A Patient-Based Needs Assessment for Living Well with Parkinson Disease: Implementation via Nominal Group Technique
Identifieur interne : 000723 ( Pmc/Checkpoint ); précédent : 000722; suivant : 000724A Patient-Based Needs Assessment for Living Well with Parkinson Disease: Implementation via Nominal Group Technique
Auteurs : Galit Kleiner-Fisman [Canada] ; Pearl Gryfe [Canada] ; Gary Naglie [Canada]Source :
- Parkinson's Disease [ 2090-8083 ] ; 2013.
Abstract
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DOI: 10.1155/2013/974964
PubMed: 23476891
PubMed Central: 3588173
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">A Patient-Based Needs Assessment for Living Well with Parkinson Disease: Implementation via Nominal Group Technique</title><author><name sortKey="Kleiner Fisman, Galit" sort="Kleiner Fisman, Galit" uniqKey="Kleiner Fisman G" first="Galit" last="Kleiner-Fisman">Galit Kleiner-Fisman</name><affiliation wicri:level="4"><nlm:aff id="I1">ATC and Jeff and Diane Ross Movement Disorders Clinic, Baycrest Hospital, University of Toronto, 3560 Bathurst Street, Toronto, ON, Canada M6A 2E1</nlm:aff><country>Canada</country><wicri:regionArea>ATC and Jeff and Diane Ross Movement Disorders Clinic, Baycrest Hospital, University of Toronto, 3560 Bathurst Street, Toronto, ON</wicri:regionArea><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Gryfe, Pearl" sort="Gryfe, Pearl" uniqKey="Gryfe P" first="Pearl" last="Gryfe">Pearl Gryfe</name><affiliation wicri:level="4"><nlm:aff id="I1">ATC and Jeff and Diane Ross Movement Disorders Clinic, Baycrest Hospital, University of Toronto, 3560 Bathurst Street, Toronto, ON, Canada M6A 2E1</nlm:aff><country>Canada</country><wicri:regionArea>ATC and Jeff and Diane Ross Movement Disorders Clinic, Baycrest Hospital, University of Toronto, 3560 Bathurst Street, Toronto, ON</wicri:regionArea><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Naglie, Gary" sort="Naglie, Gary" uniqKey="Naglie G" first="Gary" last="Naglie">Gary Naglie</name><affiliation wicri:level="4"><nlm:aff id="I2">Baycrest Hospital, University of Toronto, 3560 Bathurst Street, Toronto, ON, Canada M6A 2E1</nlm:aff><country>Canada</country><wicri:regionArea>Baycrest Hospital, University of Toronto, 3560 Bathurst Street, Toronto, ON</wicri:regionArea><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">23476891</idno><idno type="pmc">3588173</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3588173</idno><idno type="RBID">PMC:3588173</idno><idno type="doi">10.1155/2013/974964</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">000B32</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000B32</idno><idno type="wicri:Area/Pmc/Curation">000B32</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000B32</idno><idno type="wicri:Area/Pmc/Checkpoint">000723</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000723</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">A Patient-Based Needs Assessment for Living Well with Parkinson Disease: Implementation via Nominal Group Technique</title><author><name sortKey="Kleiner Fisman, Galit" sort="Kleiner Fisman, Galit" uniqKey="Kleiner Fisman G" first="Galit" last="Kleiner-Fisman">Galit Kleiner-Fisman</name><affiliation wicri:level="4"><nlm:aff id="I1">ATC and Jeff and Diane Ross Movement Disorders Clinic, Baycrest Hospital, University of Toronto, 3560 Bathurst Street, Toronto, ON, Canada M6A 2E1</nlm:aff><country>Canada</country><wicri:regionArea>ATC and Jeff and Diane Ross Movement Disorders Clinic, Baycrest Hospital, University of Toronto, 3560 Bathurst Street, Toronto, ON</wicri:regionArea><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Gryfe, Pearl" sort="Gryfe, Pearl" uniqKey="Gryfe P" first="Pearl" last="Gryfe">Pearl Gryfe</name><affiliation wicri:level="4"><nlm:aff id="I1">ATC and Jeff and Diane Ross Movement Disorders Clinic, Baycrest Hospital, University of Toronto, 3560 Bathurst Street, Toronto, ON, Canada M6A 2E1</nlm:aff><country>Canada</country><wicri:regionArea>ATC and Jeff and Diane Ross Movement Disorders Clinic, Baycrest Hospital, University of Toronto, 3560 Bathurst Street, Toronto, ON</wicri:regionArea><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Naglie, Gary" sort="Naglie, Gary" uniqKey="Naglie