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<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE,NOIMAGEINDEX" /><meta name="author" content="National Clinical Guideline Centre (UK)" /><meta name="citation_title" content="Care of Dying Adults in the Last Days of Life" /><meta name="citation_publisher" content="National Institute for Health and Care Excellence (NICE)" /><meta name="citation_date" content="2015/12/16" /><meta name="citation_author" content="National Clinical Guideline Centre (UK)" /><meta name="citation_pmid" content="26741019" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK338140/" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Care of Dying Adults in the Last Days of Life" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="National Institute for Health and Care Excellence (NICE)" /><meta name="DC.Contributor" content="National Clinical Guideline Centre (UK)" /><meta name="DC.Date" content="2015/12/16" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK338140/" /><meta name="description" content="This guideline applies to dying people aged 18 or older. It is acknowledged that a parallel guideline is being developed by NICE to cover the end of life care for infants, children and young people." /><meta name="og:title" content="Care of Dying Adults in the Last Days of Life" /><meta name="og:type" content="book" /><meta name="og:description" content="This guideline applies to dying people aged 18 or older. It is acknowledged that a parallel guideline is being developed by NICE to cover the end of life care for infants, children and young people." /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK338140/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng31-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="bk-non-canon-loc" content="/books/n/niceng31/toc/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK338140/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} </style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/book-toc.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/Book"><div class="meta-content fm-sec"><div class="iconblock whole_rhythm clearfix no_top_margin"><a href="http://www.nice.org.uk/" title="National Institute for Health and Care Excellence (NICE)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng31-lrg.png" alt="Cover of Care of Dying Adults in the Last Days of Life" /></a><div class="icnblk_cntnt"><h1 id="_NBK338140_"><span itemprop="name">Care of Dying Adults in the Last Days of Life</span></h1><p><i>NICE Guideline, No. 31</i></p><p class="contrib-group"><h4>Authors</h4><span itemprop="author">National Clinical Guideline Centre (UK)</span>.</p><div class="half_rhythm">London: <a href="http://www.nice.org.uk/" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2015 Dec 16</span>.</div><div><a href="/books/about/copyright/">Copyright</a> © 2015 National Clinical Guideline Centre.</div></div></div></div><div class="body-content whole_rhythm" itemprop="text"><div itemprop="description"><h2>Excerpt</h2><p>This guideline applies to dying people aged 18 or older. It is acknowledged that a parallel guideline is being developed by NICE to cover the end of life care for infants, children and young people.</p><p>This guideline covers recognising dying, communication and shared decision-making and only the clinical aspects of symptom management. We have not made recommendations about how services should be configured to deliver these aspects of care. An update of the 2004 guidance on Supportive and Palliative Care for Adults with Cancer will be started in 2016, and this will not only cover the service delivery aspects of the current guideline, but will also extend beyond the cancer focus.</p></div><div><h2>Contents</h2><ul id="toc_tllNBK338140_toc_fm_s1" class="simple-list toc toc-toggle"><li class="half_rhythm" id="toc_itm_NBK338140_toc_fm_s1"><a class="toc-item" href="/books/n/niceng31/fm.s1/">Guideline Committee members</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch1"><a class="toc-item" href="/books/n/niceng31/ch1/">1. Guideline summary</a><ul id="toc_lst_NBK338140_toc_ch1" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch1_s1"><a class="toc-item" href="/books/n/niceng31/ch1/#ch1.s1">1.1. Full list of recommendations</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch1_s14"><a class="toc-item" href="/books/n/niceng31/ch1/#ch1.s14">1.2. Key research recommendation</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch2"><a class="toc-item" href="/books/n/niceng31/ch2/">2. Introduction</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch3"><a class="toc-item" href="/books/n/niceng31/ch3/">3. Development of the guideline</a><ul id="toc_lst_NBK338140_toc_ch3" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch3_s1"><a class="toc-item" href="/books/n/niceng31/ch3/#ch3.s1">3.1. What is a NICE clinical guideline?