gUXdsEU</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1654667729</pqid></control><display><type>article</type><title>Use of Cytomegalovirus Intravenous Immune Globulin for the Adjunctive Treatment of Cytomegalovirus in Hematopoietic Stem Cell Transplant Recipients</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Alexander, Bryan T. ; Hladnik, Lindsay M. ; Augustin, Kristan M. ; Casabar, Ed ; McKinnon, Peggy S. ; Reichley, Richard M. ; Ritchie, David J. ; Westervelt, Peter ; Dubberke, Erik R.</creator><creatorcontrib>Alexander, Bryan T. ; Hladnik, Lindsay M. ; Augustin, Kristan M. ; Casabar, Ed ; McKinnon, Peggy S. ; Reichley, Richard M. ; Ritchie, David J. ; Westervelt, Peter ; Dubberke, Erik R.</creatorcontrib><description>Study Objective. To describe the characteristics and clinical outcomes of hematopoietic stem cell transplant (HSCT) recipients who received adjunctive cytomegalovirus intravenous immune globulin (CMV‐IVIG) for probable or proven CMV disease.
Design. Retrospective cohort study.
Setting. Large, university‐affiliated, tertiary‐care medical center.
Patients. Thirty‐five adult HSCT recipients who received at least one dose of CMV‐IVIG for adjunctive treatment of probable or proven CMV disease between January 1, 1999, and December 31, 2007.
Measurements and Main Results. All‐cause mortality at hospital discharge was the primary outcome. All patients received an allogeneic HSCT. Twenty‐six patients (74%) had pneumonitis, nine (26%) had enteritis, and 29 (83%) had CMV viremia. All patients received concomitant antiviral therapy; 31 (89%) received ganciclovir, and 14 (40%) received foscarnet. All‐cause mortality at hospital discharge was 49% (17 patients). Patient characteristics associated with mortality included requiring intubation for CMV pneumonia (11 [79%] of 14 nonsurvivors vs 3 (25%) of 12 survivors, p=0.016) and earlier disease onset after HSCT (median 48 days for nonsurvivors vs 106 days for survivors, p<0.001). In the multivariate analysis, only requiring intubation for CMV pneumonia remained a significant risk factor for increased mortality. A low rate of adverse events was attributed to CMV‐IVIG, with mild hypertension (two patients [6%]) and erythema and chills (one patient [3%]) being the most common.
Conclusion. The mortality rate in our study population was similar to previous reports in the literature and may be somewhat lower than rates reported with antiviral monotherapy. Our analysis suggests that factors associated with mortality include the need for intubation and, possibly, earlier onset of CMV disease after HSCT. Treatment with CMV‐IVIG appears to be well tolerated in HSCT recipients. These findings support further trials of CMV‐IVIG efficacy in this setting.</description><identifier>ISSN: 0277-0008</identifier><identifier>EISSN: 1875-9114</identifier><identifier>DOI: 10.1592/phco.30.6.554</identifier><identifier>PMID: 20500045</identifier><identifier>CODEN: PHPYDQ</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Adjuvants, Immunologic - therapeutic use ; Adult ; Antiviral Agents - therapeutic use ; Biological and medical sciences ; CMV-IVIG ; Cytomegalovirus ; cytomegalovirus disease ; Cytomegalovirus Infections - drug therapy ; Cytomegalovirus Infections - mortality ; cytomegalovirus intravenous immune globulin ; Female ; hematopoietic stem cell transplantation ; Hematopoietic Stem Cell Transplantation - methods ; Hematopoietic Stem Cell Transplantation - mortality ; Hematopoietic Stem Cell Transplantation - statistics & numerical data ; Humans ; Immunoglobulins - administration & dosage ; Immunoglobulins - therapeutic use ; Immunoglobulins, Intravenous - therapeutic use ; Infectious diseases ; Male ; Medical sciences ; Pharmacology. Drug treatments ; Viral diseases</subject><ispartof>Pharmacotherapy, 2010-06, Vol.30 (6), p.554-561</ispartof><rights>2010 Pharmacotherapy Publications Inc.