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  1. Article ; Online: Communication About Complementary and Alternative Medicine When Patients Decline Conventional Cancer Treatment: Patients' and Physicians' Experiences.

    Wode, Kathrin / Sharp, Lena / Fransson, Per / Nordberg, Johanna Hök

    The oncologist

    2023  Volume 28, Issue 9, Page(s) e774–e783

    Abstract: Background: Complementary and alternative medicine (CAM) is a broad set of nonconventional practices used alongside or instead of conventional treatment: The latter poses obvious risks related to cancer prognosis. Patient-physician dialogue about CAM is ...

    Abstract Background: Complementary and alternative medicine (CAM) is a broad set of nonconventional practices used alongside or instead of conventional treatment: The latter poses obvious risks related to cancer prognosis. Patient-physician dialogue about CAM is crucial for patient safety and mutual trust. Little is known about communication in the rare situations when patients decline recommended cancer treatment and consider using CAM. The objective of this study was to explore patients' and physicians' experiences from situations when patients decline recommended cancer treatment and consider using CAM.
    Materials and methods: Semi-structured interviews were carried out with 7 CAM-using cancer patients who had declined some or all conventional treatment as well as 10 physicians from oncology and palliative care. Framework analysis was used.
    Results: Regarding treatment choices, there was a dissonance between physicians' focus on medical reasoning and patients' expression of complex values. Physicians' difficulty in understanding patients' treatment decline was exacerbated when patients considered using CAM, impairing communication even further. Inequalities in roles resulting in power struggles risked pushing both parties toward extreme and inflexible standpoints. Despite these challenges regarding treatment choices and hierarchical roles, both parties considered open and respectful communication as crucial.
    Conclusions: This study highlights the difficulty of shared decision-making in practice when patients' and physicians' views on treatment decisions deviate in clinically challenging situations. Our results point to a need to address the complexity of these situations, pay attention to patients' values, and improve knowledge among physicians about CAM.
    MeSH term(s) Humans ; Physicians ; Complementary Therapies ; Physician-Patient Relations ; Communication ; Neoplasms/therapy
    Language English
    Publishing date 2023-04-06
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1409038-7
    ISSN 1549-490X ; 1083-7159
    ISSN (online) 1549-490X
    ISSN 1083-7159
    DOI 10.1093/oncolo/oyad084
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  2. Article ; Online: Use of CAM among cancer patients : Results of a regional survey in Sweden.

    Källman, Mikael / Bergström, Stefan / Carlsson, Tobias / Järås, Jacob / Holgersson, Georg / Nordberg, Johanna Hök / Nilsson, Jonas / Wode, Kathrin / Bergqvist, Michael

    BMC complementary medicine and therapies

    2023  Volume 23, Issue 1, Page(s) 51

    Abstract: Background: The use of complementary and alternative medicine (CAM) by patients is widespread. However, there is a lack of knowledge regarding the extent and details of patient CAM use in Sweden, especially in rural Sweden. The aim of this study was to ... ...

    Abstract Background: The use of complementary and alternative medicine (CAM) by patients is widespread. However, there is a lack of knowledge regarding the extent and details of patient CAM use in Sweden, especially in rural Sweden. The aim of this study was to estimate the extent and characteristics of CAM use among cancer patients in Region Gävleborg.
    Methods: A total of 631 questionnaires were distributed to which 376 responses were registered, yielding a response rate of 59.6%. Questionnaires were distributed to oncology patients at their first visit for curative treatment at the Department of Oncology, Gävle Hospital. Palliative patients were recruited at their first visit and during enrollment in palliative outpatient care in their own homes. The characteristics of the respondents were presented with standard descriptive statistics. A multivariable logistic model was fitted to calculate odds ratios (ORs) and identify potential predictors (Age, Gender, Education, Diagnosis) of CAM use post-cancer diagnosis.
    Results: 54% of all participants reported lifetime CAM use, 34% reported CAM use post-diagnosis. The most common CAM methods used after diagnosis are vitamins, health food preparations, herbal teas, prayer and dietary methods. The most common source of information reported is family and friends. Almost 70% of those who used CAM after their diagnosis stated that they did not discuss their use with healthcare professionals. Most patients reported that they would like some CAM modalities to be offered within conventional care regardless of their own CAM use.
    Conclusions: The use of CAM is common among patients with cancer in the region of Gävleborg, and previous studies show a similar use in Sweden in general. Based on the widespread use of CAM and patient interest in discussing CAM use with healthcare professionals, greater attention and focus should be placed on creating a basis for this dialogue. If we, as healthcare professionals, are to emphasise our commitment to providing patient-centred care, we must acknowledge that patients use CAM and are seeking a dialogue about CAM use in their care.
    MeSH term(s) Humans ; Sweden ; Neoplasms/therapy ; Surveys and Questionnaires ; Health Personnel ; Complementary Therapies
    Language English
    Publishing date 2023-02-16
    Publishing country England
    Document type Journal Article
    ISSN 2662-7671
    ISSN (online) 2662-7671
    DOI 10.1186/s12906-023-03876-2
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  3. Article ; Online: Use of CAM among cancer patients : Results of a regional survey in Sweden

