Pain-management strategies among hospitalized trauma patients: a preliminary study in a teaching hospital in Indonesia

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Patients could use more than one pain-management strategy. Note.The patients could use more than one pain-management strategy." ] ] ] "textoCompleto" => "IntroductionApparently, the incidence of trauma has been high and is considered to have increased throughout the years (World Health Organization [WHO]<a class="elsevierStyleCrossRef" href="#bib0005">1</a>,<a class="elsevierStyleCrossRef" href="#bib0010">2</a>. Hospital admissions were reportedly 2.3 million in the United States and 5.7 million in European countries (Centers for Disease Control and Prevention [CDC]<a class="elsevierStyleCrossRef" href="#bib0015">3</a>,<a class="elsevierStyleCrossRef" href="#bib0020">4</a>. Most trauma patients were admitted due to motor-vehicle collisions (MVC) or falls<a class="elsevierStyleCrossRef" href="#bib0010">2</a>. Likewise, in Indonesia, the incidence of trauma from MVC accounted for close to 1.3 million every year<a class="elsevierStyleCrossRef" href="#bib0005">1</a>. This number is indicated that MVC was sitting in the top 10 of leading causes of death.Previous research in Western countries found a high prevalence of moderate to severe pain in trauma patients during hospitalization. For instance, 80 percent of musculoskeletal injury patients in a study conducted by Rosenbloom perceived moderate to severe pain when they were admitted to a large hospital in Canada<a class="elsevierStyleCrossRef" href="#bib0025">5</a>. Similarly, most patients with other types of trauma, such as burns and orthopedics injuries rated the same level of pain<a class="elsevierStyleCrossRef" href="#bib0030">6</a>,<a class="elsevierStyleCrossRef" href="#bib0035">7</a>. Also, two qualitative studies have interviewed hospitalized trauma patients in<a name="p2"></a> westernized cities of Asia<a class="elsevierStyleCrossRef" href="#bib0040">8</a>,<a class="elsevierStyleCrossRef" href="#bib0045">9</a>. These studies revealed that most trauma patients with orthopedic and burn injuries reported severe pain during hospitalization.Pain management is essential to eliminate the cause of pain<a class="elsevierStyleCrossRef" href="#bib0050">10</a>. Evidence noted that trauma patients might receive pharmacological or nonpharmacological methods (e.g., relaxation, guided imagery, and information about pain)<a class="elsevierStyleCrossRef" href="#bib0040">8</a>,<a class="elsevierStyleCrossRefs" href="#bib0055">11–15</a>. Moreover, patients are able to apply their strategies, such as music, relaxation, or praying<a class="elsevierStyleCrossRefs" href="#bib0080">16–19</a>. However, the study showed that the nonpharmacological strategy was underutilized<a class="elsevierStyleCrossRef" href="#bib0100">20</a>.Although pain and pain management in hospitalized traumatic patients has been well documented in western countries and Asia (i.e., Hong Kong), the differences of culture, society, and health care system among countries has recognized as one of the influencing factors to how person perceives and reacts to pain experience<a class="elsevierStyleCrossRef" href="#bib0105">21</a>. In Indonesia, little research on pain in hospitalized traumatic patients exists. Therefore, a study was needed to examine the issue of the intensity of pain and pain management so as to conduct preliminary estimates of the rates of pain and the types of pain management strategies used by hospitalized trauma patients. Such knowledge will be helpful in providing basic information to healthcare providers to gain an understanding about pain and its management based on patients’ preferences. Consequently, healthcare providers can provide pain management properly based on individual needs as they relate to the Indonesian context.MethodThis descriptive study analyzed hospitalized trauma patients in the surgical wards of Hasan Sadikin hospital, a teaching hospital in West java, Indonesia. Eligible patients included those admitted to the wards in one day, had a Glasgow Coma Scale score of 15, were at least 18 years old, had sustained trauma to areas of the face, chest, abdomen, pelvis, musculoskeletal structure, or limbs, or had been burned, had no psychiatric disorder, and spoke Indonesian.After the research ethics committee of the Faculty of Nursing and Hasan Sadikin hospital gave its approval, patients who agreed to participate in the study provided their informed consent. Then the first researcher collected data. On the first day, all patients were interviewed about personal information and asked to rate their pain on a numeric rating scale of the brief pain inventory (BPI).The Indonesian version of the BPI was used to measure pain intensity. It included four items of pain and assessed pain over past one day: pain at its worst, pain at its least, pain on average, and pain right now. This version showed good reliability by Cronbach's alpha equal to .77. The BPI continued assesses the pain of patients on Day 2 and 3. On the third day, in addition to the assessment of the intensity of pain, patients were asked to complete the pain management questionnaire. This questionnaire was developed by the researcher based on a symptom-management model<a class="elsevierStyleCrossRef" href="#bib0105">21</a> and