Evaluating the Use of a Modified Early Warning Score in Predicting Serious Adverse Events in Iranian Hospitalized Patients: A Prognostic Study

Assessment of early clinical warning signs and appropriate response can prevent serious adverse events in hospitalized patients. The Modified Early Warning Score (MEWS) is an applicable early warning sign system that can be used to predict serious adverse events. This study aimed to evaluate the pre...

Full description

Saved in:
Bibliographic Details
Published in:Journal of emergency nursing 2020-01, Vol.46 (1), p.72-82
Main Authors: Maftoohian, Maryam, Assarroudi, Abdolghader, Stewart, Jacqueline J., Dastani, Mostafa, Rakhshani, Mohammad Hassan, Sahebkar, Mohammad
Format: Article
Language:English
Subjects:
Adverse
Blood pressure
Clinical assessment
Clinical outcomes
Consciousness
Critical care
Critical incidents
Emergency medical care
Emergency services
Heart rate
Hospitalization
Inpatient care
Medical prognosis
Modified Early Warning Score
Nursing
Ostomy
Patient admissions
Patients
Predictive value of tests
Sensitivity and specificity
Serious adverse events
Vital signs
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by cdi_FETCH-LOGICAL-c381t-ef0df4f5cd6752238d91cc46a571173a236e285fdd8ed46e41507a48efea56d63
cites cdi_FETCH-LOGICAL-c381t-ef0df4f5cd6752238d91cc46a571173a236e285fdd8ed46e41507a48efea56d63
container_end_page 82
container_issue 1
container_start_page 72
container_title Journal of emergency nursing
container_volume 46
creator Maftoohian, Maryam
Assarroudi, Abdolghader
Stewart, Jacqueline J.
Dastani, Mostafa
Rakhshani, Mohammad Hassan
Sahebkar, Mohammad
description Assessment of early clinical warning signs and appropriate response can prevent serious adverse events in hospitalized patients. The Modified Early Warning Score (MEWS) is an applicable early warning sign system that can be used to predict serious adverse events. This study aimed to evaluate the predictive capacity of the MEWS to identify patients in an Iranian hospital who are at risk of developing serious adverse events. In this prognostic study, 381 adult patients from the emergency department who were admitted to an inpatient hospital unit of an Iranian hospital from May 2018 to October 2018 were included. The MEWS tool was completed for each patient at the time of admission and then daily for a period of up to 30 continuous days after admission or until the development of a serious adverse event. Receiver operating characteristic, specificity, sensitivity, positive predictive values, and negative predictive values were calculated. In this study, a MEWS of ≥3 on admission was associated with an increased likelihood of developing serious adverse events within 30 days of admission with the area under the curve of 0.82 (95% confidence interval [CI]: 0.77–0.85), sensitivity of 82.81% (95% CI: 71.3–91.1), specificity of 75.39% (95% CI: 70.3–80), positive predictive value of 40.5% (95% CI: 35.2–45.9), and negative predictive value of 95.6% (95% CI: 92.7–97.4). A MEWS ≥3 on admission can predict the occurrence of serious averse events in patients admitted to an Iranian hospital for 30 continuous days.