</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5428-d13e378b9acc3f92d2227770929bf6948bbb9a88e4dbc434c7eddf26e9942f533</citedby><cites>FETCH-LOGICAL-c5428-d13e378b9acc3f92d2227770929bf6948bbb9a88e4dbc434c7eddf26e9942f533</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1592%2Fphco.30.6.554$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1592%2Fphco.30.6.554$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22842269$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20500045$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Alexander, Bryan T.</creatorcontrib><creatorcontrib>Hladnik, Lindsay M.</creatorcontrib><creatorcontrib>Augustin, Kristan M.</creatorcontrib><creatorcontrib>Casabar, Ed</creatorcontrib><creatorcontrib>McKinnon, Peggy S.</creatorcontrib><creatorcontrib>Reichley, Richard M.</creatorcontrib><creatorcontrib>Ritchie, David J.</creatorcontrib><creatorcontrib>Westervelt, Peter</creatorcontrib><creatorcontrib>Dubberke, Erik R.</creatorcontrib><title>Use of Cytomegalovirus Intravenous Immune Globulin for the Adjunctive Treatment of Cytomegalovirus in Hematopoietic Stem Cell Transplant Recipients</title><title>Pharmacotherapy</title><addtitle>Pharmacotherapy</addtitle><description>Study Objective. To describe the characteristics and clinical outcomes of hematopoietic stem cell transplant (HSCT) recipients who received adjunctive cytomegalovirus intravenous immune globulin (CMV‐IVIG) for probable or proven CMV disease.
Design. Retrospective cohort study.
Setting. Large, university‐affiliated, tertiary‐care medical center.
Patients. Thirty‐five adult HSCT recipients who received at least one dose of CMV‐IVIG for adjunctive treatment of probable or proven CMV disease between January 1, 1999, and December 31, 2007.
Measurements and Main Results. All‐cause mortality at hospital discharge was the primary outcome. All patients received an allogeneic HSCT. Twenty‐six patients (74%) had pneumonitis, nine (26%) had enteritis, and 29 (83%) had CMV viremia. All patients received concomitant antiviral therapy; 31 (89%) received ganciclovir, and 14 (40%) received foscarnet. All‐cause mortality at hospital discharge was 49% (17 patients). Patient characteristics associated with mortality included requiring intubation for CMV pneumonia (11 [79%] of 14 nonsurvivors vs 3 (25%) of 12 survivors, p=0.016) and earlier disease onset after HSCT (median 48 days for nonsurvivors vs 106 days for survivors, p<0.001). In the multivariate analysis, only requiring intubation for CMV pneumonia remained a significant risk factor for increased mortality. A low rate of adverse events was attributed to CMV‐IVIG, with mild hypertension (two patients [6%]) and erythema and chills (one patient [3%]) being the most common.
Conclusion. The mortality rate in our study population was similar to previous reports in the literature and may be somewhat lower than rates reported with antiviral monotherapy. Our analysis suggests that factors associated with mortality include the need for intubation and, possibly, earlier onset of CMV disease after HSCT. Treatment with CMV‐IVIG appears to be well tolerated in HSCT recipients. These findings support further trials of CMV‐IVIG efficacy in this setting.</description><subject>Adjuvants, Immunologic - therapeutic use</subject><subject>Adult</subject><subject>Antiviral Agents - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>CMV-IVIG</subject><subject>Cytomegalovirus</subject><subject>cytomegalovirus disease</subject><subject>Cytomegalovirus Infections - drug therapy</subject><subject>Cytomegalovirus Infections - mortality</subject><subject>cytomegalovirus intravenous immune globulin</subject><subject>Female</subject><subject>hematopoietic stem cell transplantation</subject><subject>Hematopoietic Stem Cell Transplantation - methods</subject><subject>Hematopoietic Stem Cell Transplantation - mortality</subject><subject>Hematopoietic Stem Cell Transplantation - statistics & numerical data</subject><subject>Humans</subject><subject>Immunoglobulins - administration & dosage</subject><subject>Immunoglobulins - therapeutic use</subject><subject>Immunoglobulins, Intravenous - therapeutic use</subject><subject>Infectious diseases</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Pharmacology. Drug treatments</subject><subject>Viral diseases</subject><issn>0277-0008</issn><issn>1875-9114</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUtv1DAUhSMEotPCki3KBsEmg9-Ol6MRzLQqD5VWsLMc54a6JHEaO1Pmd_CH8WiGdoO6suX7nXPv9cmyVxjNMVfk_XBt_ZyiuZhzzp5kM1xKXiiM2dNshoiUBUKoPMqOQ7hBiGDByPPsiCCenhmfZX-uAuS-yZfb6Dv4aVq_ceMU8tM-jmYDvd_du27qIV-1vppa1-eNH_N4Dfmivpl6G90G8ssRTOygj__zSpI1dCb6wTuIzubfInT5Eto26UwfhtYk4QVYN7hkEV5kzxrTBnh5OE-yq48fLpfr4vzL6nS5OC8sZ6QsakyByrJSxlraKFITkvaVSBFVNUKxsqpSrSyB1ZVllFkJdd0QAUox0nBKT7K3e99h9LcThKg7F2way_SQ9taSUowVpySR7x4lseBMCCmJSmixR-3oQxih0cPoOjNuNUZ6l5jeJaYp0kKnxBL_-mA9VR3U9_S_iBLw5gCYYE3bpB-zLjxwpGSEiF1juufuXAvbx7vqr-vFBWGyfBjXhQi_71Vm_KWFpJLr759Xmp9hcfbpB9OE_gUXdsEU</recordid><startdate>201006</startdate><enddate>201006</enddate><creator>Alexander, Bryan T.</creator><creator>Hladnik, Lindsay M.</creator><creator>Augustin, Kristan M.</creator><creator>Casabar, Ed</creator><creator>McKinnon, Peggy S.</creator><creator>Reichley, Richard M.</creator><creator>Ritchie, David J.</creator><creator>Westervelt, Peter</creator><creator>Dubberke, Erik R.</creator><general>Blackwell Publishing Ltd</general><general>Pharmacotherapy</general><scope>BSCLL</scope><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>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>7X8</scope></search><sort><creationdate>201006</creationdate><title>Use of Cytomegalovirus Intravenous Immune Globulin for the Adjunctive Treatment of Cytomegalovirus in Hematopoietic Stem Cell Transplant Recipients</title><author>Alexander, Bryan T. ; Hladnik, Lindsay M. ; Augustin, Kristan M. ; Casabar, Ed ; McKinnon, Peggy S. ; Reichley, Richard M. ; Ritchie, David J. ; Westervelt, Peter ; Dubberke, Erik R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5428-d13e378b9acc3f92d2227770929bf6948bbb9a88e4dbc434c7eddf26e9942f533</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adjuvants, Immunologic - therapeutic use</topic><topic>Adult</topic><topic>Antiviral Agents - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>CMV-IVIG</topic><topic>Cytomegalovirus</topic><topic>cytomegalovirus disease</topic><topic>Cytomegalovirus Infections - drug therapy</topic><topic>Cytomegalovirus Infections - mortality</topic><topic>cytomegalovirus intravenous immune globulin</topic><topic>Female</topic><topic>hematopoietic stem cell transplantation</topic><topic>Hematopoietic Stem Cell Transplantation - methods</topic><topic>Hematopoietic Stem Cell Transplantation - mortality</topic><topic>Hematopoietic Stem Cell Transplantation - statistics & numerical data</topic><topic>Humans</topic><topic>Immunoglobulins - administration & dosage</topic><topic>Immunoglobulins - therapeutic use</topic><topic>Immunoglobulins, Intravenous - therapeutic use</topic><topic>Infectious diseases</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Pharmacology. Drug treatments</topic><topic>Viral diseases</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Alexander, Bryan T.</creatorcontrib><creatorcontrib>Hladnik, Lindsay M.</creatorcontrib><creatorcontrib>Augustin, Kristan M.</creatorcontrib><creatorcontrib>Casabar, Ed</creatorcontrib><creatorcontrib>McKinnon, Peggy S.</creatorcontrib><creatorcontrib>Reichley, Richard M.</creatorcontrib><creatorcontrib>Ritchie, David J.</creatorcontrib><creatorcontrib>Westervelt, Peter</creatorcontrib><creatorcontrib>Dubberke, Erik R.</creatorcontrib><collection>Istex</collection><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>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Pharmacotherapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Alexander, Bryan T.