    Källman, Mikael / Bergström, Stefan / Carlsson, Tobias / Järås, Jacob / Holgersson, Georg / Nordberg, Johanna Hök / Nilsson, Jonas / Wode, Kathrin / Bergqvist, Michael

    BMC Complement Med Ther. 2023 Dec., v. 23, no. 1 p.51-51

    2023  

    Abstract: BACKGROUND: The use of complementary and alternative medicine (CAM) by patients is widespread. However, there is a lack of knowledge regarding the extent and details of patient CAM use in Sweden, especially in rural Sweden. The aim of this study was to ... ...

    Abstract BACKGROUND: The use of complementary and alternative medicine (CAM) by patients is widespread. However, there is a lack of knowledge regarding the extent and details of patient CAM use in Sweden, especially in rural Sweden. The aim of this study was to estimate the extent and characteristics of CAM use among cancer patients in Region Gävleborg. METHODS: A total of 631 questionnaires were distributed to which 376 responses were registered, yielding a response rate of 59.6%. Questionnaires were distributed to oncology patients at their first visit for curative treatment at the Department of Oncology, Gävle Hospital. Palliative patients were recruited at their first visit and during enrollment in palliative outpatient care in their own homes. The characteristics of the respondents were presented with standard descriptive statistics. A multivariable logistic model was fitted to calculate odds ratios (ORs) and identify potential predictors (Age, Gender, Education, Diagnosis) of CAM use post-cancer diagnosis. RESULTS: 54% of all participants reported lifetime CAM use, 34% reported CAM use post-diagnosis. The most common CAM methods used after diagnosis are vitamins, health food preparations, herbal teas, prayer and dietary methods. The most common source of information reported is family and friends. Almost 70% of those who used CAM after their diagnosis stated that they did not discuss their use with healthcare professionals. Most patients reported that they would like some CAM modalities to be offered within conventional care regardless of their own CAM use. CONCLUSIONS: The use of CAM is common among patients with cancer in the region of Gävleborg, and previous studies show a similar use in Sweden in general. Based on the widespread use of CAM and patient interest in discussing CAM use with healthcare professionals, greater attention and focus should be placed on creating a basis for this dialogue. If we, as healthcare professionals, are to emphasise our commitment to providing patient-centred care, we must acknowledge that patients use CAM and are seeking a dialogue about CAM use in their care.
    Keywords alternative medicine ; complement ; descriptive statistics ; education ; gender ; health foods ; health services ; hospitals ; information sources ; logit analysis ; patients ; regional surveys ; Sweden
    Language English
    Dates of publication 2023-12
    Size p. 51.
    Publishing place BioMed Central
    Document type Article ; Online
    ISSN 2662-7671
    DOI 10.1186/s12906-023-03876-2
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  4. Article ; Online: Acupuncture in cancer care: recommendations for safe practice (peer-reviewed expert opinion).

    de Valois, Beverley / Young, Teresa / Zollman, Catherine / Appleyard, Ian / Ben-Arye, Eran / Cummings, Mike / Green, Ruth / Hoffman, Caroline / Lacey, Judith / Moir, Felicity / Peckham, Rachel / Stringer, Jacqui / Veleber, Susan / Weitzman, Matthew / Wode, Kathrin

    Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer

    2024  Volume 32, Issue 4, Page(s) 229

    Abstract: Background: Up-to-date recommendations for the safe practice of acupuncture in integrative oncology are overdue with new cancer treatments and an increase in survivors with late effects of disease; 17 years have elapsed since Filshie and Hester's 2006 ... ...