literature review. It consisted of 11 options for pain. A blank space also provided that allowed patients to describe the strategies that may not have been among the options.Data were statistically analyzed and described by the descriptive statistic. In addition, for the benefit of the analysis, pain intensity was categorized as mild (BPI, 1-4), moderate (BPI, 5-6), and severe (BPI, 7-10)<a class="elsevierStyleCrossRef" href="#bib0035">7</a>.ResultsCharacteristics of the hospitalized trauma patientsA total of 95 hospitalized trauma patients were enrolled in this pilot study. The average of age of the patients was 35.87 (SD=11.05). Most patients were male (71.6%) and Islamic. Half of the patients had orthopedic injuries (52.6%). Most patients received nonsurgical treatments (88.4%) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Pain intensity of the hospitalized trauma patientsOverall, the pain intensity of hospitalized trauma patients during the first 3 days after admission was at a mild to moderate level. The average pain was 3.99 (SD=1.18) on day 1, 3.63 (SD=1.02) on day 2, and 3.22 (SD=.97) on day 3. Furthermore, the repeated measures ANOVA test revealed<a name="p3"></a> statistically significant differences in pain on day 1, day 2, and day 3 after hospital admission (p < .001) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Pain management of the hospitalized trauma patientsGenerally, all patients used the strategies provided in the questionnaire to reduce their pain (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). Most hospitalized trauma patients frequently used praying (84.2%) as their strategy to reduce pain. This strategy was followed by Slow and Deep Breathing (SDB) (78.9%) and an attempt to tolerate it (46.3%). Meanwhile, other strategies least frequently used by patients included changing position, reading, and immediately telling the nurses about the pain (17.9%, 15.8%, and 15.8%, respectively).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>DiscussionThe objective of this study was to provide a pilot description of the rate of the intensity of pain and frequency of pain-management strategies of hospitalized trauma patients. This study found that the intensity of pain of hospitalized trauma patients was at the mild to moderate level. These findings contrasted with those of previous studies in Western countries that found that the intensity of pain was at a moderate to severe level<a class="elsevierStyleCrossRefs" href="#bib0025">5–7</a>. The result of current find-ing can be explained as follows. The patients in this study had a single injury, which indicated minor-injury level<a class="elsevierStyleCrossRef" href="#bib0110">22</a>. Also, patients received several pharmacological pain-management, including paracetamol, ketorolac, tramadol, and fentanyl, which were used to relieve pain effectively. Pa-tients also applied several strategies by themselves.With respect to patients’ pain-management strategies, most patients in this study reported that they prayed to relieve their pain. This is not surprising because most patients were Muslim. The spiritual aspects are personal concerns that relate to the belief about pain and affect patients’ views on pain management<a class="elsevierStyleCrossRef" href="#bib0115">23</a>. Patients in this study noted that the pain and its relief came from God (Allah); therefore, they prayed frequently and recited the name of Allah (Dzikir). Moreover, they noted that hope and asking for help from God could make them calm and relax them. Factoring praying into pain management is important because it can<a name="p4"></a> improve patients’ physical and emotional well-being, enhance the immune system, and foster pain relief<a class="elsevierStyleCrossRef" href="#bib0120">24</a>. In a cross-sectional study, chronic pain patients found that praying was related to pain tolerance. Patients with a high level of praying had a lower intensity of pain<a class="elsevierStyleCrossRef" href="#bib0125">25</a>.The SDB was in second place. It has been proved to be effective in reducing pain<a class="elsevierStyleCrossRef" href="#bib0070">14</a>. Consistent with this finding, trauma patients in this study applied it when they felt pain at its worst. More specifically, orthopedic trauma patients reported that they performed SDB while nurses made up their bed. In addition, almost half the patients tried to bear their pain (trying to tolerate). No patients gave the reason for these strategies. Wong and Chan noted that patients tried to bear and tolerate the pain because of their perception that pain is normal if one is wounded<a class="elsevierStyleCrossRef" href="#bib0040">8</a>.Meanwhile, some pain-management strategies were used by patients the least, such as reading and immediately informing the nurse about pain. Patients were reluctant to report pain intensity to nurses and preferred to endure the pain - this behavior was possibly related to gender and the nature of nursing work." "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:3 [ "identificador" => "xres1092613" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1035485" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Method" ] 4 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Characteristics of the hospitalized trauma patients" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Pain