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9
]
.
T
o
i
m
p
r
o
v
e
a
n
d
p
r
ac
tice
e
f
f
e
ctiv
e
co
m
m
u
n
icatio
n
s
k
i
lls
f
o
r
b
o
th
d
o
cto
r
s
an
d
m
ed
ical
s
t
u
d
en
t
s
,
t
h
e
C
alg
ar
y
C
a
m
b
r
id
g
e
G
u
id
e
ca
n
b
e
u
s
ed
.
T
h
e
C
alg
ar
y
C
a
m
b
r
i
d
g
e
Gu
id
e
d
escr
ib
es
a
n
d
d
ef
i
n
es
th
e
co
n
s
u
ltatio
n
p
r
o
ce
s
s
in
to
s
ta
g
es
i
n
a
s
y
s
te
m
atic
a
n
d
co
m
p
r
eh
e
n
s
i
v
e
m
a
n
n
er
t
h
at
co
n
ta
in
s
7
1
b
asic
clin
ical
s
k
ill
p
o
in
t
s
.
T
h
is
g
u
id
e
h
as
b
ee
n
u
s
ed
ex
t
en
s
i
v
el
y
in
v
ar
io
u
s
co
u
n
tr
ie
s
as
a
r
eso
u
r
ce
o
f
th
e
m
ai
n
s
t
u
d
y
,
as
s
es
s
m
en
t,
a
n
d
r
esear
ch
co
m
m
u
n
icatio
n
s
k
ills
o
f
d
o
cto
r
-
p
atien
t
[
2
]
,
[
1
0
]
.
T
h
e
C
a
lg
ar
y
C
a
m
b
r
id
g
e
Gu
id
e
h
as
a
lar
g
e
n
u
m
b
e
r
o
f
p
o
in
ts
,
an
d
it
i
s
d
ee
m
ed
les
s
ef
f
ec
ti
v
e
to
b
e
ap
p
lied
in
th
e
ex
is
ti
n
g
co
n
d
itio
n
s
,
s
o
it
is
n
ec
ess
ar
y
to
m
ak
e
a
s
i
m
p
ler
an
d
m
o
r
e
ap
p
licab
le
g
u
id
e
ad
ap
ted
to
th
e
ex
is
ti
n
g
p
r
ac
tical
co
n
d
itio
n
s
,
s
o
cial
an
d
c
u
lt
u
r
e.
2
.
RE
S
E
ARCH
M
E
T
H
O
D
T
h
i
s
r
es
e
a
r
ch
u
s
e
d
q
u
a
li
t
a
ti
v
e
a
p
p
r
o
a
c
h
b
y
d
es
c
r
i
b
in
g
d
at
a
f
r
o
m
a
p
h
en
o
m
en
o
n
s
y
s
t
em
ati
c
a
l
ly
a
n
d
p
r
e
s
en
t
e
d
in
ex
p
l
an
a
t
o
r
y
s
en
t
en
c
es
[
1
1
]
.
T
h
e
r
e
w
e
r
e
f
o
u
r
s
ta
g
es
in
th
is
s
tu
d
y
,
n
am
e
ly
ex
p
e
r
t
p
a
n
e
l
s
,
s
t
u
d
en
t
p
a
n
e
ls
an
d
f
o
cu
s
g
r
o
u
p
d
i
s
cu
s
s
i
o
n
(
FG
D
)
,
ex
p
e
r
ts
r
ev
i
e
w
,
an
d
t
r
i
a
ls
[
1
2
]
.
I
n
f
o
r
m
an
ts
w
e
r
e
s
e
le
c
t
e
d
b
y
p
u
r
p
o
s
i
v
e
s
am
p
l
in
g
.
T
h
e
ex
p
e
r
t
p
an
e
l
in
f
o
r
m
a
n
t
s
w
e
r
e
r
e
p
r
e
s
en
t
a
t
iv
es
o
f
s
p
e
c
i
al
is
t
d
o
c
t
o
r
s
f
r
o
m
1
2
d
i
v
i
s
i
o
n
s
a
t
D
r
.
M
o
h
am
m
a
d
H
o
e
s
i
n
c
en
t
r
a
l
p
u
b
l
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c
h
o
s
p
it
a
l
(
R
SM
H
)
,
Pa
l
em
b
a
n
g
,
I
n
d
o
n
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ia
an
d
as
k
e
d
t
o
ch
o
o
s
e
m
ax
im
u
m
2
0
p
o
i
n
ts
o
u
t
o
f
7
1
C
a
l
g
a
r
y
C
am
b
r
i
d
g
e
p
o
i
n
t
s
th
a
t
a
r
e
c
o
n
s
i
d
e
r
e
d
t
o
b
e
t
h
e
m
o
s
t
e
f
f
ec
t
iv
e
an
d
u
s
e
f
u
l
f
o
r
c
o
m
m
u
n
i
c
at
i
o
n
t
o
b
e
a
p
p
l
i
e
d
.
S
tu
d
e
n
t
p
an
e
l
,
F
G
D
,
a
n
d
t
r
i
a
l
in
f
o
r
m
a
n
t
s
w
e
r
e
in
te
r
n
s
h
i
p
d
o
c
to
r
s
a
t
R
S
MH
.
T
h
e
to
tal
o
f
r
ec
o
m
m
e
n
d
atio
n
p
o
in
ts
f
r
o
m
t
h
e
ex
p
er
t
p
an
el
w
a
s
co
m
p
ar
ed
to
d
o
cto
r
-
p
atien
t
ch
ec
k
li
s
t
f
r
o
m
t
h
e
p
r
ev
io
u
s
r
e
s
ea
r
ch
a
n
d
Un
i
v
er
s
itas
P
ad
j
a
j
ar
an
(
UNP
A
D)
ch
ec
k
li
s
t.
