intervention

干预
  • 文章类型: Journal Article
    注意缺陷/多动障碍(ADHD)是一种神经发育障碍,其特征是持续的注意力不集中。多动症,和冲动。这是儿科服务中最常见的神经发育障碍,儿科医生经常参与早期评估,诊断,和治疗儿童多动症。多动症的治疗通常涉及多模式方法,包括心理教育的组合,家长/教师培训,社会心理/心理治疗干预,和药物治疗。关于药物治疗,指南在药物选择和测序方面各不相同,用精神兴奋剂,如哌醋甲酯和(LIS)右旋氨胺,通常是首选的初始治疗。替代品包括托莫西汀和胍法辛。药物治疗被证明是有效的,但是密切关注身体生长,心血管监测,以及对包括抽搐在内的潜在副作用的监测,情绪波动,和精神病症状,是必不可少的。本文概述了当前ADHD的药物治疗方案,并探讨了不同欧洲国家治疗指南的差异。结论:儿童和青少年ADHD的药物治疗方案有效且耐受性良好。ADHD的药物治疗始终是多模式方法的一部分。虽然欧洲关于ADHD药物治疗的指南有相当大的共识,存在显著差异,特别是关于各种药物的选择和排序。已知:•对于儿童和青少年中的ADHD,存在药物治疗的重要证据基础。•儿科医生经常参与评估,儿童多动症的诊断和治疗。新增内容:•我们对不同欧洲指南的概述揭示了在儿童和青少年ADHD药物治疗方面的重要共识。•差异主要存在于不同药物的选择和排序方面。
    Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by a persistent pattern of inattention, hyperactivity, and impulsivity. It is the most common neurodevelopmental disorder presenting to pediatric services, and pediatricians are often involved in the early assessment, diagnosis, and treatment of children with ADHD. The treatment of ADHD typically involves a multimodal approach that encompasses a combination of psychoeducation, parent/teacher training, psychosocial/psychotherapeutic interventions, and pharmacotherapy. Concerning pharmacotherapy, guidelines vary in drug choice and sequencing, with psychostimulants, such as methylphenidate and (lis)dexamfetamine, generally being the favored initial treatment. Alternatives include atomoxetine and guanfacine. Pharmacotherapy has been proven effective, but close follow-up focusing on physical growth, cardiovascular monitoring, and the surveillance of potential side effects including tics, mood fluctuations, and psychotic symptoms, is essential. This paper presents an overview of current pharmacological treatment options for ADHD and explores disparities in treatment guidelines across different European countries.   Conclusion: Pharmacological treatment options for ADHD in children and adolescents are effective and generally well-tolerated. Pharmacotherapy for ADHD is always part of a multimodal approach. While there is a considerable consensus among European guidelines on pharmacotherapy for ADHD, notable differences exist, particularly concerning the selection and sequencing of various medications. What is Known: • There is a significant base of evidence for pharmacological treatment for ADHD in children and adolescents. • Pediatricians are often involved in assessment, diagnosis and management of children with ADHD. What is New: • Our overview of different European guidelines reveals significant agreement in the context of pharmacotherapy for ADHD in children and adolescents. • Discrepancies exist primarily in terms of selection and sequencing of different medications.
