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  1. Article: Evaluating the Harms of Cancer Testing-A Systematic Review of the Adverse Psychological Correlates of Testing for Cancer and the Effectiveness of Interventions to Mitigate These.

    Kwong, Fong Lien / Davenport, Clare / Sundar, Sudha

    Cancers

    2023  Volume 15, Issue 13

    Abstract: 1) Background: Several studies have described the psychological harms of testing for cancer. However, most were conducted in asymptomatic subjects and in cancers with a well-established screening programme. We sought to establish cancers in which the ... ...

    Abstract (1) Background: Several studies have described the psychological harms of testing for cancer. However, most were conducted in asymptomatic subjects and in cancers with a well-established screening programme. We sought to establish cancers in which the literature is deficient, and identify variables associated with psychological morbidity and interventions to mitigate their effect. (2) Methods: Electronic bibliographic databases were searched up to December 2020. We included quantitative studies reporting on variables associated with psychological morbidity associated with cancer testing and primary studies describing interventions to mitigate these. (3) Results: Twenty-six studies described individual, testing-related, and organisational variables. Thirteen randomised controlled trials on interventions were included, and these were categorised into five groups, namely the use of information aids, music therapy, the use of real-time videos, patient navigators and one-stop clinics, and pharmacological or homeopathic therapies. (4) Conclusions: The contribution of some factors to anxiety in cancer testing and their specificity of effect remains inconclusive and warrants further research in homogenous populations and testing contexts. Targeting young, unemployed patients with low levels of educational attainment may offer a means to mitigate anxiety. A limited body of research suggests that one-stop clinics and patient navigators may be beneficial in patients attending for diagnostic cancer testing.
    Language English
    Publishing date 2023-06-25
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2527080-1
    ISSN 2072-6694
    ISSN 2072-6694
    DOI 10.3390/cancers15133335
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Training the gynecologic oncologists of the future - challenges and opportunities.

    Kemah, Ben-Lawrence / Bhagat, Nanak / Pandya, Aayushi / Sullivan, Richard / Sundar, Sudha S

    International journal of gynecological cancer : official journal of the International Gynecological Cancer Society

    2024  Volume 34, Issue 4, Page(s) 619–626

    Abstract: Several recent advances in gynecologic cancer care have improved patient outcomes. These include national screening and vaccination programs for cervical cancer as well as neoadjuvant chemotherapy for ovarian cancer. Conversely, these advances have ... ...

    Abstract Several recent advances in gynecologic cancer care have improved patient outcomes. These include national screening and vaccination programs for cervical cancer as well as neoadjuvant chemotherapy for ovarian cancer. Conversely, these advances have cumulatively reduced surgical opportunities for training creating a need to supplement existing training strategies with evidence-based adjuncts. Technologies such as virtual reality and augmented reality, if properly evaluated and validated, have transformative potential to support training. Given the changing landscape of surgical training in gynecologic oncology, we were keen to summarize the evidence underpinning current training in gynecologic oncology.In this review, we undertook a literature search of Medline, Google, Google Scholar, Embase and Scopus to gather evidence on the current state of training in gynecologic oncology and to highlight existing evidence on the best methods to teach surgical skills. Drawing from the experiences of other surgical specialties we examined the use of training adjuncts such as cadaveric dissection, animation and 3D models as well as simulation training in surgical skills acquisition. Specifically, we looked at the use of training adjuncts in gynecologic oncology training as well as the evidence behind simulation training modalities such as low fidelity box trainers, virtual and augmented reality simulation in laparoscopic training. Finally, we provided context by looking at how training curriculums varied internationally.Whereas some evidence to the reliability and validity of simulation training exists in other surgical specialties, our literature review did not find such evidence in gynecologic oncology. It is important that well conducted trials are used to ascertain the utility of simulation training modalities before integrating them into training curricula.
    MeSH term(s) Female ; Humans ; Genital Neoplasms, Female/therapy ; Reproducibility of Results ; Computer Simulation ; Uterine Cervical Neoplasms ; Ovarian Neoplasms ; Clinical Competence
    Language English
    Publishing date 2024-04-01
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 1070385-8
    ISSN 1525-1438 ; 1048-891X
    ISSN (online) 1525-1438
    ISSN 1048-891X
    DOI 10.1136/ijgc-2023-004557
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Association Between Purchase of Over-the-Counter Medications and Ovarian Cancer Diagnosis in the Cancer Loyalty Card Study (CLOCS): Observational Case-Control Study.

