Analysis of Patient Adherence to Filling Emergency Department Discharge Prescriptions for Empiric Treatment of Chlamydia
Sexually transmitted infections (STIs) represent an enormous public health burden in the United States. Emergency departments (EDs) are a significant source of medical care, particularly for vulnerable patient populations. Guidelines for the treatment of Chlamydia trachomatis have evolved and now re...
Saved in:
Published in: | The American journal of emergency medicine 2024-02, Vol.76, p.207-210 |
---|---|
Main Authors: | , , , |
Format: | Article |
Language: | English |
Subjects: | |
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-c282t-f6f3084e87f1a7665c1c727b9a1945ced5b14e21b9872e1feca89c283c049cc33 |
container_end_page | 210 |
container_issue | |
container_start_page | 207 |
container_title | The American journal of emergency medicine |
container_volume | 76 |
creator | Jackson, Ashley Kilber, Emily Peter, Clinton Bhattarai, Bikash |
description | Sexually transmitted infections (STIs) represent an enormous public health burden in the United States. Emergency departments (EDs) are a significant source of medical care, particularly for vulnerable patient populations. Guidelines for the treatment of Chlamydia trachomatis have evolved and now recommend doxycycline 100 mg orally twice daily for 7 days as the primary regimen for adults. However, the single-dose azithromycin regimen can be given during the ED visit, while the new regimen has nonadherence hurdles. The purpose of this study will be determining the rate of ED discharge prescription pick ups of doxycycline for Chlamydia trachomatis infection at two discharge pharmacies.
This is a retrospective chart review of information contained in the electronic medical record (EMR) from August 1
, 2021 - July 31
, 2022. Adult patients who present to the two EDs in the healthcare system and those who received empiric antibiotic treatment for Chlamydia trachomatis infection prior to, or at, ED discharge will be included. Patients who are pregnant, less than 18 years old, those without a Chlamydia trachomatis nucleic acid amplification test during their ED visit, or patients whose antibiotic treatment prescription was sent to a pharmacy other than the two primary discharge pharmacies at the respective medical centers will be excluded. The primary outcome of this study will be determining the rate of emergency department (ED) discharge prescription pick ups of doxycycline for empiric treatment of Chlamydia trachomatis infection at two discharge pharmacies. The secondary outcomes will include the incidence of repeat positive tests between four weeks and 90 days, risk of repeat positive tests in those who do not fill doxycycline, number of positive and negative test results, rate of prescribing adherence to 2021 Centers for Disease Control and Prevention (CDC) Sexually Transmitted Infections Treatment Guidelines regimens for empiric treatment, and insurance status at the time of discharge fill.
Seven hundred and thirty patients were pulled from the EMR. One hundred of the patients were excluded from the study as they did not receive empiric antibiotic treatment for Chlamydia trachomatis infection prior to, or at, ED discharge leaving 630 participants. Among this group, 369 patients were excluded as their discharge prescription was not sent to the discharge pharmacies within the medical system, leaving 261 individuals in the study. Per chart review, 215 of the p |
doi_str_mv | 10.1016/j.ajem.2023.11.024 |
format | article |
fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2902954979</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2902954979</sourcerecordid><originalsourceid>FETCH-LOGICAL-c282t-f6f3084e87f1a7665c1c727b9a1945ced5b14e21b9872e1feca89c283c049cc33</originalsourceid><addsrcrecordid>eNpdkU1vEzEQhi0EoqHwBzggS1y47OKxvf44RmkLSJXooZwtx5ltvNov7I3U_Hu8SuHAaaTR886M5iHkI7AaGKivXe07HGrOuKgBasblK7KBRvDKgIbXZMO0aCqlG31F3uXcMQYgG_mWXAnDrNLKbsjzdvT9OcdMp5Y--CXiuNDt4YgJx4B0mehd7Ps4PtHbAdNTaZ7pDc4-LcNK3sQcjr706UPCHFKclziNmbZTKoE5phjoY0J_ocuK3bH3w_kQ_XvypvV9xg8v9Zr8urt93H2v7n9--7Hb3leBG75UrWoFMxKNbsFrpZoAQXO9tx6sbAIemj1I5LC3RnOEFoM3tkRFYNKGIMQ1-XKZO6fp9wnz4oZyM_a9H3E6Zcct47aRVtuCfv4P7aZTKv9ZKVASlBGmUPxChTTlnLB1c4qDT2cHzK1eXOdWL2714gBc8VJCn15Gn_YDHv5F_ooQfwC-gYr_</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2916416838</pqid></control><display><type>article</type><title>Analysis of Patient Adherence to Filling Emergency Department Discharge Prescriptions for Empiric Treatment of Chlamydia</title><source>Elsevier</source><creator>Jackson, Ashley ; Kilber, Emily ; Peter, Clinton ; Bhattarai, Bikash</creator><creatorcontrib>Jackson, Ashley ; Kilber, Emily ; Peter, Clinton ; Bhattarai, Bikash</creatorcontrib><description>Sexually transmitted infections (STIs) represent an enormous public health burden in the United States. Emergency departments (EDs) are a significant source of medical care, particularly for vulnerable patient populations. Guidelines for the treatment of Chlamydia trachomatis have evolved and now recommend doxycycline 100 mg orally twice daily for 7 days as the primary regimen for adults. However, the single-dose azithromycin regimen can be given during the ED visit, while the new regimen has nonadherence hurdles. The purpose of this study will be determining the rate of ED discharge prescription pick ups of doxycycline for Chlamydia trachomatis infection at two discharge pharmacies.
This is a retrospective chart review of information contained in the electronic medical record (EMR) from August 1
, 2021 - July 31
, 2022. Adult patients who present to the two EDs in the healthcare system and those who received empiric antibiotic treatment for Chlamydia trachomatis infection prior to, or at, ED discharge will be included. Patients who are pregnant, less than 18 years old, those without a Chlamydia trachomatis nucleic acid amplification test during their ED visit, or patients whose antibiotic treatment prescription was sent to a pharmacy other than the two primary discharge pharmacies at the respective medical centers will be excluded. The primary outcome of this study will be determining the rate of emergency department (ED) discharge prescription pick ups of doxycycline for empiric treatment of Chlamydia trachomatis infection at two discharge pharmacies. The secondary outcomes will include the incidence of repeat positive tests between four weeks and 90 days, risk of repeat positive tests in those who do not fill doxycycline, number of positive and negative test results, rate of prescribing adherence to 2021 Centers for Disease Control and Prevention (CDC) Sexually Transmitted Infections Treatment Guidelines regimens for empiric treatment, and insurance status at the time of discharge fill.
Seven hundred and thirty patients were pulled from the EMR. One hundred of the patients were excluded from the study as they did not receive empiric antibiotic treatment for Chlamydia trachomatis infection prior to, or at, ED discharge leaving 630 participants. Among this group, 369 patients were excluded as their discharge prescription was not sent to the discharge pharmacies within the medical system, leaving 261 individuals in the study. Per chart review, 215 of the patients picked up their doxycycline prescription (82.4%) and 46 (17.6%) patients failed to pick up their prescription. Additionally, 43 (16.5) of the patients who were prescribed empiric therapy had a positive chlamydia trachomatis test, while 209 (83.5%) of those had a negative test. This study also showed 188 (72%) patients received treatment according to the current CDC recommendations.
