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PMID- 28467879
OWN - NLM
STAT- MEDLINE
DA  - 20170503
DCOM- 20170512
LR  - 20170512
IS  - 1533-4406 (Electronic)
IS  - 0028-4793 (Linking)
VI  - 376
IP  - 18
DP  - 2017 May 04
TI  - Bystander Efforts and 1-Year Outcomes in Out-of-Hospital Cardiac Arrest.
PG  - 1737-1747
LID - 10.1056/NEJMoa1601891 [doi]
AB  - BACKGROUND: The effect of bystander interventions on long-term functional
      outcomes among survivors of out-of-hospital cardiac arrest has not been
      extensively studied. METHODS: We linked nationwide data on out-of-hospital
      cardiac arrests in Denmark to functional outcome data and reported the 1-year
      risks of anoxic brain damage or nursing home admission and of death from any
      cause among patients who survived to day 30 after an out-of-hospital cardiac
      arrest. We analyzed risks according to whether bystander cardiopulmonary
      resuscitation (CPR) or defibrillation was performed and evaluated temporal
      changes in bystander interventions and outcomes. RESULTS: Among the 2855 patients
      who were 30-day survivors of an out-of-hospital cardiac arrest during the period 
      from 2001 through 2012, a total of 10.5% had brain damage or were admitted to a
      nursing home and 9.7% died during the 1-year follow-up period. During the study
      period, among the 2084 patients who had cardiac arrests that were not witnessed
      by emergency medical services (EMS) personnel, the rate of bystander CPR
      increased from 66.7% to 80.6% (P<0.001), the rate of bystander defibrillation
      increased from 2.1% to 16.8% (P<0.001), the rate of brain damage or nursing home 
      admission decreased from 10.0% to 7.6% (P<0.001), and all-cause mortality
      decreased from 18.0% to 7.9% (P=0.002). In adjusted analyses, bystander CPR was
      associated with a risk of brain damage or nursing home admission that was
      significantly lower than that associated with no bystander resuscitation (hazard 
      ratio, 0.62; 95% confidence interval [CI], 0.47 to 0.82), as well as a lower risk
      of death from any cause (hazard ratio, 0.70; 95% CI, 0.50 to 0.99) and a lower
      risk of the composite end point of brain damage, nursing home admission, or death
      (hazard ratio, 0.67; 95% CI, 0.53 to 0.84). The risks of these outcomes were even
      lower among patients who received bystander defibrillation as compared with no
      bystander resuscitation. CONCLUSIONS: In our study, we found that bystander CPR
      and defibrillation were associated with risks of brain damage or nursing home
      admission and of death from any cause that were significantly lower than those
      associated with no bystander resuscitation. (Funded by TrygFonden and the Danish 
      Heart Foundation.).
FAU - Kragholm, Kristian
AU  - Kragholm K
AD  - From the Departments of Anesthesiology and Intensive Care Medicine (K.K.,
      B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery 
      (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University
      Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health
      Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg
      University, Aalborg, the Clinical Institute of Medicine, Aarhus University,
      Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear
      Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen
      University Hospital, Emergency Medical Services Copenhagen and University of
      Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen
      University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute
      of Public Health, University of Southern Denmark (G.G.), and the Department of
      Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark;
      and Duke Clinical Research Institute, Durham, NC (C.M.H.).
FAU - Wissenberg, Mads
AU  - Wissenberg M
AD  - From the Departments of Anesthesiology and Intensive Care Medicine (K.K.,
      B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery 
      (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University
      Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health
      Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg
      University, Aalborg, the Clinical Institute of Medicine, Aarhus University,
      Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear
      Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen
      University Hospital, Emergency Medical Services Copenhagen and University of
      Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen
      University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute
      of Public Health, University of Southern Denmark (G.G.), and the Department of
      Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark;
      and Duke Clinical Research Institute, Durham, NC (C.M.H.).
FAU - Mortensen, Rikke N
AU  - Mortensen RN
AD  - From the Departments of Anesthesiology and Intensive Care Medicine (K.K.,
      B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery 
      (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University
      Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health
      Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg
      University, Aalborg, the Clinical Institute of Medicine, Aarhus University,
      Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear
      Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen
      University Hospital, Emergency Medical Services Copenhagen and University of
      Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen
      University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute
      of Public Health, University of Southern Denmark (G.G.), and the Department of
      Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark;
      and Duke Clinical Research Institute, Durham, NC (C.M.H.).
