Safety and efficacy of pimecrolimus versus vehicle for the treatment of atopic dermatitis in adults and paediatric population: a systematic review and meta-analysis

Atopic dermatitis remains a widespread problem affecting various populations globally. While numerous treatment options have been employed, pimecrolimus remains a potent and viable option. Recently, there has been increasing interest in comparing the safety and efficacy of pimecrolimus with its vehi...

Full description

Saved in:
Bibliographic Details
Published in:Annals of medicine and surgery 2023-07, Vol.85 (7), p.3563-3573
Main Authors: Akhtar, Sareema E, Shakil, Saad, Farooqui, Sabeeh K, Khedro, Tarek, Alzufairi, Ahmad L, Niaz, Muhammad A, Syed, Saifullah, Jiffry, Riaz, Alsubai, Abdulla K, Almesri, Abdullah, Ismail, Hebatalla, Khan, Kashif A, Al-Hindawi, Ahmed, Ali, Hussein K, Falodun, Timothy, Tabassi, Aysa, Tabassi, Aylin, Almas, Talal
Format: Article
Language:English
Subjects:
Review
Citations: Items that this one cites
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by
cites cdi_FETCH-LOGICAL-c288t-118ed52f1cec6ad2eb4795fb341e8aba5ee0c6ef56c7663aca69911e7867e2af3
container_end_page 3573
container_issue 7
container_start_page 3563
container_title Annals of medicine and surgery
container_volume 85
creator Akhtar, Sareema E
Shakil, Saad
Farooqui, Sabeeh K
Khedro, Tarek
Alzufairi, Ahmad L
Niaz, Muhammad A
Syed, Saifullah
Jiffry, Riaz
Alsubai, Abdulla K
Almesri, Abdullah
Ismail, Hebatalla
Khan, Kashif A
Al-Hindawi, Ahmed
Ali, Hussein K
Falodun, Timothy
Tabassi, Aysa
Tabassi, Aylin
Almas, Talal
description Atopic dermatitis remains a widespread problem affecting various populations globally. While numerous treatment options have been employed, pimecrolimus remains a potent and viable option. Recently, there has been increasing interest in comparing the safety and efficacy of pimecrolimus with its vehicle. The authors conducted a comprehensive search of several databases, including PubMed, COCHRANE, MEDLINE, and Cochrane Central, from inception to May 2022, using a wide search strategy with Boolean operators. The authors also employed backward snowballing to identify any studies missed in the initial search. The authors included randomized controlled trials in our meta-analysis and extracted data from the identified studies. The authors used Review Manager (RevMan) Version 5.4 to analyze the data, selecting a random-effects model due to observed differences in study populations and settings. The authors considered a -value of 0.05 or lower to be statistically significant. The authors initially identified 211 studies, of which 13 randomized controlled trials involving 4180 participants were selected for analysis. Our pooled analysis revealed that pimecrolimus 1% was more effective at reducing the severity of atopic dermatitis than its vehicles. However, no significant difference was observed in adverse effects between pimecrolimus and vehicle, except for pyrexia, nasopharyngitis, and headache, which were increased with pimecrolimus. Our meta-analysis showed that pimecrolimus 1% is more effective than vehicle, although the safety profile remains inconclusive. Pimecrolimus reduced the Investigator's Global Assessment score, Eczema Area and Severity Index score, and severity of pruritus when compared to its vehicle, indicating a higher efficacy profile. This is one of the first meta-analyses to assess the efficacy and safety profile of pimecrolimus 1% against a vehicle and may assist physicians in making informed decisions.