Majority of patients who received prescriptions from the in-hospital discharge pharmacy picked up their prescriptions.</description><identifier>ISSN: 0735-6757</identifier><identifier>ISSN: 1532-8171</identifier><identifier>EISSN: 1532-8171</identifier><identifier>DOI: 10.1016/j.ajem.2023.11.024</identifier><identifier>PMID: 38096769</identifier><language>eng</language><publisher>United States: Elsevier Limited</publisher><subject>Antibiotics ; Azithromycin ; Chlamydia ; Chlamydia trachomatis ; Disease control ; Doxycycline ; Drug stores ; Electronic medical records ; Emergency medical care ; Emergency medical services ; Health care ; Infections ; Medical records ; Nucleic acids ; Patient compliance ; Patients ; Pharmacy ; Prescriptions ; Public health ; Sexually transmitted diseases ; STD</subject><ispartof>The American journal of emergency medicine, 2024-02, Vol.76, p.207-210</ispartof><rights>Copyright © 2023 Elsevier Inc. All rights reserved.</rights><rights>2023. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c282t-f6f3084e87f1a7665c1c727b9a1945ced5b14e21b9872e1feca89c283c049cc33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38096769$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jackson, Ashley</creatorcontrib><creatorcontrib>Kilber, Emily</creatorcontrib><creatorcontrib>Peter, Clinton</creatorcontrib><creatorcontrib>Bhattarai, Bikash</creatorcontrib><title>Analysis of Patient Adherence to Filling Emergency Department Discharge Prescriptions for Empiric Treatment of Chlamydia</title><title>The American journal of emergency medicine</title><addtitle>Am J Emerg Med</addtitle><description>Sexually transmitted infections (STIs) represent an enormous public health burden in the United States. Emergency departments (EDs) are a significant source of medical care, particularly for vulnerable patient populations. Guidelines for the treatment of Chlamydia trachomatis have evolved and now recommend doxycycline 100 mg orally twice daily for 7 days as the primary regimen for adults. However, the single-dose azithromycin regimen can be given during the ED visit, while the new regimen has nonadherence hurdles. The purpose of this study will be determining the rate of ED discharge prescription pick ups of doxycycline for Chlamydia trachomatis infection at two discharge pharmacies.
This is a retrospective chart review of information contained in the electronic medical record (EMR) from August 1
, 2021 - July 31
, 2022. Adult patients who present to the two EDs in the healthcare system and those who received empiric antibiotic treatment for Chlamydia trachomatis infection prior to, or at, ED discharge will be included. Patients who are pregnant, less than 18 years old, those without a Chlamydia trachomatis nucleic acid amplification test during their ED visit, or patients whose antibiotic treatment prescription was sent to a pharmacy other than the two primary discharge pharmacies at the respective medical centers will be excluded. The primary outcome of this study will be determining the rate of emergency department (ED) discharge prescription pick ups of doxycycline for empiric treatment of Chlamydia trachomatis infection at two discharge pharmacies. The secondary outcomes will include the incidence of repeat positive tests between four weeks and 90 days, risk of repeat positive tests in those who do not fill doxycycline, number of positive and negative test results, rate of prescribing adherence to 2021 Centers for Disease Control and Prevention (CDC) Sexually Transmitted Infections Treatment Guidelines regimens for empiric treatment, and insurance status at the time of discharge fill.
Seven hundred and thirty patients were pulled from the EMR. One hundred of the patients were excluded from the study as they did not receive empiric antibiotic treatment for Chlamydia trachomatis infection prior to, or at, ED discharge leaving 630 participants. Among this group, 369 patients were excluded as their discharge prescription was not sent to the discharge pharmacies within the medical system, leaving 261 individuals in the study. Per chart review, 215 of the patients picked up their doxycycline prescription (82.4%) and 46 (17.6%) patients failed to pick up their prescription. Additionally, 43 (16.5) of the patients who were prescribed empiric therapy had a positive chlamydia trachomatis test, while 209 (83.5%) of those had a negative test. This study also showed 188 (72%) patients received treatment according to the current CDC recommendations.