G" first="Gary" last="Naglie">Gary Naglie</name><affiliation wicri:level="4"><nlm:aff id="I2">Baycrest Hospital, University of Toronto, 3560 Bathurst Street, Toronto, ON, Canada M6A 2E1</nlm:aff><country>Canada</country><wicri:regionArea>Baycrest Hospital, University of Toronto, 3560 Bathurst Street, Toronto, ON</wicri:regionArea><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author></analytic><series><title level="j">Parkinson's Disease</title><idno type="ISSN">2090-8083</idno><idno type="eISSN">2042-0080</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><italic>Background</italic>. Parkinson's disease (PD) is a neurodegenerative condition with complex subtleties, making it challenging for physicians to fully inform their patients. Given that approximately 50% of Americans access the Internet for health information, the development of a multimedia, web-based application emphasizing targeted needs of people with Parkinson's disease (PwP) has the potential to change patient's lives.
<italic>Objectives</italic>. To determine what information PwP perceive could enhance their quality of life. <italic>Methods</italic>. Group sessions utilizing nominal group technique (NGT) were conducted. Participants were asked “what information do you want to know about that would help you live well with PD?” Silent generation of ideas preceded discussion followed by anonymous ranking of items. A “summary score” (sum of rank × frequency) was calculated. <italic>Results</italic>. 36 individual items were collapsed into 9 categories. Coping with emotions, changing relationships, and social implications of PD were ranked as most important. Financial supports and skills for self-advocacy were also highly ranked. <italic>Conclusions</italic>. Qualitative research methodology was utilized to determine the unmet needs of PwP. Results of this survey will inform the development of a patient-oriented, online resource, the goal will be to provide information and strategies to improve symptom management, reduce disability and address all relevant concerns important to those affected by PD.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Hirtz, D" uniqKey="Hirtz D">D Hirtz</name></author><author><name sortKey="Thurman, Dj" uniqKey="Thurman D">DJ Thurman</name></author><author><name sortKey="Gwinn Hardy, K" uniqKey="Gwinn Hardy K">K Gwinn-Hardy</name></author><author><name sortKey="Mohamed, M" uniqKey="Mohamed M">M Mohamed</name></author><author><name sortKey="Chaudhuri, Ar" uniqKey="Chaudhuri A">AR Chaudhuri</name></author><author><name sortKey="Zalutsky, R" uniqKey="Zalutsky R">R Zalutsky</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Chen, Jj" uniqKey="Chen J">JJ 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Parkinsons Dis</journal-id><journal-id journal-id-type="iso-abbrev">Parkinsons Dis</journal-id><journal-id journal-id-type="publisher-id">PD</journal-id><journal-title-group><journal-title>Parkinson's Disease</journal-title></journal-title-group><issn pub-type="ppub">2090-8083</issn><issn pub-type="epub">2042-0080</issn><publisher><publisher-name>Hindawi Publishing Corporation</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">23476891</article-id><article-id pub-id-type="pmc">3588173</article-id><article-id pub-id-type="doi">10.1155/2013/974964</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group></article-categories><title-group><article-title>A Patient-Based Needs Assessment for Living Well with Parkinson Disease: Implementation via Nominal Group Technique</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Kleiner-Fisman</surname><given-names>Galit</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1">*</xref></contrib><contrib contrib-type="author"><name><surname>Gryfe</surname><given-names>Pearl</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Naglie</surname><given-names>Gary</given-names></name><xref ref-type="aff" rid="I2"><sup>2</sup></xref></contrib></contrib-group><aff id="I1"><sup>1</sup>ATC and Jeff and Diane Ross Movement Disorders Clinic, Baycrest Hospital, University of Toronto, 3560 Bathurst Street, Toronto, ON, Canada M6A 2E1</aff><aff id="I2"><sup>2</sup>Baycrest Hospital, University of Toronto, 