T
h
en
,
t
h
e
d
at
a
o
b
tain
ed
f
r
o
m
th
e
ex
p
er
t p
an
el
s
tag
e
w
as c
ate
g
o
r
ized
b
ased
o
n
a
s
co
r
in
g
s
y
s
te
m
.
Sco
r
e
o
f
0
-
5
is
p
r
ese
n
ted
a
s
lo
w
ca
te
g
o
r
y
,
6
-
10
as
m
id
d
le
ca
teg
o
r
y
,
a
n
d
1
1
-
1
4
as
h
i
g
h
ca
te
g
o
r
y
.
Hi
g
h
a
n
d
m
id
d
le
p
o
in
ts
w
er
e
d
is
cu
s
s
ed
in
th
e
s
t
u
d
en
t
p
an
el
an
d
FGD
s
ta
g
e
b
y
t
w
o
g
r
o
u
p
s
o
f
i
n
ter
n
s
h
ip
d
o
cto
r
s
i
n
R
SMH
w
h
i
le
th
e
lo
w
ca
te
g
o
r
y
p
o
in
ts
w
er
e
n
o
t
in
cl
u
d
ed
in
th
e
n
ex
t sta
g
e.
3
.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
T
h
e
ex
p
er
t
p
an
el
s
tag
e
w
a
s
ca
r
r
ied
o
u
t
b
y
i
n
f
o
r
m
an
ts
w
h
o
w
er
e
r
ep
r
esen
tat
iv
e
s
o
f
s
p
ec
ia
lis
t
d
o
cto
r
s
f
r
o
m
1
2
d
iv
is
io
n
s
o
f
R
SM
H.
R
esear
ch
er
s
ask
ed
in
f
o
r
m
a
n
t
s
to
ch
o
o
s
e
as
m
a
n
y
a
s
1
0
-
2
0
p
o
in
ts
f
r
o
m
7
1
p
o
in
t
s
in
t
h
e
c
h
ec
k
l
is
t
o
f
C
alg
ar
y
C
a
m
b
r
id
g
e
w
h
ic
h
ar
e
b
eliev
ed
to
b
e
th
e
m
o
s
t
i
m
p
o
r
tan
t
an
d
e
f
f
ec
tiv
e
p
o
in
t
s
to
b
e
i
m
p
le
m
en
ted
.
Af
ter
th
e
d
ata
w
a
s
co
llected
,
a
s
co
r
in
g
w
as
c
ar
r
ied
o
u
t
an
d
r
esu
lted
i
n
t
h
r
e
e
p
o
in
ts
f
o
r
t
h
e
h
i
g
h
ca
teg
o
r
y
,
2
4
p
o
in
t
s
f
o
r
th
e
m
id
d
le
ca
te
g
o
r
y
,
a
n
d
4
4
p
o
in
ts
f
o
r
t
h
e
lo
w
ca
te
g
o
r
y
.
St
u
d
en
t
p
an
el
an
d
FGD
d
is
cu
s
s
ed
t
h
e
2
4
m
id
d
le
ca
te
g
o
r
y
p
o
in
ts
.
Se
v
en
tee
n
p
o
in
ts
w
er
e
c
h
o
s
e
n
a
n
d
a
g
r
ee
d
b
y
th
e
t
w
o
F
GD
g
r
o
u
p
s
,
f
i
v
e
p
o
in
ts
w
er
e
ch
o
s
e
n
b
y
o
n
e
g
r
o
u
p
,
an
d
t
w
o
p
o
in
t
s
w
er
e
n
o
t
ch
o
s
e
n
at
al
l
b
y
b
o
th
t
w
o
g
r
o
u
p
s
.
T
h
e
P
o
in
ts
ag
r
ee
d
b
y
b
o
th
o
f
g
r
o
u
p
s
b
ase
d
o
n
FGD
p
r
ese
n
ted
in
T
ab
le
1
.
T
h
e
p
o
in
ts
ag
r
ee
d
b
y
o
n
e
g
r
o
u
p
b
ased
o
n
FGD
p
r
esen
ted
in
T
ab
le
2
.
T
h
e
p
o
in
ts
o
f
d
is
a
g
r
ee
m
e
n
t b
y
b
o
th
g
r
o
u
p
s
b
ased
o
n
FGD
p
r
esen
ted
in
T
ab
le
3
.
T
ab
le
1
.
P
o
in
ts
ag
r
ee
d
b
y
b
o
th
o
f
g
r
o
u
p
s
b
ased
o
n
FGD
N
o
.
C
o
n
t
e
n
t
3
D
e
mo
n
st
r
a
t
e
r
e
sp
e
c
t
a
n
d
i
n
t
e
r
e
st
,
p
r
i
o
r
i
t
i
z
e
p
h
y
si
c
a
l
c
o
mf
o
r
t
.
F
G
D
1
:
“
I
t
'
s n
e
c
e
ssa
r
y
,
so
t
h
e
y
f
e
e
l
c
o
m
f
o
rt
a
b
l
e
a
n
d
b
e
i
n
g
r
e
sp
e
c
t
e
d
b
y
t
h
e
d
o
c
t
o
r”
F
G
D
2
:
“
I
t
i
s i
m
p
o
rt
a
n
t
d
u
ri
n
g
t
h
e
m
e
e
t
i
n
g
w
i
t
h
t
h
e
p
a
t
i
e
n
t
,
e
sp
e
c
i
a
l
l
y
a
t
t
h
e
b
e
g
i
n
n
i
n
g
t
o
b
u
i
l
d
p
a
t
i
e
n
t
’
s t
r
u
s
t
.