intensity of the hospitalized trauma patients" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Pain management of the hospitalized trauma patients" ] ] ] 5 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "xack371199" "titulo" => "Acknowledgement" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1035485" "palabras" => array:3 [ 0 => "Pain" 1 => "Pain management" 2 => "Trauma" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "The incidence of trauma has been high and is considered to have increased throughout the years. This study aimed to describe the pain intensity and pain-management strategies of hospitalized trauma patients. Ninety-five adults presenting trauma with full consciousness, and who were admitted to surgical wards were recruited. Outcomes were assessed in a 3-day follow-up of pain and pain management from January to February 2016 by using questionnaires for interviews. Data were analyzed using descriptive statistics and repeated measures ANOVA. Preliminary research found that hospitalized trauma patients perceived mild to severe pain intensity. The trend of pain at its worst, pain at its least, average pain, and current pain decreased from Day 1 to day 3, which were statistically and significantly different (p < .001). The pain management often used by patients were: praying (84.2%), slow and deep breathing (78.9%), and at an attempt at toleration (46.3%). The least frequent method of pain management included immediately informing nurses about the pain (15.8%), reading (15.8%), and changing position (17.9%). Besides the pharmacological and nonpharmacological interventions received from physicians and nurses, strategies were crucial to alleviating pain in hospitalized trauma patients related to cultural context." ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 482 "Ancho" => 1983 "Tamanyo" => 93518 ] ] "descripcion" => array:1 [ "en" => "Percentage of pain-management strategies used by patients (n=95). Patients could use more than one pain-management strategy. Note.The patients could use more than one pain-management strategy." ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">n (%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age (years) (Mean/SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">(35.87/11.05) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Gender \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68 (71.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 (28.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Religion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Islam \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81 (85.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Christian \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (14.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Medical diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Orthopedic injuries (i.e., fracture of clavicle, hand, leg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 (52.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Mild head injury \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (23.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Burn injury (i.e., grades 2-3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (7.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Musculoskeletal injury (i.e., strain) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Multiple injuries (e.g., head injury + leg fracture) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (15.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Cause of injury \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Traffic accident \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65 (68.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Fall \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (17.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Industrial accident \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (8,4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Other (i.e., home accident, assault, sports) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (5.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Treatments<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Nonsurgerical \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84 (88.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Wound dressing \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 (35.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Splint board, sling \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 (48.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Skeletal, skin traction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (8.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Surgery (i.e., open reduction internal/external fixation) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (11.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1868539.