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Clinical presentation, diagnosis, and management

This section covers the clinical decision-making process primary care physicians employ in patient management. This section covers, though is not limited to, diagnostic practices, referral practices, and shared-decision making.

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  1. Female urinary incontinence is underdiagnosed and undertreated in primary care. There is little evidence on factors that determine whether women with urinary incontinence are referred to specialist services. T...

    Authors: Ipek Gurol-Urganci, Rebecca S. Geary, Jil B. Mamza, Masao Iwagami, Dina El-Hamamsy, Jonathan Duckett, Andrew Wilson, Douglas Tincello and Jan van der Meulen

    Citation: BMC Family Practice 2020 21:211

    Content type: Research article

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  2. Transthyretin amyloidosis (also known as ATTR amyloidosis) is a systemic, life-threatening disease characterized by transthyretin (TTR) fibril deposition in organs and tissue. A definitive diagnosis of ATTR am...

    Authors: Morie Gertz, David Adams, Yukio Ando, João Melo Beirão, Sabahat Bokhari, Teresa Coelho, Raymond L. Comenzo, Thibaud Damy, Sharmila Dorbala, Brian M. Drachman, Marianna Fontana, Julian D. Gillmore, Martha Grogan, Philip N. Hawkins, Isabelle Lousada, Arnt V. Kristen…

    Citation: BMC Family Practice 2020 21:198

    Content type: Guidelines

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  3. Multimorbidity is of increasing prevalence and importance. It has been associated with poorer health-related quality of life (HrQoL) especially in the elderly population. Despite substantial multimorbidity in ...

    Authors: Sai Zhen Sim, Hui Li Koh, Sabrina Poay Sian Lee, Doris Yee Ling Young and Eng Sing Lee

    Citation: BMC Family Practice 2020 21:190

    Content type: Research article

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  4. Acute otitis media (AOM) is a common and most often self-limiting infection in childhood, usually managed in general practice. Even though antibiotics are only recommended when certain diagnostic and clinical ...

    Authors: Jonas K. Olsen, Jesper Lykkegaard, Malene Plejdrup Hansen, Frans B. Waldorff, Jørgen Lous and Merethe K. Andersen

    Citation: BMC Family Practice 2020 21:177

    Content type: Research article

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  5. The responsibility for helping patients understand potential health benefits and risks, especially regarding screening tests, falls largely to general practitioners (GPs). The Berlin Numeracy Test (BNT) specif...

    Authors: Hendrik Friederichs, Roman Birkenstein, Jan C. Becker, Bernhard Marschall and Anne Weissenstein

    Citation: BMC Family Practice 2020 21:143

    Content type: Research article

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  6. Rectal bleeding and a change in bowel habits are considered to be alarm symptoms for colorectal cancer and they are also common symptoms for inflammatory bowel disease. However, most patients with these sympto...

    Authors: Cecilia Högberg, Pontus Karling, Jörgen Rutegård and Mikael Lilja

    Citation: BMC Family Practice 2020 21:129

    Content type: Research article

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  7. Urinary tract infections are one of the most common reasons for prescribing antibiotics in primary care. Current guidelines recommend fosfomycin, nitrofurantoin, or trimethoprim - sulfamethoxazol as empiric fi...

    Authors: Andreas Plate, Andreas Kronenberg, Martin Risch, Yolanda Mueller, Stefania Di Gangi, Thomas Rosemann and Oliver Senn

    Citation: BMC Family Practice 2020 21:125

    Content type: Research article

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  8. The 2017 Canadian opioid Guideline made both strong recommendations, indicating that all or almost all fully informed patients would choose the recommended course of action, and weak recommendations, in which ...

    Authors: Jason W. Busse, David Juurlink, D. Norman Buckley and Gordon H. Guyatt

    Citation: BMC Family Practice 2020 21:109

    Content type: Correspondence

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    The original article was published in BMC Family Practice 2019 20:59

  9. Unhealthy alcohol use is the third leading cause of preventable death in the United States. Evidence demonstrates that screening for unhealthy alcohol use and providing persons engaged in risky drinking with b...

