Cognitive-behavioral therapy in the time of coronavirus: Clinician tips for working with eating disorders via telehealth when face-to-face meetings are not possible.
Identifieur interne : 000A53 ( Main/Exploration ); précédent : 000A52; suivant : 000A54Cognitive-behavioral therapy in the time of coronavirus: Clinician tips for working with eating disorders via telehealth when face-to-face meetings are not possible.
Auteurs : Glenn Waller [Royaume-Uni] ; Matthew Pugh [Royaume-Uni] ; Sandra Mulkens [Pays-Bas] ; Elana Moore [Royaume-Uni] ; Victoria A. Mountford [Royaume-Uni] ; Jacqueline Carter [Canada] ; Amy Wicksteed [Royaume-Uni] ; Aryel Maharaj [Canada] ; Tracey D. Wade [Australie] ; Lucene Wisniewski [États-Unis] ; Nicholas R. Farrell [États-Unis] ; Bronwyn Raykos [Australie] ; Susanne Jorgensen [Royaume-Uni] ; Jane Evans [Royaume-Uni] ; Jennifer J. Thomas [États-Unis] ; Ivana Osenk [Australie] ; Carolyn Paddock [Royaume-Uni] ; Brittany Bohrer [États-Unis] ; Kristen Anderson [États-Unis] ; Hannah Turner [Royaume-Uni] ; Tom Hildebrandt [États-Unis] ; Nikos Xanidis [Royaume-Uni] ; Vera Smit [Pays-Bas]Source :
- The International journal of eating disorders [ 1098-108X ] ; 2020.
Descripteurs français
- KwdFr :
- MESH :
- méthodes : Télémédecine.
- normes : Télémédecine.
- prévention et contrôle : Infections à coronavirus, Pandémies, Pneumopathie virale.
- thérapie : Troubles de l'alimentation.
- Guides de bonnes pratiques cliniques comme sujet, Humains.
English descriptors
- KwdEn :
- Betacoronavirus, Cognitive Behavioral Therapy (methods), Cognitive Behavioral Therapy (standards), Coronavirus Infections (prevention & control), Feeding and Eating Disorders (therapy), Humans, Pandemics (prevention & control), Pneumonia, Viral (prevention & control), Practice Guidelines as Topic, Telemedicine (methods), Telemedicine (standards).
- MESH :
- methods : Cognitive Behavioral Therapy, Telemedicine.
- prevention & control : Coronavirus Infections, Pandemics, Pneumonia, Viral.
- standards : Cognitive Behavioral Therapy, Telemedicine.
- therapy : Feeding and Eating Disorders.
- Betacoronavirus, Humans, Practice Guidelines as Topic.
Abstract
OBJECTIVE
The coronavirus pandemic has led to a dramatically different way of working for many therapists working with eating disorders, where telehealth has suddenly become the norm. However, many clinicians feel ill equipped to deliver therapy via telehealth, while adhering to evidence-based interventions. This article draws together clinician experiences of the issues that should be attended to, and how to address them within a telehealth framework.
METHOD
Seventy clinical colleagues of the authors were emailed and invited to share their concerns online about how to deliver cognitive-behavioral therapy for eating disorders (CBT-ED) via telehealth, and how to adapt clinical practice to deal with the problems that they and others had encountered. After 96 hr, all the suggestions that had been shared by 22 clinicians were collated to provide timely advice for other clinicians.
RESULTS
A range of themes emerged from the online discussion. A large proportion were general clinical and practical domains (patient and therapist concerns about telehealth; technical issues in implementing telehealth; changes in the environment), but there were also specific considerations and clinical recommendations about the delivery of CBT-ED methods.
DISCUSSION
Through interaction and sharing of ideas, clinicians across the world produced a substantial number of recommendations about how to use telehealth to work with people with eating disorders while remaining on track with evidence-based practice. These are shared to assist clinicians over the period of changed practice.
DOI: 10.1002/eat.23289
PubMed: 32383530
PubMed Central: PMC7267365
Affiliations:
- Australie, Canada, Pays-Bas, Royaume-Uni, États-Unis
- Angleterre, Californie, Grand Londres, Grand Manchester, Illinois, Massachusetts, Ohio, Ontario, Wisconsin, État de New York
- Londres, Manchester, Toronto
- Université de Toronto
Links toward previous steps (curation, corpus...)