</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch3_s2"><a class="toc-item" href="/books/n/niceng31/ch3/#ch3.s2">3.2. Remit</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch3_s3"><a class="toc-item" href="/books/n/niceng31/ch3/#ch3.s3">3.3. Who developed this guideline?</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch4"><a class="toc-item" href="/books/n/niceng31/ch4/">4. Methods</a><ul id="toc_lst_NBK338140_toc_ch4" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch4_s1"><a class="toc-item" href="/books/n/niceng31/ch4/#ch4.s1">4.1. Developing the review questions and outcomes</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch4_s2"><a class="toc-item" href="/books/n/niceng31/ch4/#ch4.s2">4.2. Searching for evidence</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch4_s35"><a class="toc-item" href="/books/n/niceng31/ch4/#ch4.s35">4.3. Evidence of cost effectiveness</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch4_s41"><a class="toc-item" href="/books/n/niceng31/ch4/#ch4.s41">4.4. Developing recommendations</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch5"><a class="toc-item" href="/books/n/niceng31/ch5/">5. Recognising when a person may be in the last days of life</a><ul id="toc_lst_NBK338140_toc_ch5" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch5_s1"><a class="toc-item" href="/books/n/niceng31/ch5/#ch5.s1">5.1. Introduction</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch5_s2"><a class="toc-item" href="/books/n/niceng31/ch5/#ch5.s2">5.2. Review question: What signs and symptoms indicate that adults are likely to be entering their final days of life; or that they may be recovering? How are uncertainties about either situation dealt with?</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch5_s3"><a class="toc-item" href="/books/n/niceng31/ch5/#ch5.s3">5.3. Quantitative review: clinical evidence</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch5_s4"><a class="toc-item" href="/books/n/niceng31/ch5/#ch5.s4">5.4. Qualitative review: clinical evidence</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch5_s7"><a class="toc-item" href="/books/n/niceng31/ch5/#ch5.s7">5.5. Economic evidence</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch5_s9"><a class="toc-item" href="/books/n/niceng31/ch5/#ch5.s9">5.6. Evidence statements</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch5_s13"><a class="toc-item" href="/books/n/niceng31/ch5/#ch5.s13">5.7. Conceptual framework</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch5_s14"><a class="toc-item" href="/books/n/niceng31/ch5/#ch5.s14">5.8. Recommendations and link to evidence</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch5_s15"><a class="toc-item" href="/books/n/niceng31/ch5/#ch5.s15">5.9. Research recommendation</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch6"><a class="toc-item" href="/books/n/niceng31/ch6/">6. Communication</a><ul id="toc_lst_NBK338140_toc_ch6" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch6_s1"><a class="toc-item" href="/books/n/niceng31/ch6/#ch6.s1">6.1. Introduction</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch6_s2"><a class="toc-item" href="/books/n/niceng31/ch6/#ch6.s2">6.2. Review question: What are the barriers and facilitators to good communication between the dying person, those important to them and the healthcare professional surrounding the likelihood of entering the last days of life?</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch6_s3"><a class="toc-item" href="/books/n/niceng31/ch6/#ch6.s3">6.3. Clinical evidence</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch6_s7"><a class="toc-item" href="/books/n/niceng31/ch6/#ch6.s7">6.4. Economic evidence</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch6_s9"><a class="toc-item" href="/books/n/niceng31/ch6/#ch6.s9">6.5. Evidence statements</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch6_s12"><a class="toc-item" href="/books/n/niceng31/ch6/#ch6.s12">6.6. Recommendations and link to evidence</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch7"><a class="toc-item" href="/books/n/niceng31/ch7/">7. Shared decision making</a><ul id="toc_lst_NBK338140_toc_ch7" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch7_s1"><a class="toc-item" href="/books/n/niceng31/ch7/#ch7.s1">7.1. Introduction</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch7_s2"><a class="toc-item" href="/books/n/niceng31/ch7/#ch7.s2">7.2. Review question: What are the facilitators and barriers to the multi-professional team, dying person and those important to them in being involved in shared decision-making to inform the development of personalised care plans for the last few days of life?