    Authors: Alison N. Huffstetler, Anton J. Kuzel, Roy T. Sabo, Alicia Richards, E. Marshall Brooks, Paulette Lail Kashiri, Gabriela Villalobos, Albert J. Arias, Dace Svikis, Beth A. Bortz, Ashley Edwards, John Epling, Deborah J. Cohen, Michael L. Parchman, Jonathan Winter, Patricia Wessler…

    Citation: BMC Family Practice 2020 21:93

    Content type: Study protocol

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  10. The 2017 American College of Cardiology and American Heart Association guideline defined hypertension as blood pressure (BP) ≥ 130/80 mmHg compared to the traditional definition of ≥140/90 mmHg. This change ra...

    Authors: Bumsoo Park, Katarzyna Budzynska, Nada Almasri, Sumaiya Islam, Fanar Alyas, Rachel L. Carolan, Benjamin E. Abraham, Pamela A. Castro-Camero, Maria E. Shreve, Della A. Rees and Lois Lamerato

    Citation: BMC Family Practice 2020 21:91

    Content type: Research article

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  11. This study evaluated the impact of multifaceted NPS MedicineWise programs that targeted all general practitioners (GPs) in Australia in 2009 and 2015 with the aim of reducing unnecessary prescribing of proton ...

    Authors: Jianyun Wu, Scott Dickinson, Zain Elgebaly, Suzanne Blogg, Aine Heaney, Yien Soo, Benjamin Daniels and Lynn Weekes

    Citation: BMC Family Practice 2020 21:85

    Content type: Research article

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  12. Patients with high cardiovascular risk are usually cared for in primary care settings. Assessment of the effectiveness of long-time care was a subject of many European studies in the last two decades. This pap...

    Authors: Zoltán Jancsó, Imre Rurik, László Kolozsvári, Lajos Mester, Anna Nánási, Csaba Oláh, Tímea Ungvári, Katalin Vraukó TCs, László Kalabay and Péter Torzsa

    Citation: BMC Family Practice 2020 21:83

    Content type: Research article

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  13. Ankylosing spondylitis (AS) often has a long period from first symptom presentation to diagnosis. We examined the occurrence of symptoms, prescriptions and diagnostic tests in primary care electronic records o...

    Authors: Mohammed T. Bashir, Lisa Iversen and Christopher Burton

    Citation: BMC Family Practice 2020 21:78

    Content type: Research article

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  14. In western countries, psychological stress is among the most common causes of long-lasting sick leave and a frequent reason to consult the general practitioner (GP). This study aimed to investigate how GPs man...

    Authors: Jesper Lykkegaard, Anders Prior and Marianne Rosendal

    Citation: BMC Family Practice 2020 21:67

    Content type: Research article

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  15. In hypertensive patients, reducing plasma low-density lipoprotein cholesterol level (LDL-C) is one of the main interventions for preventing chronic cardiovascular diseases (CVD). However, LDL-C control remains...

    Authors: Aapo Tahkola, Päivi Korhonen, Hannu Kautiainen, Teemu Niiranen and Pekka Mäntyselkä

    Citation: BMC Family Practice 2020 21:62

    Content type: Research article

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  16. The oldest old (individuals over 90 years) are a fast-growing population. Characterizing their specificity would be helpful to adapt health care. This study aimed to characterize the cognitive, functional, nut...

    Authors: Emile Escourrou, Florence Durrieu, Bruno Chicoulaa, Julie Dupouy, Stéphane Oustric, Sandrine Andrieu and Virginie Gardette

    Citation: BMC Family Practice 2020 21:58

    Content type: Research article

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  17. We aimed to describe primary care management at the time of a suicide attempt (SA) and after the SA.

    Authors: Nadia Younes, Mathieu Rivière, Frédéric Urbain, Romain Pons, Thomas Hanslik, Louise Rossignol, Christine Chan Chee and Thierry Blanchon

    Citation: BMC Family Practice 2020 21:55

    Content type: Research article

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  18. Experienced and anticipated regret influence physicians’ decision-making. In medicine, diagnostic decisions and diagnostic errors can have a severe impact on both patients and physicians. Little empirical rese...

    Authors: Beate S. Müller, Norbert Donner-Banzhoff, Martin Beyer, Jörg Haasenritter, Angelina Müller and Carola Seifart

    Citation: BMC Family Practice 2020 21:53

    Content type: Research article

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  19. Stratified care involves subgrouping patients based on key characteristics, e.g. prognostic risk, and matching these subgroups to appropriate early treatment options. The STarT MSK feasibility and pilot cluste...