”
54
P
r
e
p
a
r
e
safe
t
y
n
e
t
s,
e
x
p
l
a
i
n
p
o
ssi
b
l
e
u
n
e
x
p
e
c
t
e
d
o
u
t
c
o
me
s,
w
h
a
t
t
o
d
o
i
f
t
h
e
p
l
a
n
d
o
e
s n
o
t
w
o
r
k
,
w
h
e
n
a
n
d
h
o
w
t
o
se
e
k
h
e
l
p
.
F
G
D
1
:
"
Ag
r
e
e
,
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t
i
s
n
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c
e
ss
a
ry
t
o
e
x
p
l
a
i
n
.
"
F
G
D
2
:
"
Pa
t
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e
n
t
s m
u
st
b
e
p
ro
v
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e
d
w
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t
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C
I
E
(
C
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f
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rm
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c
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t
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n
)
”
62
I
n
f
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r
m
t
h
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n
a
me
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f
t
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a
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a
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me
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t
o
f
f
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e
d
,
st
e
p
s
i
n
v
o
l
v
e
d
,
h
o
w
i
t
w
o
r
k
s,
t
h
e
b
e
n
e
f
i
t
s
a
n
d
a
d
v
a
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a
g
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s,
a
n
d
t
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p
o
ssi
b
l
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si
d
e
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f
f
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c
t
s.
F
G
D
1
:
"
M
u
st
b
e
e
x
p
l
a
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e
d
.
"
F
G
D
2
:
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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P
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2
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(
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G
D
2
:
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(
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c
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8
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2
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32
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F
G
D
1
:
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F
G
D
2
:
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:
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M
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p
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.
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2
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:
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48
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v
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t
:
-
To
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P
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F
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1
1
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1
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1
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F
G
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2
2
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"
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2
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.
"
2
B
:
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r
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m
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15
U
se
c
o
n
c
i
se
,
e
a
s
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l
y
u
n
d
e
r
st
o
o
d
q
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st
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o
n
s a
n
d
c
o
mm
e
n
t
s,
a
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d
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me
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.
F
G
D
1
:
1D
:
"
W
h
e
n
a
sk
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,
y
o
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d
e
rst
a
n
d
.
"
1
B
:
"
B
u
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p
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t
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s t
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sks
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1
H
:
"
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s g
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o
d
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F
G
D
2
:
"
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o
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.
"
40
U
se
c
o
n
c
i
se
,
e
a
s
i
l
y
u
n
d
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r
st
o
o
d
l
a
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g
u
a
g
e
a
n
d
se
n
t
e
n
c
e
s a
n
d
c
o
mm
e
n
t
s
,
a
v
o
i
d
u
si
n
g
me
d
i
c
a
l
l
a
n
g
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a
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e
.
F
G
D
1
a
n
d
F
G
D
2
:
"
T
h
i
s
p
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m
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p
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t
1
5
,
s
o
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c
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.
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56
D
o
a
f
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l
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k
t
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su
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t
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t
p
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s
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n
d
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s
c
o
mf
o
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t
a
b
l
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w
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t
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p
l
a
n
,
a
n
d
a
s
k
w
h
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y
c
o
r
r
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c
t
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o
n
s,
q
u
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st
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o
n
s o
r
o
t
h
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t
e
ms t
o
d
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s
c
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ss
.
F
G
D
1
:
"
I
t
m
u
st
b
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,
a
sk
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n
.
"
F
G
D
2
:
"
Y
e
s,
i
t
sh
o
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l
d
b
e
.
I
f
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e
ss
a
r
y
,
rev
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w
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p
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s t
o
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rri
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.
"
9
U
se
o
p
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n
a
n
d
c
l
o
se
d
q
u
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st
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n
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n
g
t
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c
h
n
i
q
u
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s,
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t
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s
mo
r
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a
p
p
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p
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w
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o
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n
q
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st
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n
s t
h
e
n
mo
v
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t
o
t
h
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c
l
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se
d
o
n
e
s.
F
G
D
1
:
"
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t
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q
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44
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e
o
u
rsel
v
e
s.
"
1
C
:
"
B
u
t
i
f
t
h
e
st
ru
c
t
u
re
o
f
t
h
e
i
n
t
e
rv
i
e
w
f
ro
m
t
h
e
b
e
g
i
n
n
i
n
g
t
o
t
h
e
c
l
o
s
i
n
g
m
u
st
b
e
se
q
u
e
n
t
i
a
l
."
F
G
D
2
2
C
:
"
T
o
o
f
o
rm
a
l
i
f
y
o
u
h
a
v
e
t
o
a
s
k
t
h
e
h
i
st
o
ry
i
n
o
rd
e
r.
"
2
F
:
"
J
u
st
a
c
c
o
r
d
i
n
g
t
o
t
h
e
si
t
u
a
t
i
o
n
a
n
d
c
o
n
d
i
t
i
o
n
s,
w
h
i
c
h
o
n
e
i
s re
m
e
m
b
e
r
e
d
f
i
rst
,
b
u
t
f
o
r t
h
e
seq
u
e
n
c
e
f
r
o
m
i
n
t
r
o
d
u
c
i
n
g
n
a
m
e
s
,
a
sk
i
n
g
c
o
m
p
l
a
i
n
t
s,
p
h
y
s
i
c
a
l
e
x
a
m
i
n
a
t
i
o
n
t
o
t
h
e
e
n
d
o
f
t
h
e
r
e
v
i
e
w
,
t
h
e
g
o
o
d
o
n
e
s
a
r
e
i
n
o
r
d
e
r
so
t
h
a
t
i
t
i
s m
o
re
f
o
c
u
se
d
.