doi_str_mv 10.1016/j.jen.2019.10.015
format article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2322747332</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0099176719305124</els_id><sourcerecordid>2333904858</sourcerecordid><originalsourceid>FETCH-LOGICAL-c381t-ef0df4f5cd6752238d91cc46a571173a236e285fdd8ed46e41507a48efea56d63</originalsourceid><addsrcrecordid>eNp9kc1u1DAUhS0EokPLA7BBlth0k8E_sZ3AalQNtFJRKw0VS8vYN8VRxh7sZKTpQ_DMOEzpggUry9Z3ju89B6E3lCwpofJ9v-whLBmhbbkvCRXP0IIKpirWSvkcLQhp24oqqU7Qq5x7QohQtH2JTjhtKJFMLNCv9d4Mkxl9uMfjD8B3GXDssMFfovOdB4fXJg0H_M2kMDMbGxNgH_BtAuftH90Gko9Txiu3h1T06z2EMc_QVTLBm4AvY9750Qz-oRjelt9m4ANeFZd4H2IevcWbcXKHM_SiM0OG14_nKbr7tP56cVld33y-ulhdV5Y3dKygI66rO2GdVIIx3riWWltLU_ajihvGJbBGdM414GoJNRVEmbqBDoyQTvJTdH703aX4c4I86q3PFobBBCiraMYZU7XinBX03T9oH6cUynSF4rwldSOaQtEjZVPMOUGnd8lvTTpoSvRclu51KUvPZc1PpayiefvoPH3fgntS_G2nAB-PAJQo9h6SzrZEZ0vyCeyoXfT_sf8NAJqlTg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2333904858</pqid></control><display><type>article</type><title>Evaluating the Use of a Modified Early Warning Score in Predicting Serious Adverse Events in Iranian Hospitalized Patients: A Prognostic Study</title><source>Applied Social Sciences Index &amp; Abstracts (ASSIA)</source><source>ScienceDirect Freedom Collection</source><source>Sociology Collection</source><source>ProQuest Social Science Premium Collection</source><creator>Maftoohian, Maryam ; Assarroudi, Abdolghader ; Stewart, Jacqueline J. ; Dastani, Mostafa ; Rakhshani, Mohammad Hassan ; Sahebkar, Mohammad</creator><creatorcontrib>Maftoohian, Maryam ; Assarroudi, Abdolghader ; Stewart, Jacqueline J. ; Dastani, Mostafa ; Rakhshani, Mohammad Hassan ; Sahebkar, Mohammad</creatorcontrib><description>Assessment of early clinical warning signs and appropriate response can prevent serious adverse events in hospitalized patients. The Modified Early Warning Score (MEWS) is an applicable early warning sign system that can be used to predict serious adverse events. This study aimed to evaluate the predictive capacity of the MEWS to identify patients in an Iranian hospital who are at risk of developing serious adverse events. In this prognostic study, 381 adult patients from the emergency department who were admitted to an inpatient hospital unit of an Iranian hospital from May 2018 to October 2018 were included. The MEWS tool was completed for each patient at the time of admission and then daily for a period of up to 30 continuous days after admission or until the development of a serious adverse event. Receiver operating characteristic, specificity, sensitivity, positive predictive values, and negative predictive values were calculated. In this study, a MEWS of ≥3 on admission was associated with an increased likelihood of developing serious adverse events within 30 days of admission with the area under the curve of 0.82 (95% confidence interval [CI]: 0.77–0.85), sensitivity of 82.81% (95% CI: 71.3–91.1), specificity of 75.39% (95% CI: 70.3–80), positive predictive value of 40.5% (95% CI: 35.2–45.9), and negative predictive value of 95.6% (95% CI: 92.7–97.4). A MEWS ≥3 on admission can predict the occurrence of serious averse events in patients admitted to an Iranian hospital for 30 continuous days.</description><identifier>ISSN: 0099-1767</identifier><identifier>EISSN: 1527-2966</identifier><identifier>DOI: 10.1016/j.jen.2019.10.015</identifier><identifier>PMID: 31810625</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adverse ; Blood pressure ; Clinical assessment ; Clinical outcomes ; Consciousness ; Critical care ; Critical incidents ; Emergency medical care ; Emergency services ; Heart rate ; Hospitalization ; Inpatient care ; Medical prognosis ; Modified Early Warning Score ; Nursing ; Ostomy ; Patient admissions ; Patients ; Predictive value of tests ; Sensitivity and specificity ; Serious adverse events ; Vital signs</subject><ispartof>Journal of emergency nursing, 2020-01, Vol.46 (1), p.72-82</ispartof><rights>2019 Emergency Nurses Association</rights><rights>Copyright © 2019 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.