3560 Bathurst Street, Toronto, ON, Canada M6A 2E1</aff><author-notes><corresp id="cor1">*Galit Kleiner-Fisman: <email>gkleinerfisman@yahoo.com</email></corresp><fn fn-type="other"><p>Academic Editor: Marjan Jahanshahi</p></fn></author-notes><pub-date pub-type="ppub"><year>2013</year></pub-date><pub-date pub-type="epub"><day>17</day><month>2</month><year>2013</year></pub-date><volume>2013</volume><elocation-id>974964</elocation-id><history><date date-type="received"><day>20</day><month>11</month><year>2012</year></date><date date-type="accepted"><day>19</day><month>12</month><year>2012</year></date></history><permissions><copyright-statement>Copyright © 2013 Galit Kleiner-Fisman et al.</copyright-statement><copyright-year>2013</copyright-year><license license-type="open-access"><license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p><italic>Background</italic>. Parkinson's disease (PD) is a neurodegenerative condition with complex subtleties, making it challenging for physicians to fully inform their patients. Given that approximately 50% of Americans access the Internet for health information, the development of a multimedia, web-based application emphasizing targeted needs of people with Parkinson's disease (PwP) has the potential to change patient's lives.
<italic>Objectives</italic>. To determine what information PwP perceive could enhance their quality of life. <italic>Methods</italic>. Group sessions utilizing nominal group technique (NGT) were conducted. Participants were asked “what information do you want to know about that would help you live well with PD?” Silent generation of ideas preceded discussion followed by anonymous ranking of items. A “summary score” (sum of rank × frequency) was calculated. <italic>Results</italic>. 36 individual items were collapsed into 9 categories. Coping with emotions, changing relationships, and social implications of PD were ranked as most important. Financial supports and skills for self-advocacy were also highly ranked. <italic>Conclusions</italic>. Qualitative research methodology was utilized to determine the unmet needs of PwP. Results of this survey will inform the development of a patient-oriented, online resource, the goal will be to provide information and strategies to improve symptom management, reduce disability and address all relevant concerns important to those affected by PD.</p></abstract></article-meta></front><floats-group><fig id="fig1" orientation="portrait" position="float"><label>Figure 1</label><caption><p>Summary scores for informational categories identified by patients as missing from their care. Raw scores are plotted on the left <italic>Y</italic>-axis; rescaled (0–100 scale) are plotted on the right <italic>Y</italic>-axis.</p></caption><graphic xlink:href="PD2013-974964.001"></graphic></fig><table-wrap id="tab1" orientation="portrait" position="float"><label>Table 1</label><caption><p>Demographic characteristics of PwP participating in focus group (<italic>n</italic> = 17, 2 caregivers not included).</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Characteristic</th><th align="center" rowspan="1" colspan="1">Mean (%)</th><th align="center" rowspan="1" colspan="1">SD or CI</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Male = 39%</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Age (43–84)</td><td align="center" rowspan="1" colspan="1">64.4</td><td align="center" rowspan="1" colspan="1">9.4</td></tr><tr><td align="left" rowspan="1" colspan="1">Disease duration (1–17 yrs)</td><td align="center" rowspan="1" colspan="1">8.8</td><td align="center" rowspan="1" colspan="1">4.7</td></tr><tr><td align="left" rowspan="1" colspan="1">Schwab and England ON (0–100)</td><td align="center" rowspan="1" colspan="1">81.3</td><td align="center" rowspan="1" colspan="1">54.4–96.0 </td></tr><tr><td align="left" rowspan="1" colspan="1">Marital status</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Married</td><td align="center" rowspan="1" colspan="1">67.0</td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Divorced</td><td align="center" rowspan="1" colspan="1">17.0</td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Single</td><td