Majority of patients who received prescriptions from the in-hospital discharge pharmacy picked up their prescriptions.</description><subject>Antibiotics</subject><subject>Azithromycin</subject><subject>Chlamydia</subject><subject>Chlamydia trachomatis</subject><subject>Disease control</subject><subject>Doxycycline</subject><subject>Drug stores</subject><subject>Electronic medical records</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Health care</subject><subject>Infections</subject><subject>Medical records</subject><subject>Nucleic acids</subject><subject>Patient compliance</subject><subject>Patients</subject><subject>Pharmacy</subject><subject>Prescriptions</subject><subject>Public health</subject><subject>Sexually transmitted diseases</subject><subject>STD</subject><issn>0735-6757</issn><issn>1532-8171</issn><issn>1532-8171</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNpdkU1vEzEQhi0EoqHwBzggS1y47OKxvf44RmkLSJXooZwtx5ltvNov7I3U_Hu8SuHAaaTR886M5iHkI7AaGKivXe07HGrOuKgBasblK7KBRvDKgIbXZMO0aCqlG31F3uXcMQYgG_mWXAnDrNLKbsjzdvT9OcdMp5Y--CXiuNDt4YgJx4B0mehd7Ps4PtHbAdNTaZ7pDc4-LcNK3sQcjr706UPCHFKclziNmbZTKoE5phjoY0J_ocuK3bH3w_kQ_XvypvV9xg8v9Zr8urt93H2v7n9--7Hb3leBG75UrWoFMxKNbsFrpZoAQXO9tx6sbAIemj1I5LC3RnOEFoM3tkRFYNKGIMQ1-XKZO6fp9wnz4oZyM_a9H3E6Zcct47aRVtuCfv4P7aZTKv9ZKVASlBGmUPxChTTlnLB1c4qDT2cHzK1eXOdWL2714gBc8VJCn15Gn_YDHv5F_ooQfwC-gYr_</recordid><startdate>20240201</startdate><enddate>20240201</enddate><creator>Jackson, Ashley</creator><creator>Kilber, Emily</creator><creator>Peter, Clinton</creator><creator>Bhattarai, Bikash</creator><general>Elsevier Limited</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20240201</creationdate><title>Analysis of Patient Adherence to Filling Emergency Department Discharge Prescriptions for Empiric Treatment of Chlamydia</title><author>Jackson, Ashley ; Kilber, Emily ; Peter, Clinton ; Bhattarai, Bikash</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c282t-f6f3084e87f1a7665c1c727b9a1945ced5b14e21b9872e1feca89c283c049cc33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Antibiotics</topic><topic>Azithromycin</topic><topic>Chlamydia</topic><topic>Chlamydia trachomatis</topic><topic>Disease control</topic><topic>Doxycycline</topic><topic>Drug stores</topic><topic>Electronic medical records</topic><topic>Emergency medical care</topic><topic>Emergency medical services</topic><topic>Health care</topic><topic>Infections</topic><topic>Medical records</topic><topic>Nucleic acids</topic><topic>Patient compliance</topic><topic>Patients</topic><topic>Pharmacy</topic><topic>Prescriptions</topic><topic>Public health</topic><topic>Sexually transmitted diseases</topic><topic>STD</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jackson, Ashley</creatorcontrib><creatorcontrib>Kilber, Emily</creatorcontrib><creatorcontrib>Peter, Clinton</creatorcontrib><creatorcontrib>Bhattarai, Bikash</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</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 Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</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>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest research library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</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 Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jackson, Ashley</au><au>Kilber, Emily</au><au>Peter, Clinton</au><au>Bhattarai, Bikash</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Analysis of Patient Adherence to Filling Emergency Department Discharge Prescriptions for Empiric Treatment of Chlamydia</atitle><jtitle>The American journal of emergency medicine</jtitle><addtitle>Am J Emerg Med</addtitle><date>2024-02-01</date><risdate>2024</risdate><volume>76</volume><spage>207</spage><epage>210</epage><pages>207-210</pages><issn>0735-6757</issn><issn>1532-8171</issn><eissn>1532-8171</eissn><abstract>Sexually transmitted infections (STIs) represent an enormous public health burden in the United States. Emergency departments (EDs) are a significant source of medical care, particularly for vulnerable patient populations. Guidelines for the treatment of Chlamydia trachomatis have evolved and now recommend doxycycline 100 mg orally twice daily for 7 days as the primary regimen for adults. However, the single-dose azithromycin regimen can be given during the ED visit, while the new regimen has nonadherence hurdles. The purpose of this study will be determining the rate of ED discharge prescription pick ups of doxycycline for Chlamydia trachomatis infection at two discharge pharmacies.
