Delirium Bibliography

**The Delirium Bibliography is moving!**

 

We're excited to announce that the Delirium Bibliography has been moved to the Network for Investigation of Delirium: Unifying Scientists (NIDUS) website! The new bibliography includes well over 3,000 references on delirium and acute care for elders in addition to new references on pediatric delirium, as well. Articles in the new bibliography are still indexed by keywords taken from MEDLINE and other relevant databases, and they can be easily browsed with a search function. Questions? Email margaretwebb@hsl.harvard.edu

The searchable delirium bibliography page is one of our most popular features, allowing you to quickly gain access to the literature on delirium and acute care of older persons.  The HELP team keeps it updated for you on a monthly basis!  Feel free to search by author, title, keywords. It is primarily intended for clinicians and researchers interested in exploring these topics.

Each article is indexed by keywords taken from MEDLINE and other relevant databases.

You may base your search on as many search terms as you like. A search term can be a keyword, an author's name, all or part of an article's title, or any word or phrase that you might expect to find in an article's abstract. You may then indicate whether you would like to limit the search to one or more options.

The results are prioritized so that entries including all search terms will be listed first, but you can indicate whether to then sort by title (the default), by author, by journal name or by publication year.

You may further restrict to a topic category. Note: If you do not enter any search terms, the results will include all of the entries for the selected topic category.

More information about each entry on this page is available by moving the mouse over the green information symbols.

Please note that Pub Med Central (PMC) full text links are provided wherever available.  However, due to copyright restrictions, only abstracts can be provided for articles not available in PMC.

Total Results: 3263

  • Dexmedetomidine for the prevention of postoperative delirium in elderly patients undergoing noncardiac surgery: A meta-analysis of randomized controlled trials. 2019 Zeng, H. Li, Z. He, J. Fu, W.. PLoS One, 14:8 (e0218088)
    • Title

      Dexmedetomidine for the prevention of postoperative delirium in elderly patients undergoing noncardiac surgery: A meta-analysis of randomized controlled trials.

    • Authors
      Zeng, H. Li, Z. He, J. Fu, W.
    • Year
      2019
    • Journal
      PLoS One
    • URL
    • Abstract
      BACKGROUND: Postoperative delirium (POD) among the elderly population that undergoes noncardiac surgery is significantly associated with adverse clinical outcomes. We conducted this meta-analysis to evaluate the effectiveness and safety of dexmedetomidine for the prophylaxis of POD among the elderly population after noncardiac surgery. METHODS: We searched Embase, PubMed, and the Cochrane Library from inception date to March 2019 for randomized controlled trials (RCTs) that compared dexmedetomidine and placebo for the prevention of POD and evaluated the major cardiovascular outcomes among elderly people after noncardiac surgery. Two authors independently screened the studies and extracted data from the published articles. The main outcome was the incidence of POD. The secondary outcomes included the occurrence of bradycardia, hypotension, hypertension, tachycardia, myocardial infarction, stroke, hypoxaemia, and all-cause mortality. RESULTS: A total of 6 RCTs with 2102 participants were included. Compared with placebo, dexmedetomidine significantly reduced the prevalence of POD (RR = 0.61, 95% CI 0.34-0.76, P = 0.001, I2 = 66%), and the risk of tachycardia (RR = 0.48, 95% CI 0.30-0.76, P = 0.002, I2 = 0%), hypertension (RR = 0.59, 95% CI 0.44-0.79, P < 0.001, I2 = 20%), stroke (RR = 0.22, 95% CI 0.06-0.76, P = 0.02, I2 = 0%), and hypoxaemia (RR = 0.50, 95% CI 0.32-0.78, P = 0.002, I2 = 0%) in elderly patients who underwent noncardiac surgery. However, dexmedetomidine accelerated the occurrence of bradycardia (RR = 1.36, 95% CI 1.11-1.67, P = 0.003, I2 = 0%). Furthermore, no significant differences were observed in the incidence of hypotension, myocardial infarction, and all-cause mortality between the dexmedetomidine and placebo groups. CONCLUSIONS: Among elderly patients after noncardiac surgery, the prophylactic use of dexmedetomidine, compared with the use of placebo, was related to a decline in the incidence of POD.
    • PubMed ID
  • Risk factors for delirium: Are therapeutic interventions part of it? 2019 Xing, J. Yuan, Z. Jie, Y. Liu, Y. Wang, M. Sun, Y.. Neuropsychiatric Disease and Treatment, (1321-7)
    • Title

      Risk factors for delirium: Are therapeutic interventions part of it?