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "Patient received more than one treatment." ] ] ] "descripcion" => array:1 [ "en" => "Patients’ characteristics (n=95)." ] ] 2 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pain \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Duration after admission \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Mean (interpretation) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">F \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Right now</td><td class="td" title="table-entry " align="left" valign="top">Day 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.74 (moderate) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">133.85<a class="elsevierStyleCrossRef" href="#tblfn0010">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Day 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.11 (moderate) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Day 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.38 (mild) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">At worst</td><td class="td" title="table-entry " align="left" valign="top">Day 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.33 (moderate) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">124.29<a class="elsevierStyleCrossRef" href="#tblfn0010">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Day 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.76 (moderate) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Day 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.15 (moderate) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">At least</td><td class="td" title="table-entry " align="left" valign="top">Day 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.85 (mild) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39.98<a class="elsevierStyleCrossRef" href="#tblfn0010">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Day 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.57 (mild) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Day 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.26 (mild) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Average</td><td class="td" title="table-entry " align="left" valign="top">Day 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.99 (mild) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78.06<a class="elsevierStyleCrossRef" href="#tblfn0010">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Day 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.63 (mild) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Day 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.22 (mild) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.97 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1868540.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "*" "nota" => "p < .001." ] ] ] "descripcion" => array:1 [ "en" => "Pain intensity during day 1, day 2, and day 3 after patients were admitted to the hospital (n=95)." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => 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Corveleyn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10865-011-9348-2" "Revista" => array:6 [ "tituloSerie" => "J Behav Med" "fecha" => "2011" "volumen" => "34" "paginaInicial" => "542" "paginaFinal" => "549" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21516338" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack371199" "titulo" => "Acknowledgement" "texto" => "This study was supported by Thailand's Education Hub for ASEAN Countries (TEH-AC). We thank Graduate School and Faculty of Nursing, Prince of Songkla University, Thailand, Hasan Sadikin general hospital, Indonesia, and all participants of this study." "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/11308621/00000028000000S1/v4_201810090949/S1130862118300585/v4_201810090949/en/main.assets" "Apartado" => array:4 [ "identificador" => "75447" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Part 1" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/11308621/00000028000000S1/v4_201810090949/S1130862118300585/v4_201810090949/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130862118300585?idApp=UINPBA00004N"]

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Deya Prastika

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prastika.dy@gmail.com

Corresponding author.

, Luppana Kitrungrote, Jintana Damkliang

Faculty of Nursing, Prince of Songkla University, Songkhla, Thailand

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Apparently&#44; the incidence of trauma has been high and is considered to have increased throughout the years &#40;World Health Organization &#91;WHO&#93;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; Hospital admissions were reportedly 2&#46;3 million in the United States and 5&#46;7 million in European countries &#40;Centers for Disease Control and Prevention &#91;CDC&#93;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; Most trauma patients were admitted due to motor-vehicle collisions &#40;MVC&#41; or falls<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; Likewise&#44; in Indonesia&#44; the incidence of trauma from MVC accounted for close to 1&#46;3 million every year<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; This number is indicated that MVC was sitting in the top 10 of leading causes of death&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Previous research in Western countries found a high prevalence of moderate to severe pain in trauma patients during hospitalization&#46; For instance&#44; 80 percent of musculoskeletal injury patients in a study conducted by Rosenbloom perceived moderate to severe pain when they were admitted to a large hospital in Canada<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46; Similarly&#44; most