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  • 文章类型: Journal Article
    背景:2017年CATALISE项目第2阶段的出版澄清了患有发育性语言障碍(DLD)或延迟但无意中混淆了言语难以理解的儿童的术语。DLD(语音)的诊断标签表明预后不良和语音障碍持续到儿童中期。然而,与属于语音障碍(SSD)总体术语的其他诊断标签相比,DLD(语音)没有阐明儿童言语的特征,也没有指出我们适当干预的方向。
    目的:本文的目的是讨论SSD中的术语,从而导致基于证据的模型,该模型建立在CATALISE中开发的DLD模型上,支持描述性诊断和路标干预。
    方法:在对提出或描述SSD术语的文献进行重点回顾之后,开发SSD研究人员的专家组提出了现有术语的修订模型。为SSD儿童提供服务的英国言语和语言治疗师(SLT)小组被要求对其可接受性和可行性发表评论。
    结论:建立了三级术语模型。这包括一个首要的1级术语;2级术语,将未知来源的SSD与相关或潜在条件的SSD区分开来;以及3级的特定诊断术语,以支持进一步的评估和干预决策。经协商的SLT普遍表示同意拟议的术语,并愿意在实践中采用该术语。
    结论:儿童SSD的现有术语为临床决策提供了良好的基础。Dodd\(2005)术语的修改版本被英国SLT接受。SSD与CATALISE术语有明显的重叠。然而,需要比“DLD(语音)”更详细和专业的术语来支持临床决策。建议英国皇家言语和语言治疗师学院的认可将消除对Delphi过程的需要。
    结论:在这个问题上已经知道了近一百年,随着我们对语音障碍(SSD)的认识和理解的增加,用来描述这些疾病的术语也是如此。当前的术语不仅描述了SSD的亚型,而且还可以指导我们进行有效的干预。随着出版物,2017年,在CATALISE第2阶段,引入了一个新的术语“发育性语言障碍(DLD)(语音)”,其无意的后果是挑战SSD的更具体的描述性术语。本文在CATALISE和DLD(语音)的背景下增加了什么,重新评估SSD术语的历史和性质。在CATALISE中开发的DLD模型的基础上,提出了一个支持描述性诊断和路标干预的分层模型供讨论.这项研究的临床意义提出的SSD术语模型提供了描述性和详细的标签,这些标签将支持言语和语言治疗师对发育性SSD的鉴别诊断的准确性。此外,SSD的决策树展示了从术语的诊断使用到基于证据的选择的途径,有效的干预措施。
    BACKGROUND: The publication of phase 2 of the CATALISE project in 2017 clarified terminology for children with developmental language disorder (DLD) or delay but unintentionally muddied the water for children with unintelligible speech. A diagnostic label of DLD (phonology) indicates poor prognosis and phonological disorder that persists into middle childhood. However, in contrast to other diagnostic labels that fall under the overarching term of speech sound disorder (SSD), DLD (phonology) does not elucidate the characteristics of the child\'s speech nor does it point us in the direction of appropriate intervention.
    OBJECTIVE: The aim of this paper is to discuss terminology in SSD leading to an evidence-based model which builds on the model of DLD developed in CATALISE, supports descriptive diagnosis and signposts intervention.
    METHODS: Following a focused review of literature proposing or describing terminology for SSD, an expert group of researchers in developmental SSD proposed a revised model of existing terminology. Groups of UK speech and language therapists (SLTs) who provide services for children with SSD were asked to comment on its acceptability and feasibility.
    CONCLUSIONS: A three-level terminology model was developed. This comprised an overarching Level 1 term; Level 2 terms that differentiated SSD of unknown origin from SSD with associated or underlying conditions; and specific diagnostic terms at Level 3 to support further assessment and intervention decisions. Consulted SLTs generally expressed agreement with the proposed terminology and a willingness to adopt it in practice.
    CONCLUSIONS: Existing terminology for childhood SSD provides a good basis for clinical decision-making. A modified version of Dodd\'s (2005) terminology was found to be acceptable to UK SLTs. There is an evident overlap of SSD with CATALISE terminology. However more detailed and specialist terminology than \'DLD (phonology)\' is required to support clinical decision-making. It is proposed that endorsement by the UK Royal College of Speech and Language Therapists would obviate the need for a Delphi process.
    CONCLUSIONS: What is already known on this subject Over nearly a hundred years, as our knowledge and understanding of speech sound disorder (SSD) has increased, so has the terminology that is used to describe those disorders. Current terminology not only describes subtypes of SSD but can also signpost us to effective interventions. With the publication, in 2017, of phase 2 of CATALISE a new term of \'developmental language disorder (DLD) (phonology)\' was introduced with the unintentional consequence of challenging more specific descriptive terms for SSD. What this paper adds In the context of CATALISE and DLD (phonology), the history and nature of SSD terminology are reappraised. Building on the model of DLD developed in CATALISE, a tiered model that supports descriptive diagnosis and signposts intervention is proposed for discussion. Clinical implications of this study The proposed model of terminology for SSD provides descriptive and detailed labels that will support accuracy in differential diagnosis of developmental SSD by speech and language therapists. Furthermore, a decision-making tree for SSD demonstrates the pathway from diagnostic use of the terminology to the selection of evidence-based, effective interventions.