    • Authors
      Xing, J. Yuan, Z. Jie, Y. Liu, Y. Wang, M. Sun, Y.
    • Year
      2019
    • Journal
      Neuropsychiatric Disease and Treatment
    • URL
    • Abstract
      Background: Delirium is associated with increased morbidity and mortality in critically ill patients. Research on risk factors for delirium allows clinicians to identify high-risk patients, which is the basis for early prevention and diagnosis. Besides the risk factors for delirium that are commonly studied, here we more focused on the less-studied therapeutic interventions for critically ill patients which are potentially modifiable. Materials and methods: A total of 320 non-comatose patients admitted to the ICU for more than 24 hrs during 9 months were eligible for the study. Delirium was screened once daily using the CAM-ICU. Demographics, admission clinical data, and daily interventions were collected. Results: Ninety-two patients (28.75%) experienced delirium at least once. Delirious patients were more likely to have longer duration of mechanical ventilation, ICU stay, and hospital stay. Most of the less-studied therapeutic interventions were linked to delirium in the univariate analysis, including gastric tube, artificial airway, deep intravenous catheter, arterial line, urinary catheter, use of vasoactive drugs, and sedative medication. After adjusting with age and ICU length of stay, mechanical ventilation (OR: 5.123; 95% CI: 2.501–10.494), Acute Physiology and Chronic Health Evaluation (APACHE) II score≥20 at admission (OR: 1.897; 95% CI: 1.045–3.441), and gastric tube (OR: 1.935, 95% CI: 1.012–3.698) were associated with increased risk of delirium in multivariate analysis. Conclusion: Delirium was associated with prolonged mechanical ventilation, ICU stay, and hospital stay. Multivariate risk factors were gastric tube, mechanical ventilation, and APACHE II score. Although being a preliminary study, this study suggests the necessity of earliest removal of tubes and catheters when no longer needed.
    • PubMed ID
  • Intraoperative hyperglycemia increases the incidence of postoperative delirium. 2019 Windmann, V. Spies, C. Knaak, C. Wollersheim, T. Piper, S. K. Vorderwulbecke, G. Kurpanik, M. Kuenz, S. Lachmann, G.. Minerva Anestesiol,
    • Title

      Intraoperative hyperglycemia increases the incidence of postoperative delirium.

    • Authors
      Windmann, V. Spies, C. Knaak, C. Wollersheim, T. Piper, S. K. Vorderwulbecke, G. Kurpanik, M. Kuenz, S. Lachmann, G.
    • Year
      2019
    • Journal
      Minerva Anestesiol
    • URL
    • Abstract
      BACKGROUND: Hyperglycemia frequently occurs during major surgery and is associated with adverse postoperative outcomes. This study aimed to investigate the influence of intraoperative hyperglycemia on incidences of postoperative delirium (POD) and postoperative cognitive dysfunction (POCD). METHODS: 87 Patients aged >/=65 years undergoing elective surgery were included in this prospective observational subproject of the BioCog study. Blood glucose levels were measured every 20 minutes intraoperatively. Hyperglycemia was defined as blood glucose levels >/=150 mg*dL-1. Patients were assessed for POD twice daily until postoperative day 7. The occurrence of POCD was determined 3 months after surgery. Multivariable logistic regression was used to identify associations between hyperglycemia and POD as well as POCD. Secondary endpoints comprised duration of hyperglycemia, maximum glucose level (Glucosemax) and differences between diabetic and non- diabetic patients. RESULTS: POD occurred in 41 (47.1%), POCD in 5 (15.2%) patients. In two separate multivariable logistic regression models, hyperglycemia was significantly associated with POD (OR 3.86 (CI 95% 1.13, 39.49), p=0.044) but not POCD (3.59 (NaN, NaN), p=0.157). Relative duration of hyperglycemia was higher in POD patients compared to patients without POD (20 [0; 71] % versus 0 [0; 55] %, p=0.075), whereas the maximum glucose levels during surgery were similar between the two groups. Considering only non-diabetic patients, relative duration of hyperglycemia (p=0.003) and Glucosemax (p=0.015) were significantly higher in patients with POD. CONCLUSIONS: Intraoperative hyperglycemia was independently associated with POD but not POCD. Relative duration of hyperglycemia appeared thereby to also play a role. Especially hyperglycemic non-diabetic patients might be at high risk for POD.
    • PubMed ID
  • External Validation of Two Models to Predict Delirium in Critically Ill Adults Using Either the Confusion Assessment Method-ICU or the Intensive Care Delirium Screening Checklist for Delirium Assessment. 2019 Wassenaar, A. Schoonhoven, L. Devlin, J. W. van Haren, F. M. P. Slooter, A. J. C. Jorens, P. G. van der Jagt, M. Simons, K. S. Egerod, I. Burry, L. D. Beishuizen, A. Matos, J. Donders, A. R. T. Pickkers, P. van den Boogaard, M.. Crit Care Med, 47:10 (e827-e835)
    • Title

