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  1. AU="Fenrich, Craig A"
  2. AU="Staehelin, Cornelia"
  3. AU="Akhtar, Suraiya"
  4. AU="Georgel, Philippe"
  5. AU="Gruenewald, Leon D"
  6. AU="Charron, Morgane"
  7. AU="Leona S. Alizadeh" AU="Leona S. Alizadeh"
  8. AU="Soriano, Stéphane"
  9. AU="Lin, Pao-Yen"
  10. AU="Mudali, Gayathri"
  11. AU="McElveen, John T"
  12. AU="Kraimps, Jean-Louis"
  13. AU="Patel, Sheila K"
  14. AU="Zian, Zeineb"
  15. AU="Langley, Jonathan"
  16. AU="Bell, Thomas G."
  17. AU="Harris, Charles"
  18. AU="Lai, Renfa"
  19. AU="Sakane, Tatsuya"
  20. AU="Mirza, I."
  21. AU="Beatriz Amorim Beltrão"
  22. AU="Wildman, D"
  23. AU="Manghi, Manoel"
  24. AU="van Dinther, Maarten"
  25. AU="Adams, Ashley L"
  26. AU="Zhang, Er-Bin"
  27. AU="Diuk-Wasser, Maria A"
  28. AU="Chowdhury, Muhtamim"
  29. AU="Rivas, Manuel A"
  30. AU="Mangelis, Anastasios"
  31. AU="Simpson, Tina Y"
  32. AU="Li, Peirang"
  33. AU="Zhang, Zhao-Liang"
  34. AU="Perner, Sven"
  35. AU=Suwanwongse Kulachanya AU=Suwanwongse Kulachanya
  36. AU="Rose, Jacqueline"
  37. AU="E Lostis"

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  1. Artikel ; Online: Relationship Between Burn Wound Location and Outcomes in Severely Burned Patients: More Than Meets the Size.

    Liu, Nehemiah T / Rizzo, Julie A / Shingleton, Sarah K / Fenrich, Craig A / Serio-Melvin, Maria L / Christy, Robert J / Salinas, José

    Journal of burn care & research : official publication of the American Burn Association

    2019  Band 40, Heft 5, Seite(n) 558–565

    Abstract: We hypothesized that burn location plays an important role in wound healing, mortality, and other outcomes and conducted the following study to test this multifold hypothesis. We conducted a study to retrospectively look at patients with burns ≥10% TBSA. ...

    Abstract We hypothesized that burn location plays an important role in wound healing, mortality, and other outcomes and conducted the following study to test this multifold hypothesis. We conducted a study to retrospectively look at patients with burns ≥10% TBSA. Demographics, TBSA, partial/full thickness burns (PT/FT) in various wound locations, fluids, inhalation injury, mortality, ICU duration, and hospital duration were considered. Initial wound healing rates (%/d) were also calculated as a slope from the time of the first mapping of open wound size to the time of the third mapping of open wound size. Multivariate logistic regression and operating curves were used to measure mortality prediction performance. All values were expressed as median [interquartile range]. The mortality rate for 318 patients was 17% (54/318). In general, patients were 43 years [29, 58 years] old and had a TBSA of 25% [17, 39%], PT of 16% [10, 25%], and FT of 4% [0, 15%]. Between patients who lived and did not, age, TBSA, FT, 24-hour fluid, and ICU duration were statistically different (P < .001). Furthermore, there were statistically significant differences in FT head (0% [0, 0%] vs 0% [0, 1%], P = .048); FT anterior torso (0% [0, 1%] vs 1% [0, 4%], P < .001); FT posterior torso (0% [0, 0%] vs 0% [0, 4%], P < 0.001); FT upper extremities (0% [0, 3%] vs 2% [0, 11%], P < .001); FT lower extremities (0% [0, 2%] vs 6% [0, 17%], P < .001); and FT genitalia (0% [0, 0%] vs 0% [0, 2%], P < .001). Age, presence of inhalation injury, PT/FT upper extremities, and FT lower extremities were independent mortality predictors and per unit increases of these variables were associated with an increased risk for mortality (P < .05): odds ratio of 1.09 (95% confidence interval [CI] = 1.61-1.13; P < .001) for mean age; 2.69 (95% CI = 1.04-6.93; P = .041) for inhalation injury; 1.14 (95% CI = 1.01-1.27; P = .031) for mean PT upper extremities; 1.26 (95% CI = 1.11-1.42; P < .001) for mean FT upper extremities; and 1.07 (95% CI = 1.01-1.12; P = .012) for mean FT lower extremities. Prediction of mortality was better using specific wound locations (area under the curve [AUC], AUC of 0.896) rather than using TBSA and FT (AUC of 0.873). Graphs revealed that initial healing rates were statistically lower and 24-hour fluids and ICU length of stay were statistically higher in patients with FT upper extremities than in patients without FT extremities (P < .001). Burn wound location affects wound healing and helps predict mortality and ICU length of stay and should be incorporated into burn triage strategies to enhance resource allocation or stratify wound care.
    Mesh-Begriff(e) Adult ; Aged ; Burns/mortality ; Burns/pathology ; Burns/therapy ; Female ; Humans ; Length of Stay ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Outcome Assessment, Health Care ; Retrospective Studies ; Survival Rate ; Wound Healing
    Sprache Englisch
    Erscheinungsdatum 2019-07-05
    Erscheinungsland England
    Dokumenttyp Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2224246-6
    ISSN 1559-0488 ; 1559-047X
    ISSN (online) 1559-0488
    ISSN 1559-047X
    DOI 10.1093/jbcr/irz098
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  2. Artikel ; Online: Quantifying the effects of wound healing risk and potential on clinical measurements and outcomes of severely burned patients: A data-driven approach.

