Patterns in emergency department unscheduled return visits during the COVID-19 pandemic
Fear surrounding nosocomial infections, expanded telehealth, and decreases in ED (emergency department) utilization altered the way patients sought emergency care during the COVID pandemic. This study aims to evaluate COVID-19's impact on the frequency and characteristics of unscheduled return...
Gespeichert in:
| Veröffentlicht in: | The American journal of emergency medicine 2022-08, Vol.58, p.126-130 |
|---|---|
| Hauptverfasser: | , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 130 |
|---|---|
| container_issue | |
| container_start_page | 126 |
| container_title | The American journal of emergency medicine |
| container_volume | 58 |
| creator | Thompson, Garrett S. Olympia, Robert P. |
| description | Fear surrounding nosocomial infections, expanded telehealth, and decreases in ED (emergency department) utilization altered the way patients sought emergency care during the COVID pandemic. This study aims to evaluate COVID-19's impact on the frequency and characteristics of unscheduled return visits (URVs) to the adult and pediatric ED.
In this retrospective cohort study, the electronic medical record was used to identify ≤9-day URVs at a tertiary adult and pediatric ED from 4/16/19–2/29/20 (control) and 4/16/20–2/28/21 (COVID). The primary outcome, proportion of total ED visits made up by URVs, and secondary outcomes, patient characteristics (age), illness acuity (emergency severity index (ESI)), disposition, and mortality were compared between the cohorts. Pediatric and adult data were analyzed separately. A sub-analysis was performed to exclude patients with suspected respiratory infections.
For adults, n = 4265, there was no significant difference between the proportion of ED census made up by URVs (4.56% (control) vs 4.76% (COVID), p = 0.17), mean patient age (46.33 (control) vs 46.18 (COVID), p = 0.80), ESI acuity (2.95 (control) vs 2.95 (COVID), p = 0.83), disposition (admission 0.32% (control) vs 0.39% (COVID), p = 0.69), and mortality (0.23% (control) and 0.49% (COVID), p = 0.15). When excluding possible respiratory infections comparisons remained insignificant.
For pediatrics, n = 1214, there was a significant difference in the proportion of ED census made up by URVs (4.83% (control) to 3.55% (COVID), p < 0.01), age (5.52 (control) vs 6.43 (COVID), p = 0.01), and ESI acuity (3.31 (control) vs 3.17 (COVID), p < 0.01). There was no difference in disposition (admission 0.12% (control) vs 0% (COVID), p = 1). When excluding possible respiratory infections acuity (p = 0.03) remained significant.
In the adult population, COVID did not significantly alter any of our outcomes. For pediatric patients, a decrease in the proportion of URVs and increase in acuity during COVID suggests that patients may have had other means of accessing care, avoided the ED, received more adequate care at initial presentation, or represented when more acutely ill. |
| doi_str_mv | 10.1016/j.ajem.2022.05.018 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9121646</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0735675722003199</els_id><sourcerecordid>2689062441</sourcerecordid><originalsourceid>FETCH-LOGICAL-c413t-f23124131f34cff4c21db7e27f1f64f07a1bba452a7855cf17c5380fab04a933</originalsourceid><addsrcrecordid>eNp9kU-LFDEQxYMo7uzoF_AgAS9euk0lnU4PiCCjqwsL62HRY0inKzNp-s-YpAf225th1kU9eEpBXj3qvR8hr4CVwKB-15emx7HkjPOSyZJB84SsQApeNKDgKVkxJWRRK6kuyGWMPWMAlayekwsha7WppVyRH99MShimSP1EccSww8ne0w4PJqQRp0SXKdo9dsuAHQ2YljDRo48-RdotwU87mvZIt7ffrz8VsKEHM3U4evuCPHNmiPjy4V2Tu6vPd9uvxc3tl-vtx5vCViBS4bgAnidworLOVZZD1yrkyoGrK8eUgbY1leRGNVJaB8pK0TBnWlaZjRBr8uFse1jaETubDw5m0IfgRxPu9Wy8_vtn8nu9m496Axzqqs4Gbx8MwvxzwZj06KPFYTATzkvUPNdXAxfqJH3zj7Sfcxs5XVY1G1bzKidZE35W2TDHGNA9HgNMn7DpXp-w6RM2zaTO2PLS6z9jPK785pQF788CzF0ePQYdrc-ksPMBbdLd7P_n_wujxqmk</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2689062441</pqid></control><display><type>article</type><title>Patterns in emergency department unscheduled return visits during the COVID-19 pandemic</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><source>ProQuest Central UK/Ireland</source><creator>Thompson, Garrett S. ; Olympia, Robert P.</creator><creatorcontrib>Thompson, Garrett S. ; Olympia, Robert P.</creatorcontrib><description>Fear surrounding nosocomial infections, expanded telehealth, and decreases in ED (emergency department) utilization altered the way patients sought emergency care during the COVID pandemic. This study aims to evaluate COVID-19's impact on the frequency and characteristics of unscheduled return visits (URVs) to the adult and pediatric ED.