"
5
L
i
st
e
n
a
t
t
e
n
t
i
v
e
l
y
t
o
t
h
e
p
a
t
i
e
n
t
’
s o
p
e
n
i
n
g
st
a
t
e
me
n
t
,
w
i
t
h
o
u
t
i
n
t
e
r
r
u
p
t
i
n
g
o
r
d
i
r
e
c
t
i
n
g
p
a
t
i
e
n
t
’
s re
sp
o
n
se
S
t
u
d
e
n
t
P
a
n
e
l
“
T
i
m
e
d
o
e
s
n
o
t
a
l
l
o
w
t
h
e
d
o
c
t
o
r
t
o
l
i
st
e
n
t
o
a
l
l
t
h
e
p
a
t
i
e
n
t
'
s
c
o
m
p
l
a
i
n
t
s
w
i
t
h
o
u
t
i
n
t
e
rru
p
t
i
o
n
,
so
m
e
t
i
m
e
s
p
a
t
i
e
n
t
sa
y
s
so
m
e
t
h
i
n
g
o
u
t
o
f
c
o
n
t
e
x
t
,
t
h
e
r
e
f
o
re
,
p
e
rm
i
ssi
o
n
t
o
i
n
t
e
rr
u
p
t
i
s
n
e
e
d
e
d
so
t
h
a
t
t
h
e
c
o
n
t
e
n
t
s
o
f
t
h
e
i
n
t
e
rv
i
e
w
d
o
n
o
t
d
e
v
i
a
t
e
.
”
F
G
D
1
1
A
:
"
D
o
n
’
t
u
se
i
t
,
i
t
w
i
l
l
t
a
k
e
t
o
o
l
o
n
g
i
f
y
o
u
d
o
n
'
t
i
n
t
e
rr
u
p
t
.
"
1
B
:
“
I
f
t
h
e
r
e
a
r
e
a
l
o
t
o
f
p
a
t
i
e
n
t
s
,
i
t
'
s
n
o
t
e
f
f
e
c
t
i
v
e
t
o
l
i
s
t
e
n
t
o
t
h
e
c
o
m
p
l
a
i
n
t
s
w
i
t
h
o
u
t
i
n
t
e
r
ru
p
t
i
o
n
.
Ev
e
n
i
n
t
h
e
p
o
l
y
c
l
i
n
i
c
,
w
e
h
a
v
e
n
'
t
a
sk
e
d
y
e
t
b
u
t
t
h
e
p
a
t
i
e
n
t
h
a
s
a
l
re
a
d
y
t
o
l
d
a
l
o
n
g
s
t
o
ry.
"
1
C
:
"
I
t
i
s
n
e
c
e
ss
a
r
y
t
o
k
e
e
p
t
h
e
t
i
m
i
n
g
,
so
i
t
n
e
e
d
s
t
o
i
n
t
e
rr
u
p
t
a
n
d
d
i
re
c
t
(
t
h
e
p
a
t
i
e
n
t
)
.
"
F
G
D
2
2
C
:
"No
,
y
o
u
c
a
n
'
t
,
t
h
e
p
a
t
i
e
n
t
w
i
l
l
p
o
u
r
h
i
s
h
e
a
r
t
o
u
t
t
o
o
l
o
n
g
.
"
2
F
:
"
I
f
y
o
u
h
a
v
e
d
e
v
i
a
t
e
d
a
n
y
w
h
e
r
e
,
i
t
m
u
st
b
e
i
n
t
e
rr
u
p
t
e
d
.
"
2
A
:
"
I
f
t
h
e
a
n
a
m
n
e
si
s
t
a
k
e
s s
o
l
o
n
g
,
i
t
w
i
l
l
b
e
sc
o
l
d
e
d
b
y
t
h
e
res
i
d
e
n
t
d
o
c
t
o
r
s."
B
esid
es
d
is
cu
s
s
i
n
g
th
e
m
id
d
l
e
ca
teg
o
r
y
p
o
in
t
s
,
th
e
t
w
o
g
r
o
u
p
s
also
d
is
c
u
s
s
ed
h
i
g
h
ca
te
g
o
r
y
p
o
in
t
s
b
ec
au
s
e
t
w
o
p
o
in
t
s
i
n
th
e
h
i
g
h
ca
te
g
o
r
y
w
er
e
n
o
t
ca
r
r
ied
o
u
t
an
d
n
o
t
ap
p
r
o
v
ed
b
y
i
n
f
o
r
m
an
t
s
i
n
p
r
ev
io
u
s
s
tu
d
ie
s
[
4
]
.
T
h
e
h
ig
h
ca
teg
o
r
y
p
o
in
ts
a
s
s
h
o
w
n
i
n
T
ab
le
4
.
T
ab
le
4
.
Hig
h
ca
teg
o
r
y
p
o
in
t
s
N
o
.
C
o
n
t
e
n
t
1
G
r
e
e
t
p
a
t
i
e
n
t
a
n
d
a
sk
p
a
t
i
e
n
t
's
n
a
me
.
2
I
n
t
r
o
d
u
c
e
y
o
u
r
se
l
f
a
n
d
c
l
a
r
i
f
y
t
h
e
r
o
l
e
,
a
n
d
n
a
t
u
r
e
o
f
t
h
e
i
n
t
e
r
v
i
e
w
,
a
sk
a
p
p
r
o
v
a
l
.
4
I
d
e
n
t
i
f
y
t
h
e
p
a
t
i
e
n
t
's p
r
o
b
l
e
m,
t
h
e
mai
n
r
e
a
so
n
f
o
r
v
i
si
t
i
n
g
,
a
n
d
t
h
e
e
x
p
e
c
t
a
t
i
o
n
s t
h
a
t
y
o
u
w
a
n
t
t
o
g
e
t
f
r
o
m t
h
e
c
o
n
su
l
t
a
t
i
o
n
w
i
t
h
o
p
e
n
-
e
n
d
e
d
q
u
e
st
i
o
n
s
.