Le document en format XML
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<sourceDesc><biblStruct><analytic><title xml:lang="en">Cognitive-behavioral therapy in the time of coronavirus: Clinician tips for working with eating disorders via telehealth when face-to-face meetings are not possible.</title>
<author><name sortKey="Waller, Glenn" sort="Waller, Glenn" uniqKey="Waller G" first="Glenn" last="Waller">Glenn Waller</name>
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<author><name sortKey="Mulkens, Sandra" sort="Mulkens, Sandra" uniqKey="Mulkens S" first="Sandra" last="Mulkens">Sandra Mulkens</name>
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<author><name sortKey="Moore, Elana" sort="Moore, Elana" uniqKey="Moore E" first="Elana" last="Moore">Elana Moore</name>
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<author><name sortKey="Raykos, Bronwyn" sort="Raykos, Bronwyn" uniqKey="Raykos B" first="Bronwyn" last="Raykos">Bronwyn Raykos</name>
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<author><name sortKey="Jorgensen, Susanne" sort="Jorgensen, Susanne" uniqKey="Jorgensen S" first="Susanne" last="Jorgensen">Susanne Jorgensen</name>
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<author><name sortKey="Evans, Jane" sort="Evans, Jane" uniqKey="Evans J" first="Jane" last="Evans">Jane Evans</name>
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<country xml:lang="fr">Royaume-Uni</country>
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<author><name sortKey="Thomas, Jennifer J" sort="Thomas, Jennifer J" uniqKey="Thomas J" first="Jennifer J" last="Thomas">Jennifer J. Thomas</name>
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<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Department of Psychiatry, Harvard Medical School, Boston, Massachusetts</wicri:regionArea>
<placeName><region type="state">Massachusetts</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Osenk, Ivana" sort="Osenk, Ivana" uniqKey="Osenk I" first="Ivana" last="Osenk">Ivana Osenk</name>
<affiliation wicri:level="1"><nlm:affiliation>Blackbird Initiative, Órama Institute, Flinders University, Adelaide, South Australia, Australia.</nlm:affiliation>
<country xml:lang="fr">Australie</country>
<wicri:regionArea>Blackbird Initiative, Órama Institute, Flinders University, Adelaide, South Australia</wicri:regionArea>
<wicri:noRegion>South Australia</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Paddock, Carolyn" sort="Paddock, Carolyn" uniqKey="Paddock C" first="Carolyn" last="Paddock">Carolyn Paddock</name>
<affiliation wicri:level="1"><nlm:affiliation>Bedfordshire and Luton Community Eating Disorders Service, Luton, UK.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Bedfordshire and Luton Community Eating Disorders Service, Luton</wicri:regionArea>
<wicri:noRegion>Luton</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Bohrer, Brittany" sort="Bohrer, Brittany" uniqKey="Bohrer B" first="Brittany" last="Bohrer">Brittany Bohrer</name>
<affiliation wicri:level="2"><nlm:affiliation>UCSD Eating Disorders Center for Treatment and Research, San Diego, California, USA.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>UCSD Eating Disorders Center for Treatment and Research, San Diego, California</wicri:regionArea>
<placeName><region type="state">Californie</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Anderson, Kristen" sort="Anderson, Kristen" uniqKey="Anderson K" first="Kristen" last="Anderson">Kristen Anderson</name>
<affiliation wicri:level="2"><nlm:affiliation>Chicago Center for Evidence-Based Treatment, Chicago, Illinois, USA.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Chicago Center for Evidence-Based Treatment, Chicago, Illinois</wicri:regionArea>
<placeName><region type="state">Illinois</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Turner, Hannah" sort="Turner, Hannah" uniqKey="Turner H" first="Hannah" last="Turner">Hannah Turner</name>
<affiliation wicri:level="1"><nlm:affiliation>Southern NHS Foundation Trust, Southampton, UK.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Southern NHS Foundation Trust, Southampton</wicri:regionArea>
<wicri:noRegion>Southampton</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Hildebrandt, Tom" sort="Hildebrandt, Tom" uniqKey="Hildebrandt T" first="Tom" last="Hildebrandt">Tom Hildebrandt</name>
<affiliation wicri:level="2"><nlm:affiliation>Mount Sinai School of Medicine, New York, New York, USA.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Mount Sinai School of Medicine, New York, New York</wicri:regionArea>