In this retrospective cohort study, the electronic medical record was used to identify ≤9-day URVs at a tertiary adult and pediatric ED from 4/16/19–2/29/20 (control) and 4/16/20–2/28/21 (COVID). The primary outcome, proportion of total ED visits made up by URVs, and secondary outcomes, patient characteristics (age), illness acuity (emergency severity index (ESI)), disposition, and mortality were compared between the cohorts. Pediatric and adult data were analyzed separately. A sub-analysis was performed to exclude patients with suspected respiratory infections.
For adults, n = 4265, there was no significant difference between the proportion of ED census made up by URVs (4.56% (control) vs 4.76% (COVID), p = 0.17), mean patient age (46.33 (control) vs 46.18 (COVID), p = 0.80), ESI acuity (2.95 (control) vs 2.95 (COVID), p = 0.83), disposition (admission 0.32% (control) vs 0.39% (COVID), p = 0.69), and mortality (0.23% (control) and 0.49% (COVID), p = 0.15). When excluding possible respiratory infections comparisons remained insignificant.
For pediatrics, n = 1214, there was a significant difference in the proportion of ED census made up by URVs (4.83% (control) to 3.55% (COVID), p < 0.01), age (5.52 (control) vs 6.43 (COVID), p = 0.01), and ESI acuity (3.31 (control) vs 3.17 (COVID), p < 0.01). There was no difference in disposition (admission 0.12% (control) vs 0% (COVID), p = 1). When excluding possible respiratory infections acuity (p = 0.03) remained significant.
In the adult population, COVID did not significantly alter any of our outcomes. For pediatric patients, a decrease in the proportion of URVs and increase in acuity during COVID suggests that patients may have had other means of accessing care, avoided the ED, received more adequate care at initial presentation, or represented when more acutely ill.</description><identifier>ISSN: 0735-6757</identifier><identifier>EISSN: 1532-8171</identifier><identifier>DOI: 10.1016/j.ajem.2022.05.018</identifier><identifier>PMID: 35679655</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acuity ; Adult ; Adults ; Age ; Attitude to health ; Census ; Censuses ; Child ; Coronaviruses ; COVID-19 ; COVID-19 - epidemiology ; Data analysis ; Disease transmission ; Electronic medical records ; Emergency medical care ; Emergency medical services ; Emergency Service, Hospital ; Health care access ; Hospitals ; Humans ; Infections ; Medical overuse ; Mortality ; Nosocomial infection ; Pandemics ; Patients ; Pediatric emergency medicine ; Pediatrics ; Quality improvement ; Retrospective Studies ; Telemedicine ; Time Factors</subject><ispartof>The American journal of emergency medicine, 2022-08, Vol.58, p.126-130</ispartof><rights>2022</rights><rights>Copyright © 2022. Published by Elsevier Inc.</rights><rights>Copyright Elsevier Limited Aug 2022</rights><rights>2022 Published by Elsevier Inc. 2022</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c413t-f23124131f34cff4c21db7e27f1f64f07a1bba452a7855cf17c5380fab04a933</citedby><cites>FETCH-LOGICAL-c413t-f23124131f34cff4c21db7e27f1f64f07a1bba452a7855cf17c5380fab04a933</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2689062441?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>230,314,776,780,881,3536,27903,27904,64361,64363,64365,65309,72215</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35679655$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Thompson, Garrett S.</creatorcontrib><creatorcontrib>Olympia, Robert P.</creatorcontrib><title>Patterns in emergency department unscheduled return visits during the COVID-19 pandemic</title><title>The American journal of emergency medicine</title><addtitle>Am J Emerg Med</addtitle><description>Fear surrounding nosocomial infections, expanded telehealth, and decreases in ED (emergency department) utilization altered the way patients sought emergency care during the COVID pandemic. This study aims to evaluate COVID-19's impact on the frequency and characteristics of unscheduled return visits (URVs) to the adult and pediatric ED.
In this retrospective cohort study, the electronic medical record was used to identify ≤9-day URVs at a tertiary adult and pediatric ED from 4/16/19–2/29/20 (control) and 4/16/20–2/28/21 (COVID). The primary outcome, proportion of total ED visits made up by URVs, and secondary outcomes, patient characteristics (age), illness acuity (emergency severity index (ESI)), disposition, and mortality were compared between the cohorts. Pediatric and adult data were analyzed separately. A sub-analysis was performed to exclude patients with suspected respiratory infections.