doi_str_mv 10.1097/MS9.0000000000000844
format article
fullrecord <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10328566</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2839251870</sourcerecordid><originalsourceid>FETCH-LOGICAL-c288t-118ed52f1cec6ad2eb4795fb341e8aba5ee0c6ef56c7663aca69911e7867e2af3</originalsourceid><addsrcrecordid>eNpdkctuFDEQRS0EItGQP0DISzad-NEPNxuEIiBIQSwCa6vGXWaM3O3Gdg_q_-FD8UxCNOBNWfK5t1x1CXnJ2SVnfXf1-a6_ZKdH1fUTci5Y3VdMMf705H5GLlL6URjOGtm26jk5k10tOq7kOfl9BxbzSmEaKFrrDJiVBktnN6KJwbtxSXSPMR3LzhmP1IZI8w5pjgh5xCkfBJDD7AwdMI6QXXaJuonCsPicjuYz4OAgx8LMYV58gcL0hgJNa8p40Bgace_w1xEfMUMFE_g1ufSCPLPgE1481A359uH91-ub6vbLx0_X724rI5TKFecKh0ZYbtC0MAjc1l3f2K2sOSrYQoPITIu2aU3XthIMtH3POXaq7VCAlRvy9t53XrYjDqaMFsHrOboR4qoDOP3vy-R2-nvYa86kUE3x3JDXDw4x_FwwZT26ZNB7mDAsSQsle9Fw1bGC1vdoWXNKEe1jH870IWRdQtb_h1xkr07_-Cj6G6n8A9VmqCE</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2839251870</pqid></control><display><type>article</type><title>Safety and efficacy of pimecrolimus versus vehicle for the treatment of atopic dermatitis in adults and paediatric population: a systematic review and meta-analysis</title><source>BACON - Elsevier - GLOBAL_SCIENCEDIRECT-OPENACCESS</source><source>PubMed Central</source><creator>Akhtar, Sareema E ; Shakil, Saad ; Farooqui, Sabeeh K ; Khedro, Tarek ; Alzufairi, Ahmad L ; Niaz, Muhammad A ; Syed, Saifullah ; Jiffry, Riaz ; Alsubai, Abdulla K ; Almesri, Abdullah ; Ismail, Hebatalla ; Khan, Kashif A ; Al-Hindawi, Ahmed ; Ali, Hussein K ; Falodun, Timothy ; Tabassi, Aysa ; Tabassi, Aylin ; Almas, Talal</creator><creatorcontrib>Akhtar, Sareema E ; Shakil, Saad ; Farooqui, Sabeeh K ; Khedro, Tarek ; Alzufairi, Ahmad L ; Niaz, Muhammad A ; Syed, Saifullah ; Jiffry, Riaz ; Alsubai, Abdulla K ; Almesri, Abdullah ; Ismail, Hebatalla ; Khan, Kashif A ; Al-Hindawi, Ahmed ; Ali, Hussein K ; Falodun, Timothy ; Tabassi, Aysa ; Tabassi, Aylin ; Almas, Talal</creatorcontrib><description>Atopic dermatitis remains a widespread problem affecting various populations globally. While numerous treatment options have been employed, pimecrolimus remains a potent and viable option. Recently, there has been increasing interest in comparing the safety and efficacy of pimecrolimus with its vehicle. The authors conducted a comprehensive search of several databases, including PubMed, COCHRANE, MEDLINE, and Cochrane Central, from inception to May 2022, using a wide search strategy with Boolean operators. The authors also employed backward snowballing to identify any studies missed in the initial search. The authors included randomized controlled trials in our meta-analysis and extracted data from the identified studies. The authors used Review Manager (RevMan) Version 5.4 to analyze the data, selecting a random-effects model due to observed differences in study populations and settings. The authors considered a -value of 0.05 or lower to be statistically significant. The authors initially identified 211 studies, of which 13 randomized controlled trials involving 4180 participants were selected for analysis. Our pooled analysis revealed that pimecrolimus 1% was more effective at reducing the severity of atopic dermatitis than its vehicles. However, no significant difference was observed in adverse effects between pimecrolimus and vehicle, except for pyrexia, nasopharyngitis, and headache, which were increased with pimecrolimus. Our meta-analysis showed that pimecrolimus 1% is more effective than vehicle, although the safety profile remains inconclusive. Pimecrolimus reduced the Investigator's Global Assessment score, Eczema Area and Severity Index score, and severity of pruritus when compared to its vehicle, indicating a higher efficacy profile. This is one of the first meta-analyses to assess the efficacy and safety profile of pimecrolimus 1% against a vehicle and may assist physicians in making informed decisions.</description><identifier>ISSN: 2049-0801</identifier><identifier>EISSN: 2049-0801</identifier><identifier>DOI: 10.1097/MS9.0000000000000844</identifier><identifier>PMID: 37427183</identifier><language>eng</language><publisher>England: Lippincott Williams &amp; Wilkins</publisher><subject>Review</subject><ispartof>Annals of medicine and surgery, 2023-07, Vol.85 (7), p.3563-3573</ispartof><rights>Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.