align="center" rowspan="1" colspan="1">11.0</td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Widowed</td><td align="center" rowspan="1" colspan="1">5.0</td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Level of education completed</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Post graduate</td><td align="center" rowspan="1" colspan="1">33.0</td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Undergraduate</td><td align="center" rowspan="1" colspan="1">28.0</td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> College diploma</td><td align="center" rowspan="1" colspan="1">22.0</td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> High school</td><td align="center" rowspan="1" colspan="1">17.0</td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Employment status</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Retired</td><td align="center" rowspan="1" colspan="1">73.0</td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Disability pension</td><td align="center" rowspan="1" colspan="1">17.0</td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Short-term disability</td><td align="center" rowspan="1" colspan="1">5.0</td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Employed</td><td align="center" rowspan="1" colspan="1">5.0</td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Living arrangements</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> With spouse</td><td align="center" rowspan="1" colspan="1">67.0</td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Alone</td><td align="center" rowspan="1" colspan="1">23.0</td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> With children</td><td align="center" rowspan="1" colspan="1">5.0</td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> With parent</td><td align="center" rowspan="1" colspan="1">5.0</td><td align="center" rowspan="1" colspan="1"> </td></tr></tbody></table></table-wrap><table-wrap id="tab2" orientation="portrait" position="float"><label>Table 2</label><caption><p>Results of needs assessment from nominal group technique regarding what PD patients believe to be missing from their healthcare and educational experience.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Rank</th><th align="center" rowspan="1" colspan="1">Categories</th><th align="left" rowspan="1" colspan="1">Items or ideas included</th><th align="center" rowspan="1" colspan="1">Frequency</th><th align="center" rowspan="1" colspan="1">Importance score</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">(1)</td><td align="center" rowspan="1" colspan="1">Emotional coping, relationships, and social aspects</td><td align="left" rowspan="1" colspan="1">(i) Dealing with fear about the future.<break></break>(ii) Coping strategies.<break></break>(iii) Coming to terms with living with a chronic illness.<break></break>(iv) Challenges for marital relationship (including helping unaffected spouses come to terms with living with a chronically ill individual).<break></break>(v) Availability of programs that promote a sense of wellbeing in dealing with disease.</td><td align="center" rowspan="1" colspan="1">34</td><td align="center" rowspan="1" colspan="1">143</td></tr><tr><td align="left" colspan="5" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">(2)</td><td align="center" rowspan="1" colspan="1">Legal, financial, and bureaucratic implications of life with PD</td><td align="left" rowspan="1" colspan="1">(i) Legal implications of living with PD (e.g., maintenance of driver's license; proxy decision making).<break></break>(ii) Financial implications of living with PD (e.g., public financial assistance and subsidies; financial and estate planning). <break></break>(iii) Transportation.<break></break>(iv) Managing government paperwork.<break></break>(v) Where to find local resources for people with disabilities. <break></break>(vi) Health-care system interactions. </td><td align="center" rowspan="1" colspan="1">19</td><td align="center" rowspan="1" colspan="1">76</td></tr><tr><td align="left" colspan="5" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">(3)</td><td align="center" rowspan="1" colspan="1">Empowerment and self-advocacy</td><td align="left" rowspan="1" colspan="1">(i) Managing one's own expectations.