    Liu, Nehemiah T / Shingleton, Sarah K / Fenrich, Craig A / Serio-Melvin, Maria L / Christy, Robert J / Salinas, José

    Burns : journal of the International Society for Burn Injuries

    2019  Band 46, Heft 2, Seite(n) 303–313

    Abstract: Introduction: Given recent advances in computational power, the goal of this study was to quantify the effects of wound healing risk and potential on clinical measurements and outcomes of severely burned patients, with the hope of providing more insight ...

    Abstract Introduction: Given recent advances in computational power, the goal of this study was to quantify the effects of wound healing risk and potential on clinical measurements and outcomes of severely burned patients, with the hope of providing more insight on factors that affect wound healing.
    Methods: This retrospective study involved patients who had at least 10% TBSA% "burned" and three burn mappings each. To model risk to wounds, we defined the variable θ, a hypothetical threshold for TBSA% "open wound" used to demarcate "low-risk" from "high-risk" patients. Low-risk patients denoted those patients whose actual TBSA% "open wound" ≤θ, whereas high-risk patients denoted those patients whose actual TBSA% "open wound" >θ. To consider all possibilities of risk, 100 sub analyses were performed by (1) varying θ from 100% to 1% in decrements of 1%, (2) grouping all patients as either "low-risk" or "high-risk" for each θ, and (3) comparing all means and deviations of variables and outcomes between the two groups for each θ. Hence, this study employed a data-driven approach to capture trends in clinical measurements and outcomes. Plots and tables were also obtained.
    Results: For 303 patients, median age and weight were 43 [29-59] years and 85 [72-99]kg, respectively. Mean TBSA% "burned" was 25 [17-39] %, with a full-thickness burn of 4 [0-15] %. Average crystalloid volumes were 4.25±2.27mL/kg/TBSA% "burned" in the first 24h. Importantly, for high-risk patients, decreasing θ was matched by significant increases in PaO2-FiO2 ratio, platelet count, Glasgow coma score (GCS), and MAP. On the other hand, increasing their risk θ was also matched by significant increases in creatinine, bilirubin, lactate, blood, estimated blood loss, and 24-h and total fluid volumes. As expected, for low-risk patients, clinical measurements were more stable, despite decreasing or increasing θ. At a θ of 80%, statistical tests indicated much disparity between high-risk and low-risk patients for TBSA% "burned", full thickness burn, bilirubin (1.66±1.16mg/dL versus 0.83±0.65mg/dL, p=0.005), GCS (7±2 versus 12±3, p<0.001), MAP (42±22mm Hg versus 59±22mm Hg, p=0.004), 24-h blood, estimated blood loss, 24-h fluid, total fluid, and ICU length of stay (81±113 days versus 24±27 days, p=0.002). These differences were all statistically significant and remained significant down to θ=10%.
    Conclusion: Wound healing risk and potential may be forecasted by many different clinical measurements and outcomes and has many implications on multi-organ function. Future work will be needed to further explain and understand these effects, in order to facilitate development of new predictive models for wound healing.
    Mesh-Begriff(e) Acid-Base Equilibrium ; Adult ; Arterial Pressure ; Bilirubin/blood ; Blood Loss, Surgical ; Blood Urea Nitrogen ; Body Surface Area ; Burns/blood ; Burns/mortality ; Burns/pathology ; Creatinine/blood ; Disease Progression ; Female ; Fluid Therapy ; Glasgow Coma Scale ; Glycated Hemoglobin A/metabolism ; Humans ; Hypernatremia/blood ; Intensive Care Units/statistics & numerical data ; Lactic Acid/blood ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Mortality ; Oxygen ; Partial Pressure ; Platelet Count ; Retrospective Studies ; Risk Assessment ; Wound Healing
    Chemische Substanzen Glycated Hemoglobin A ; hemoglobin A1c protein, human ; Lactic Acid (33X04XA5AT) ; Creatinine (AYI8EX34EU) ; Bilirubin (RFM9X3LJ49) ; Oxygen (S88TT14065)
    Sprache Englisch
    Erscheinungsdatum 2019-12-10
    Erscheinungsland Netherlands
    Dokumenttyp Journal Article
    ZDB-ID 197308-3
    ISSN 1879-1409 ; 0305-4179
    ISSN (online) 1879-1409
    ISSN 0305-4179
    DOI 10.1016/j.burns.2019.11.017
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  3. Artikel ; Online: The impact of patient weight on burn resuscitation.