    Abstract Background: Up-to-date recommendations for the safe practice of acupuncture in integrative oncology are overdue with new cancer treatments and an increase in survivors with late effects of disease; 17 years have elapsed since Filshie and Hester's 2006 guidelines. During 2022/2023 an expert panel assembled to produce updated recommendations aiming to facilitate safe and appropriate care by acupuncturists working with people with cancer.
    Methods: A core development team comprising three integrative oncology professionals comprehensively updated pre-existing unpublished recommendations. Twelve invited international experts (senior acupuncturists with and without experience of working in oncology settings, oncologists, physicians and nurses trained in integrative oncology, researchers, academics, and professional body representatives) reviewed the recommendations. In multiple iterations, the core team harmonised comments for final ratification. To aid dissemination and uptake the panel represents national and international integrative oncology associations and major cancer treatment centres in Europe, USA, Australia, and the Middle East.
    Results: These recommendations facilitate safe care by articulating contra-indications, cautions, and risks for patients both on and off treatment (surgery, SACT, radiotherapy). Situations where acupuncture may be contra-indicated or practices need adapting are identified. "Red and Amber Flags" highlight where urgent referral is essential.
    Conclusion: These are the first international, multidisciplinary peer-reviewed recommendations for safe acupuncture practice in integrative oncology. Concerns about safety remain a significant barrier to appropriate referral from oncology teams, to use by acupuncturists and to uptake by patients. Disseminating trustworthy, widely accessible guidance should facilitate informed, confident practice of acupuncture in and outside of oncology healthcare settings.
    MeSH term(s) Humans ; Expert Testimony ; Acupuncture Therapy ; Acupuncture ; Neoplasms/therapy ; Medical Oncology
    Language English
    Publishing date 2024-03-14
    Publishing country Germany
    Document type Journal Article ; Review
    ZDB-ID 1134446-5
    ISSN 1433-7339 ; 0941-4355
    ISSN (online) 1433-7339
    ISSN 0941-4355
    DOI 10.1007/s00520-024-08386-6
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    Zs.A 3697: Show issues Location:
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  5. Article ; Online: Cancer patients’ use of complementary and alternative medicine in Sweden: a cross-sectional study

    Wode, Kathrin / Henriksson, Roger / Sharp, Lena / Stoltenberg, Anna / Hök Nordberg, Johanna

    BMC Complement Altern Med. 2019 Dec., v. 19, no. 1 p.62-62

    2019  

    Abstract: BACKGROUND: Access to and advice on Complementary and Alternative Medicine (CAM) are uncommon within Swedish conventional cancer care and little is known about cancer patients’ own use of CAM. The aim of this cross-sectional study was to explore Swedish ... ...

    Abstract BACKGROUND: Access to and advice on Complementary and Alternative Medicine (CAM) are uncommon within Swedish conventional cancer care and little is known about cancer patients’ own use of CAM. The aim of this cross-sectional study was to explore Swedish cancer patients´ patterns of CAM use, their experiences and preferences. METHODS: Questionnaires were distributed consecutively to 1297 cancer patients at a university hospital’s out-patient oncology units. The response rate was 58% (n = 755). Descriptive statistics were used to analyze the survey data. A logistic regression model was used to investigate the association between CAM use and gender, age and level of education. Open-ended responses were analyzed, using qualitative content analysis. RESULTS: Lifetime CAM use was reported by 34% (n = 256), and 26% (n = 198) used CAM after cancer diagnosis. Being female, younger and having higher education predicted CAM use. Most commonly used methods were natural products including vitamins and minerals and relaxation. Main reasons for CAM use were improvement of physical, general and emotional wellbeing and increasing the body’s ability to fight cancer. Satisfaction with CAM usage was generally high. Reported adverse effects were few and mild; 54% of users spent < 50 Euro a month on CAM. One third had discussed their CAM use with cancer care providers. More than half of all participants thought that cancer care providers should be able to discuss (58%) and to consider (54%) use of CAM modalities in cancer care. CONCLUSIONS: Despite limited access and advice within conventional cancer care, one fourth of Swedish cancer patients use CAM. The insufficient patient-provider dialogue diverges with most patients’ wish for professional guidance in their decisions and integration of CAM modalities in conventional cancer care. Concurrent and multimodal CAM use implies challenges and possibilities for cancer care that need to be considered.
    Keywords alternative medicine ; complement ; cross-sectional studies ; descriptive statistics ; educational status ; females ; hospitals ; regression analysis ; surveys ; Sweden
    Language English
    Dates of publication 2019-12
    Size p. 62.
    Publishing place BioMed Central
    Document type Article ; Online
    Note Resource is Open Access
    ZDB-ID 2050429-9
    ISSN 1472-6882
    ISSN 1472-6882
    DOI 10.1186/s12906-019-2452-5
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  6. Article ; Online: Cancer patients' use of complementary and alternative medicine in Sweden: a cross-sectional study.