</rights><rights>2019. Emergency Nurses Association</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c381t-ef0df4f5cd6752238d91cc46a571173a236e285fdd8ed46e41507a48efea56d63</citedby><cites>FETCH-LOGICAL-c381t-ef0df4f5cd6752238d91cc46a571173a236e285fdd8ed46e41507a48efea56d63</cites><orcidid>0000-0003-2788-2827 ; 0000-0001-7234-3895</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2333904858/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$H</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2333904858?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>315,786,790,12873,21422,21423,27957,27958,31034,33646,33647,34565,34566,43768,44150,74578,74996</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31810625$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Maftoohian, Maryam</creatorcontrib><creatorcontrib>Assarroudi, Abdolghader</creatorcontrib><creatorcontrib>Stewart, Jacqueline J.</creatorcontrib><creatorcontrib>Dastani, Mostafa</creatorcontrib><creatorcontrib>Rakhshani, Mohammad Hassan</creatorcontrib><creatorcontrib>Sahebkar, Mohammad</creatorcontrib><title>Evaluating the Use of a Modified Early Warning Score in Predicting Serious Adverse Events in Iranian Hospitalized Patients: A Prognostic Study</title><title>Journal of emergency nursing</title><addtitle>J Emerg Nurs</addtitle><description>Assessment of early clinical warning signs and appropriate response can prevent serious adverse events in hospitalized patients. The Modified Early Warning Score (MEWS) is an applicable early warning sign system that can be used to predict serious adverse events. This study aimed to evaluate the predictive capacity of the MEWS to identify patients in an Iranian hospital who are at risk of developing serious adverse events. In this prognostic study, 381 adult patients from the emergency department who were admitted to an inpatient hospital unit of an Iranian hospital from May 2018 to October 2018 were included. The MEWS tool was completed for each patient at the time of admission and then daily for a period of up to 30 continuous days after admission or until the development of a serious adverse event. Receiver operating characteristic, specificity, sensitivity, positive predictive values, and negative predictive values were calculated. In this study, a MEWS of ≥3 on admission was associated with an increased likelihood of developing serious adverse events within 30 days of admission with the area under the curve of 0.82 (95% confidence interval [CI]: 0.77–0.85), sensitivity of 82.81% (95% CI: 71.3–91.1), specificity of 75.39% (95% CI: 70.3–80), positive predictive value of 40.5% (95% CI: 35.2–45.9), and negative predictive value of 95.6% (95% CI: 92.7–97.4). A MEWS ≥3 on admission can predict the occurrence of serious averse events in patients admitted to an Iranian hospital for 30 continuous days.</description><subject>Adverse</subject><subject>Blood pressure</subject><subject>Clinical assessment</subject><subject>Clinical outcomes</subject><subject>Consciousness</subject><subject>Critical care</subject><subject>Critical incidents</subject><subject>Emergency medical care</subject><subject>Emergency services</subject><subject>Heart rate</subject><subject>Hospitalization</subject><subject>Inpatient care</subject><subject>Medical prognosis</subject><subject>Modified Early Warning Score</subject><subject>Nursing</subject><subject>Ostomy</subject><subject>Patient admissions</subject><subject>Patients</subject><subject>Predictive value of tests</subject><subject>Sensitivity and specificity</subject><subject>Serious adverse events</subject><subject>Vital signs</subject><issn>0099-1767</issn><issn>1527-2966</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>7QJ</sourceid><sourceid>ALSLI</sourceid><sourceid>HEHIP</sourceid><recordid>eNp9kc1u1DAUhS0EokPLA7BBlth0k8E_sZ3AalQNtFJRKw0VS8vYN8VRxh7sZKTpQ_DMOEzpggUry9Z3ju89B6E3lCwpofJ9v-whLBmhbbkvCRXP0IIKpirWSvkcLQhp24oqqU7Qq5x7QohQtH2JTjhtKJFMLNCv9d4Mkxl9uMfjD8B3GXDssMFfovOdB4fXJg0H_M2kMDMbGxNgH_BtAuftH90Gko9Txiu3h1T06z2EMc_QVTLBm4AvY9750Qz-oRjelt9m4ANeFZd4H2IevcWbcXKHM_SiM0OG14_nKbr7tP56cVld33y-ulhdV5Y3dKygI66rO2GdVIIx3riWWltLU_ajihvGJbBGdM414GoJNRVEmbqBDoyQTvJTdH703aX4c4I86q3PFobBBCiraMYZU7XinBX03T9oH6cUynSF4rwldSOaQtEjZVPMOUGnd8lvTTpoSvRclu51KUvPZc1PpayiefvoPH3fgntS_G2nAB-PAJQo9h6SzrZEZ0vyCeyoXfT_sf8NAJqlTg</recordid><startdate>202001</startdate><enddate>202001</enddate><creator>Maftoohian, Maryam</creator><creator>Assarroudi, Abdolghader</creator><creator>Stewart, Jacqueline J.