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  • 文章类型: Journal Article
    为中风后的运动康复提出基于共识的定义和框架。
    欧洲专家工作组审查了文献,在外部反馈后达成内部共识。
    运动康复被定义为使中风患者参与运动功能的过程,日常生活中的活动能力和表现。这是必要的人与残余运动残疾的目标是提高他们的功能,独立和参与。运动康复通过学习和使用依赖机制进行。运动恢复的轨迹因患者和恢复阶段而异。运动功能的早期行为恢复取决于自发的生物学机制。日常生活活动的进一步改善是通过补偿实现的。运动康复是通过使用基于共识的措施定期评估运动功能和活动来指导的,包括患者报告的结果。与患者及其护理人员讨论结果以设定个人目标。在运动康复期间,患者学会优化和适应他们的运动,通过适当的重复剂量的感觉和认知功能,以目标为导向,进步,任务和上下文特定的培训。运动康复支持中风患者,以最大限度地提高健康,幸福和生活质量。该框架描述了国际功能分类,中风背景下的残疾和健康,描述了行为恢复和补偿的神经生物学机制,并总结了临床评估的建议,预测工具,和运动干预,并从临床实践指南(2016-2022)的强烈推荐。
    这个定义和框架可以指导临床教育工作者,告知临床医生当前的建议和指南,并找出证据基础中的漏洞。
    UNASSIGNED: To propose a consensus-based definition and framework for motor rehabilitation after stroke.
    UNASSIGNED: An expert European working group reviewed the literature, attaining internal consensus after external feedback.
    UNASSIGNED: Motor rehabilitation is defined as a process that engages people with stroke to benefit their motor function, activity capacity and performance in daily life. It is necessary for people with residual motor disability whose goal is to enhance their functioning, independence and participation. Motor rehabilitation operates through learning- and use-dependent mechanisms. The trajectory of motor recovery varies across patients and stages of recovery. Early behavioral restitution of motor function depends on spontaneous biological mechanisms. Further improvements in activities of daily living are achieved by compensations. Motor rehabilitation is guided by regular assessment of motor function and activity using consensus-based measures, including patient-reported outcomes. Results are discussed with the patient and their carers to set personal goals. During motor rehabilitation patients learn to optimize and adapt their motor, sensory and cognitive functioning through appropriately dosed repetitive, goal-oriented, progressive, task- and context-specific training. Motor rehabilitation supports people with stroke to maximize health, well-being and quality of life. The framework describes the International Classification of Functioning, Disability and Health in the context of stroke, describes neurobiological mechanisms of behavioral restitution and compensation, and summarizes recommendations for clinical assessment, prediction tools, and motor interventions with strong recommendations from clinical practice guidelines (2016-2022).
    UNASSIGNED: This definition and framework may guide clinical educators, inform clinicians on current recommendations and guidelines, and identify gaps in the evidence base.
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  • 文章类型: English Abstract
    Sequelae of viral disease with SARS-CoV-2 impact clients\' biopsychosocial health, thus their daily life, with limitations resp. barriers in their occupational capacities and opportunities. Occupational therapists have numerous and, with constantly growing evidence, personalised therapeutic means, measures, and methods in any intervention phase relevant to these according health problems, supporting i. e. coping, occupational adaptation, quality of life and participatory re-shaping of (daily) life. Based on ongoing research findings and practice evidence, this document contains recommendations for occupational therapy intervention for clients with biopsychosocial health conditions post COVID-19.