<placeName><region type="state">État de New York</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Xanidis, Nikos" sort="Xanidis, Nikos" uniqKey="Xanidis N" first="Nikos" last="Xanidis">Nikos Xanidis</name>
<affiliation wicri:level="1"><nlm:affiliation>Lanarkshire NHS CAMHS Eating Disorders Service, Lanarkshire, UK.</nlm:affiliation>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Lanarkshire NHS CAMHS Eating Disorders Service, Lanarkshire</wicri:regionArea>
<wicri:noRegion>Lanarkshire</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Smit, Vera" sort="Smit, Vera" uniqKey="Smit V" first="Vera" last="Smit">Vera Smit</name>
<affiliation wicri:level="1"><nlm:affiliation>Department of Eating Disorders, GZ Centraal, Hilversum, The Netherlands.</nlm:affiliation>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Department of Eating Disorders, GZ Centraal, Hilversum</wicri:regionArea>
<wicri:noRegion>Hilversum</wicri:noRegion>
</affiliation>
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<series><title level="j">The International journal of eating disorders</title>
<idno type="eISSN">1098-108X</idno>
<imprint><date when="2020" type="published">2020</date>
</imprint>
</series>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Betacoronavirus</term>
<term>Cognitive Behavioral Therapy (methods)</term>
<term>Cognitive Behavioral Therapy (standards)</term>
<term>Coronavirus Infections (prevention & control)</term>
<term>Feeding and Eating Disorders (therapy)</term>
<term>Humans</term>
<term>Pandemics (prevention & control)</term>
<term>Pneumonia, Viral (prevention & control)</term>
<term>Practice Guidelines as Topic</term>
<term>Telemedicine (methods)</term>
<term>Telemedicine (standards)</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr"><term>Guides de bonnes pratiques cliniques comme sujet</term>
<term>Humains</term>
<term>Infections à coronavirus (prévention et contrôle)</term>
<term>Pandémies (prévention et contrôle)</term>
<term>Pneumopathie virale (prévention et contrôle)</term>
<term>Troubles de l'alimentation (thérapie)</term>
<term>Télémédecine (méthodes)</term>
<term>Télémédecine (normes)</term>
</keywords>
<keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Cognitive Behavioral Therapy</term>
<term>Telemedicine</term>
</keywords>
<keywords scheme="MESH" qualifier="méthodes" xml:lang="fr"><term>Télémédecine</term>
</keywords>
<keywords scheme="MESH" qualifier="normes" xml:lang="fr"><term>Télémédecine</term>
</keywords>
<keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Coronavirus Infections</term>
<term>Pandemics</term>
<term>Pneumonia, Viral</term>
</keywords>
<keywords scheme="MESH" qualifier="prévention et contrôle" xml:lang="fr"><term>Infections à coronavirus</term>
<term>Pandémies</term>
<term>Pneumopathie virale</term>
</keywords>
<keywords scheme="MESH" qualifier="standards" xml:lang="en"><term>Cognitive Behavioral Therapy</term>
<term>Telemedicine</term>
</keywords>
<keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Feeding and Eating Disorders</term>
</keywords>
<keywords scheme="MESH" qualifier="thérapie" xml:lang="fr"><term>Troubles de l'alimentation</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Betacoronavirus</term>
<term>Humans</term>
<term>Practice Guidelines as Topic</term>
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<front><div type="abstract" xml:lang="en"><p><b>OBJECTIVE</b>
</p>
<p>The coronavirus pandemic has led to a dramatically different way of working for many therapists working with eating disorders, where telehealth has suddenly become the norm. However, many clinicians feel ill equipped to deliver therapy via telehealth, while adhering to evidence-based interventions. This article draws together clinician experiences of the issues that should be attended to, and how to address them within a telehealth framework.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>METHOD</b>
</p>
<p>Seventy clinical colleagues of the authors were emailed and invited to share their concerns online about how to deliver cognitive-behavioral therapy for eating disorders (CBT-ED) via telehealth, and how to adapt clinical practice to deal with the problems that they and others had encountered. After 96 hr, all the suggestions that had been shared by 22 clinicians were collated to provide timely advice for other clinicians.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>RESULTS</b>
</p>
<p>A range of themes emerged from the online discussion. A large proportion were general clinical and practical domains (patient and therapist concerns about telehealth; technical issues in implementing telehealth; changes in the environment), but there were also specific considerations and clinical recommendations about the delivery of CBT-ED methods.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>DISCUSSION</b>