</creator><creator>Dastani, Mostafa</creator><creator>Rakhshani, Mohammad Hassan</creator><creator>Sahebkar, Mohammad</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0-V</scope><scope>3V.</scope><scope>7QJ</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ALSLI</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HEHIP</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M2S</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2788-2827</orcidid><orcidid>https://orcid.org/0000-0001-7234-3895</orcidid></search><sort><creationdate>202001</creationdate><title>Evaluating the Use of a Modified Early Warning Score in Predicting Serious Adverse Events in Iranian Hospitalized Patients: A Prognostic Study</title><author>Maftoohian, Maryam ; Assarroudi, Abdolghader ; Stewart, Jacqueline J. ; Dastani, Mostafa ; Rakhshani, Mohammad Hassan ; Sahebkar, Mohammad</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c381t-ef0df4f5cd6752238d91cc46a571173a236e285fdd8ed46e41507a48efea56d63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adverse</topic><topic>Blood pressure</topic><topic>Clinical assessment</topic><topic>Clinical outcomes</topic><topic>Consciousness</topic><topic>Critical care</topic><topic>Critical incidents</topic><topic>Emergency medical care</topic><topic>Emergency services</topic><topic>Heart rate</topic><topic>Hospitalization</topic><topic>Inpatient care</topic><topic>Medical prognosis</topic><topic>Modified Early Warning Score</topic><topic>Nursing</topic><topic>Ostomy</topic><topic>Patient admissions</topic><topic>Patients</topic><topic>Predictive value of tests</topic><topic>Sensitivity and specificity</topic><topic>Serious adverse events</topic><topic>Vital signs</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Maftoohian, Maryam</creatorcontrib><creatorcontrib>Assarroudi, Abdolghader</creatorcontrib><creatorcontrib>Stewart, Jacqueline J.</creatorcontrib><creatorcontrib>Dastani, Mostafa</creatorcontrib><creatorcontrib>Rakhshani, Mohammad Hassan</creatorcontrib><creatorcontrib>Sahebkar, Mohammad</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Social Sciences Premium Collection</collection><collection>ProQuest Central (Corporate)</collection><collection>Applied Social Sciences Index &amp; Abstracts (ASSIA)</collection><collection>ProQuest Nursing &amp; Allied Health Database</collection><collection>ProQuest_Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Public Health Database</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)</collection><collection>ProQuest Central</collection><collection>ProQuest Social Science Premium Collection</collection><collection>British Nursing Database</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</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>Sociology Collection</collection><collection>British Nursing Index</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Database (Alumni Edition)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest research library</collection><collection>Sociology Database (ProQuest)</collection><collection>Research Library (Corporate)</collection><collection>Nursing &amp; 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 China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of emergency nursing</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Maftoohian, Maryam</au><au>Assarroudi, Abdolghader</au><au>Stewart, Jacqueline J.