For adults, n = 4265, there was no significant difference between the proportion of ED census made up by URVs (4.56% (control) vs 4.76% (COVID), p = 0.17), mean patient age (46.33 (control) vs 46.18 (COVID), p = 0.80), ESI acuity (2.95 (control) vs 2.95 (COVID), p = 0.83), disposition (admission 0.32% (control) vs 0.39% (COVID), p = 0.69), and mortality (0.23% (control) and 0.49% (COVID), p = 0.15). When excluding possible respiratory infections comparisons remained insignificant.
For pediatrics, n = 1214, there was a significant difference in the proportion of ED census made up by URVs (4.83% (control) to 3.55% (COVID), p < 0.01), age (5.52 (control) vs 6.43 (COVID), p = 0.01), and ESI acuity (3.31 (control) vs 3.17 (COVID), p < 0.01). There was no difference in disposition (admission 0.12% (control) vs 0% (COVID), p = 1). When excluding possible respiratory infections acuity (p = 0.03) remained significant.
In the adult population, COVID did not significantly alter any of our outcomes. For pediatric patients, a decrease in the proportion of URVs and increase in acuity during COVID suggests that patients may have had other means of accessing care, avoided the ED, received more adequate care at initial presentation, or represented when more acutely ill.</description><subject>Acuity</subject><subject>Adult</subject><subject>Adults</subject><subject>Age</subject><subject>Attitude to health</subject><subject>Census</subject><subject>Censuses</subject><subject>Child</subject><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>COVID-19 - epidemiology</subject><subject>Data analysis</subject><subject>Disease transmission</subject><subject>Electronic medical records</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Emergency Service, Hospital</subject><subject>Health care access</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Infections</subject><subject>Medical overuse</subject><subject>Mortality</subject><subject>Nosocomial infection</subject><subject>Pandemics</subject><subject>Patients</subject><subject>Pediatric emergency medicine</subject><subject>Pediatrics</subject><subject>Quality improvement</subject><subject>Retrospective Studies</subject><subject>Telemedicine</subject><subject>Time Factors</subject><issn>0735-6757</issn><issn>1532-8171</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</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>eNp9kU-LFDEQxYMo7uzoF_AgAS9euk0lnU4PiCCjqwsL62HRY0inKzNp-s-YpAf225th1kU9eEpBXj3qvR8hr4CVwKB-15emx7HkjPOSyZJB84SsQApeNKDgKVkxJWRRK6kuyGWMPWMAlayekwsha7WppVyRH99MShimSP1EccSww8ne0w4PJqQRp0SXKdo9dsuAHQ2YljDRo48-RdotwU87mvZIt7ffrz8VsKEHM3U4evuCPHNmiPjy4V2Tu6vPd9uvxc3tl-vtx5vCViBS4bgAnidworLOVZZD1yrkyoGrK8eUgbY1leRGNVJaB8pK0TBnWlaZjRBr8uFse1jaETubDw5m0IfgRxPu9Wy8_vtn8nu9m496Axzqqs4Gbx8MwvxzwZj06KPFYTATzkvUPNdXAxfqJH3zj7Sfcxs5XVY1G1bzKidZE35W2TDHGNA9HgNMn7DpXp-w6RM2zaTO2PLS6z9jPK785pQF788CzF0ePQYdrc-ksPMBbdLd7P_n_wujxqmk</recordid><startdate>20220801</startdate><enddate>20220801</enddate><creator>Thompson, Garrett S.</creator><creator>Olympia, Robert P.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><general>Published by Elsevier 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>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>AEUYN</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><scope>5PM</scope></search><sort><creationdate>20220801</creationdate><title>Patterns in emergency department unscheduled return visits during the COVID-19 pandemic</title><author>Thompson, Garrett S. ; Olympia, Robert P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c413t-f23124131f34cff4c21db7e27f1f64f07a1bba452a7855cf17c5380fab04a933</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Acuity</topic><topic>Adult</topic><topic>Adults</topic><topic>Age</topic><topic>Attitude to health</topic><topic>Census</topic><topic>Censuses</topic><topic>Child</topic><topic>Coronaviruses</topic><topic>COVID-19</topic><topic>COVID-19 - epidemiology</topic><topic>Data analysis</topic><topic>Disease transmission</topic><topic>Electronic medical records</topic><topic>Emergency medical care</topic><topic>Emergency medical services</topic><topic>Emergency Service, Hospital</topic><topic>Health care access</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Infections</topic><topic>Medical overuse</topic><topic>Mortality</topic><topic>Nosocomial infection</topic><topic>Pandemics</topic><topic>Patients</topic><topic>Pediatric emergency medicine</topic><topic>Pediatrics</topic><topic>Quality improvement</topic><topic>Retrospective Studies</topic><topic>Telemedicine</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Thompson, Garrett S.</creatorcontrib><creatorcontrib>Olympia, Robert P.</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 One Sustainability</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><collection>PubMed Central (Full Participant titles)</collection><jtitle>The American journal of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Thompson, Garrett S.</au><au>Olympia, Robert P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Patterns in emergency department unscheduled return visits during the COVID-19 pandemic</atitle><jtitle>The American journal of emergency medicine</jtitle><addtitle>Am J Emerg Med</addtitle><date>2022-08-01</date><risdate>2022</risdate><volume>58</volume><spage>126</spage><epage>130</epage><pages>126-130</pages><issn>0735-6757</issn><eissn>1532-8171</eissn><abstract>Fear surrounding nosocomial infections, expanded telehealth, and decreases in ED (emergency department) utilization altered the way patients sought emergency care during the COVID pandemic. This study aims to evaluate COVID-19's impact on the frequency and characteristics of unscheduled return visits (URVs) to the adult and pediatric ED.