    UNASSIGNED: Folgen viraler Erkrankung mit SARS-CoV-2 wirken sich auf die biopsychosoziale Gesundheit und damit auf den Alltag Betroffener, deren Handlungs- und Partizipationsmöglichkeiten in sämtlichen Lebensbereichen aus. Ergotherapeut*innen verfügen in sämtlichen Versorgungsphasen über zahlreiche Möglichkeiten in der Auswahl und Gestaltung des Settings, der Interventionsmittel, -maßnahmen und -methoden, um Betroffenen im Hinblick auf größtmögliche Lebensqualität und in einer aktiven Neu-Gestaltung ihres Lebens zu unterstützen. Dieses Dokument bietet diesbezüglich einen Einblick und enthält Empfehlungen für die ergotherapeutische Praxis im Rahmen der bis zum Zeitpunkt der Verfassung verfügbaren Evidenzquellen.
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  • 文章类型: Journal Article
    目的:推广一种有效的策略,以改善危重患者预防应激性溃疡(SUP)的酸抑制性药物的非指南推荐处方(NGRP),并评估对危重患者NGRP的多方面干预的影响和障碍。研究设计与方法:回顾性研究,干预前研究在内科外科ICU中进行。本研究包括干预前和干预后。在干预前期间没有SUP指南和干预。在干预后时期,多方面的干预包括五个特征:实践指南,一场教育运动,药物审查和建议,药物和解,还有ICU团队的药剂师。结果:共研究了557例患者(干预前305例,干预后252例)。接受手术的病人,住在ICU超过7天,或使用皮质类固醇在干预前的NGRP发生率明显较高。通过实施多方面干预措施,NGRP患者平均天数百分比从44.2%显著降低至23.5%(P<0.001)。就所有5项标准而言,NGRP患者的百分比从86.7%降至45.5%(适应症,剂量,IVtoPO,持续时间,和ICU出院)(P=0.003)。每位患者的NGRP费用从45.1美元(22.6,93.0美元)下降到11.3美元(11.3,45.1美元)(P=0.004)。影响NGRP的主要障碍是患者的因素,包括同时使用非甾体抗炎药(NSAIDs),合并症的数量,并接受手术。结论:多方位干预可有效改善NGRP。需要进一步的研究来确认我们的策略是否具有成本效益。
    To promote an effective strategy to improve the non-guideline-recommended prescribing (NGRP) of acid suppressive medications for stress ulcer prophylaxis (SUP) in critically ill patients and to evaluate the impact and barriers of a multifaceted intervention on NGRP in critically ill patients.
    A retrospective, pre- post-intervention study was performed in the medical-surgical ICU. This study included pre-intervention and post-intervention period. There was no SUP guideline and intervention in the pre-intervention period. In the post-intervention period, the multifaceted intervention included five features: a practice guideline, an education campaign, medication review and recommendations, medication reconciliation, and pharmacist rounding with the ICU team.
    A total of 557 patients were studied (305 in the pre-intervention group and 252 in the post-intervention group). Patients who underwent surgery, stayed in ICU more than 7 days, or used corticosteroids experienced significantly higher rate of NGRP in the pre-intervention group. The average percentage of patient days of NGRP was significantly reduced from 44.2% to 23.5% (p < .001) by implementing the multifaceted intervention. The percentage of patients with NGRP decreased from 86.7% to 45.5% in terms of all 5 criteria (indication, dosage, IV to PO, duration, and ICU discharge; p = .003). Per-patient NGRP cost decreased from $45.1 (22.6, 93.0) to $11.3 (11.3, 45.1; p = .004). The main barrier influencing NGRP was the factors of the patient, including the concurrent use of nonsteroidal anti-inflammatory drugs (NSAIDs), the number of comorbidities, and undergoing surgery.
    The multifaceted intervention was effective in improving NGRP. Further studies are needed to confirm whether our strategy is cost-effective.