    Wode, Kathrin / Henriksson, Roger / Sharp, Lena / Stoltenberg, Anna / Hök Nordberg, Johanna

    BMC complementary and alternative medicine

    2019  Volume 19, Issue 1, Page(s) 62

    Abstract: Background: Access to and advice on Complementary and Alternative Medicine (CAM) are uncommon within Swedish conventional cancer care and little is known about cancer patients' own use of CAM. The aim of this cross-sectional study was to explore Swedish ...

    Abstract Background: Access to and advice on Complementary and Alternative Medicine (CAM) are uncommon within Swedish conventional cancer care and little is known about cancer patients' own use of CAM. The aim of this cross-sectional study was to explore Swedish cancer patients´ patterns of CAM use, their experiences and preferences.
    Methods: Questionnaires were distributed consecutively to 1297 cancer patients at a university hospital's out-patient oncology units. The response rate was 58% (n = 755). Descriptive statistics were used to analyze the survey data. A logistic regression model was used to investigate the association between CAM use and gender, age and level of education. Open-ended responses were analyzed, using qualitative content analysis.
    Results: Lifetime CAM use was reported by 34% (n = 256), and 26% (n = 198) used CAM after cancer diagnosis. Being female, younger and having higher education predicted CAM use. Most commonly used methods were natural products including vitamins and minerals and relaxation. Main reasons for CAM use were improvement of physical, general and emotional wellbeing and increasing the body's ability to fight cancer. Satisfaction with CAM usage was generally high. Reported adverse effects were few and mild; 54% of users spent < 50 Euro a month on CAM. One third had discussed their CAM use with cancer care providers. More than half of all participants thought that cancer care providers should be able to discuss (58%) and to consider (54%) use of CAM modalities in cancer care.
    Conclusions: Despite limited access and advice within conventional cancer care, one fourth of Swedish cancer patients use CAM. The insufficient patient-provider dialogue diverges with most patients' wish for professional guidance in their decisions and integration of CAM modalities in conventional cancer care. Concurrent and multimodal CAM use implies challenges and possibilities for cancer care that need to be considered.
    MeSH term(s) Adult ; Aged ; Complementary Therapies ; Cross-Sectional Studies ; Female ; Humans ; Male ; Middle Aged ; Neoplasms/epidemiology ; Neoplasms/therapy ; Oncology Service, Hospital ; Surveys and Questionnaires ; Sweden/epidemiology
    Language English
    Publishing date 2019-03-13
    Publishing country England
    Document type Journal Article
    ZDB-ID 2050429-9
    ISSN 1472-6882 ; 1472-6882
    ISSN (online) 1472-6882
    ISSN 1472-6882
    DOI 10.1186/s12906-019-2452-5
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  7. Article ; Online: Consultations with health care providers and use of self-management strategies for prevention and treatment of COVID-19 related symptoms. A population based cross-sectional study in Norway, Sweden and the Netherlands.

    Kristoffersen, Agnete E / van der Werf, Esther T / Stub, Trine / Musial, Frauke / Wider, Barbara / Jong, Miek C / Wode, Kathrin / Danell, Jenny-Ann B / Busch, Martine / Hoenders, H J Rogier / Nordberg, Johanna H

    Complementary therapies in medicine

    2021  Volume 64, Page(s) 102792

    Abstract: Objectives: The present study was initiated to determine consultations with health care providers and use of self-management strategies for prevention or treatment of COVID-19 related symptoms in countries with a full lockdown (Norway), a partial ... ...