</au><au>Hladnik, Lindsay M.</au><au>Augustin, Kristan M.</au><au>Casabar, Ed</au><au>McKinnon, Peggy S.</au><au>Reichley, Richard M.</au><au>Ritchie, David J.</au><au>Westervelt, Peter</au><au>Dubberke, Erik R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Use of Cytomegalovirus Intravenous Immune Globulin for the Adjunctive Treatment of Cytomegalovirus in Hematopoietic Stem Cell Transplant Recipients</atitle><jtitle>Pharmacotherapy</jtitle><addtitle>Pharmacotherapy</addtitle><date>2010-06</date><risdate>2010</risdate><volume>30</volume><issue>6</issue><spage>554</spage><epage>561</epage><pages>554-561</pages><issn>0277-0008</issn><eissn>1875-9114</eissn><coden>PHPYDQ</coden><abstract>Study Objective. To describe the characteristics and clinical outcomes of hematopoietic stem cell transplant (HSCT) recipients who received adjunctive cytomegalovirus intravenous immune globulin (CMV‐IVIG) for probable or proven CMV disease.
Design. Retrospective cohort study.
Setting. Large, university‐affiliated, tertiary‐care medical center.
Patients. Thirty‐five adult HSCT recipients who received at least one dose of CMV‐IVIG for adjunctive treatment of probable or proven CMV disease between January 1, 1999, and December 31, 2007.
Measurements and Main Results. All‐cause mortality at hospital discharge was the primary outcome. All patients received an allogeneic HSCT. Twenty‐six patients (74%) had pneumonitis, nine (26%) had enteritis, and 29 (83%) had CMV viremia. All patients received concomitant antiviral therapy; 31 (89%) received ganciclovir, and 14 (40%) received foscarnet. All‐cause mortality at hospital discharge was 49% (17 patients). Patient characteristics associated with mortality included requiring intubation for CMV pneumonia (11 [79%] of 14 nonsurvivors vs 3 (25%) of 12 survivors, p=0.016) and earlier disease onset after HSCT (median 48 days for nonsurvivors vs 106 days for survivors, p<0.001). In the multivariate analysis, only requiring intubation for CMV pneumonia remained a significant risk factor for increased mortality. A low rate of adverse events was attributed to CMV‐IVIG, with mild hypertension (two patients [6%]) and erythema and chills (one patient [3%]) being the most common.
Conclusion. The mortality rate in our study population was similar to previous reports in the literature and may be somewhat lower than rates reported with antiviral monotherapy. Our analysis suggests that factors associated with mortality include the need for intubation and, possibly, earlier onset of CMV disease after HSCT. Treatment with CMV‐IVIG appears to be well tolerated in HSCT recipients. These findings support further trials of CMV‐IVIG efficacy in this setting.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>20500045</pmid><doi>10.1592/phco.30.6.554</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adjuvants, Immunologic - therapeutic use Adult Antiviral Agents - therapeutic use Biological and medical sciences CMV-IVIG Cytomegalovirus cytomegalovirus disease Cytomegalovirus Infections - drug therapy Cytomegalovirus Infections - mortality cytomegalovirus intravenous immune globulin Female hematopoietic stem cell transplantation Hematopoietic Stem Cell Transplantation - methods Hematopoietic Stem Cell Transplantation - mortality Hematopoietic Stem Cell Transplantation - statistics & numerical data Humans Immunoglobulins - administration & dosage Immunoglobulins - therapeutic use Immunoglobulins, Intravenous - therapeutic use Infectious diseases Male Medical sciences Pharmacology. Drug treatments Viral diseases |
| title | Use of Cytomegalovirus Intravenous Immune Globulin for the Adjunctive Treatment of Cytomegalovirus in Hematopoietic Stem Cell Transplant Recipients |
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