In this retrospective cohort study, the electronic medical record was used to identify ≤9-day URVs at a tertiary adult and pediatric ED from 4/16/19–2/29/20 (control) and 4/16/20–2/28/21 (COVID). The primary outcome, proportion of total ED visits made up by URVs, and secondary outcomes, patient characteristics (age), illness acuity (emergency severity index (ESI)), disposition, and mortality were compared between the cohorts. Pediatric and adult data were analyzed separately. A sub-analysis was performed to exclude patients with suspected respiratory infections.
For adults, n = 4265, there was no significant difference between the proportion of ED census made up by URVs (4.56% (control) vs 4.76% (COVID), p = 0.17), mean patient age (46.33 (control) vs 46.18 (COVID), p = 0.80), ESI acuity (2.95 (control) vs 2.95 (COVID), p = 0.83), disposition (admission 0.32% (control) vs 0.39% (COVID), p = 0.69), and mortality (0.23% (control) and 0.49% (COVID), p = 0.15). When excluding possible respiratory infections comparisons remained insignificant.
For pediatrics, n = 1214, there was a significant difference in the proportion of ED census made up by URVs (4.83% (control) to 3.55% (COVID), p < 0.01), age (5.52 (control) vs 6.43 (COVID), p = 0.01), and ESI acuity (3.31 (control) vs 3.17 (COVID), p < 0.01). There was no difference in disposition (admission 0.12% (control) vs 0% (COVID), p = 1). When excluding possible respiratory infections acuity (p = 0.03) remained significant.
In the adult population, COVID did not significantly alter any of our outcomes. For pediatric patients, a decrease in the proportion of URVs and increase in acuity during COVID suggests that patients may have had other means of accessing care, avoided the ED, received more adequate care at initial presentation, or represented when more acutely ill.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>35679655</pmid><doi>10.1016/j.ajem.2022.05.018</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0735-6757 |
| ispartof | The American journal of emergency medicine, 2022-08, Vol.58, p.126-130 |
| issn | 0735-6757 1532-8171 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9121646 |
| source | MEDLINE; Elsevier ScienceDirect Journals; ProQuest Central UK/Ireland |
| subjects | Acuity Adult Adults Age Attitude to health Census Censuses Child Coronaviruses COVID-19 COVID-19 - epidemiology Data analysis Disease transmission Electronic medical records Emergency medical care Emergency medical services Emergency Service, Hospital Health care access Hospitals Humans Infections Medical overuse Mortality Nosocomial infection Pandemics Patients Pediatric emergency medicine Pediatrics Quality improvement Retrospective Studies Telemedicine Time Factors |
| title | Patterns in emergency department unscheduled return visits during the COVID-19 pandemic |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-26T12%3A09%3A58IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Patterns%20in%20emergency%20department%20unscheduled%20return%20visits%20during%20the%20COVID-19%20pandemic&rft.jtitle=The%20American%20journal%20of%20emergency%20medicine&rft.au=Thompson,%20Garrett%20S.&rft.date=2022-08-01&rft.volume=58&rft.spage=126&rft.epage=130&rft.pages=126-130&rft.issn=0735-6757&rft.eissn=1532-8171&rft_id=info:doi/10.1016/j.ajem.2022.05.018&rft_dat=%3Cproquest_pubme%3E2689062441%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2689062441&rft_id=info:pmid/35679655&rft_els_id=S0735675722003199&rfr_iscdi=true |