Fro
m
th
e
r
esu
lts
o
f
FGD
b
y
th
e
t
w
o
g
r
o
u
p
s
,
it
w
a
s
f
o
u
n
d
th
at
t
h
e
ef
f
ec
ti
v
e
ti
m
e
e
s
ti
m
ated
f
o
r
i
m
p
le
m
en
t
in
g
d
o
cto
r
-
p
atien
t
co
m
m
u
n
icatio
n
is
ab
o
u
t
5
-
1
5
m
i
n
u
tes
w
i
th
1
5
-
2
0
ef
f
ec
ti
v
e
p
o
in
ts
.
A
cc
o
r
d
in
g
to
th
e
i
n
f
o
r
m
an
ts
,
t
h
e
allo
ca
te
d
ti
m
e
co
u
ld
b
e
co
n
d
itio
n
ed
i
f
t
h
er
e
w
er
e
n
o
o
b
s
tacle
s
s
u
c
h
as
d
i
f
f
er
en
ce
s
in
lan
g
u
a
g
e
an
d
m
is
u
n
d
er
s
tan
d
i
n
g
.
T
h
e
r
esu
lts
g
a
in
ed
f
r
o
m
th
e
h
ig
h
an
d
m
id
d
le
p
o
in
t’
s
d
is
c
u
s
s
io
n
,
t
h
e
e
s
ti
m
ated
ti
m
e
a
n
d
n
u
m
b
er
o
f
ef
f
ec
tiv
e
p
o
i
n
ts
,
w
er
e
t
h
en
co
n
s
u
lted
w
it
h
d
o
cto
r
-
p
atien
t
co
m
m
u
n
icatio
n
ex
p
er
t
to
v
al
id
ate
an
d
ap
p
r
o
v
e
th
e
m
o
d
i
f
icat
io
n
o
f
th
e
C
al
g
ar
y
C
a
m
b
r
id
g
e
c
h
ec
k
lis
t.
T
h
e
ex
p
er
t
ap
p
r
o
v
ed
2
7
p
o
in
ts
p
r
o
p
o
s
ed
co
n
s
is
ti
n
g
o
f
th
r
ee
p
o
in
ts
f
o
r
th
e
h
i
g
h
ca
te
g
o
r
y
a
n
d
2
4
p
o
in
ts
f
o
r
th
e
m
id
d
le
ca
teg
o
r
y
.
Sev
er
al
p
o
in
ts
t
h
at
h
a
v
e
t
h
e
s
a
m
e
m
ea
n
in
g
w
er
e
co
m
b
i
n
ed
o
r
u
s
ed
o
n
l
y
o
n
e
o
f
t
h
e
m
a
n
d
f
in
all
y
th
e
y
w
er
e
s
ep
ar
ated
in
to
t
wo
p
ar
ts
,
eig
h
t
m
a
i
n
p
o
in
ts
an
d
ele
v
en
tip
s
.
T
h
ese
p
o
in
ts
w
er
e
ar
r
an
g
ed
i
n
o
r
d
er
o
f
th
e
i
n
ter
v
ie
w
s
tr
u
ct
u
r
e
f
r
o
m
t
h
e
b
eg
i
n
n
in
g
to
th
e
en
d
o
f
t
h
e
d
o
cto
r
-
p
atien
t
c
o
m
m
u
n
icatio
n
p
r
o
ce
s
s
.
T
h
e
m
ain
p
o
in
ts
a
n
d
tip
s
o
f
C
al
g
ar
y
C
a
m
b
r
id
g
e
G
u
id
e
m
o
d
i
f
icat
io
n
a
s
h
o
w
n
i
n
T
ab
le
s
5
an
d
6
.
T
ab
le
5
.
C
alg
ar
y
C
a
m
b
r
id
g
e
Gu
id
e
m
o
d
i
f
icatio
n
(
m
ai
n
p
o
in
ts
)
N
o
.
C
o
n
t
e
n
t
1
G
r
e
e
t
s p
a
t
i
e
n
t
,
o
b
t
a
i
n
s
p
a
t
i
e
n
t
's
n
a
me
,
i
n
t
r
o
d
u
c
e
s se
l
f
,
r
o
l
e
a
n
d
n
a
t
u
r
e
i
n
t
e
r
v
i
e
w
2
I
d
e
n
t
i
f
i
e
s t
h
e
p
a
t
i
e
n
t
's
p
r
o
b
l
e
m o
r
t
h
e
i
ssu
e
s
t
h
a
t
t
h
e
p
a
t
i
e
n
t
w
i
sh
e
s
t
o
a
d
d
r
e
ss w
i
t
h
a
p
p
r
o
p
r
i
a
t
e
o
p
e
n
i
n
g
q
u
e
st
i
o
n
3
En
c
o
u
r
a
g
e
s p
a
t
i
e
n
t
t
o
t
e
l
l
st
o
r
y
o
f
t
h
e
p
r
o
b
l
e
m(
s)
f
r
o
m
w
h
e
n
f
i
r
st
s
t
a
r
t
e
d
t
o
t
h
e
p
r
e
se
n
t
i
n
o
w
n
w
o
r
d
s
4
I
n
v
o
l
v
e
s t
h
e
p
a
t
i
e
n
t
d
u
r
i
n
g
p
h
y
si
c
a
l
e
x
a
mi
n
a
t
i
o
n
,
e
x
p
l
a
i
n
p
r
o
c
e
ss,
a
s
k
s
p
e
r
mi
ssi
o
n
5
D
i
scu
sse
s
o
p
t
i
o
n
e
.
g
.