    Authors: Benjamin Saunders, Jonathan C. Hill, Nadine E. Foster, Vince Cooper, Joanne Protheroe, Adrian Chudyk, Carolyn Chew-Graham and Bernadette Bartlam

    Citation: BMC Family Practice 2020 21:31

    Content type: Research article

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  20. Musculoskeletal (MSK) pain from the five most common presentations to primary care (back, neck, shoulder, knee or multi-site pain), where the majority of patients are managed, is a costly global health challen...

    Authors: J. C. Hill, S. Garvin, Y. Chen, V. Cooper, S. Wathall, B. Saunders, M. Lewis, J. Protheroe, A. Chudyk, K. M. Dunn, E. Hay, D. van der Windt, C. Mallen and N. E. Foster

    Citation: BMC Family Practice 2020 21:30

    Content type: Research article

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  21. Vitamin D (VD) may increase sirtuin 1 (SIRT1) and subsequently PPAR-γ coactivator 1α (PGC-1α) and irisin levels and these improvements may reduce insulin resistance (IR). The aim was to assess the effects of v...

    Authors: Peivasteh Safarpour, Milad Daneshi-Maskooni, Mohammadreza Vafa, Mitra Nourbakhsh, Leila Janani, Mohsen Maddah, Fatemeh-Sadat Amiri, Fereshteh Mohammadi and Homa Sadeghi

    Citation: BMC Family Practice 2020 21:26

    Content type: Research article

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  22. Patient reported outcome measures (PROMs) are increasingly used to assess impact of disease and treatment on quality of life and symptoms; however, their use in primary care is fragmented.

    Authors: Grace M. Turner, Ian Litchfield, Sam Finnikin, Olalekan Lee Aiyegbusi and Melanie Calvert

    Citation: BMC Family Practice 2020 21:14

    Content type: Research article

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  23. Detection and treatment of atrial fibrillation (AF) are important given the serious health consequences. AF may be silent or paroxysmal and remain undetected. It is unclear whether general practitioners (GPs) ...

    Authors: N. Verbiest - van Gurp, D. van Mil, H. A. M. van Kesteren, J. A. Knottnerus and H. E. J. H. Stoffers

    Citation: BMC Family Practice 2019 20:175

    Content type: Research article

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    The Correction to this article has been published in BMC Family Practice 2020 21:24

  24. Patients who have experienced a cardiovascular clinical event such as a myocardial infarction or stroke qualify for intensive risk factor evaluation and management.

    Authors: Diana Fernández, Carlos Brotons, Irene Moral, Mateja Bulc, Mélanie Afonso, Hülya Akan, Susana Pinto, Jasna Vucak and Carlos Manuel da Silva Martins

    Citation: BMC Family Practice 2019 20:162

    Content type: Research article

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  25. Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. Little is known on how posterior canal BPPV affects health-related quality of life in patients diagnosed and treated at primary ...

    Authors: Ricard Carrillo Muñoz, José Luis Ballve Moreno, Iván Villar Balboa, Yolanda Rando Matos, Oriol Cunillera Puertolas, Jesús Almeda Ortega, Estrella Rodero Perez, Xavier Monteverde Curto, Carles Rubio Ripollès, Noemí Moreno Farres, Austria Matos Mendez, Jean Carlos Gomez Nova, Marta Bardina Santos, Johan Josué Villarreal Miñano, Diana Lizzeth Pacheco Erazo and Anabella María Hernández Sánchez

    Citation: BMC Family Practice 2019 20:156

    Content type: Research article

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  26. The changes in the models of care for mental disorders towards a community focus and deinstitutionalisation might have risen General practitioners’ (GPs) workload, increasing their mental health concerns and t...

    Authors: C. Barcons, B. García, C. Sarri, E. Rodríguez, O. Cunillera, N. Parellada, B. Fernández, C. E. Alvarado, C. Barrio, J. C. Fleta, D. Ruiz and R. Torrubia

    Citation: BMC Family Practice 2019 20:155

    Content type: Research article

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  27. Adherence to treatment, a public health issue, is of particular importance in chronic disease therapies. Primary care practices offer ideal venues for the effective care and management of these conditions. The...