    Liu, Nehemiah T / Fenrich, Craig A / Serio-Melvin, Maria L / Peterson, Wylan C / Cancio, Leopoldo C / Salinas, José

    The journal of trauma and acute care surgery

    2017  Band 83, Heft 1 Suppl 1, Seite(n) S112–S119

    Abstract: Background: Optimal fluid resuscitation of burn patients with burns greater than 20% total body surface area is critical to prevent burn shock during the initial 24 hours to 48 hours postburn. Currently, most resuscitation formulas incorporate the ... ...

    Abstract Background: Optimal fluid resuscitation of burn patients with burns greater than 20% total body surface area is critical to prevent burn shock during the initial 24 hours to 48 hours postburn. Currently, most resuscitation formulas incorporate the patient's weight when estimating 24-hour fluid requirements. The objective of this study was to determine the impact of weight on fluid resuscitation requirements and outcomes during the initial 24 hours after admission.
    Methods: We performed a retrospective review of patients admitted to our burn intensive care unit from December 2007 to April 2013, resuscitated with a computerized decision support system. We classified patients into body mass index (BMI) categories of underweight (BMI: <18.5), normal (BMI: 18.5-24.9), overweight (BMI: 25.0-29.9), or obese (BMI: >30.0). We also calculated the percent difference from ideal body weight (IBW) and compared 24-hour fluid volumes received.
    Results: Patients with missing weight and/or height values were excluded from the study, resulting in a final cohort of 161 patients for analysis. Mean total body surface area was 42 ± 20% with a full thickness burn of 18 ± 23%. Mean age, weight, and height were 47 ± 19 years, 83 ± 19 kg, and 68 ± 4 inches, respectively. IBW for this cohort was 68 ± 11 kg with a BMI of 28 ± 6. Univariate analysis showed significant differences in 24-hour resuscitation volumes (mL/kg) between normal and obese patients (p < 0.05). Further analysis revealed that increasing percent difference from IBW was associated with lower fluid volumes. Although obesity was not associated with inhalation injury or renal replacement therapy, it was correlated to an increased risk for mortality (p < 0.05).
    Conclusion: This analysis showed that increasing weight was associated with lower fluid resuscitation volume requirements and a higher mortality rate, despite the low incidence of inhalation injury and renal replacement therapy in our obese patients. The use of actual body weight to drive resuscitation volumes may result in overresuscitation of obese patients, depending on the resuscitation formula. Further studies are needed to better explain the relationship between mortality and obesity in burn patients.
    Level of evidence: Therapeutic/care management, level IV.
    Mesh-Begriff(e) Body Mass Index ; Body Weight ; Burns/mortality ; Burns/therapy ; Decision Support Systems, Clinical ; Female ; Fluid Therapy/methods ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Resuscitation/methods ; Retrospective Studies
    Sprache Englisch
    Erscheinungsdatum 2017-03-13
    Erscheinungsland United States
    Dokumenttyp Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 2651070-4
    ISSN 2163-0763 ; 2163-0755
    ISSN (online) 2163-0763
    ISSN 2163-0755
    DOI 10.1097/TA.0000000000001486
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  4. Artikel ; Online: Improving Clinician Decisions and Communication in Critical Care Using Novel Information Technology.