,
n
o
a
c
t
i
o
n
,
i
n
v
e
st
i
g
a
t
i
o
n
,
me
d
i
c
a
t
i
o
n
o
r
su
r
g
e
r
y
,
n
o
n
-
d
r
u
g
t
r
e
a
t
me
n
t
s
(
p
h
y
si
o
t
h
e
r
a
p
y
,
w
a
l
k
i
n
g
a
i
d
e
s
,
f
l
u
i
d
s,
c
o
u
n
se
l
i
n
g
)
,
p
r
e
v
e
n
t
i
v
e
me
a
su
r
e
s
6
P
r
o
v
i
d
e
s
i
n
f
o
r
mat
i
o
n
o
n
a
c
t
i
o
n
o
r
t
r
e
a
t
me
n
t
o
f
f
e
r
e
d
:
n
a
me
st
e
p
s
i
n
v
o
l
v
e
d
,
h
o
w
i
t
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366
T
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6
.
C
alg
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y
C
a
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b
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id
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id
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m
o
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i
f
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(
tip
s
)
N
o
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C
o
n
t
e
n
t
1
D
e
mo
n
st
r
a
t
e
s re
sp
e
c
t
,
i
n
t
e
r
e
st
,
a
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d
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L
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st
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p
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me
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3
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q
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st
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p
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4
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mi
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d
a
p
p
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o
p
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i
a
t
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y
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x
p
l
o
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s:
p
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s
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d
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s,
p
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n
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p
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5
P
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c
k
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b
a
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a
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d
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-
v
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b
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x
p
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a
f
f
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6
S
t
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u
c
t
u
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s i
n
t
e
r
v
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w
i
n
l
o
g
i
c
a
l
se
q
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c
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7
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f
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s,
w
r
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9
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p
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10
P
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p
p
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n
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a
t
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se
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k
c
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x
p
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ss
d
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b
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11
I
n
v
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l
v
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p
a
t
i
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n
t
:
o
f
f
e
r
s
su
g
g
e
st
i
o
n
s
a
n
d
c
h
o
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c
e
s
r
a
t
h
e
r
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h
a
n
d
i
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v
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s,
e
n
c
o
u
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p
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t
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w
n
i
d
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a
s,
su
g
g
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st
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Af
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ein
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tio
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th
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k
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ical
e
x
a
m
in
atio
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is
f
i
v
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to
s
ix
m
i
n
u
tes.
3
.
1
.
Sta
rt
ing
t
he
inte
rv
iew
(
I
nitia
t
ing
t
he
s
ess
io
n)
T
h
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p
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t's
f
ir
s
t
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p
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ti
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p
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co
m
m
u
n
ica
tio
n
p
r
o
ce
s
s
.
So
m
e
d
o
cto
r
'
s
b
eh
a
v
i
o
u
r
s
th
at
ca
n
g
iv
e
t
h
e
f
ir
s
t
i
m
p
r
ess
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n
as
e
x
p
ec
ted
b
y
t
h
e
p
a
tien
t
ar
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as
k
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n
g
a
n
d
m
en
tio
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g
th
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p
atien
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'
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a
m
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in
tr
o
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cin
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lf
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tell
in
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co
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u
ltatio
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d
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h
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ap
p
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iate
ex
p
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i
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s
,
e
y
e
co
n
tac
t,
an
d
g
es
tu
r
e
s
[
1
3
]
.
Fro
m
th
e
FG
D
r
esu
lt
s
,
it
w
as
f
o
u
n
d
th
at
g
r
ee
tin
g
a
n
d
as
k
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n
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t
h
e
p
atie
n
t
'
s
n
a
m
e
ca
n
a
v
o
id
m
is
ta
k
es
o
f
p
atie
n
t
id
e
n
ti
f
icatio
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an
d
s
tatu
s
b
u
ild
r
ap
p
o
r
t
an
d
co
m
f
o
r
t.
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t
is
i
m
p
o
r
tan
t
f
o
r
d
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cto
r
s
to
in
tr
o
d
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ce
th
e
m
s
elv
e
s
to
p
atien
ts
b
ec
au
s
e
t
h
e
y
ca
n
b
u
ild
in
i
tial
r
elatio
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s
h
ip
s
a
n
d
g
o
o
d
co
m
m
u
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ica
tio
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w
i
th
p
atien
t
s
,
b
esid
es
th
a
t
t
h
e
J
o
in
t
C
o
m
m
is
s
io
n
I
n
ter
n
atio
n
al
(
J
C
I
)
ass
es
s
m
en
t a
t
R
SMH
r
e
q
u
ir
e
s
p
atien
ts
to
k
n
o
w
t
h
e
n
a
m
e
o
f
t
h
e
d
o
cto
r
w
h
o
tr
ea
ts
t
h
e
m
.
T
h
is
r
esu
lt
co
n
tr
a
s
ts
w
i
th
t
h
e
p
r
ev
io
u
s
r
esear
ch
t
h
at
as
s
es
s
ed
th
e
d
o
cto
r
-
p
atien
t
co
m
m
u
n
icatio
n
i
n
2014
c
o
n
d
u
cted
to
th
e
r
esid
en
ts
o
f
i
n
ter
n
al
m
ed
ici
n
e
p
o
l
y
cli
n
ic
at
R
SMH
P
ale
m
b
a
n
g
u
s
i
n
g
a
c
h
e
c
k
lis
t
co
n
cise
C
al
g
ar
y
C
a
m
b
r
id
g
e
Gu
id
e.
T
h
e
o
b
s
er
v
atio
n
s
co
n
d
u
cted
to
th
e
in
ter
n
a
l
m
ed
ici
n
e
r
esid
en
ts
in
d
icate
d
th
at
t
h
e
p
atie
n
t
'
s
n
a
m
e
w
a
s
n
o
t
ask
ed
b
ec
au
s
e
o
f
s
tated
p
atien
t
's
s
tat
u
s
.