    Brewer, Hannah R / Hirst, Yasemin / Chadeau-Hyam, Marc / Johnson, Eric / Sundar, Sudha / Flanagan, James M

    JMIR public health and surveillance

    2023  Volume 9, Page(s) e41762

    Abstract: Background: Over-the-counter (OTC) medications are frequently used to self-care for nonspecific ovarian cancer symptoms prior to diagnosis. Monitoring such purchases may provide an opportunity for earlier diagnosis.: Objective: The aim of the Cancer ... ...

    Abstract Background: Over-the-counter (OTC) medications are frequently used to self-care for nonspecific ovarian cancer symptoms prior to diagnosis. Monitoring such purchases may provide an opportunity for earlier diagnosis.
    Objective: The aim of the Cancer Loyalty Card Study (CLOCS) was to investigate purchases of OTC pain and indigestion medications prior to ovarian cancer diagnosis in women with and without ovarian cancer in the United Kingdom using loyalty card data.
    Methods: An observational case-control study was performed comparing purchases of OTC pain and indigestion medications prior to diagnosis in women with (n=153) and without (n=120) ovarian cancer using loyalty card data from two UK-based high street retailers. Monthly purchases of pain and indigestion medications for cases and controls were compared using the Fisher exact test, conditional logistic regression, and receiver operating characteristic (ROC) curve analysis.
    Results: Pain and indigestion medication purchases were increased among cases 8 months before diagnosis, with maximum discrimination between cases and controls 8 months before diagnosis (Fisher exact odds ratio [OR] 2.9, 95% CI 2.1-4.1). An increase in indigestion medication purchases was detected up to 9 months before diagnosis (adjusted conditional logistic regression OR 1.38, 95% CI 1.04-1.83). The ROC analysis for indigestion medication purchases showed a maximum area under the curve (AUC) at 13 months before diagnosis (AUC=0.65, 95% CI 0.57-0.73), which further improved when stratified to late-stage ovarian cancer (AUC=0.68, 95% CI 0.59-0.78).
    Conclusions: There is a difference in purchases of pain and indigestion medications among women with and without ovarian cancer up to 8 months before diagnosis. Facilitating earlier presentation among those who self-care for symptoms using this novel data source could improve ovarian cancer patients' options for treatment and improve survival.
    Trial registration: ClinicalTrials.gov NCT03994653; https://clinicaltrials.gov/ct2/show/NCT03994653.
    MeSH term(s) Humans ; Female ; Case-Control Studies ; Dyspepsia ; Early Detection of Cancer ; Ovarian Neoplasms/diagnosis ; Ovarian Neoplasms/drug therapy ; Pain
    Language English
    Publishing date 2023-01-26
    Publishing country Canada
    Document type Observational Study ; Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 2369-2960
    ISSN (online) 2369-2960
    DOI 10.2196/41762
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Identifying strategies to support gynaecological cancer patients and carers during COVID-19: Learning from patient-charity interactions.

    Saha, Pratyusha / Sheikh, Jameela / Hebbar, Meghnaa / Sundar, Sudha / Lanceley, Anne

    European journal of cancer care

    2022  Volume 31, Issue 6, Page(s) e13682

    Abstract: Objectives: Supporting cancer patients during COVID-19 has posed unique challenges for health care providers. We investigated patient and carer-charity interactions to explore the role of charities and identify concerns expressed by patients. The study ... ...