</p>
<p>Through interaction and sharing of ideas, clinicians across the world produced a substantial number of recommendations about how to use telehealth to work with people with eating disorders while remaining on track with evidence-based practice. These are shared to assist clinicians over the period of changed practice.</p>
</div>
</front>
</TEI>
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<DateCompleted><Year>2020</Year>
<Month>07</Month>
<Day>22</Day>
</DateCompleted>
<DateRevised><Year>2020</Year>
<Month>07</Month>
<Day>22</Day>
</DateRevised>
<Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1098-108X</ISSN>
<JournalIssue CitedMedium="Internet"><Volume>53</Volume>
<Issue>7</Issue>
<PubDate><Year>2020</Year>
<Month>07</Month>
</PubDate>
</JournalIssue>
<Title>The International journal of eating disorders</Title>
<ISOAbbreviation>Int J Eat Disord</ISOAbbreviation>
</Journal>
<ArticleTitle>Cognitive-behavioral therapy in the time of coronavirus: Clinician tips for working with eating disorders via telehealth when face-to-face meetings are not possible.</ArticleTitle>
<Pagination><MedlinePgn>1132-1141</MedlinePgn>
</Pagination>
<ELocationID EIdType="doi" ValidYN="Y">10.1002/eat.23289</ELocationID>
<Abstract><AbstractText Label="OBJECTIVE">The coronavirus pandemic has led to a dramatically different way of working for many therapists working with eating disorders, where telehealth has suddenly become the norm. However, many clinicians feel ill equipped to deliver therapy via telehealth, while adhering to evidence-based interventions. This article draws together clinician experiences of the issues that should be attended to, and how to address them within a telehealth framework.</AbstractText>
<AbstractText Label="METHOD">Seventy clinical colleagues of the authors were emailed and invited to share their concerns online about how to deliver cognitive-behavioral therapy for eating disorders (CBT-ED) via telehealth, and how to adapt clinical practice to deal with the problems that they and others had encountered. After 96 hr, all the suggestions that had been shared by 22 clinicians were collated to provide timely advice for other clinicians.</AbstractText>
<AbstractText Label="RESULTS">A range of themes emerged from the online discussion. A large proportion were general clinical and practical domains (patient and therapist concerns about telehealth; technical issues in implementing telehealth; changes in the environment), but there were also specific considerations and clinical recommendations about the delivery of CBT-ED methods.</AbstractText>
<AbstractText Label="DISCUSSION">Through interaction and sharing of ideas, clinicians across the world produced a substantial number of recommendations about how to use telehealth to work with people with eating disorders while remaining on track with evidence-based practice. These are shared to assist clinicians over the period of changed practice.</AbstractText>
<CopyrightInformation>© 2020 The Authors. International Journal of Eating Disorders published by Wiley Periodicals, Inc.</CopyrightInformation>
</Abstract>
<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Waller</LastName>
<ForeName>Glenn</ForeName>
<Initials>G</Initials>
<Identifier Source="ORCID">0000-0001-7794-9546</Identifier>
<AffiliationInfo><Affiliation>Department of Psychology, University of Sheffield, Sheffield, UK.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Pugh</LastName>
<ForeName>Matthew</ForeName>
<Initials>M</Initials>
<AffiliationInfo><Affiliation>Central and North West London NHS Foundation Trust, London, UK.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Mulkens</LastName>
<ForeName>Sandra</ForeName>
<Initials>S</Initials>
<AffiliationInfo><Affiliation>University of Maastricht, Maastricht, The Netherlands.</Affiliation>
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<Author ValidYN="Y"><LastName>Moore</LastName>
<ForeName>Elana</ForeName>
<Initials>E</Initials>
<AffiliationInfo><Affiliation>South Yorkshire Eating Disorders Association, Sheffield, UK.</Affiliation>
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<Author ValidYN="Y"><LastName>Mountford</LastName>
<ForeName>Victoria A</ForeName>
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</AffiliationInfo>
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<ForeName>Jacqueline</ForeName>
<Initials>J</Initials>
<AffiliationInfo><Affiliation>Memorial University of Newfoundland, St. Johns, Newfoundland, Canada.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Wicksteed</LastName>