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  • 文章类型: Journal Article
    肌肉减少症是与年龄相关的骨骼肌质量和肌肉力量或身体功能的损失。这在老年人中最常见。由于其发病率高,阴险的发作,对身体的广泛影响,对我国家庭医疗负担和社会公共卫生支出产生了巨大的影响。我国对肌少症的认识还很缺乏,以及预防建议,control,干预不够明确和统一。这份共识报告的目的是规范预防,control,以及中国老年肌少症患者的干预方法;提高干预效果;减少干预过程中的并发症;降低跌倒风险,骨折,残疾,住院治疗,甚至是老年人的死亡。
    Sarcopenia is the age-related loss of skeletal muscle mass and muscle strength or physical function. It is most common in elderly individuals. Due to its high incidence, insidious onset, and extensive impact on the body, it has a huge impact on the family medical burden and the social public health expenditure in China. The understanding of sarcopenia in China is still lacking, and the recommendations for prevention, control, and intervention are not clear and unified. The purpose of this consensus report is to standardize the prevention, control, and intervention methods for sarcopenia in elderly patients in China; improve the efficacy of intervention; reduce complications during the intervention process; and reduce the risk of falls, fractures, disability, hospitalization, and even death in elderly individuals.
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  • 文章类型: Journal Article
    患有严重精神疾病(SMI)的人的预期寿命比其他人群短。多发病和较差的身体健康导致了这种健康不平等。心脏代谢多重性在该人群中赋予显著的死亡风险。多症不限于老年人和SMI患者在生命早期出现多症。尽管如此,大多数筛选,预防和治疗策略针对老年人。目前的心血管风险评估和降低指南对40岁以下SMI患者的服务不足。需要研究制定和实施干预措施以降低该人群的心脏代谢风险。
    People with severe mental illness (SMI) have a shorter life expectancy than the rest of the population. Multimorbidity and poorer physical health contribute to this health inequality. Cardiometabolic multimorbidity confers a significant mortality risk in this population. Multimorbidity is not restricted to older people and people with SMI present with multimorbidity earlier in life. Despite this, most screening, prevention and treatment strategies target older people. People under 40 years with SMI are underserved by current guidelines for cardiovascular risk assessment and reduction. Research is needed to develop and implement interventions to reduce cardiometabolic risk in this population.
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  • 文章类型: Journal Article
    南非少女意外怀孕和包括艾滋病毒在内的性传播感染的发生率很高。为文化上量身定制的双重保护干预措施提供信息,以防止意外怀孕和性传播感染/艾滋病毒,这项研究定性地检查了女孩的性健康干预偏好。参与者年龄为14-17岁,讲塞索托语(N=25)。为了阐明共同的文化信仰,个别访谈检查了参与者对其他少女怀孕的看法和性传播感染/艾滋病毒预防干预的偏好。面试在塞索托进行,并翻译成英文。两个独立的编码器使用传统的内容分析方法确定了数据中的关键主题,差异由第三个编码器解决。参与者指出,干预内容应包括有效的怀孕和性传播感染/艾滋病毒预防方法以及应对同伴压力的方法。干预措施应该是可以获得的,避免批评,提供高质量的信息。首选的干预形式包括在线,SMS/text,或由社会工作者或更年长的人交付,知识渊博的同龄人,父母或同龄同龄人对分娩的接受度参差不齐。学校,青年中心和性健康诊所是首选的干预机构.结果强调了文化背景在调整双重保护干预措施以解决南非少女生殖健康差距方面的重要性。
    South African adolescent girls experience high rates of unintended pregnancy and sexually transmitted infections including HIV. To inform culturally-tailored dual protection interventions to prevent both unintended pregnancy and STIs/HIV, this study qualitatively examined girls\' sexual health intervention preferences. Participants were aged 14-17 years old and Sesotho-speaking (N = 25). To elucidate shared cultural beliefs, individual interviews examined participants\' perceptions about other adolescent girls\' pregnancy and STI/HIV prevention intervention preferences. Interviews were conducted in Sesotho and translated into English. Two independent coders identified key themes in the data using a conventional content analysis approach with discrepancies resolved by a third coder. Participants indicated that intervention content should include efficacious pregnancy and STI/HIV prevention methods and ways to navigate peer pressure. Interventions should be accessible, avoid criticism and provide high-quality information. Preferred intervention formats included online, SMS/text, or delivery by social workers or older, knowledgeable peers, with mixed acceptability for delivery by parents or same-age peers. Schools, youth centres and sexual health clinics were preferred intervention settings. Results highlight the importance of cultural context in tailoring dual protection interventions to address the reproductive health disparities among adolescent girls in South Africa.