</au><au>Dastani, Mostafa</au><au>Rakhshani, Mohammad Hassan</au><au>Sahebkar, Mohammad</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluating the Use of a Modified Early Warning Score in Predicting Serious Adverse Events in Iranian Hospitalized Patients: A Prognostic Study</atitle><jtitle>Journal of emergency nursing</jtitle><addtitle>J Emerg Nurs</addtitle><date>2020-01</date><risdate>2020</risdate><volume>46</volume><issue>1</issue><spage>72</spage><epage>82</epage><pages>72-82</pages><issn>0099-1767</issn><eissn>1527-2966</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Assessment of early clinical warning signs and appropriate response can prevent serious adverse events in hospitalized patients. The Modified Early Warning Score (MEWS) is an applicable early warning sign system that can be used to predict serious adverse events. This study aimed to evaluate the predictive capacity of the MEWS to identify patients in an Iranian hospital who are at risk of developing serious adverse events. In this prognostic study, 381 adult patients from the emergency department who were admitted to an inpatient hospital unit of an Iranian hospital from May 2018 to October 2018 were included. The MEWS tool was completed for each patient at the time of admission and then daily for a period of up to 30 continuous days after admission or until the development of a serious adverse event. Receiver operating characteristic, specificity, sensitivity, positive predictive values, and negative predictive values were calculated. In this study, a MEWS of ≥3 on admission was associated with an increased likelihood of developing serious adverse events within 30 days of admission with the area under the curve of 0.82 (95% confidence interval [CI]: 0.77–0.85), sensitivity of 82.81% (95% CI: 71.3–91.1), specificity of 75.39% (95% CI: 70.3–80), positive predictive value of 40.5% (95% CI: 35.2–45.9), and negative predictive value of 95.6% (95% CI: 92.7–97.4). A MEWS ≥3 on admission can predict the occurrence of serious averse events in patients admitted to an Iranian hospital for 30 continuous days.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31810625</pmid><doi>10.1016/j.jen.2019.10.015</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0003-2788-2827</orcidid><orcidid>https://orcid.org/0000-0001-7234-3895</orcidid></addata></record>
fulltext fulltext
identifier ISSN: 0099-1767
ispartof Journal of emergency nursing, 2020-01, Vol.46 (1), p.72-82
issn 0099-1767
1527-2966
language eng
recordid cdi_proquest_miscellaneous_2322747332
source Applied Social Sciences Index & Abstracts (ASSIA); ScienceDirect Freedom Collection; Sociology Collection; ProQuest Social Science Premium Collection
subjects Adverse
Blood pressure
Clinical assessment
Clinical outcomes
Consciousness
Critical care
Critical incidents
Emergency medical care
Emergency services
Heart rate
Hospitalization
Inpatient care
Medical prognosis
Modified Early Warning Score
Nursing
Ostomy
Patient admissions
Patients
Predictive value of tests
Sensitivity and specificity
Serious adverse events
Vital signs
title Evaluating the Use of a Modified Early Warning Score in Predicting Serious Adverse Events in Iranian Hospitalized Patients: A Prognostic Study
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-09-22T10%3A31%3A18IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Evaluating%20the%20Use%20of%20a%20Modified%20Early%20Warning%20Score%20in%20Predicting%20Serious%20Adverse%20Events%20in%20Iranian%20Hospitalized%20Patients:%20A%20Prognostic%20Study&rft.jtitle=Journal%20of%20emergency%20nursing&rft.au=Maftoohian,%20Maryam&rft.date=2020-01&rft.volume=46&rft.issue=1&rft.spage=72&rft.epage=82&rft.pages=72-82&rft.issn=0099-1767&rft.eissn=1527-2966&rft_id=info:doi/10.1016/j.jen.2019.10.015&rft_dat=%3Cproquest_cross%3E2333904858%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c381t-ef0df4f5cd6752238d91cc46a571173a236e285fdd8ed46e41507a48efea56d63%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2333904858&rft_id=info:pmid/31810625&rfr_iscdi=true