Sel
f
-
in
tr
o
d
u
ci
n
g
an
d
ex
p
lai
n
i
n
g
th
e
p
u
r
p
o
s
e
o
f
an
a
m
n
e
s
is
w
er
e
n
o
t a
p
p
l
ied
b
ec
au
s
e
it
w
as
n
o
t i
m
p
o
r
ta
n
t a
n
d
t
h
e
at
m
o
s
p
h
er
e
w
a
s
to
o
s
tiff
[
8
]
.
3
.
2
.
G
a
t
hering
info
r
m
a
t
io
n
I
n
d
o
cto
r
p
atien
t
co
m
m
u
n
ic
atio
n
,
th
er
e
ar
e
t
w
o
i
m
p
o
r
tan
t
s
e
s
s
io
n
s
,
n
a
m
e
l
y
t
h
e
i
n
f
o
r
m
atio
n
g
ath
er
i
n
g
s
es
s
io
n
w
h
ic
h
co
n
t
ain
s
t
h
e
h
is
to
r
y
ta
k
i
n
g
p
r
o
ce
s
s
an
d
t
h
e
d
eliv
er
y
o
f
i
n
f
o
r
m
atio
n
.
T
h
r
o
u
g
h
a
co
m
p
lete
h
is
to
r
y
,
ab
o
u
t
7
8
.
6
%
ca
n
s
u
p
p
o
r
t
th
e
d
iag
n
o
s
i
s
[
1
4
]
.
Fo
r
ty
p
ical
a
n
d
f
r
eq
u
en
tl
y
e
n
co
u
n
ter
ed
co
m
p
lai
n
t
s
,
d
o
cto
r
s
ca
n
g
i
v
e
s
p
ec
if
ic
an
d
n
ar
r
o
w
q
u
es
tio
n
s
to
m
a
k
e
th
e
m
m
o
r
e
f
o
cu
s
ed
an
d
s
a
v
e
ti
m
e
[
1
5
]
.
A
cc
o
r
d
in
g
to
t
h
e
F
GD
g
r
o
u
p
,
a
co
m
p
lete
h
is
to
r
y
in
v
o
l
v
in
g
p
atien
ts
to
tell
s
to
r
ies
ab
o
u
t
t
h
e
co
m
p
lain
t
its
e
lf
i
s
i
m
p
o
r
tan
t,
b
u
t
if
th
e
p
atie
n
t
tal
k
s
i
n
le
n
g
th
an
d
i
s
n
o
t d
ir
ec
te
d
,
th
e
d
o
cto
r
m
a
y
i
n
ter
r
u
p
t a
n
d
d
ir
ec
t th
e
f
o
c
u
s
o
f
th
e
co
n
v
er
s
atio
n
p
o
litel
y
an
d
s
u
b
tl
y
.
T
h
e
FGD
in
f
o
r
m
a
n
t
ar
g
u
ed
th
at
th
e
u
s
e
o
f
o
p
en
-
e
n
d
ed
q
u
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tio
n
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ir
s
t
th
e
n
clo
s
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q
u
esti
o
n
s
m
u
s
t
b
e
d
o
n
e
an
d
th
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er
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n
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ay
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f
th
e
y
u
s
e
to
o
o
f
ten
clo
s
ed
q
u
est
io
n
,
it
ca
n
g
i
v
e
i
m
p
r
ess
io
n
to
th
e
p
atien
t
th
at
it
is
d
i
f
f
icu
lt
f
o
r
h
i
m
to
te
ll
a
n
d
p
u
t
f
o
r
w
ar
d
h
i
s
o
p
in
io
n
,
s
o
th
e
i
n
f
o
r
m
atio
n
o
b
tai
n
ed
i
s
li
m
ited
a
n
d
p
atien
t
s
ar
e
les
s
o
p
en
.
L
i
s
te
n
in
g
s
k
i
lls
,
e
m
p
ath
y
,
an
d
th
e
u
s
e
o
f
o
p
en
-
en
d
ed
q
u
esti
o
n
s
ar
e
s
o
m
e
ex
a
m
p
le
s
o
f
co
m
m
u
n
icatio
n
s
k
ill
s
th
at
ca
n
af
f
ec
t p
atie
n
t sat
i
s
f
ac
tio
n
an
d
i
m
p
r
o
v
e
h
ea
lt
h
ca
r
e
o
u
tco
m
es [
1
6
]
.
3
.
3
.
P
hy
s
ica
l e
x
a
m
ina
t
io
n
I
n
th
e
co
n
s
u
ltat
io
n
p
r
o
ce
s
s
,
p
h
y
s
ical
e
x
a
m
in
a
tio
n
co
n
tr
ib
u
t
es
8
.
2
%
in
d
eter
m
in
in
g
t
h
e
d
i
ag
n
o
s
is
o
f
th
e
p
atie
n
t
'
s
d
is
ea
s
e.
A
cc
o
r
d
in
g
to
t
h
e
F
GD
i
n
f
o
r
m
an
t,
b
ef
o
r
e
th
e
p
h
y
s
ical
e
x
a
m
i
n
atio
n
,
i
t
is
i
m
p
o
r
ta
n
t
f
o
r
th
e
d
o
cto
r
to
o
u
tlin
e
th
e
p
r
o
ce
s
s
an
d
as
k
f
o
r
i
n
f
o
r
m
ed
co
n
s
en
t.
P
r
o
v
id
in
g
co
n
s
e
n
t
is
ca
r
r
ied
o
u
t
to
a
co
n
s
cio
u
s
p
atien
t
b
y
ex
p
lai
n
i
n
g
th
e
p
ati
en
t
'
s
c
u
r
r
en
t
co
n
d
itio
n
,
th
e
p
h
y
s
ical
ex
a
m
i
n
atio
n
to
b
e
ca
r
r
ied
o
u
t,
th
e
b
e
n
e
f
its
an
d
r
is
k
s
an
d
g
iv
e
n
i
n
u
n
d
e
r
s
tan
d
ab
le
lan
g
u
ag
e.