</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch7_s3"><a class="toc-item" href="/books/n/niceng31/ch7/#ch7.s3">7.3. Clinical evidence</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch7_s7"><a class="toc-item" href="/books/n/niceng31/ch7/#ch7.s7">7.4. Economic evidence</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch7_s9"><a class="toc-item" href="/books/n/niceng31/ch7/#ch7.s9">7.5. Evidence statements</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch7_s12"><a class="toc-item" href="/books/n/niceng31/ch7/#ch7.s12">7.6. Recommendations and link to evidence</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch8"><a class="toc-item" href="/books/n/niceng31/ch8/">8. Maintaining hydration</a><ul id="toc_lst_NBK338140_toc_ch8" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch8_s1"><a class="toc-item" href="/books/n/niceng31/ch8/#ch8.s1">8.1. Introduction</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch8_s2"><a class="toc-item" href="/books/n/niceng31/ch8/#ch8.s2">8.2. Review question: In patients in their last days of life, is clinically assisted hydration effective in improving symptoms and general comfort?</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch8_s3"><a class="toc-item" href="/books/n/niceng31/ch8/#ch8.s3">8.3. Clinical evidence</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch8_s9"><a class="toc-item" href="/books/n/niceng31/ch8/#ch8.s9">8.4. Economic evidence</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch8_s12"><a class="toc-item" href="/books/n/niceng31/ch8/#ch8.s12">8.5. Evidence statements</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch8_s17"><a class="toc-item" href="/books/n/niceng31/ch8/#ch8.s17">8.6. Recommendations and link to evidence</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch9"><a class="toc-item" href="/books/n/niceng31/ch9/">9. Pharmacological interventions</a><ul id="toc_lst_NBK338140_toc_ch9" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch9_s1"><a class="toc-item" href="/books/n/niceng31/ch9/#ch9.s1">9.1. Review question: For people in the last days of life, which pharmacological agents are most effective in relieving pain, breathlessness, nausea and vomiting, anxiety, agitation, delirium and noisy respiratory secretions and what degree of sedation do they cause?</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch9_s2"><a class="toc-item" href="/books/n/niceng31/ch9/#ch9.s2">Managing pain</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch9_s14"><a class="toc-item" href="/books/n/niceng31/ch9/#ch9.s14">Managing breathlessness</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch9_s29"><a class="toc-item" href="/books/n/niceng31/ch9/#ch9.s29">Managing nausea and vomiting</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch9_s39"><a class="toc-item" href="/books/n/niceng31/ch9/#ch9.s39">Managing anxiety</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch9_s48"><a class="toc-item" href="/books/n/niceng31/ch9/#ch9.s48">Managing delirium</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch9_s58"><a class="toc-item" href="/books/n/niceng31/ch9/#ch9.s58">Managing agitation</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch9_s67"><a class="toc-item" href="/books/n/niceng31/ch9/#ch9.s67">Managing noisy respiratory secretions</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch9_s79"><a class="toc-item" href="/books/n/niceng31/ch9/#ch9.s79">General pharmacological considerations</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch10"><a class="toc-item" href="/books/n/niceng31/ch10/">10. Anticipatory prescribing</a><ul id="toc_lst_NBK338140_toc_ch10" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch10_s1"><a class="toc-item" href="/books/n/niceng31/ch10/#ch10.s1">10.1. Introduction</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch10_s2"><a class="toc-item" href="/books/n/niceng31/ch10/#ch10.s2">10.2. Review question – quantitative: How effective is anticipatory prescribing at improving comfort in adults in the last days of life compared with prescribing at the bed side?</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch10_s3"><a class="toc-item" href="/books/n/niceng31/ch10/#ch10.s3">10.3. Review question – qualitative: What are the experiences, opinions and attitudes of healthcare professionals, the dying person and those important to them regarding access to anticipatory prescribing?