</rights><rights>Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. 2023</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c288t-118ed52f1cec6ad2eb4795fb341e8aba5ee0c6ef56c7663aca69911e7867e2af3</cites><orcidid>0000-0001-5397-3082 ; 0000-0002-8867-600X ; 0000-0003-0394-5256 ; 0000-0003-1622-7675 ; 0000-0001-6991-4060 ; 0000-0002-3965-3442 ; 0000-0001-5289-3582 ; 0000-0001-7479-3224 ; 0000-0002-7072-8297</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10328566/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10328566/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,315,733,786,790,891,27957,27958,53827,53829</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37427183$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Akhtar, Sareema E</creatorcontrib><creatorcontrib>Shakil, Saad</creatorcontrib><creatorcontrib>Farooqui, Sabeeh K</creatorcontrib><creatorcontrib>Khedro, Tarek</creatorcontrib><creatorcontrib>Alzufairi, Ahmad L</creatorcontrib><creatorcontrib>Niaz, Muhammad A</creatorcontrib><creatorcontrib>Syed, Saifullah</creatorcontrib><creatorcontrib>Jiffry, Riaz</creatorcontrib><creatorcontrib>Alsubai, Abdulla K</creatorcontrib><creatorcontrib>Almesri, Abdullah</creatorcontrib><creatorcontrib>Ismail, Hebatalla</creatorcontrib><creatorcontrib>Khan, Kashif A</creatorcontrib><creatorcontrib>Al-Hindawi, Ahmed</creatorcontrib><creatorcontrib>Ali, Hussein K</creatorcontrib><creatorcontrib>Falodun, Timothy</creatorcontrib><creatorcontrib>Tabassi, Aysa</creatorcontrib><creatorcontrib>Tabassi, Aylin</creatorcontrib><creatorcontrib>Almas, Talal</creatorcontrib><title>Safety and efficacy of pimecrolimus versus vehicle for the treatment of atopic dermatitis in adults and paediatric population: a systematic review and meta-analysis</title><title>Annals of medicine and surgery</title><addtitle>Ann Med Surg (Lond)</addtitle><description>Atopic dermatitis remains a widespread problem affecting various populations globally. While numerous treatment options have been employed, pimecrolimus remains a potent and viable option. Recently, there has been increasing interest in comparing the safety and efficacy of pimecrolimus with its vehicle. The authors conducted a comprehensive search of several databases, including PubMed, COCHRANE, MEDLINE, and Cochrane Central, from inception to May 2022, using a wide search strategy with Boolean operators. The authors also employed backward snowballing to identify any studies missed in the initial search. The authors included randomized controlled trials in our meta-analysis and extracted data from the identified studies. The authors used Review Manager (RevMan) Version 5.4 to analyze the data, selecting a random-effects model due to observed differences in study populations and settings. The authors considered a -value of 0.05 or lower to be statistically significant. The authors initially identified 211 studies, of which 13 randomized controlled trials involving 4180 participants were selected for analysis. Our pooled analysis revealed that pimecrolimus 1% was more effective at reducing the severity of atopic dermatitis than its vehicles. However, no significant difference was observed in adverse effects between pimecrolimus and vehicle, except for pyrexia, nasopharyngitis, and headache, which were increased with pimecrolimus. Our meta-analysis showed that pimecrolimus 1% is more effective than vehicle, although the safety profile remains inconclusive. Pimecrolimus reduced the Investigator's Global Assessment score, Eczema Area and Severity Index score, and severity of pruritus when compared to its vehicle, indicating a higher efficacy profile. This is one of the first meta-analyses to assess the efficacy and safety profile of pimecrolimus 1% against a vehicle and may assist physicians in making informed decisions.