FAU - Hansen, Steen M
AU  - Hansen SM
AD  - From the Departments of Anesthesiology and Intensive Care Medicine (K.K.,
      B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery 
      (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University
      Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health
      Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg
      University, Aalborg, the Clinical Institute of Medicine, Aarhus University,
      Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear
      Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen
      University Hospital, Emergency Medical Services Copenhagen and University of
      Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen
      University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute
      of Public Health, University of Southern Denmark (G.G.), and the Department of
      Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark;
      and Duke Clinical Research Institute, Durham, NC (C.M.H.).
FAU - Malta Hansen, Carolina
AU  - Malta Hansen C
AD  - From the Departments of Anesthesiology and Intensive Care Medicine (K.K.,
      B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery 
      (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University
      Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health
      Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg
      University, Aalborg, the Clinical Institute of Medicine, Aarhus University,
      Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear
      Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen
      University Hospital, Emergency Medical Services Copenhagen and University of
      Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen
      University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute
      of Public Health, University of Southern Denmark (G.G.), and the Department of
      Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark;
      and Duke Clinical Research Institute, Durham, NC (C.M.H.).
FAU - Thorsteinsson, Kristinn
AU  - Thorsteinsson K
AD  - From the Departments of Anesthesiology and Intensive Care Medicine (K.K.,
      B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery 
      (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University
      Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health
      Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg
      University, Aalborg, the Clinical Institute of Medicine, Aarhus University,
      Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear
      Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen
      University Hospital, Emergency Medical Services Copenhagen and University of
      Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen
      University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute
      of Public Health, University of Southern Denmark (G.G.), and the Department of
      Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark;
      and Duke Clinical Research Institute, Durham, NC (C.M.H.).
FAU - Rajan, Shahzleen
AU  - Rajan S
AD  - From the Departments of Anesthesiology and Intensive Care Medicine (K.K.,
      B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery 
      (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University
      Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health
      Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg
      University, Aalborg, the Clinical Institute of Medicine, Aarhus University,
      Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear
      Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen
      University Hospital, Emergency Medical Services Copenhagen and University of
      Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen
      University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute
      of Public Health, University of Southern Denmark (G.G.), and the Department of
      Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark;
      and Duke Clinical Research Institute, Durham, NC (C.M.H.).
FAU - Lippert, Freddy
AU  - Lippert F
AD  - From the Departments of Anesthesiology and Intensive Care Medicine (K.K.,
      B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery 
      (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University
      Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health
      Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg
      University, Aalborg, the Clinical Institute of Medicine, Aarhus University,
      Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear
      Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen
      University Hospital, Emergency Medical Services Copenhagen and University of
      Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen
      University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute
      of Public Health, University of Southern Denmark (G.G.), and the Department of
      Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark;
      and Duke Clinical Research Institute, Durham, NC (C.M.H.).
FAU - Folke, Fredrik
AU  - Folke F
AD  - From the Departments of Anesthesiology and Intensive Care Medicine (K.K.,
      B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery 
      (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University
      Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health
      Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg
      University, Aalborg, the Clinical Institute of Medicine, Aarhus University,
      Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear
      Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen
      University Hospital, Emergency Medical Services Copenhagen and University of
      Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen
      University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute
      of Public Health, University of Southern Denmark (G.G.), and the Department of
      Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark;
      and Duke Clinical Research Institute, Durham, NC (C.M.H.).
FAU - Gislason, Gunnar
AU  - Gislason G
AD  - From the Departments of Anesthesiology and Intensive Care Medicine (K.K.,
      B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery 
      (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University
      Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health
      Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg
      University, Aalborg, the Clinical Institute of Medicine, Aarhus University,
      Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear
      Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen
      University Hospital, Emergency Medical Services Copenhagen and University of
      Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen
      University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute
      of Public Health, University of Southern Denmark (G.G.), and the Department of
      Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark;
      and Duke Clinical Research Institute, Durham, NC (C.M.H.).
FAU - Kober, Lars
AU  - Kober L
AD  - From the Departments of Anesthesiology and Intensive Care Medicine (K.K.,
      B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery 
      (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University
      Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health
      Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg
      University, Aalborg, the Clinical Institute of Medicine, Aarhus University,
      Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear
      Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen
      University Hospital, Emergency Medical Services Copenhagen and University of
      Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen
      University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute
      of Public Health, University of Southern Denmark (G.G.), and the Department of
      Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark;
      and Duke Clinical Research Institute, Durham, NC (C.M.H.).