</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch10_s4"><a class="toc-item" href="/books/n/niceng31/ch10/#ch10.s4">10.4. Clinical evidence – quantitative</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch10_s5"><a class="toc-item" href="/books/n/niceng31/ch10/#ch10.s5">10.5. Clinical evidence – qualitative</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch10_s10"><a class="toc-item" href="/books/n/niceng31/ch10/#ch10.s10">10.6. Economic evidence</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch10_s13"><a class="toc-item" href="/books/n/niceng31/ch10/#ch10.s13">10.7. Evidence Statements</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch10_s18"><a class="toc-item" href="/books/n/niceng31/ch10/#ch10.s18">10.8. Recommendations and link to evidence</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_ch10_s19"><a class="toc-item" href="/books/n/niceng31/ch10/#ch10.s19">10.9. Research recommendations</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_abbreviations_s1"><a class="toc-item" href="/books/n/niceng31/abbreviations.s1/">11. Acronyms and abbreviations</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_glossary_s1"><a class="toc-item" href="/books/n/niceng31/glossary.s1/">12. Glossary</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_references"><a class="toc-item" href="/books/n/niceng31/references/">13. References</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_appendixes_appgroup1"><a class="toc-item" href="/books/n/niceng31/appendixes.appgroup1/">Appendices</a><ul id="toc_lst_NBK338140_toc_appendixes_appgroup1" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK338140_toc_appa"><a class="toc-item" href="/books/n/niceng31/appa/">Appendix A. Scope</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_appb"><a class="toc-item" href="/books/n/niceng31/appb/">Appendix B. Declarations of interest</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_appc"><a class="toc-item" href="/books/n/niceng31/appc/">Appendix C. Clinical review protocols</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_appd"><a class="toc-item" href="/books/n/niceng31/appd/">Appendix D. Economic review protocol</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_appe"><a class="toc-item" href="/books/n/niceng31/appe/">Appendix E. Clinical article selection</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_appf"><a class="toc-item" href="/books/n/niceng31/appf/">Appendix F. Economic article selection</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_appg"><a class="toc-item" href="/books/n/niceng31/appg/">Appendix G. Literature search strategies</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_apph"><a class="toc-item" href="/books/n/niceng31/apph/">Appendix H. Clinical evidence tables</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_appi"><a class="toc-item" href="/books/n/niceng31/appi/">Appendix I. Economic evidence tables</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_appj"><a class="toc-item" href="/books/n/niceng31/appj/">Appendix J. GRADE tables</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_appk"><a class="toc-item" href="/books/n/niceng31/appk/">Appendix K. Forest plots</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_appl"><a class="toc-item" href="/books/n/niceng31/appl/">Appendix L. Excluded clinical studies</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_appm"><a class="toc-item" href="/books/n/niceng31/appm/">Appendix M. Excluded economic studies</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_appn"><a class="toc-item" href="/books/n/niceng31/appn/">Appendix N. Unit Costs</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_appo"><a class="toc-item" href="/books/n/niceng31/appo/">Appendix O. Research recommendations</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_appp"><a class="toc-item" href="/books/n/niceng31/appp/">Appendix P. NICE technical team</a></li><li class="half_rhythm" id="toc_itm_NBK338140_toc_appq"><a class="toc-item" href="/books/n/niceng31/appq/">Appendix Q. References</a></li></ul></li></ul></div><div>
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<b>Funding:</b> National Institute for Health and Care Excellence
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</div><div><p><b>Disclaimer:</b> Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and, where appropriate, their guardian or carer.
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<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © 2015 National Clinical Guideline Centre.</div><div class="small"><span class="label">Bookshelf ID: NBK338140</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/26741019" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">26741019</a></span></div><div style="margin-top:2em" class="bk_noprnt"><div class="pagination bk_noprnt"><span class="inactive page_link prev">< Prev</span><a class="active page_link next" href="/books/n/niceng31/fm.s1/" title="Next page in this title">Next ></a></div></div></div></div>
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