    Pamplin, Jeremy / Nemeth, Christopher P / Serio-Melvin, Maria L / Murray, Sarah J / Rule, Gregory T / Veinott, Elizabeth S / Veazey, Sena R / Hamilton, Anthony J / Fenrich, Craig A / Laufersweiler, Dawn E / Salinas, Jose

    Military medicine

    2019  Band 185, Heft 1-2, Seite(n) e254–e261

    Abstract: Introduction: The electronic medical record (EMR) is presumed to support clinician decisions by documenting and retrieving patient information. Research shows that the EMR variably affects patient care and clinical decision making. The way information ... ...

    Abstract Introduction: The electronic medical record (EMR) is presumed to support clinician decisions by documenting and retrieving patient information. Research shows that the EMR variably affects patient care and clinical decision making. The way information is presented likely has a significant impact on this variability. Well-designed representations of salient information can make a task easier by integrating information in useful patterns that clinicians use to make improved clinical judgments and decisions. Using Cognitive Systems Engineering methods, our research team developed a novel health information technology (NHIT) that interfaces with the EMR to display salient clinical information and enabled communication with a dedicated text-messaging feature. The software allows clinicians to customize displays according to their role and information needs. Here we present results of usability and validation assessments of the NHIT.
    Materials and methods: Our subjects were physicians, nurses, respiratory therapists, and physician trainees. Two arms of this study were conducted, a usability assessment and then a validation assessment. The usability assessment was a computer-based simulation using deceased patient data. After a brief five-minute orientation, the usability assessment measured individual clinician performance of typical tasks in two clinical scenarios using the NHIT. The clinical scenarios included patient admission to the unit and patient readiness for surgery. We evaluated clinician perspective about the NHIT after completing tasks using 7-point Likert scale surveys. In the usability assessment, the primary outcome was participant perceptions about the system's ease of use compared to the legacy system.A subsequent cross-over, validation assessment compared performance of two clinical teams during simulated care scenarios: one using only the legacy IT system and one using the NHIT in addition to the legacy IT system. We oriented both teams to the NHIT during a 1-hour session on the night before the first scenario. Scenarios were conducted using high-fidelity simulation in a real burn intensive care unit room. We used observations, task completion times, semi-structured interviews, and surveys to compare user decisions and perceptions about their performance. The primary outcome for the validation assessment was time to reach accurate (correct) decision points.
    Results: During the usability assessment, clinicians were able to complete all tasks requested. Clinicians reported the NHIT was easier to use and the novel information display allowed for easier data interpretation compared to subject recollection of the legacy EMR.In the validation assessment, a more junior team of clinicians using the NHIT arrived at accurate diagnoses and decision points at similar times as a more experienced team. Both teams noted improved communication between team members when using the NHIT and overall rated the NHIT as easier to use than the legacy EMR, especially with respect to finding information.
    Conclusions: The primary findings of these assessments are that clinicians found the NHIT easy to use despite minimal training and experience and that it did not degrade clinician efficiency or decision-making accuracy. These findings are in contrast to common user experiences when introduced to new EMRs in clinical practice.
    Mesh-Begriff(e) Communication ; Critical Care ; Electronic Health Records ; Humans ; Information Technology ; User-Computer Interface
    Sprache Englisch
    Erscheinungsdatum 2019-07-04
    Erscheinungsland England
    Dokumenttyp Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 391061-1
    ISSN 1930-613X ; 0026-4075
    ISSN (online) 1930-613X
    ISSN 0026-4075
    DOI 10.1093/milmed/usz151
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  5. Artikel ; Online: Predicting wound healing rates and survival with the use of automated serial evaluations of burn wounds.