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  • 文章类型: Journal Article
    目的:概述用于诊断0至18岁儿童和青少年听力损失的主要循证建议。
    方法:对工作组成员进行了知识综合方法的教育,包括电子数据库搜索,审查和选择相关引文,以及对选定研究的批判性评估。用英语或葡萄牙语撰写的有关儿童听力损失的文章有资格纳入。美国医师学会的指南分级系统和美国甲状腺协会的指南标准被用于对治疗干预措施的证据和建议的关键评估。
    结果:听力损失的评估和诊断:通用新生儿听力筛查,实验室测试,先天性感染(尤其是巨细胞病毒),基因检测和主要综合征,放射学成像研究,听力损失儿童的前庭评估,听觉神经病变谱系障碍,自闭症谱系障碍,和噪声引起的听力损失。
    结论:每个疑似听力损失的儿童都有权在必要时进行诊断和适当治疗。该工作组考虑了5项基本权利:(1)耳鼻喉科医师咨询;(2)言语评估和治疗;(3)诊断测试;(4)治疗;(5)眼科医生咨询。
    OBJECTIVE: To provide an overview of the main evidence-based recommendations for the diagnosis of hearing loss in children and adolescents aged 0 to 18 years.
    METHODS: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on childhood hearing loss were eligible for inclusion. The American College of Physicians\' guideline grading system and the American Thyroid Association\'s guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions.
    RESULTS: The evaluation and diagnosis of hearing loss: universal newborn hearing screening, laboratory testing, congenital infections (especially cytomegalovirus), genetic testing and main syndromes, radiologic imaging studies, vestibular assessment of children with hearing loss, auditory neuropathy spectrum disorder, autism spectrum disorder, and noise-induced hearing loss.
    CONCLUSIONS: Every child with suspected hearing loss has the right to diagnosis and appropriate treatment if necessary. This task force considers 5 essential rights: (1) Otolaryngologist consultation; (2) Speech assessment and therapy; (3) Diagnostic tests; (4) Treatment; (5) Ophthalmologist consultation.
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  • 文章类型: Journal Article
    目的:概述用于诊断0-18岁儿童和青少年听力损失的主要循证建议。
    方法:对工作组成员进行了知识综合方法的教育,包括电子数据库搜索,审查和选择相关引文,以及对选定研究的批判性评估。用英语或葡萄牙语撰写的有关儿童听力损失的文章有资格纳入。美国医师学会的指南分级系统和美国甲状腺协会的指南标准被用于对治疗干预措施的证据和建议的关键评估。
    结果:主题分为2部分:(1)感觉神经性听力损失的治疗:个人助听器,双侧人工耳蜗植入,幼儿人工耳蜗植入,单侧听力损失,和听觉神经病变谱系障碍;(2)传导性/混合性听力损失的治疗:外/中耳畸形,通风管插入,和儿童鼓室成形术。
    结论:听力损失儿童,除了言语治疗,可指示助听器(HA)或可植入系统。即使是严重听力损失的儿童,使用HAs和使用器械时的行为评估都很重要.
    OBJECTIVE: To provide an overview of the main evidence-based recommendations for the diagnosis of hearing loss in children and adolescents aged 0-18 years.
    METHODS: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on childhood hearing loss were eligible for inclusion. The American College of Physicians\' guideline grading system and the American Thyroid Association\'s guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions.
    RESULTS: The topics were divided into 2 parts: (1) treatment of sensorineural hearing loss: individual hearing aids, bilateral cochlear implants, cochlear implants in young children, unilateral hearing loss, and auditory neuropathy spectrum disorder; and (2) treatment of conductive/mixed hearing loss: external/middle ear malformations, ventilation tube insertion, and tympanoplasty in children.
    CONCLUSIONS: In children with hearing loss, in addition to speech therapy, Hearing AIDS (HAs) or implantable systems may be indicated. Even in children with profound hearing loss, both the use of HAs and behavioral assessments while using the device are important.
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