    Abstract Objectives: The present study was initiated to determine consultations with health care providers and use of self-management strategies for prevention or treatment of COVID-19 related symptoms in countries with a full lockdown (Norway), a partial lockdown (the Netherlands) and no lockdown (Sweden) during the first three months of the COVID-19 pandemic, and if such use correlates with worries of being infected by COVID-19 disease.
    Design: Data were collected in collaboration with Ipsos A/S in April-June 2020. An adapted version of the International Questionnaire to measure use of Complementary and Alternative Medicine (I-CAM-Q) was used with the categories "for prevention of COVID-19" and "to treat COVID-19-related symptoms" added. Data were collected among a representative sample in Norway, Sweden and the Netherlands using data assisted telephone interviews (Norway, n=990 and Sweden, n=500), and an online survey (the Netherlands, n=1004). Total response rate was 30%.
    Results: Very few consulted a health care provider with the intention to treat or prevent COVID-19 (1.2% and 1.0% respectively) with medical doctors mostly visited (1.0% and 0.9% respectively). Similarly, the use of self-management strategies to prevent or treat COVID-19 was low (3.4% and 0.2% respectively); most commonly used for prevention of COVID-19 were vitamins and minerals (2.8%). Consultations with health care providers and use of self-management strategies for prevention of COVID-19 were positively associated with worries of being infected with COVID-19.
    Conclusions: The COVID-19 pandemic does not seem to have evoked a large-scale difference in behavior related to consultations with health care providers or the use of self-management strategies in any of the three countries.
    MeSH term(s) COVID-19 ; Communicable Disease Control ; Cross-Sectional Studies ; Health Personnel ; Humans ; Netherlands/epidemiology ; Pandemics ; Referral and Consultation ; SARS-CoV-2 ; Self-Management ; Sweden/epidemiology
    Language English
    Publishing date 2021-11-23
    Publishing country Scotland
    Document type Journal Article
    ZDB-ID 1155895-7
    ISSN 1873-6963 ; 0965-2299
    ISSN (online) 1873-6963
    ISSN 0965-2299
    DOI 10.1016/j.ctim.2021.102792
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    Zs.A 3726: Show issues Location:
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  8. Article ; Online: Efficacy of mistletoe extract as a complement to standard treatment in advanced pancreatic cancer: study protocol for a multicentre, parallel group, double-blind, randomised, placebo-controlled clinical trial (MISTRAL).

    Wode, Kathrin / Hök Nordberg, Johanna / Kienle, Gunver S / Elander, Nils O / Bernhardson, Britt-Marie / Sunde, Berit / Sharp, Lena / Henriksson, Roger / Fransson, Per

    Trials

    2020  Volume 21, Issue 1, Page(s) 783

    Abstract: Background: Most pancreatic cancer patients present with advanced stage at diagnosis with extremely short expected survival and few treatment options. A multimodal palliative approach is necessary for symptom relief and optimisation of health-related ... ...

    Abstract Background: Most pancreatic cancer patients present with advanced stage at diagnosis with extremely short expected survival and few treatment options. A multimodal palliative approach is necessary for symptom relief and optimisation of health-related quality of life. In a recent open-label trial of mistletoe extract for advanced pancreatic cancer patients not eligible for chemotherapy, promising results on improved overall survival and better health-related quality of life were reported. The objective of the present study is to assess the value of mistletoe extract as a complement to standard treatment (palliative chemotherapy or best supportive care) in advanced pancreatic cancer patients with regard to overall survival and health-related quality of life.
    Methods: The trial is prospective, randomised, double-blind, multicentre, parallel group and placebo-controlled. In total, 290 participants are randomly assigned to placebo or mistletoe extract given subcutaneously in increasing dosage from 0.01 to 20 mg three times per week for 9 months. Stratification is performed for site and palliative chemotherapy. Main inclusion criteria are advanced pancreatic cancer and Eastern Cooperative Oncology Group performance status 0 to 2; main exclusion criteria are life expectancy less than 4 weeks and neuroendocrine tumour of the pancreas. Two ancillary studies on sub-sets of participants are nested in the trial: a biomarker study collecting blood samples and a cross-sectional qualitative study with semi-structured face-to-face interviews.
    Discussion: To our knowledge, this is the first placebo-controlled randomised trial assessing the impact of mistletoe extract as a complement to standard treatment on overall survival and health-related quality of life in patients with advanced pancreatic cancer. The presented trial with its two nested ancillary studies exploring biomarkers and patient experiences is expected to give new insights into the treatment of advanced pancreatic cancer.
    Trial registration: EU Clinical Trial Register, EudraCT Number 2014-004552-64 . Registered on 19 January 2016. ClinicalTrials.gov NCT02948309 . Registered on 28 October 2016.
    MeSH term(s) Cross-Sectional Studies ; Double-Blind Method ; Humans ; Mistletoe ; Multicenter Studies as Topic ; Pancreatic Neoplasms/drug therapy ; Plant Extracts/adverse effects ; Prospective Studies ; Quality of Life ; Randomized Controlled Trials as Topic ; Treatment Outcome
    Chemical Substances Plant Extracts
    Language English
    Publishing date 2020-09-11
    Publishing country England
    Document type Clinical Trial Protocol ; Journal Article
    ZDB-ID 2040523-6
    ISSN 1745-6215 ; 1468-6694 ; 1468-6708
    ISSN (online) 1745-6215 ; 1468-6694
    ISSN 1468-6708
    DOI 10.1186/s13063-020-04581-y
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  9. Article ; Online: Anthroposophic health care--different and home-like.