This is a retrospective chart review of information contained in the electronic medical record (EMR) from August 1
, 2021 - July 31
, 2022. Adult patients who present to the two EDs in the healthcare system and those who received empiric antibiotic treatment for Chlamydia trachomatis infection prior to, or at, ED discharge will be included. Patients who are pregnant, less than 18 years old, those without a Chlamydia trachomatis nucleic acid amplification test during their ED visit, or patients whose antibiotic treatment prescription was sent to a pharmacy other than the two primary discharge pharmacies at the respective medical centers will be excluded. The primary outcome of this study will be determining the rate of emergency department (ED) discharge prescription pick ups of doxycycline for empiric treatment of Chlamydia trachomatis infection at two discharge pharmacies. The secondary outcomes will include the incidence of repeat positive tests between four weeks and 90 days, risk of repeat positive tests in those who do not fill doxycycline, number of positive and negative test results, rate of prescribing adherence to 2021 Centers for Disease Control and Prevention (CDC) Sexually Transmitted Infections Treatment Guidelines regimens for empiric treatment, and insurance status at the time of discharge fill.
Seven hundred and thirty patients were pulled from the EMR. One hundred of the patients were excluded from the study as they did not receive empiric antibiotic treatment for Chlamydia trachomatis infection prior to, or at, ED discharge leaving 630 participants. Among this group, 369 patients were excluded as their discharge prescription was not sent to the discharge pharmacies within the medical system, leaving 261 individuals in the study. Per chart review, 215 of the patients picked up their doxycycline prescription (82.4%) and 46 (17.6%) patients failed to pick up their prescription. Additionally, 43 (16.5) of the patients who were prescribed empiric therapy had a positive chlamydia trachomatis test, while 209 (83.5%) of those had a negative test. This study also showed 188 (72%) patients received treatment according to the current CDC recommendations.
Majority of patients who received prescriptions from the in-hospital discharge pharmacy picked up their prescriptions.</abstract><cop>United States</cop><pub>Elsevier Limited</pub><pmid>38096769</pmid><doi>10.1016/j.ajem.2023.11.024</doi><tpages>4</tpages></addata></record> |
fulltext | fulltext |
identifier | ISSN: 0735-6757 |
ispartof | The American journal of emergency medicine, 2024-02, Vol.76, p.207-210 |
issn | 0735-6757 1532-8171 1532-8171 |
language | eng |
recordid | cdi_proquest_miscellaneous_2902954979 |
source | Elsevier |
subjects | Antibiotics Azithromycin Chlamydia Chlamydia trachomatis Disease control Doxycycline Drug stores Electronic medical records Emergency medical care Emergency medical services Health care Infections Medical records Nucleic acids Patient compliance Patients Pharmacy Prescriptions Public health Sexually transmitted diseases STD |
title | Analysis of Patient Adherence to Filling Emergency Department Discharge Prescriptions for Empiric Treatment of Chlamydia |
url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-19T09%3A44%3A52IST&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=Analysis%20of%20Patient%20Adherence%20to%20Filling%20Emergency%20Department%20Discharge%20Prescriptions%20for%20Empiric%20Treatment%20of%20Chlamydia&rft.jtitle=The%20American%20journal%20of%20emergency%20medicine&rft.au=Jackson,%20Ashley&rft.date=2024-02-01&rft.volume=76&rft.spage=207&rft.epage=210&rft.pages=207-210&rft.issn=0735-6757&rft.eissn=1532-8171&rft_id=info:doi/10.1016/j.ajem.2023.11.024&rft_dat=%3Cproquest_cross%3E2902954979%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c282t-f6f3084e87f1a7665c1c727b9a1945ced5b14e21b9872e1feca89c283c049cc33%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2916416838&rft_id=info:pmid/38096769&rfr_iscdi=true |