<break></break>(ii) Managing expectations of family and friends.<break></break>(iii) Strategies to ensure assertive and informed participation in health-related decisions.</td><td align="center" rowspan="1" colspan="1">16</td><td align="center" rowspan="1" colspan="1">50</td></tr><tr><td align="left" colspan="5" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">(4)</td><td align="center" rowspan="1" colspan="1">Nonmotor symptoms</td><td align="left" rowspan="1" colspan="1">(i) Sleep difficulties.<break></break>(ii) Bowel, and bladder dysfunction.<break></break>(iii) Mood changes.<break></break>(iv) Difficulties with cognition.<break></break>(v) Holistic approaches to managing nonmotor symptoms.</td><td align="center" rowspan="1" colspan="1">11</td><td align="center" rowspan="1" colspan="1">65</td></tr><tr><td align="left" colspan="5" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">(5)</td><td align="center" rowspan="1" colspan="1">Strategies and lifestyle tips to cope with symptoms</td><td align="left" rowspan="1" colspan="1">(i) Practical solutions for common symptoms experienced in PD.<break></break>(ii) Use of adaptive technologies to facilitate activities of daily living and home safety.</td><td align="center" rowspan="1" colspan="1">15</td><td align="center" rowspan="1" colspan="1">47</td></tr><tr><td align="left" colspan="5" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">(6)</td><td align="center" rowspan="1" colspan="1">Physical approaches to symptom management</td><td align="left" rowspan="1" colspan="1">(i) Role of exercise in PD management.<break></break>(ii) Information on accessible home activity programs.<break></break>(iii) Management of daily physical challenges (e.g., rolling over in bed or getting out of chair).</td><td align="center" rowspan="1" colspan="1">11</td><td align="center" rowspan="1" colspan="1">46</td></tr><tr><td align="left" colspan="5" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">(7)</td><td align="center" rowspan="1" colspan="1">PD symptoms</td><td align="left" rowspan="1" colspan="1">(i) Definition of “symptoms of parkinsonism.”<break></break>(ii) Differentiation of PD symptoms from medication side-effects.</td><td align="center" rowspan="1" colspan="1">10</td><td align="center" rowspan="1" colspan="1">35</td></tr><tr><td align="left" colspan="5" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">(8)</td><td align="center" rowspan="1" colspan="1">Medications</td><td align="left" rowspan="1" colspan="1">(i) Correct use of medications (e.g., timing, quantity).<break></break>(ii) Common drug side-effects and their management.<break></break>(iii) Relationship between diet and medications.</td><td align="center" rowspan="1" colspan="1">8</td><td align="center" rowspan="1" colspan="1">33</td></tr><tr><td align="left" colspan="5" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">(9)</td><td align="center" rowspan="1" colspan="1">Scientific information</td><td align="left" rowspan="1" colspan="1">(i) Genetic basis of PD and heritability.<break></break>(ii) Current promising areas of research.<break></break>(iii) Etiology of PD.</td><td align="center" rowspan="1" colspan="1">5</td><td align="center" rowspan="1" colspan="1">15</td></tr></tbody></table><table-wrap-foot><fn><p>Though there were 16 respondents, the frequency is > than 16 due to the fact that multiple responses from individual participants were collapsed into single categories.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc><affiliations><list><country><li>Canada</li></country><region><li>Ontario</li></region><settlement><li>Toronto</li></settlement><orgName><li>Université de Toronto</li></orgName></list><tree><country name="Canada"><region name="Ontario"><name sortKey="Kleiner Fisman, Galit" sort="Kleiner Fisman, Galit" uniqKey="Kleiner Fisman G" first="Galit" last="Kleiner-Fisman">Galit Kleiner-Fisman</name></region><name sortKey="Gryfe, Pearl" sort="Gryfe, Pearl" uniqKey="Gryfe P" first="Pearl" last="Gryfe">Pearl Gryfe</name><name sortKey="Naglie, Gary" sort="Naglie, Gary" uniqKey="Naglie G" first="Gary" last="Naglie">Gary Naglie</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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