    Arman, Maria / Ranheim, Albertine / Rehnsfeldt, Arne / Wode, Kathrin

    Scandinavian journal of caring sciences

    2008  Volume 22, Issue 3, Page(s) 357–366

    Abstract: Anthroposophic health care is rooted in the work of Steiner and Wegman in Switzerland during the 1920s. The Swedish hospital in this study offers integrated conventional and anthroposophic health care therapies which are conceptualized as an extended and ...

    Abstract Anthroposophic health care is rooted in the work of Steiner and Wegman in Switzerland during the 1920s. The Swedish hospital in this study offers integrated conventional and anthroposophic health care therapies which are conceptualized as an extended and integrative variant of health care and not as CAM. In anthroposophic care, health is viewed as a matter of body, soul and spirit in balance. Therapeutic resources include nursing care, therapeutic conduct (art and body therapies) and medicines based on natural remedies. This study aims to deepen the understanding of what constitutes good care from a patient's perspective to alleviate patients' suffering and to identify clinical markers for good care. As anthroposophic care is associated with theory and holistic ideas, this study aims at exploring whether or not anthroposophic care has a beneficial effect. A qualitative method was used, and the analysis was conducted with a phenomenological hermeneutic approach. Sixteen former patients, of whom nine were diagnosed with various kinds of cancer and seven with burnout syndrome, were interviewed regarding their experience of anthroposophic care. Patients especially noted the benefits of the holistic caring environment; the empathetic approach and true caring offered, as well as the peaceful atmosphere and rest. A turning point or shift in perspectives, implying a home coming in relation to inner aspects was discussed as an outcome. Although patients in general were overwhelmingly impressed and positive they were also ambivalent. One interpretation is that there is a gap between the anthroposophic and conventional paradigm that affects patients negatively. As mutual scepticism still prevents any real integration between integrative and conventional care, the onus appears to be on the patient to take the risk and act as bridge-builder. From a caring science perspective, the study shows that appropriation of specific values and theory makes it possible to create a true caring culture.
    MeSH term(s) Adult ; Aged ; Anthroposophy/psychology ; Female ; Holistic Health ; Humans ; Interviews as Topic ; Male ; Middle Aged ; Neoplasms ; Patient Care ; Quality Indicators, Health Care ; Stress, Psychological/complications ; Switzerland
    Language English
    Publishing date 2008-09
    Publishing country Sweden
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 639217-9
    ISSN 1471-6712 ; 0283-9318
    ISSN (online) 1471-6712
    ISSN 0283-9318
    DOI 10.1111/j.1471-6712.2007.00536.x
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  10. Article: Anthroposophie health care - different and home-like

    Arman, Maria / Ranheim, Albertine / Rehnsfeldt, Arne / Wode, Kathrin

    Der Merkurstab

    2011  Volume 64, Issue 3, Page(s) 138

    Language German
    Document type Article
    ZDB-ID 392536-5
    ISSN 0935-798X
    Database Current Contents Medicine

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