    Authors: Cesar I. Fernandez-Lazaro, Juan M. García-González, David P. Adams, Diego Fernandez-Lazaro, Juan Mielgo-Ayuso, Alberto Caballero-Garcia, Francisca Moreno Racionero, Alfredo Córdova and Jose A. Miron-Canelo

    Citation: BMC Family Practice 2019 20:132

    Content type: Research article

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  28. Otoscopy alone has low sensitivity and specificity for acute otitis media (AOM). Otomicroscopy and pneumatic methods are superior to otoscopy. However, these methods require clinical skills. The use of differe...

    Authors: Pär-Daniel Sundvall, Chrysoula E. Papachristodoulou and Lena Nordeman

    Citation: BMC Family Practice 2019 20:127

    Content type: Research article

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  29. Brain tumour patients see their primary care doctor on average three or more times before diagnosis, so there may be an opportunity to identify ‘at risk’ patients earlier. Suspecting a brain tumour diagnosis i...

    Authors: K. Zienius, Ip Chak-Lam, J. Park, M. Ozawa, W. Hamilton, D. Weller, D. Summers, L. Porteous, S. Mohiuddin, E. Keeney, W. Hollingworth, Y. Ben-Shlomo, R. Grant and P. M. Brennan

    Citation: BMC Family Practice 2019 20:118

    Content type: Research article

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  30. Few studies in Portugal have attempted to assess the impact of psychological interventions in primary health care regarding the problems shared by clients, and which variables predicted the success of this int...

    Authors: Miguel Ricou, Sílvia Marina, Paula Marinho Vieira, Ivone Duarte, Inês Sampaio, Joana Regalado and Catarina Canário

    Citation: BMC Family Practice 2019 20:116

    Content type: Research article

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  31. Harmful alcohol consumption in Germany is a serious public health problem: About 7.7 million adults in Germany can be classified as risky alcohol consumers, about 74,000 deaths per year are related to alcohol ...

    Authors: T. Hoffmann, K. Voigt, J. Kugler, L. Peschel, A. Bergmann and H. Riemenschneider

    Citation: BMC Family Practice 2019 20:115

    Content type: Research article

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  32. The German clinical guideline on tobacco addiction recommends that general practitioners (GPs) provide brief stop-smoking advice to their patients according to the “5A” or the much briefer “ABC” method, but it...

    Authors: Sabrina Kastaun, Verena Leve, Jaqueline Hildebrandt, Christian Funke, Stephanie Becker, Diana Lubisch, Wolfgang Viechtbauer, Olaf Reddemann, Linn Hempel, Hayden McRobbie, Tobias Raupach, Robert West and Daniel Kotz

    Citation: BMC Family Practice 2019 20:107

    Content type: Study protocol

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  33. Anxiety is under-recorded and under-treated in the UK and is under-represented in research compared with depression. Detecting anxiety can be difficult because of co-existing conditions. GPs can be reluctant t...

    Authors: M. C. Barnes, D. Kessler, C. Archer and N. Wiles

    Citation: BMC Family Practice 2019 20:106

    Content type: Research article

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  34. Antidepressant use continues to rise, mainly explained by an increase in the proportion of patients receiving long term treatment. Although treatment guidelines recommend discontinuation after sustained remiss...

    Authors: Carolien Wentink, Marloes J. Huijbers, Peter Lucassen, Cornelis Kramers, Reinier Akkermans, Eddy Adang, Jan Spijker and Anne E. M. Speckens

    Citation: BMC Family Practice 2019 20:105

    Content type: Study protocol

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  35. Malnutrition (specifically undernutrition) in older, community-dwelling adults reduces well-being and predisposes to disease. Implementation of screen-and-treat policies could help to systematically detect and...

    Authors: Philine S. Harris, Liz Payne, Leanne Morrison, Sue M. Green, Daniela Ghio, Claire Hallett, Emma L. Parsons, Paul Aveyard, Helen C. Roberts, Michelle Sutcliffe, Siân Robinson, Joanna Slodkowska-Barabasz, Paul S. Little, Michael A. Stroud and Lucy Yardley

    Citation: BMC Family Practice 2019 20:100

    Content type: Research article

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  36. General practitioners increasingly use point-of-care ultrasonography despite a lack of evidence-based guidelines for their appropriate use in primary care. Little is known about the integration of ultrasonogra...