      External Validation of Two Models to Predict Delirium in Critically Ill Adults Using Either the Confusion Assessment Method-ICU or the Intensive Care Delirium Screening Checklist for Delirium Assessment.

    • Authors
      Wassenaar, A. Schoonhoven, L. Devlin, J. W. van Haren, F. M. P. Slooter, A. J. C. Jorens, P. G. van der Jagt, M. Simons, K. S. Egerod, I. Burry, L. D. Beishuizen, A. Matos, J. Donders, A. R. T. Pickkers, P. van den Boogaard, M.
    • Year
      2019
    • Journal
      Crit Care Med
    • URL
    • Abstract
      OBJECTIVES: To externally validate two delirium prediction models (early prediction model for ICU delirium and recalibrated prediction model for ICU delirium) using either the Confusion Assessment Method-ICU or the Intensive Care Delirium Screening Checklist for delirium assessment. DESIGN: Prospective, multinational cohort study. SETTING: Eleven ICUs from seven countries in three continents. PATIENTS: Consecutive, delirium-free adults admitted to the ICU for greater than or equal to 6 hours in whom delirium could be reliably assessed.None. MEASUREMENTS AND MAIN RESULTS: The predictors included in each model were collected at the time of ICU admission (early prediction model for ICU delirium) or within 24 hours of ICU admission (recalibrated prediction model for ICU delirium). Delirium was assessed using the Confusion Assessment Method-ICU or the Intensive Care Delirium Screening Checklist. Discrimination was determined using the area under the receiver operating characteristic curve. The predictive performance was determined for the Confusion Assessment Method-ICU and Intensive Care Delirium Screening Checklist cohort, and compared with both prediction models' original reported performance. A total of 1,286 Confusion Assessment Method-ICU-assessed patients and 892 Intensive Care Delirium Screening Checklist-assessed patients were included. Compared with the area under the receiver operating characteristic curve of 0.75 (95% CI, 0.71-0.79) in the original study, the area under the receiver operating characteristic curve of the early prediction model for ICU delirium was 0.67 (95% CI, 0.64-0.71) for delirium as assessed using the Confusion Assessment Method-ICU and 0.70 (95% CI, 0.66-0.74) using the Intensive Care Delirium Screening Checklist. Compared with the original area under the receiver operating characteristic curve of 0.77 (95% CI, 0.74-0.79), the area under the receiver operating characteristic curve of the recalibrated prediction model for ICU delirium was 0.75 (95% CI, 0.72-0.78) for assessing delirium using the Confusion Assessment Method-ICU and 0.71 (95% CI, 0.67-0.75) using the Intensive Care Delirium Screening Checklist. CONCLUSIONS: Both the early prediction model for ICU delirium and recalibrated prediction model for ICU delirium are externally validated using either the Confusion Assessment Method-ICU or the Intensive Care Delirium Screening Checklist for delirium assessment. Per delirium prediction model, both assessment tools showed a similar moderate-to-good statistical performance. These results support the use of either the early prediction model for ICU delirium or recalibrated prediction model for ICU delirium in ICUs around the world regardless of whether delirium is evaluated with the Confusion Assessment Method-ICU or Intensive Care Delirium Screening Checklist.
    • PubMed ID
  • Risk Factors and Incidence of Postoperative Delirium in Patients Undergoing Laryngectomy. 2019 Wang, Y. Yu, H. Qiao, H. Li, C. Chen, K. Shen, X.. Otolaryngol Head Neck Surg,
    • Title

      Risk Factors and Incidence of Postoperative Delirium in Patients Undergoing Laryngectomy.