    Abstract Objectives: Supporting cancer patients during COVID-19 has posed unique challenges for health care providers. We investigated patient and carer-charity interactions to explore the role of charities and identify concerns expressed by patients. The study aims to address these concerns and learn how health care providers can support patients.
    Methods: Digital interactions on forum posts and social media were collected from four gynaecological cancer charities from March-May 2019 (before COVID-19) and 2020 (during COVID-19). Thematic analysis of forum posts and semistructured charity staff interviews investigated patient and charity-focused perspectives.
    Results: Thematic analysis of forum posts and charity staff interviews (n = 8) revealed three consistent themes: (1) Health care changes and the effect on cancer management concerns; (2) psychological impact of lockdown isolation and anxiety of changed treatment; (3) the complexity of shielding guidance on self-risk assessment. Patients valued cancer charities' responses through digital and conventional methods (webinars, social media, forums, and websites).
    Conclusion: Gynaecological cancer patients had concerns about the risk and impact of changed treatment plans, contacting charities as the first port of call when anxious not to burden health systems. Real-time analysis of charities' communications can be used to identify concerns and to proactively provide patient support, together with health care providers.
    MeSH term(s) Humans ; COVID-19 ; Charities ; Caregivers ; Communicable Disease Control ; Neoplasms
    Language English
    Publishing date 2022-08-12
    Publishing country England
    Document type Journal Article
    ZDB-ID 1303114-4
    ISSN 1365-2354 ; 0961-5423 ; 1360-5801
    ISSN (online) 1365-2354
    ISSN 0961-5423 ; 1360-5801
    DOI 10.1111/ecc.13682
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Cancer Loyalty Card Study (CLOCS): feasibility outcomes for an observational case-control study focusing on the patient interval in ovarian cancer.

    Brewer, Hannah R / Chadeau-Hyam, Marc / Johnson, Eric / Sundar, Sudha / Flanagan, James / Hirst, Yasemin

    BMJ open

    2023  Volume 13, Issue 6, Page(s) e066022

    Abstract: Objectives: Ovarian cancer symptoms are often non-specific and can be normalised before patients seek medical help. The Cancer Loyalty Card Study investigated self-management behaviours of patients with ovarian cancer prior to their diagnosis using ... ...

    Abstract Objectives: Ovarian cancer symptoms are often non-specific and can be normalised before patients seek medical help. The Cancer Loyalty Card Study investigated self-management behaviours of patients with ovarian cancer prior to their diagnosis using loyalty card data collected by two UK-based high street retailers. Here, we discuss the feasibility outcomes for this novel research.
    Design: Observational case-control study.
    Setting: Control participants were invited to the study using social media and other sources from the general public. Once consented, control participants were required to submit proof of identification (ID) for their loyalty card data to be shared. Cases were identified using unique National Health Service (NHS) numbers (a proxy for ID) and were recruited through 12 NHS tertiary care clinics.
    Participants: Women in the UK, 18 years or older, with at least one of the participating high street retailers' loyalty cards. Those with an ovarian cancer diagnosis within 2 years of recruitment were considered cases, and those without an ovarian cancer diagnosis were considered controls.
    Primary outcome measures: Recruitment rates, demographics of participants and identification of any barriers to recruitment.
    Results: In total, 182 cases and 427 controls were recruited with significant differences by age, number of people in participants' households and the geographical region in the UK. However, only 37% (n=160/427) of control participants provided sufficient ID details and 81% (n=130/160) matched retailers' records. The majority of the participants provided complete responses to the 24-Item Ovarian Risk Questionnaire.
    Conclusions: Our findings show that recruitment to a study aiming to understand self-care behaviours using loyalty card data is challenging but feasible. The general public were willing to share their data for health research. Barriers in data sharing mechanisms need to be addressed to maximise participant retention.
    Trial registration number: ISRCTN14897082, CPMS 43323, NCT03994653.
    MeSH term(s) Humans ; Female ; Case-Control Studies ; Feasibility Studies ; State Medicine ; Ovarian Neoplasms/therapy ; Publications
    Language English
    Publishing date 2023-06-14
    Publishing country England
    Document type Observational Study ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2022-066022
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: COVID-19 and the impact on gynecologic cancer care.