    Rittenhouse, Bradley A / Rizzo, Julie A / Shields, Beth A / Rowan, Matthew P / Aden, James K / Salinas, José / Fenrich, Craig A / Shingleton, Sarah K / Serio-Melvin, Maria / Burmeister, David M / Cancio, Leopoldo C

    Burns : journal of the International Society for Burn Injuries

    2018  Band 45, Heft 1, Seite(n) 48–53

    Abstract: Healing of burn wounds is necessary for survival; however tracking progression or healing of burns is an inexact science. Recently, the relationship of mortality and wound healing has been documented with a software termed WoundFlow. The objective of the ...

    Abstract Healing of burn wounds is necessary for survival; however tracking progression or healing of burns is an inexact science. Recently, the relationship of mortality and wound healing has been documented with a software termed WoundFlow. The objective of the current study was to confirm various factors that impact burn wound healing, as well as to establish a timeline and rate of successful healing. A retrospective analysis was performed on adults (n=115) with at least 20% TBSA burn that had at least two computer-based wound mappings. The % open wound (%OW) was calculated over time to document healing trajectory until successful healing or death. Only 2% of patients in the group with successful wound healing died. A decrease in the %OW of 0.8 (IQR: 0.7-1.1) was associated with survival. Disparities in wound healing trajectories between survivors and non-survivors were distinguishable by 2weeks post-injury (P<0.05). When %TBSA was stratified by decile, the 40-49% TBSA group had the highest healing rate. Taken together, the data indicate that wound healing trajectory (%OW) varies with injury severity and survival. As such, automated mapping of wound healing trajectory may provide valuable information concerning patient/prognosis, and may recommend early interventions to optimize wound healing.
    Mesh-Begriff(e) Adult ; Age Factors ; Aged ; Automation ; Body Surface Area ; Burns/mortality ; Burns/pathology ; Burns/therapy ; Female ; Humans ; Linear Models ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Prognosis ; Renal Replacement Therapy/statistics & numerical data ; Retrospective Studies ; Skin Transplantation ; Software ; Survival Rate ; Wound Healing
    Sprache Englisch
    Erscheinungsdatum 2018-11-22
    Erscheinungsland Netherlands
    Dokumenttyp Journal Article
    ZDB-ID 197308-3
    ISSN 1879-1409 ; 0305-4179
    ISSN (online) 1879-1409
    ISSN 0305-4179
    DOI 10.1016/j.burns.2018.10.018
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  6. Artikel ; Online: Predicting the proportion of full-thickness involvement for any given burn size based on burn resuscitation volumes.

    Liu, Nehemiah T / Salinas, José / Fenrich, Craig A / Serio-Melvin, Maria L / Kramer, George C / Driscoll, Ian R / Schreiber, Martin A / Cancio, Leopoldo C / Chung, Kevin K

    The journal of trauma and acute care surgery

    2016  Band 81, Heft 5 Suppl 2 Proceedings of the 2015 Military Health System Research Symposium, Seite(n) S144–S149

    Abstract: Introduction: The depth of burn has been an important factor often overlooked when estimating the total resuscitation fluid needed for early burn care. The goal of this study was to determine the degree to which full-thickness (FT) involvement affected ... ...