<ForeName>Amy</ForeName>
<Initials>A</Initials>
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</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Maharaj</LastName>
<ForeName>Aryel</ForeName>
<Initials>A</Initials>
<AffiliationInfo><Affiliation>University of Toronto, Toronto, Ontario, Canada.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Wade</LastName>
<ForeName>Tracey D</ForeName>
<Initials>TD</Initials>
<Identifier Source="ORCID">0000-0003-4402-770X</Identifier>
<AffiliationInfo><Affiliation>Blackbird Initiative, Órama Institute, Flinders University, Adelaide, South Australia, Australia.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Wisniewski</LastName>
<ForeName>Lucene</ForeName>
<Initials>L</Initials>
<AffiliationInfo><Affiliation>Center for Evidence Based Treatment, Shaker Heights, Ohio, USA.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Farrell</LastName>
<ForeName>Nicholas R</ForeName>
<Initials>NR</Initials>
<AffiliationInfo><Affiliation>Rogers Behavioral Health, Oconomowoc, Wisconsin, USA.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Raykos</LastName>
<ForeName>Bronwyn</ForeName>
<Initials>B</Initials>
<Identifier Source="ORCID">0000-0003-3640-4229</Identifier>
<AffiliationInfo><Affiliation>Centre for Clinical Interventions, Perth, Western Australia, Australia.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Jorgensen</LastName>
<ForeName>Susanne</ForeName>
<Initials>S</Initials>
<AffiliationInfo><Affiliation>Dorset All Age Eating Disorders Service, Bournemouth, UK.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Evans</LastName>
<ForeName>Jane</ForeName>
<Initials>J</Initials>
<AffiliationInfo><Affiliation>Eating Disorder Service, Greater Manchester Mental Health NHS Trust, Manchester, UK.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Thomas</LastName>
<ForeName>Jennifer J</ForeName>
<Initials>JJ</Initials>
<Identifier Source="ORCID">0000-0003-2601-581X</Identifier>
<AffiliationInfo><Affiliation>Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Osenk</LastName>
<ForeName>Ivana</ForeName>
<Initials>I</Initials>
<AffiliationInfo><Affiliation>Blackbird Initiative, Órama Institute, Flinders University, Adelaide, South Australia, Australia.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Paddock</LastName>
<ForeName>Carolyn</ForeName>
<Initials>C</Initials>
<AffiliationInfo><Affiliation>Bedfordshire and Luton Community Eating Disorders Service, Luton, UK.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Bohrer</LastName>
<ForeName>Brittany</ForeName>
<Initials>B</Initials>
<AffiliationInfo><Affiliation>UCSD Eating Disorders Center for Treatment and Research, San Diego, California, USA.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Anderson</LastName>
<ForeName>Kristen</ForeName>
<Initials>K</Initials>
<AffiliationInfo><Affiliation>Chicago Center for Evidence-Based Treatment, Chicago, Illinois, USA.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Turner</LastName>
<ForeName>Hannah</ForeName>
<Initials>H</Initials>
<Identifier Source="ORCID">0000-0003-4338-5476</Identifier>
<AffiliationInfo><Affiliation>Southern NHS Foundation Trust, Southampton, UK.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Hildebrandt</LastName>
<ForeName>Tom</ForeName>
<Initials>T</Initials>
<Identifier Source="ORCID">0000-0001-7054-9590</Identifier>
<AffiliationInfo><Affiliation>Mount Sinai School of Medicine, New York, New York, USA.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Xanidis</LastName>
<ForeName>Nikos</ForeName>
<Initials>N</Initials>
<AffiliationInfo><Affiliation>Lanarkshire NHS CAMHS Eating Disorders Service, Lanarkshire, UK.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Smit</LastName>
<ForeName>Vera</ForeName>
<Initials>V</Initials>
<AffiliationInfo><Affiliation>Department of Eating Disorders, GZ Centraal, Hilversum, The Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
</AuthorList>
<Language>eng</Language>
<PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType>
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<ArticleDate DateType="Electronic"><Year>2020</Year>
<Month>05</Month>
<Day>08</Day>
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<ISSNLinking>0276-3478</ISSNLinking>
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<Keyword MajorTopicYN="Y">psychotherapy</Keyword>
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<Day>29</Day>
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<PubMedPubDate PubStatus="revised"><Year>2020</Year>
<Month>04</Month>
<Day>26</Day>
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