    Manchanda, Ranjit / Oxley, Samuel / Ghaem-Maghami, Sadaf / Sundar, Sudha

    International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics

    2021  Volume 155 Suppl 1, Page(s) 94–101

    Abstract: The COVID-19 pandemic resulted in significant reconfiguration of gynecologic cancer services and care pathways across the globe, with a transformation of working practices. Services had to adapt to protect their vulnerable patients from infection, whilst ...

    Abstract The COVID-19 pandemic resulted in significant reconfiguration of gynecologic cancer services and care pathways across the globe, with a transformation of working practices. Services had to adapt to protect their vulnerable patients from infection, whilst providing care despite reduced resources/capacity and staffing. The international gynecologic cancer community introduced modified clinical care guidelines. Remote working, reduced hospital visiting, routine COVID-testing, and use of COVID-free surgical areas/hubs enabled the ongoing and safe delivery of complex cancer care, with priority levels for cancer treatments established to guide decision-making by multidisciplinary tumor boards. Some 2.3 million cancer surgeries were delayed or cancelled during the first peak, with many patients reporting significant anxiety/concern for cancer progression and COVID infection. Although COVID trials were prioritized, recruitment to other cancer trials/research activity was significantly reduced. The impact of resultant protocol deviations on outcomes remains to be established. During the recovery healthcare services must maintain capacity and flexibility to manage future surges of infection, address the large backlog of patients with altered or delayed treatments, along with salvaging screening and prevention services. Training needs/mental well-being of trainees need addressing and staff burnout prevented. Future research needs to fully evaluate the impact of COVID-19 on long-term patient outcomes.
    MeSH term(s) COVID-19 ; Female ; Genital Neoplasms, Female/therapy ; Humans ; Mental Health ; Pandemics ; SARS-CoV-2
    Language English
    Publishing date 2021-10-20
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80149-5
    ISSN 1879-3479 ; 0020-7292
    ISSN (online) 1879-3479
    ISSN 0020-7292
    DOI 10.1002/ijgo.13868
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article: The Performance of HE4 Alone and in Combination with CA125 for the Detection of Ovarian Cancer in an Enriched Primary Care Population.

    Barr, Chloe E / Funston, Garth / Jeevan, David / Sundar, Sudha / Mounce, Luke T A / Crosbie, Emma J

    Cancers

    2022  Volume 14, Issue 9

    Abstract: Human epididymis 4 (HE4) is a promising ovarian cancer biomarker, but it has not been evaluated in primary care. In this prospective observational study, we investigated the diagnostic accuracy of HE4 alone and in combination with CA125 for the detection ...

    Abstract Human epididymis 4 (HE4) is a promising ovarian cancer biomarker, but it has not been evaluated in primary care. In this prospective observational study, we investigated the diagnostic accuracy of HE4 alone and in combination with CA125 for the detection of ovarian cancer in symptomatic women attending primary care. General practitioner (GP)-requested CA125 samples were tested for HE4 at a large teaching hospital in Manchester, and cancer outcomes were tracked for 12 months. We found a low incidence of ovarian cancer in primary care; thus, the cohort was enriched with pre-surgical samples from 81 ovarian cancer patients. The Risk of Ovarian Malignancy Algorithm (ROMA) was calculated using age (</>51) as a surrogate for menopause. Conventional diagnostic accuracy metrics were determined. A total of 1229 patients were included; 82 had ovarian cancer. Overall, ROMA performed best (AUC-0.96 (95%CI: 0.94−0.98, p = <0.001)). In women under 50 years, the combination of CA125 and HE4 (either marker positive) was superior (sensitivity: 100% (95%CI: 81.5−100.0), specificity: 80.1% (95%CI 76.7−83.1)). In women over 50, ROMA performed best (sensitivity: 84.4% (95%CI: 73.1−92.2), specificity: 87.2% (95%CI 84.1−90)). HE4 and ROMA may improve ovarian cancer detection in primary care, particularly for women under 50 years, in whom diagnosis is challenging. Validation in a larger primary care cohort is required.
    Language English
    Publishing date 2022-04-24
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2527080-1
    ISSN 2072-6694
    ISSN 2072-6694
    DOI 10.3390/cancers14092124
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: How do we deliver safe bowel resection in ovarian cancer cytoreductive surgery?