    Abstract Introduction: The depth of burn has been an important factor often overlooked when estimating the total resuscitation fluid needed for early burn care. The goal of this study was to determine the degree to which full-thickness (FT) involvement affected overall 24-hour burn resuscitation volumes.
    Methods: We performed a retrospective review of patients admitted to our burn intensive care unit from December 2007 to April 2013, with significant burns that required resuscitation using our computerized decision support system for burn fluid resuscitation. We defined the degree of FT involvement as FT Index (FTI; percentage of FT injury/percentage of total body surface area (TBSA) burned [%FT / %TBSA]) and compared variables on actual 24-hour fluid resuscitation volumes overall as well as for any given burn size.
    Results: A total of 203 patients admitted to our burn center during the study period were included in the analysis. Mean age and weight were 47 ± 19 years and 87 ± 18 kg, respectively. Mean %TBSA was 41 ± 20 with a mean %FT of 18 ± 24. As %TBSA, %FT, and FTI increased, so did actual 24-hour fluid resuscitation volumes (mL/kg). However, increase in FTI did not result in increased volume indexed to burn size (mL/kg per %TBSA). This was true even when patients with inhalation injury were excluded. Further investigation revealed that as %TBSA increased, %FT increased nonlinearly (quadratic polynomial) (R = 0.994).
    Conclusion: Total burn size and FT burn size were both highly correlated with increased 24-hour fluid resuscitation volumes. However, FTI did not correlate with a corresponding increase in resuscitation volumes for any given burn size, even when patients with inhalation injury were excluded. Thus, there are insufficient data to presume that those who receive more volume at any given burn size are likely to be mostly full thickness or vice versa. This was influenced by a relatively low sample size at each 10%TBSA increment and larger burn sizes disproportionately having more FT burns. A more robust sample size may elucidate this relationship better.
    Level of evidence: Therapeutic/care management study, level IV.
    Mesh-Begriff(e) Adult ; Aged ; Burns/pathology ; Burns/therapy ; Decision Support Systems, Clinical ; Fluid Therapy ; Humans ; Isotonic Solutions/administration & dosage ; Middle Aged ; Multivariate Analysis ; Resuscitation ; Retrospective Studies
    Chemische Substanzen Isotonic Solutions ; crystalloid solutions
    Sprache Englisch
    Erscheinungsdatum 2016
    Erscheinungsland United States
    Dokumenttyp Journal Article
    ZDB-ID 2651070-4
    ISSN 2163-0763 ; 2163-0755
    ISSN (online) 2163-0763
    ISSN 2163-0755
    DOI 10.1097/TA.0000000000001166
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  7. Artikel ; Online: Comparison of traditional burn wound mapping with a computerized program.

    Williams, James F / King, Booker T / Aden, James K / Serio-Melvin, Maria / Chung, Kevin K / Fenrich, Craig A / Salinas, José / Renz, Evan M / Wolf, Steven E / Blackbourne, Lorne H / Cancio, Leopoldo C

    Journal of burn care & research : official publication of the American Burn Association

    2013  Band 34, Heft 1, Seite(n) e29–35

    Abstract: Accurate burn estimation affects the use of burn resuscitation formulas and treatment strategies, and thus can affect patient outcomes. The objective of this process-improvement project was to compare the accuracy of a computer-based burn mapping program, ...

    Abstract Accurate burn estimation affects the use of burn resuscitation formulas and treatment strategies, and thus can affect patient outcomes. The objective of this process-improvement project was to compare the accuracy of a computer-based burn mapping program, WoundFlow (WF), with the widely used hand-mapped Lund-Browder (LB) diagram. Manikins with various burn representations (from 1% to more than 60% TBSA) were used for comparison of the WF system and LB diagrams. Burns were depicted on the manikins using red vinyl adhesive. Healthcare providers responsible for mapping of burn patients were asked to perform burn mapping of the manikins. Providers were randomized to either an LB or a WF group. Differences in the total map area between groups were analyzed. Also, direct measurements of the burn representations were taken and compared with LB and WF results. The results of 100 samples, compared using Bland-Altman analysis, showed no difference between the two methods. WF was as accurate as LB mapping for all burn surface areas. WF may be additionally beneficial in that it can track daily progress until complete wound closure, and can automatically calculate burn size, thus decreasing the chances of mathematical errors.
    Mesh-Begriff(e) Adolescent ; Adult ; Body Surface Area ; Burns/classification ; Burns/therapy ; Diagnosis, Computer-Assisted/methods ; Documentation ; Electronic Health Records ; Forms and Records Control ; Humans ; Injury Severity Score ; Manikins ; Process Assessment (Health Care)
    Sprache Englisch
    Erscheinungsdatum 2013-01
    Erscheinungsland United States
    Dokumenttyp Comparative Study ; Journal Article ; Randomized Controlled Trial ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 2224246-6
    ISSN 1559-0488 ; 1559-047X
    ISSN (online) 1559-0488
    ISSN 1559-047X
    DOI 10.1097/BCR.0b013e3182676e07
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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