patients with other types of trauma&#44; such as burns and orthopedics injuries rated the same level of pain<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46; Also&#44; two qualitative studies have interviewed hospitalized trauma patients in<a name="p2"></a> westernized cities of Asia<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46; These studies revealed that most trauma patients with orthopedic and burn injuries reported severe pain during hospitalization&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Pain management is essential to eliminate the cause of pain<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46; Evidence noted that trauma patients might receive pharmacological or nonpharmacological methods &#40;e&#46;g&#46;&#44; relaxation&#44; guided imagery&#44; and information about pain&#41;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#8211;15</span></a>&#46; Moreover&#44; patients are able to apply their strategies&#44; such as music&#44; relaxation&#44; or praying<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#8211;19</span></a>&#46; However&#44; the study showed that the nonpharmacological strategy was underutilized<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Although pain and pain management in hospitalized traumatic patients has been well documented in western countries and Asia &#40;i&#46;e&#46;&#44; Hong Kong&#41;&#44; the differences of culture&#44; society&#44; and health care system among countries has recognized as one of the influencing factors to how person perceives and reacts to pain experience<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#46; In Indonesia&#44; little research on pain in hospitalized traumatic patients exists&#46; Therefore&#44; a study was needed to examine the issue of the intensity of pain and pain management so as to conduct preliminary estimates of the rates of pain and the types of pain management strategies used by hospitalized trauma patients&#46; Such knowledge will be helpful in providing basic information to healthcare providers to gain an understanding about pain and its management based on patients&#8217; preferences&#46; Consequently&#44; healthcare providers can provide pain management properly based on individual needs as they relate to the Indonesian context&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Method</span><p id="par0025" class="elsevierStylePara elsevierViewall">This descriptive study analyzed hospitalized trauma patients in the surgical wards of Hasan Sadikin hospital&#44; a teaching hospital in West java&#44; Indonesia&#46; Eligible patients included those admitted to the wards in one day&#44; had a Glasgow Coma Scale score of 15&#44; were at least 18 years old&#44; had sustained trauma to areas of the face&#44; chest&#44; abdomen&#44; pelvis&#44; musculoskeletal structure&#44; or limbs&#44; or had been burned&#44; had no psychiatric disorder&#44; and spoke Indonesian&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">After the research ethics committee of the Faculty of Nursing and Hasan Sadikin hospital gave its approval&#44; patients who agreed to participate in the study provided their informed consent&#46; Then the first researcher collected data&#46; On the first day&#44; all patients were interviewed about personal information and asked to rate their pain on a numeric rating scale of the brief pain inventory &#40;BPI&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The Indonesian version of the BPI was used to measure pain intensity&#46; It included four items of pain and assessed pain over past one day&#58; pain at its worst&#44; pain at its least&#44; pain on average&#44; and pain right now&#46; This version showed good reliability by Cronbach&#39;s alpha equal to &#46;77&#46; The BPI continued assesses the pain of patients on Day 2 and 3&#46; On the third day&#44; in addition to the assessment of the intensity of pain&#44; patients were asked to complete the pain management questionnaire&#46; This questionnaire was developed by the researcher based on a symptom-management model<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> and literature review&#46; It consisted of 11 options for pain&#46; A blank space also provided that allowed patients to describe the strategies that may not have been among the options&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Data were statistically analyzed and described by the descriptive statistic&#46; In addition&#44; for the benefit of the analysis&#44; pain intensity was categorized as mild &#40;BPI&#44; 1-4&#41;&#44; moderate &#40;BPI&#44; 5-6&#41;&#44; and severe &#40;BPI&#44; 7-10&#41;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Characteristics of the hospitalized trauma patients</span><p id="par0045" class="elsevierStylePara elsevierViewall">A total of 95 hospitalized trauma patients were enrolled in this pilot study&#46; The average of age of the patients was 35&#46;87 &#40;SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#46;05&#41;&#46; Most patients were male &#40;71&#46;6&#37;&#41; and Islamic&#46; Half of the patients had orthopedic injuries &#40;52&#46;6&#37;&#41;&#46; Most patients received nonsurgical treatments &#40;88&#46;4&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Pain intensity of the hospitalized trauma patients</span><p