    • Authors
      Wang, Y. Yu, H. Qiao, H. Li, C. Chen, K. Shen, X.
    • Year
      2019
    • Journal
      Otolaryngol Head Neck Surg
    • URL
    • Abstract
      OBJECTIVE: To explore the risk factors and incidence of postoperative delirium (POD) in patients undergoing laryngectomy for laryngeal cancer. STUDY DESIGN: Prospective cohort study. SETTING: Shanghai Eye, Ear, Nose, and Throat Hospital, Fudan University. SUBJECTS AND METHODS: A total of 323 patients underwent laryngectomy from April 4, 2018, to December 28, 2018. Perioperative data were collected. The primary outcome was the presence of POD as defined by the Confusion Assessment Method diagnostic algorithm. Univariate and multivariable logistic regression analyses were used to identify risk factors associated with POD. RESULTS: Of the patients who underwent laryngectomy during the study period, 99.1% were male, with a mean age of 60.0 years. Of these patients, 28 developed POD, with most episodes (88.1%) occurring during the first 3 postoperative days. The type of POD was hyperactive in 7 cases and hypoactive in 21 cases. The mean duration of POD was 1 day. The mean Delirium Rating Scale-Revised-98 score (a measure of POD severity) was 11.5. For the multivariable analysis, risk factors associated with POD included advanced cancer stage, lower educational level, higher American Society of Anesthesiologists classification, and intraoperative hypotension lasting at least 30 minutes. Intraoperative dexmedetomidine use was protective against POD. CONCLUSION: This study identified risk factors associated with POD, providing a target population for quality improvement initiatives. Furthermore, intraoperative dexmedetomidine use can reduce POD.
    • PubMed ID
  • Regional cerebral oxygen saturation and postoperative delirium in endovascular surgery: a prospective cohort study. 2019 Wang, X. Feng, K. Liu, H. Liu, Y. Ye, M. Zhao, G. Wang, T.. Trials, 20:1 (504)
    • Title

      Regional cerebral oxygen saturation and postoperative delirium in endovascular surgery: a prospective cohort study.

    • Authors
      Wang, X. Feng, K. Liu, H. Liu, Y. Ye, M. Zhao, G. Wang, T.
    • Year
      2019
    • Journal
      Trials
    • URL
    • Abstract
      BACKGROUND: Delirium is an acute mental disorder and common postoperative complication. Monitoring regional cerebral oxygen saturation (rSO2) in endovascular therapeutic surgery may allow real-time monitoring of cerebral desaturation, avoiding profound cerebral dysfunction, and reducing the incidence of delirium. We sought to examine the incidence of delirium in patients undergoing endovascular surgery. METHODS: This was a clinical cohort trial (registered with http://www.clinicaltrials.gov [NCT02356133]). We monitored the rSO2 of 43 patients undergoing general anesthesia and cerebral endovascular surgery. The occurrence of delirium after surgery was recorded with the Confusion Assessment Method (CAM). Multivariate logistic regression was performed to identify the main predictor of delirium. RESULTS: rSO2 was significantly different between the delirium and no-delirium groups. The occurrence of delirium was 35% in our cohort, and higher rSO2 desaturation scores were significantly associated with profound delirium (higher CAM score; odds ratio = 1.002; P = 0.021). The maximum declines of systolic blood pressure were 24.86 (21.78-27.93) and 32.98 (28.78-37.19) in the no-delirium and delirium groups, respectively, which were significantly different (P = 0.002) but not closely associated with delirium in multivariate analysis (P = 0.512). Anesthesia, mechanical ventilation duration, and having two vascular risk factors differed significantly between groups but were poorly associated with delirium outcome. CONCLUSIONS: Elevated rSO2 desaturation score was predictive of the occurrence of postoperative delirium following endovascular surgery. Monitoring rSO2 is invaluable for managing controlled hypotension during endovascular surgery and reducing postoperative delirium. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02356133 . Registered 1 February 2015. All statistical analysis results submitted August 4, 2018.
    • PubMed ID
  • The impact of analgosedation on mortality and delirium in critically ill patients: A systematic review and meta-analysis. 2019 Wang, C. T. Mao, Y. Zhao, L. Ma, B.. Intensive Crit Care Nurs, (7-14)
    • Title

      The impact of analgosedation on mortality and delirium in critically ill patients: A systematic review and meta-analysis.