    Authors: Camilla Aakjær Andersen, Annette Sofie Davidsen, John Brodersen, Ole Graumann and Martin Bach Jensen

    Citation: BMC Family Practice 2019 20:89

    Content type: Research article

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  37. Patients with anemia are frequently encountered in primary care. Once anemia is detected, it is essential to define the type and identify the underlying cause prior to initiation of treatment. In most cases, t...

    Authors: Anders Larsson, Lena Carlsson, Bo Karlsson and Miklos Lipcsey

    Citation: BMC Family Practice 2019 20:77

    Content type: Research article

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  38. The national guideline for sore throat, endorsed by the Danish Society of General Medicine, recommends the use of the modified Centor score and streptococcal rapid antigen detection test to guide diagnosis and...

    Authors: Kasper Basse Reinholdt, Maria Rusan, Pernille Rosbjerg Hansen and Tejs Ehlers Klug

    Citation: BMC Family Practice 2019 20:75

    Content type: Research article

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  39. Patients with medically unexplained physical symptoms (MUPS) are common in primary care, with a spectrum from mild to moderate and chronic MUPS. The burden of chronic MUPS is high, and early identification of ...

    Authors: Paula Elisabeth van Westrienen, Martijn Frits Pisters, Cindy Veenhof and Nicolaas Johannes de Wit

    Citation: BMC Family Practice 2019 20:66

    Content type: Research article

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  40. Right bundle branch block is one of the most common electrocardiographic abnormalities. Most cases of right bundle branch block are detected in asymptomatic patients in primary care, so a correct interpretatio...

    Authors: M. Alventosa-Zaidin, G. Pera, C. Roca Saumell, N. Mengual Miralles, M. V. Zamora Sanchez, T. Gros Garcia, L. Guix Font, M. Benitez Camps, J. Francisco-Pascual and J. Brugada Terradellas

    Citation: BMC Family Practice 2019 20:58

    Content type: Research article

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  41. Serious infections in older people are associated with unplanned hospital admissions and high mortality. Recognising the presence of a serious infection and making an accurate diagnosis are important challenge...

    Authors: Sara McKelvie, Abigail Moore, Caroline Croxson, Daniel S. Lasserson and Gail N. Hayward

    Citation: BMC Family Practice 2019 20:56

    Content type: Research article

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  42. The demand for out-of-hours (OOH) primary care has increased during the last decades, with a considerable amount of contacts for young children. This study aims to describe the reasons for encounter (RFE), the...

    Authors: Jørgen Lous, Grete Moth, Linda Huibers, Peter Vedsted and Morten Bondo Christensen

    Citation: BMC Family Practice 2019 20:36

    Content type: Research article

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  43. Previous studies in general practice and hospital settings have identified that prescribing of non-insulin diabetes medications may be sub-optimal in people with type 2 diabetes (T2D) and renal impairment. Sin...

    Authors: Jo-Anne Manski-Nankervis, Sharmala Thuraisingam, Janet K. Sluggett, Gary Kilov, John Furler, David O’Neal and Alicia Jenkins

    Citation: BMC Family Practice 2019 20:29

    Content type: Research article

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  44. Stress urinary incontinence (SUI) is the most prevalent subtype of urinary incontinence and is a bothering condition in women. Only a minority of those with SUI consult a general practitioner (GP). EHealth wit...

    Authors: Lotte Firet, Chrissy de Bree, Carmen M. Verhoeks, Doreth A. M. Teunissen and Antoine L. M. Lagro-Janssen

    Citation: BMC Family Practice 2019 20:21

    Content type: Research article

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  45. Uncontrolled blood pressure remains an urgent issue in clinical practice worldwide. This study aimed to compare the characteristics and effectiveness of hypertension control in family medicine pratice in the f...

    Authors: Diana Jurić, Ivančica Pavličević, Ana Marušić, Mario Malički, Ivan Buljan, Velen Šarotić, Nataša Mrduljaš-Đujić, Ante Komparak, Miona Vujević, Danijela De Micheli-Vitturi, Pjera Šušnjar, Tina Puljiz, Minka Jerčić, Dario Leskur and Matko Marušić

    Citation: BMC Family Practice 2019 20:10

    Content type: Research article

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