    Wood, Nicholas J / Dobbs, Stephen / Tierney, Gill / Maxwell-Armstrong, Charles / Sundar, Sudha S

    International journal of gynecological cancer : official journal of the International Gynecological Cancer Society

    2022  

    Language English
    Publishing date 2022-06-17
    Publishing country England
    Document type Journal Article
    ZDB-ID 1070385-8
    ISSN 1525-1438 ; 1048-891X
    ISSN (online) 1525-1438
    ISSN 1048-891X
    DOI 10.1136/ijgc-2022-003470
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Thickened endometrium in asymptomatic postmenopausal women - determining an optimum threshold for prediction of atypical hyperplasia and cancer.

    Ghoubara, Ahmed / Emovon, Emmanuel / Sundar, Sudha / Ewies, Ayman

    Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology

    2018  Volume 38, Issue 8, Page(s) 1146–1149

    Abstract: There is a lack of consensus about the significance and the management of an incidental finding of endometrial thickness (ET) > 4 mm on transvaginal ultrasound scans in postmenopausal women without postmenopausal bleeding (PMB). The data of 1995 ... ...

    Abstract There is a lack of consensus about the significance and the management of an incidental finding of endometrial thickness (ET) > 4 mm on transvaginal ultrasound scans in postmenopausal women without postmenopausal bleeding (PMB). The data of 1995 consecutive women attending PMB clinic were collected prospectively; of them 81 (4.1%) were referred because of ET >4 mm without PMB. The prevalence of endometrial atypical hyperplasia and cancer was 4/81 (4.9%), and polyp was 20/81 (24.7%). On using a receiver operator characteristic curve, the diagnosis of endometrial atypical hyperplasia and cancer using the ET threshold of ≥10 mm had a sensitivity of 100% (95% CI = 40-100%), a specificity of 60% (95% CI = 48-71%) with AUC = 0.8 (95% CI = 0.66-0.93), p = .04. For the 35 women with an ET ≥10 mm, the prevalence of endometrial atypical hyperplasia and cancer was 4/35 (11.4%) and benign endometrial polyps was 16/35 (45.7%). The use of ≥10 mm ET threshold to prompt investigations did not miss any case of endometrial atypical hyperplasia or cancer. Impact Statement What is already known on this subject? Unlike women with PMB in whom an endometrial thickness (ET) ≤ 4 mm is considered as low risk for endometrial hyperplasia and cancer, in postmenopausal women without PMB, the threshold that separates normal from a pathologically thickened endometrium has not been standardised. A decision-analysis study in a hypothetical cohort found that ET threshold of 11 mm yields a similar separation as ≤4 mm in those with PMB. What the results of this study add? The study uses prospectively collected data from consecutive patients using a standardised format, thus minimising bias from incomplete data. This study is the third prospective series in the literature to address the dilemma of the management of asymptomatic postmenopausal women with an incidental finding of a thickened endometrium. It showed that the prevalence of endometrial atypical hyperplasia and cancer is high enough to justify investigation and for the clinical problem not to be trivialised. All cases of endometrial atypical hyperplasia and cancer had ET of ≥10 mm. What are the implications of these findings for clinical practice and/or future research? Our data strengthen the current body of literature to help the development of clinical practice guidelines about the management work-up. However, a well-designed multi-centre large prospective study is required to confirm the findings since most studies in the literature are either retrospective or small.
    MeSH term(s) Aged ; Aged, 80 and over ; Asymptomatic Diseases/epidemiology ; Endometrial Hyperplasia/diagnosis ; Endometrial Hyperplasia/epidemiology ; Endometrial Hyperplasia/pathology ; Endometrial Neoplasms/diagnosis ; Endometrial Neoplasms/epidemiology ; Endometrial Neoplasms/pathology ; Female ; Humans ; Middle Aged ; Polyps/diagnosis ; Polyps/epidemiology ; Polyps/pathology ; Postmenopause ; Prevalence ; United Kingdom/epidemiology
    Language English
    Publishing date 2018-06-03
    Publishing country England
    Document type Journal Article
    ZDB-ID 604639-3
    ISSN 1364-6893 ; 0144-3615
    ISSN (online) 1364-6893
    ISSN 0144-3615
    DOI 10.1080/01443615.2018.1458081
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Quality of life outcomes following surgery for advanced ovarian cancer: a systematic review and meta-analysis.