    • Authors
      Wang, C. T. Mao, Y. Zhao, L. Ma, B.
    • Year
      2019
    • Journal
      Intensive Crit Care Nurs
    • URL
    • Abstract
      OBJECTIVES: To assess the impact of analgosedation on mortality and delirium in critically ill patients. RESEARCH METHODOLOGY: A systematic review and meta-analysis was conducted to identify studies through Pubmed, Cochrane Library, Embase and Web of Science published from June 2017 to July 2018. Only articles published in English were considered. The Cochrane Collaboration Risk of Bias Tool was used to evaluate the methodological quality of randomised trials, while Newcastle-Ottawa Scale (NOS) was used for cohort studies. RESULTS: Seventeen eligible studies were identified, including 2298 patients (1170 in the experimental group and 1128 in the control group). Varying analgesics and sedatives were investigated, showing a high clinical heterogeneity. Analgosedation significantly decreased the ICU mortality rate when compared to conventional analgesia and sedation [odds ratio (OR) 0.72, 95%CI 0.53-0.97; P=0.03]. No significant difference was demonstrated in 28-day/hospital mortality rate [OR 0.91, 95%CI 0.70-1.18; P=0.48] or in the incidence of delirium [OR 1.06, 95%CI 0.78-1.45; P=0.70]. However, subgroup analysis of trials indicated a significant increase in the delirium rate (OR: 1.88, 95%CI 1.14-3.10, p=0.01). CONCLUSION: The ICU mortality was decreased by implementing analgosedation, but the hospital mortality and the delirium rates were not. Because of the absence of higher quality study designs, clinical heterogeneity and inclusion of small number of studies, the analysis results must be cautiously interpreted.
    • PubMed ID
  • Incidence and risk factors of postoperative delirium in patients admitted to the ICU after elective intracranial surgery: A prospective cohort study. 2019 Wang, C. M. Huang, H. W. Wang, Y. M. He, X. Sun, X. M. Zhou, Y. M. Zhang, G. B. Gu, H. Q. Zhou, J. X.. Eur J Anaesthesiol,
    • Title

      Incidence and risk factors of postoperative delirium in patients admitted to the ICU after elective intracranial surgery: A prospective cohort study.

    • Authors
      Wang, C. M. Huang, H. W. Wang, Y. M. He, X. Sun, X. M. Zhou, Y. M. Zhang, G. B. Gu, H. Q. Zhou, J. X.
    • Year
      2019
    • Journal
      Eur J Anaesthesiol
    • URL
    • Abstract
      BACKGROUND: Postoperative delirium (POD) has been confirmed as an important complication after major surgery. However, neurosurgical patients have usually been excluded in previous studies. To date, data on POD and risk factors in patients after intracranial surgery are scarce. OBJECTIVES: To determine the incidence and risk factors of POD in patients after intracranial surgery. DESIGN: Prospective cohort study. SETTING: A neurosurgical ICU of a university-affiliated hospital, Beijing, China. INTERVENTIONS: Adult patients admitted to the ICU after elective intracranial surgery under general anaesthesia were consecutively enrolled between 1 March 2017 and 2 February 2018. Delirium was assessed using the Confusion Assessment Method for the ICU. POD was diagnosed as Confusion Assessment Method for the ICU positive on either postoperative day 1 or day 3. Patients were classified into groups with or without POD. Data were collected for univariate and multivariate analyses to determine the risk factors for POD. RESULTS: A total of 800 patients were included. POD was diagnosed in 157 patients (19.6%, 95% confidence interval 16.9 to 22.4%). Independent risk factors for POD included age, nature of intracranial lesion, frontal approach craniotomy, duration of surgery, presence of an episode of low pulse oxygenation at ICU admission, presence of inadequate emergence and emergence delirium, postoperative pain and presence of immobilising events. POD was associated with adverse outcomes and high costs. CONCLUSION: POD is prevalent in patients after elective intracranial surgery. The identified risk factors for and the potential association of POD with adverse outcomes suggest that a comprehensive strategy involving screening for predisposing factors and early prevention of modifiable factors should be established in this population. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov (NCT03087838).
    • PubMed ID
  • Association between preoperative nutritional status and postoperative delirium in individuals with coronary artery bypass graft surgery: A prospective cohort study. 2019 Velayati, A. Vahdat Shariatpanahi, M. Shahbazi, E. Vahdat Shariatpanahi, Z.. Nutrition, (227-232)
    • Title