</description><subject>Review</subject><issn>2049-0801</issn><issn>2049-0801</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNpdkctuFDEQRS0EItGQP0DISzad-NEPNxuEIiBIQSwCa6vGXWaM3O3Gdg_q_-FD8UxCNOBNWfK5t1x1CXnJ2SVnfXf1-a6_ZKdH1fUTci5Y3VdMMf705H5GLlL6URjOGtm26jk5k10tOq7kOfl9BxbzSmEaKFrrDJiVBktnN6KJwbtxSXSPMR3LzhmP1IZI8w5pjgh5xCkfBJDD7AwdMI6QXXaJuonCsPicjuYz4OAgx8LMYV58gcL0hgJNa8p40Bgace_w1xEfMUMFE_g1ufSCPLPgE1481A359uH91-ub6vbLx0_X724rI5TKFecKh0ZYbtC0MAjc1l3f2K2sOSrYQoPITIu2aU3XthIMtH3POXaq7VCAlRvy9t53XrYjDqaMFsHrOboR4qoDOP3vy-R2-nvYa86kUE3x3JDXDw4x_FwwZT26ZNB7mDAsSQsle9Fw1bGC1vdoWXNKEe1jH870IWRdQtb_h1xkr07_-Cj6G6n8A9VmqCE</recordid><startdate>20230701</startdate><enddate>20230701</enddate><creator>Akhtar, Sareema E</creator><creator>Shakil, Saad</creator><creator>Farooqui, Sabeeh K</creator><creator>Khedro, Tarek</creator><creator>Alzufairi, Ahmad L</creator><creator>Niaz, Muhammad A</creator><creator>Syed, Saifullah</creator><creator>Jiffry, Riaz</creator><creator>Alsubai, Abdulla K</creator><creator>Almesri, Abdullah</creator><creator>Ismail, Hebatalla</creator><creator>Khan, Kashif A</creator><creator>Al-Hindawi, Ahmed</creator><creator>Ali, Hussein K</creator><creator>Falodun, Timothy</creator><creator>Tabassi, Aysa</creator><creator>Tabassi, Aylin</creator><creator>Almas, Talal</creator><general>Lippincott Williams &amp; Wilkins</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-5397-3082</orcidid><orcidid>https://orcid.org/0000-0002-8867-600X</orcidid><orcidid>https://orcid.org/0000-0003-0394-5256</orcidid><orcidid>https://orcid.org/0000-0003-1622-7675</orcidid><orcidid>https://orcid.org/0000-0001-6991-4060</orcidid><orcidid>https://orcid.org/0000-0002-3965-3442</orcidid><orcidid>https://orcid.org/0000-0001-5289-3582</orcidid><orcidid>https://orcid.org/0000-0001-7479-3224</orcidid><orcidid>https://orcid.org/0000-0002-7072-8297</orcidid></search><sort><creationdate>20230701</creationdate><title>Safety and efficacy of pimecrolimus versus vehicle for the treatment of atopic dermatitis in adults and paediatric population: a systematic review and meta-analysis</title><author>Akhtar, Sareema E ; Shakil, Saad ; Farooqui, Sabeeh K ; Khedro, Tarek ; Alzufairi, Ahmad L ; Niaz, Muhammad A ; Syed, Saifullah ; Jiffry, Riaz ; Alsubai, Abdulla K ; Almesri, Abdullah ; Ismail, Hebatalla ; Khan, Kashif A ; Al-Hindawi, Ahmed ; Ali, Hussein K ; Falodun, Timothy ; Tabassi, Aysa ; Tabassi, Aylin ; Almas, Talal</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c288t-118ed52f1cec6ad2eb4795fb341e8aba5ee0c6ef56c7663aca69911e7867e2af3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Akhtar, Sareema E</creatorcontrib><creatorcontrib>Shakil, Saad</creatorcontrib><creatorcontrib>Farooqui, Sabeeh K</creatorcontrib><creatorcontrib>Khedro, Tarek</creatorcontrib><creatorcontrib>Alzufairi, Ahmad L</creatorcontrib><creatorcontrib>Niaz, Muhammad A</creatorcontrib><creatorcontrib>Syed, Saifullah</creatorcontrib><creatorcontrib>Jiffry, Riaz</creatorcontrib><creatorcontrib>Alsubai, Abdulla K</creatorcontrib><creatorcontrib>Almesri, Abdullah</creatorcontrib><creatorcontrib>Ismail, Hebatalla</creatorcontrib><creatorcontrib>Khan, Kashif A</creatorcontrib><creatorcontrib>Al-Hindawi, Ahmed</creatorcontrib><creatorcontrib>Ali, Hussein K</creatorcontrib><creatorcontrib>Falodun, Timothy</creatorcontrib><creatorcontrib>Tabassi, Aysa</creatorcontrib><creatorcontrib>Tabassi, Aylin</creatorcontrib><creatorcontrib>Almas, Talal</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Annals of medicine and surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Akhtar, Sareema E</au><au>Shakil, Saad</au><au>Farooqui, Sabeeh K</au><au>Khedro, Tarek</au><au>Alzufairi, Ahmad L</au><au>Niaz, Muhammad A</au><au>Syed, Saifullah</au><au>Jiffry, Riaz</au><au>Alsubai, Abdulla K</au><au>Almesri, Abdullah</au><au>Ismail, Hebatalla</au><au>Khan, Kashif A</au><au>Al-Hindawi, Ahmed</au><au>Ali, Hussein K</au><au>Falodun, Timothy</au><au>Tabassi, Aysa</au><au>Tabassi, Aylin</au><au>Almas, Talal</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Safety and efficacy of pimecrolimus versus vehicle for the treatment of atopic dermatitis in adults and paediatric population: a systematic review and meta-analysis</atitle><jtitle>Annals of medicine and surgery</jtitle><addtitle>Ann Med Surg (Lond)</addtitle><date>2023-07-01</date><risdate>2023</risdate><volume>85</volume><issue>7</issue><spage>3563</spage><epage>3573</epage><pages>3563-3573</pages><issn>2049-0801</issn><eissn>2049-0801</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Atopic dermatitis remains a widespread problem affecting various populations globally. While numerous treatment options have been employed, pimecrolimus remains a potent and viable option. Recently, there has been increasing interest in comparing the safety and efficacy of pimecrolimus with its vehicle. The authors conducted a comprehensive search of several databases, including PubMed, COCHRANE, MEDLINE, and Cochrane Central, from inception to May 2022, using a wide search strategy with Boolean operators. The authors also employed backward snowballing to identify any studies missed in the initial search. The authors included randomized controlled trials in our meta-analysis and extracted data from the identified studies. The authors used Review Manager (RevMan) Version 5.4 to analyze the data, selecting a random-effects model due to observed differences in study populations and settings. The authors considered a -value of 0.05 or lower to be statistically significant. The authors initially identified 211 studies, of which 13 randomized controlled trials involving 4180 participants were selected for analysis. Our pooled analysis revealed that pimecrolimus 1% was more effective at reducing the severity of atopic dermatitis than its vehicles. However, no significant difference was observed in adverse effects between pimecrolimus and vehicle, except for pyrexia, nasopharyngitis, and headache, which were increased with pimecrolimus. Our meta-analysis showed that pimecrolimus 1% is more effective than vehicle, although the safety profile remains inconclusive. Pimecrolimus reduced the Investigator's Global Assessment score, Eczema Area and Severity Index score, and severity of pruritus when compared to its vehicle, indicating a higher efficacy profile. This is one of the first meta-analyses to assess the efficacy and safety profile of pimecrolimus 1% against a vehicle and may assist physicians in making informed decisions.</abstract><cop>England</cop><pub>Lippincott Williams &amp; Wilkins</pub><pmid>37427183</pmid><doi>10.1097/MS9.0000000000000844</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-5397-3082</orcidid><orcidid>https://orcid.org/0000-0002-8867-600X</orcidid><orcidid>https://orcid.org/0000-0003-0394-5256</orcidid><orcidid>https://orcid.org/0000-0003-1622-7675</orcidid><orcidid>https://orcid.org/0000-0001-6991-4060</orcidid><orcidid>https://orcid.org/0000-0002-3965-3442</orcidid><orcidid>https://orcid.org/0000-0001-5289-3582</orcidid><orcidid>https://orcid.org/0000-0001-7479-3224</orcidid><orcidid>https://orcid.org/0000-0002-7072-8297</orcidid><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 2049-0801
ispartof Annals of medicine and surgery, 2023-07, Vol.85 (7), p.3563-3573
issn 2049-0801
2049-0801
language eng
recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10328566
source BACON - Elsevier - GLOBAL_SCIENCEDIRECT-OPENACCESS; PubMed Central
subjects Review
title Safety and efficacy of pimecrolimus versus vehicle for the treatment of atopic dermatitis in adults and paediatric population: a systematic review and meta-analysis
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-09-22T22%3A26%3A36IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Safety%20and%20efficacy%20of%20pimecrolimus%20versus%20vehicle%20for%20the%20treatment%20of%20atopic%20dermatitis%20in%20adults%20and%20paediatric%20population:%20a%20systematic%20review%20and%20meta-analysis&rft.jtitle=Annals%20of%20medicine%20and%20surgery&rft.au=Akhtar,%20Sareema%20E&rft.date=2023-07-01&rft.volume=85&rft.issue=7&rft.spage=3563&rft.epage=3573&rft.pages=3563-3573&rft.issn=2049-0801&rft.eissn=2049-0801&rft_id=info:doi/10.1097/MS9.0000000000000844&rft_dat=%3Cproquest_pubme%3E2839251870%3C/proquest_pubme%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c288t-118ed52f1cec6ad2eb4795fb341e8aba5ee0c6ef56c7663aca69911e7867e2af3%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2839251870&rft_id=info:pmid/37427183&rfr_iscdi=true