    Kumar, Satyam / Long, Joanna / Kehoe, Sean / Sundar, Sudha / Cummins, Carole

    International journal of gynecological cancer : official journal of the International Gynecological Cancer Society

    2019  Volume 29, Issue 8, Page(s) 1285–1291

    Abstract: Background: Quality of life after ovarian cancer treatment is an important goal for patients. Complex debulking surgeries and platinum based chemotherapy are often required but quality of life after surgery is rarely reported.: Objectives: To ... ...

    Abstract Background: Quality of life after ovarian cancer treatment is an important goal for patients. Complex debulking surgeries and platinum based chemotherapy are often required but quality of life after surgery is rarely reported.
    Objectives: To describe quality of life outcomes after surgery for advanced ovarian cancer in a systematic review and meta-analysis.
    Search strategy: MEDLINE, EMBASE, and CENTRAL through March 2019 with no language restrictions.
    Selection criteria: Included studies reported quality of life in women diagnosed with primary advanced ovarian cancer, fallopian tube carcinoma or primary peritoneal cancer undergoing cytoreduction surgery.
    Data collection and analysis: Data on extent and timing of surgery, quality of life outcomes, and surgical complications were extracted and study quality assessed.
    Results: Three randomized controlled trials comparing primary surgery to neoadjuvant chemotherapy had heterogeneous quality of life outcomes with no difference between arms, although there was a clinical improvement in global quality of life scores in both arms at 6 months compared with baseline. Data from two observational studies showed no meaningful difference in quality of life scores between patients undergoing standard or extensive surgery at 6 months.
    Conclusions: There was no clinically important difference in the quality of life of patients undergoing either primary debulking surgery or neoadjuvant chemotherapy. There is insufficient evidence on quality of life outcomes of patients undergoing extensive or ultra-radical surgery compared with those undergoing less extensive surgery. Quality of life outcomes matter to patients, but there is little evidence to inform patient choice regarding the extent of surgery.
    MeSH term(s) Carcinoma, Ovarian Epithelial/drug therapy ; Carcinoma, Ovarian Epithelial/surgery ; Chemotherapy, Adjuvant ; Cytoreduction Surgical Procedures ; Female ; Humans ; Neoadjuvant Therapy ; Ovarian Neoplasms/drug therapy ; Ovarian Neoplasms/surgery ; Quality of Life ; Randomized Controlled Trials as Topic
    Language English
    Publishing date 2019-07-03
    Publishing country England
    Document type Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Systematic Review
    ZDB-ID 1070385-8
    ISSN 1525-1438 ; 1048-891X
    ISSN (online) 1525-1438
    ISSN 1048-891X
    DOI 10.1136/ijgc-2018-000125
    Database MEDical Literature Analysis and Retrieval System OnLINE

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