      Association between preoperative nutritional status and postoperative delirium in individuals with coronary artery bypass graft surgery: A prospective cohort study.

    • Authors
      Velayati, A. Vahdat Shariatpanahi, M. Shahbazi, E. Vahdat Shariatpanahi, Z.
    • Year
      2019
    • Journal
      Nutrition
    • URL
    • Abstract
      Objectives: The prevalence of delirium and undernutrition are both relatively high subsequent to coronary artery bypass graft (CABG) surgery. The aim of this study was to evaluate the association between preoperative malnutrition and the occurrence of delirium after CABG surgery. Methods: In this prospective cohort study, body mass index, mid-upper arm circumference, triceps skinfold, and adductor pollicis muscle thickness of 398 adult patients before CABG surgery were measured by a single trained dietitian. Also, Nutritional Risk Screening 2002 (NRS-2002) and subjective global assessment (SGA) were obtained from patients. Delirium was defined by the confusion assessment method for the intensive care unit. SPSS software was used for performing the statistical analyses. Logistic regression analysis was applied to examine the effect of various factors on the development of delirium. Results: Postoperative delirium was detected in 17% of patients (n = 68). Multivariate regression analysis adjusted by other risk factors indicated that risk for delirium was 1.56-fold higher in patients with NRS-2002 >3 (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.20–3.24; P = 0.001). Severe undernutrition at admission as assessed by SGA was independently associated with the occurrence of delirium (OR, 2.58; 95% CI, 1.02–3.48; P = 0.005). Risk for delirium was 1.26-fold higher in patients with adductor pollicis muscle thickness <15 mm (OR, 1.26; 95% CI, 1.02–3.14; P = 0.02). Conclusions: Since the prevalence of delirium is relatively high in CABG surgery and undernutrition is related to postoperative delirium, considering nutrition status with NRS-2002, SGA, or adductor pollicis muscle thickness before surgery could decrease the risk for postoperative delirium.
    • PubMed ID
  • Prevalence and risk factors for delirium in elderly patients with severe burns: a retrospective cohort study. 2019 van Yperen, D. T. Raats, J. W. Dokter, J. Ziere, G. Roukema, G. R. van Baar, M. E. van der Vlies, C. H.. J Burn Care Res,
    • Title

      Prevalence and risk factors for delirium in elderly patients with severe burns: a retrospective cohort study.

    • Authors
      van Yperen, D. T. Raats, J. W. Dokter, J. Ziere, G. Roukema, G. R. van Baar, M. E. van der Vlies, C. H.
    • Year
      2019
    • Journal
      J Burn Care Res
    • URL
    • Abstract
      BACKGROUND: Little is known about delirium in elderly burn center patients. The aim of this study is to provide information on the prevalence of delirium and risk factors contributing to the onset of delirium. METHODS: All patients aged 70 years or older admitted with burn injuries to the Burn Center, Maasstad Hospital, in 2011-2017 were eligible for inclusion. We retrospectively collected data regarding the presence of delirium, potential risk factors contributing to the onset of delirium and outcome after delirium. RESULTS: We included elderly 90 patients in this study. The prevalence of delirium in our population was 13% (N=12). Risk factors for delirium were advanced age, increased American Society for Anesthesiologists score, physical impairment and the use of anticholinergic drugs during admission. Patients with delirium had a poorer outcome, with prolonged hospital stay and increased mortality 6 months and 12 months after discharge. CONCLUSION: Delirium is diagnosed in 13% of the elderly patients admitted to our burn center. Risk factors for delirium found in this study are advanced age, poor physical health status, physical impairment and the use of anticholinergic drugs. Delirium is related to poor outcomes, including prolonged hospital stay and mortality after discharge.
    • PubMed ID
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