id="par0050" class="elsevierStylePara elsevierViewall">Overall&#44; the pain intensity of hospitalized trauma patients during the first 3 days after admission was at a mild to moderate level&#46; The average pain was 3&#46;99 &#40;SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;18&#41; on day 1&#44; 3&#46;63 &#40;SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;02&#41; on day 2&#44; and 3&#46;22 &#40;SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;97&#41; on day 3&#46; Furthermore&#44; the repeated measures ANOVA test revealed<a name="p3"></a> statistically significant differences in pain on day 1&#44; day 2&#44; and day 3 after hospital admission &#40;p &#60; &#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pain management of the hospitalized trauma patients</span><p id="par0055" class="elsevierStylePara elsevierViewall">Generally&#44; all patients used the strategies provided in the questionnaire to reduce their pain &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; Most hospitalized trauma patients frequently used praying &#40;84&#46;2&#37;&#41; as their strategy to reduce pain&#46; This strategy was followed by Slow and Deep Breathing &#40;SDB&#41; &#40;78&#46;9&#37;&#41; and an attempt to tolerate it &#40;46&#46;3&#37;&#41;&#46; Meanwhile&#44; other strategies least frequently used by patients included changing position&#44; reading&#44; and immediately telling the nurses about the pain &#40;17&#46;9&#37;&#44; 15&#46;8&#37;&#44; and 15&#46;8&#37;&#44; respectively&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">The objective of this study was to provide a pilot description of the rate of the intensity of pain and frequency of pain-management strategies of hospitalized trauma patients&#46; This study found that the intensity of pain of hospitalized trauma patients was at the mild to moderate level&#46; These findings contrasted with those of previous studies in Western countries that found that the intensity of pain was at a moderate to severe level<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;7</span></a>&#46; The result of current find-ing can be explained as follows&#46; The patients in this study had a single injury&#44; which indicated minor-injury level<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#46; Also&#44; patients received several pharmacological pain-management&#44; including paracetamol&#44; ketorolac&#44; tramadol&#44; and fentanyl&#44; which were used to relieve pain effectively&#46; Pa-tients also applied several strategies by themselves&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">With respect to patients&#8217; pain-management strategies&#44; most patients in this study reported that they prayed to relieve their pain&#46; This is not surprising because most patients were Muslim&#46; The spiritual aspects are personal concerns that relate to the belief about pain and affect patients&#8217; views on pain management<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#46; Patients in this study noted that the pain and its relief came from God &#40;Allah&#41;&#59; therefore&#44; they prayed frequently and recited the name of Allah <span class="elsevierStyleItalic">&#40;Dzikir&#41;&#46;</span> Moreover&#44; they noted that hope and asking for help from God could make them calm and relax them&#46; Factoring praying into pain management is important because it can<a name="p4"></a> improve patients&#8217; physical and emotional well-being&#44; enhance the immune system&#44; and foster pain relief<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#46; In a cross-sectional study&#44; chronic pain patients found that praying was related to pain tolerance&#46; Patients with a high level of praying had a lower intensity of pain<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The SDB was in second place&#46; It has been proved to be effective in reducing pain<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#46; Consistent with this finding&#44; trauma patients in this study applied it when they felt pain at its worst&#46; More specifically&#44; orthopedic trauma patients reported that they performed SDB while nurses made up their bed&#46; In addition&#44; almost half the patients tried to bear their pain &#40;trying to tolerate&#41;&#46; No patients gave the reason for these strategies&#46; Wong and Chan noted that patients tried to bear and tolerate the pain because of their perception that pain is normal if one is wounded<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Meanwhile&#44; some pain-management strategies were used by patients the least&#44; such as reading and immediately informing the nurse about pain&#46; Patients were reluctant to report pain intensity to nurses and preferred to endure the pain - this behavior was possibly related to gender and the nature of nursing work&#46;</p></span></span>"