FAU - Fonager, Kirsten
AU  - Fonager K
AD  - From the Departments of Anesthesiology and Intensive Care Medicine (K.K.,
      B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery 
      (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University
      Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health
      Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg
      University, Aalborg, the Clinical Institute of Medicine, Aarhus University,
      Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear
      Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen
      University Hospital, Emergency Medical Services Copenhagen and University of
      Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen
      University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute
      of Public Health, University of Southern Denmark (G.G.), and the Department of
      Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark;
      and Duke Clinical Research Institute, Durham, NC (C.M.H.).
FAU - Jensen, Svend E
AU  - Jensen SE
AD  - From the Departments of Anesthesiology and Intensive Care Medicine (K.K.,
      B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery 
      (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University
      Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health
      Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg
      University, Aalborg, the Clinical Institute of Medicine, Aarhus University,
      Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear
      Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen
      University Hospital, Emergency Medical Services Copenhagen and University of
      Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen
      University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute
      of Public Health, University of Southern Denmark (G.G.), and the Department of
      Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark;
      and Duke Clinical Research Institute, Durham, NC (C.M.H.).
FAU - Gerds, Thomas A
AU  - Gerds TA
AD  - From the Departments of Anesthesiology and Intensive Care Medicine (K.K.,
      B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery 
      (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University
      Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health
      Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg
      University, Aalborg, the Clinical Institute of Medicine, Aarhus University,
      Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear
      Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen
      University Hospital, Emergency Medical Services Copenhagen and University of
      Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen
      University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute
      of Public Health, University of Southern Denmark (G.G.), and the Department of
      Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark;
      and Duke Clinical Research Institute, Durham, NC (C.M.H.).
FAU - Torp-Pedersen, Christian
AU  - Torp-Pedersen C
AD  - From the Departments of Anesthesiology and Intensive Care Medicine (K.K.,
      B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery 
      (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University
      Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health
      Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg
      University, Aalborg, the Clinical Institute of Medicine, Aarhus University,
      Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear
      Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen
      University Hospital, Emergency Medical Services Copenhagen and University of
      Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen
      University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute
      of Public Health, University of Southern Denmark (G.G.), and the Department of
      Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark;
      and Duke Clinical Research Institute, Durham, NC (C.M.H.).
FAU - Rasmussen, Bodil S
AU  - Rasmussen BS
AD  - From the Departments of Anesthesiology and Intensive Care Medicine (K.K.,
      B.S.R.), Clinical Epidemiology (R.N.M., S.M.H., C.T.-P.), Cardiothoracic Surgery 
      (K.T.), Social Medicine (K.F.), and Cardiology (S.E.J.), Aalborg University
      Hospital, and the Departments of Clinical Medicine (K.K., B.S.R.) and Health
      Science and Technology (S.M.H., K.F., S.E.J., C.T.-P., B.S.R.), Aalborg
      University, Aalborg, the Clinical Institute of Medicine, Aarhus University,
      Aarhus (K.K., B.S.R.), and the Departments of Clinical Physiology, Nuclear
      Medicine and PET (M.W.), and Cardiology (L.K.), Rigshospitalet, Copenhagen
      University Hospital, Emergency Medical Services Copenhagen and University of
      Copenhagen (M.W., F.L., F.F.), the Department of Cardiology, Copenhagen
      University Hospital Gentofte (C.M.H., S.R., F.F., G.G.), the National Institute
      of Public Health, University of Southern Denmark (G.G.), and the Department of
      Biostatistics, University of Copenhagen (T.A.G.), Copenhagen - all in Denmark;
      and Duke Clinical Research Institute, Durham, NC (C.M.H.).
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - N Engl J Med
JT  - The New England journal of medicine
JID - 0255562
SB  - AIM
SB  - IM
MH  - Adult
MH  - Aged
MH  - *Cardiopulmonary Resuscitation
MH  - Denmark
MH  - *Electric Countershock
MH  - Female
MH  - Humans
MH  - Hypoxia, Brain/epidemiology/*etiology
MH  - Institutionalization/*statistics & numerical data
MH  - Intention to Treat Analysis
MH  - Male
MH  - Middle Aged
MH  - Nursing Homes
MH  - Out-of-Hospital Cardiac Arrest/complications/mortality/*therapy
MH  - Risk
MH  - Survival Analysis
MH  - Volunteers
EDAT- 2017/05/04 06:00
MHDA- 2017/05/13 06:00
CRDT- 2017/05/04 06:00
AID - 10.1056/NEJMoa1601891 [doi]
PST - ppublish
SO  - N Engl J Med. 2017 May 4;376(18):1737-1747. doi: 10.1056/NEJMoa1601891.

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