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              "titulo" => "Pain management of the hospitalized trauma patients"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The incidence of trauma has been high and is considered to have increased throughout the years&#46; This study aimed to describe the pain intensity and pain-management strategies of hospitalized trauma patients&#46; Ninety-five adults presenting trauma with full consciousness&#44; and who were admitted to surgical wards were recruited&#46; Outcomes were assessed in a 3-day follow-up of pain and pain management from January to February 2016 by using questionnaires for interviews&#46; Data were analyzed using descriptive statistics and repeated measures ANOVA&#46; Preliminary research found that hospitalized trauma patients perceived mild to severe pain intensity&#46; The trend of pain at its worst&#44; pain at its least&#44; average pain&#44; and current pain decreased from Day 1 to day 3&#44; which were statistically and significantly different &#40;p &#60; &#46;001&#41;&#46; The pain management often used by patients were&#58; praying &#40;84&#46;2&#37;&#41;&#44; slow and deep breathing &#40;78&#46;9&#37;&#41;&#44; and at an attempt at toleration &#40;46&#46;3&#37;&#41;&#46; The least frequent method of pain management included immediately informing nurses about the pain &#40;15&#46;8&#37;&#41;&#44; reading &#40;15&#46;8&#37;&#41;&#44; and changing position &#40;17&#46;9&#37;&#41;&#46; Besides the pharmacological and nonpharmacological interventions received from physicians and nurses&#44; strategies were crucial to alleviating pain in hospitalized trauma patients related to cultural context&#46;</p></span>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Percentage of pain-management strategies used by patients &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>95&#41;&#46; Patients could use more than one pain-management strategy&#46; <span class="elsevierStyleBold"><span class="elsevierStyleItalic">Note&#46;</span></span>The patients could use more than one pain-management strategy&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Age &#40;years&#41; &#40;Mean&#47;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#40;35&#46;87&#47;11&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Gender</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68 &#40;71&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27 &#40;28&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Religion</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Islam&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81 &#40;85&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Christian&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;14&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Medical diagnosis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Orthopedic injuries &#40;i&#46;e&#46;&#44; fracture of clavicle&#44; hand&#44; leg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50 &#40;52&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Mild head injury&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;23&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Burn injury &#40;i&#46;e&#46;&#44; grades 2-3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;7&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Musculoskeletal injury &#40;i&#46;e&#46;&#44; strain&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Multiple injuries &#40;e&#46;g&#46;&#44; head injury &#43; leg fracture&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;15&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Cause of injury</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Traffic accident&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65 &#40;68&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Fall&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;17&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Industrial accident&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;8&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Other &#40;i&#46;e&#46;&#44; home accident&#44; assault&#44; sports&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;5&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Treatments</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Nonsurgerical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84 &#40;88&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Wound dressing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34 &#40;35&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Splint board&#44; sling&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45 &#40;48&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Skeletal&#44; skin traction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;8&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Surgery &#40;i&#46;e&#46;&#44; open reduction internal&#47;external fixation&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;11&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Duration after admission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Mean &#40;interpretation&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Right now</td><td class="td" title="table-entry  " align="left" valign="top">Day 1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">133&#46;85<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;11 &#40;moderate&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Day 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;38 &#40;mild&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;33 &#40;moderate&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">124&#46;29<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;76 &#40;moderate&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Day 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;15 &#40;moderate&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">At least</td><td class="td" title="table-entry  " align="left" valign="top">Day 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;85 &#40;mild&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#46;98<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;57 &#40;mild&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Day 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;26 &#40;mild&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Average</td><td class="td" title="table-entry  " align="left" valign="top">Day 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;99 &#40;mild&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&#46;06<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Day 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;63 &#40;mild&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Day 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;22 &#40;mild&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => array:1 [
                  "referenciaCompleta" => "World Health Organization&#46; Injury prevention&#46; 2015&#46; Available at&#58; <a id="intr0005" class="elsevierStyleInterRef" href="http://www.searo.who.int/indonesia/areas/noncommunicable_disease/en/">http&#58;&#47;&#47;www&#46;searo&#46;who&#46;int&#47;indonesia&#47;areas&#47;noncommunicable&#95;disease&#47;en&#47;</a>&#46;"
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                  "referenciaCompleta" => "World Health Organization&#46; Injuries an violence&#58; the facts 2014&#46; Available at&#58; <a id="intr0010" class="elsevierStyleInterRef" href="http://www.who.int/violence_injury_prevention/media/news/2015/Injury_violence_facts_2014/en/">http&#58;&#47;&#47;www&#46;who&#46;int&#47;violence&#95;injury&#95;prevention&#47;media&#47;news&#47;2015&#47;Injury&#95;violence&#95;facts&#95;2014&#47;en&#47;</a>&#46;"
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              "etiqueta" => "3"
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                0 => array:1 [
                  "referenciaCompleta" => "Centers for Disease Control and Prevention&#46; Web&#8211;based injury statistics query and reporting system &#91;accessed 2015&#93;&#46; Available at&#58; <a id="intr0015" class="elsevierStyleInterRef" href="http://www.cdc.gov/injury/wisqars/leadingcauses.html">http&#58;&#47;&#47;www&#46;cdc&#46;gov&#47;injury&#47;wisqars&#47;leadingcauses&#46;html</a>&#46;"
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              "identificador" => "bib0020"
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                0 => array:1 [
                  "referenciaCompleta" => "EuroSafe&#46; Injuries in the European Union&#44; report on injury statistics 2008-2010 &#91;accessed 2013&#93;&#46; Available at&#58; <a id="intr0020" class="elsevierStyleInterRef" href="http://ec.europa.eu/health/reports/publications/index_en.htm">http&#58;&#47;&#47;ec&#46;europa&#46;eu&#47;health&#47;reports&#47;publications&#47;index&#95;en&#46;htm</a>&#46;"
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                  "referenciaCompleta" => "Rosenbloom BN&#46; Pain and Psychological Outcomes Following Traumatic Musculoskeletal Injury &#91;Master&#39;s thesis&#93;&#46; University of Toronto&#59; 2014&#46; Available at&#58; <a id="intr0025" class="elsevierStyleInterRef" href="http://hdl.handle.%20net/1807/65602">http&#58;&#47;&#47;hdl&#46;handle&#46; net&#47;1807&#47;65602</a>&#46;"
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                            0 => "G&#46; Garra"
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Article information

ISSN: 11308621
Original language: English

DOI:10.1016/S1130-8621(18)30058-5

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Year/Month	Html	Pdf	Total

2024 November	2	0	2
2024 October	30	11	41
2024 September	39	13	52
2024 August	27	16	43
2024 July	22	6	28
2024 June	23	6	29
2024 May	29	8	37
2024 April	97	11	108
2024 March	41	2	43
2024 February	55	1	56
2024 January	40	5	45
2023 December	57	5	62
2023 November	57	4	61
2023 October	59	10	69
2023 September	57	13	70
2023 August	35	1	36
2023 July	43	7	50
2023 June	43	4	47
2023 May	76	8	84
2023 April	56	3	59
2023 March	43	8	51
2023 February	40	5	45
2023 January	23	4	27
2022 December	43	7	50
2022 November	38	10	48
2022 October	30	11	41
2022 September	17	18	35
2022 August	27	14	41
2022 July	31	13	44
2022 June	27	19	46
2022 May	23	13	36
2022 April	15	5	20
2022 March	21	23	44
2022 February	24	4	28
2022 January	16	8	24
2021 December	26	12	38
2021 November	25	12	37
2021 October	23	20	43
2021 September	16	10	26
2021 August	32	15	47
2021 July	13	8	21
2021 June	12	5	17
2021 May	13	8	21
2021 April	25	15	40
2021 March	18	9	27
2021 February	14	12	26
2021 January	14	8	22
2020 December	16	8	24
2020 November	18	3	21
2020 October	4	2	6
2020 September	21	17	38
2020 August	21	9	30
2020 July	12	3	15
2020 June	11	16	27
2020 May	10	15	25
2020 April	9	6	15
2020 March	18	10	28
2020 February	22	5	27
2020 January	11	3	14
2019 December	14	11	25
2019 November	19	9	28
2019 October	30	16	46
2019 September	27	4	31
2019 August	10	5	15
2019 July	12	6	18
2019 June	19	1	20
2019 May	54	11	65
2019 April	31	2	33
2018 December	9	6	15
2018 November	1	0	1
2018 September	1	0	1
2018 April	1	0	1

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