I
f
th
e
i
n
f
o
r
m
atio
n
p
r
o
v
id
ed
b
y
t
h
e
d
o
cto
r
is
n
o
t
f
u
l
l
y
u
n
d
er
s
to
o
d
b
y
th
e
p
atie
n
t,
th
e
in
f
o
r
m
ed
co
n
s
e
n
t b
asicall
y
ca
n
n
o
t b
e
co
n
f
ir
m
ed
[
1
7
]
-
[
1
9
]
.
3
.
4
.
E
x
pla
na
t
io
n a
nd
pla
nn
i
ng
T
h
e
ex
p
lan
atio
n
an
d
p
la
n
n
in
g
s
tag
e
ai
m
to
p
r
o
v
id
e
ac
cu
r
at
e
an
d
co
m
p
r
eh
e
n
s
iv
e
in
f
o
r
m
a
tio
n
.
I
t
i
s
i
m
p
o
r
tan
t
to
ex
p
lai
n
an
d
d
is
cu
s
s
o
p
tio
n
s
an
d
p
r
o
ce
d
u
r
es
(
w
h
eth
er
th
er
e
is
ac
tio
n
o
r
n
o
t)
,
p
r
o
v
id
e
in
f
o
r
m
atio
n
an
d
ex
p
lai
n
th
e
co
u
r
s
e
o
f
ac
t
i
o
n
,
tr
ea
t
m
e
n
t,
g
o
al
s
,
s
id
e
ef
f
e
cts,
an
d
b
en
e
f
it
s
o
f
t
h
er
ap
y
o
f
f
er
ed
.
I
f
th
e
p
atie
n
t
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367
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g
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eg
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ea
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t
o
p
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s
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an
d
p
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g
n
o
s
is
ca
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i
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f
lu
e
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ce
th
e
p
atie
n
t
in
d
eter
m
i
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g
t
h
e
tr
ea
t
m
e
n
t
o
p
tio
n
s
g
iv
e
n
an
d
i
m
p
r
o
v
e
p
atien
t
ad
h
er
en
ce
[
4
]
,
[
2
0
]
.
I
t
is
also
i
m
p
o
r
tan
t
to
p
r
o
v
id
e
s
af
et
y
n
e
t
ag
ai
n
s
t
u
n
ex
p
ec
ted
th
in
g
s
,
an
d
ex
p
lai
n
th
e
p
o
s
s
ib
ilit
y
o
f
u
n
e
x
p
ec
ted
r
esu
lt
s
,
w
h
at
s
h
o
u
ld
b
e
d
o
n
e
i
f
t
h
e
p
la
n
d
o
es
n
o
t
g
o
s
m
o
o
th
l
y
ac
co
r
d
in
g
to
t
h
e
FGD
d
is
c
u
s
s
io
n
.
T
h
is
p
o
in
t
i
s
th
e
s
a
m
e
a
s
co
m
m
u
n
ica
tio
n
,
in
f
o
r
m
a
tio
n
,
ed
u
ca
t
io
n
(
C
I
E
)
an
d
i
m
p
o
r
tan
t
to
g
iv
e
to
p
atien
ts
.
T
h
e
i
m
p
o
r
ta
n
ce
o
f
p
r
o
v
id
in
g
i
n
f
o
r
m
atio
n
a
b
o
u
t
th
e
u
n
ex
p
ec
ted
t
h
in
g
s
h
a
s
led
to
th
e
cr
ea
tio
n
o
f
p
o
licies
an
d
p
r
o
g
r
a
m
s
i
n
Am
er
ica
r
eg
ar
d
i
n
g
tr
a
n
s
p
ar
en
c
y
o
f
co
m
m
u
n
icatio
n
w
it
h
p
atien
t
s
.
T
h
e
p
atien
t
ex
p
ec
ts
ea
r
lier
i
n
f
o
r
m
atio
n
a
b
o
u
t
th
e
p
o
s
s
ib
il
it
y
o
f
s
o
m
et
h
in
g
u
n
ex
p
ec
te
d
.
I
t
w
as
h
o
p
ed
th
at
t
h
e
ab
ilit
y
to
d
eliv
er
co
m
m
u
n
ica
tio
n
,
p
r
o
v
i
d
e
in
f
o
r
m
atio
n
an
d
ed
u
ca
tio
n
in
t
h
e
f
o
r
m
o
f
p
r
ev
e
n
ti
v
e,
p
r
o
m
o
tiv
e
,
cu
r
ati
v
e
a
n
d
r
eh
ab
ilit
ati
v
e
f
o
r
m
s
is
n
ee
d
ed
s
in
ce
t
h
e
p
r
i
m
ar
y
h
ea
lt
h
ca
r
e
l
ev
el
[
2
1
]
-
[
2
3
]
.
3
.
5
.
Clo
s
ing
t
he
inte
rv
iew
A
t
th
e
c
lo
s
in
g
s
ta
g
e
o
f
t
h
e
i
n
ter
v
ie
w
,
f
in
a
l
ch
ec
k
i
n
g
to
en
s
u
r
e
th
a
t
th
e
p
atien
t
u
n
d
er
s
tan
d
s
,
ag
r
ee
s
an
d
is
co
m
f
o
r
tab
le
w
it
h
t
h
e
p
l
an
a
n
d
as
k
s
if
th
er
e
ar
e
co
r
r
ec
tio
n
s
,
q
u
esti
o
n
s
o
r
o
t
h
er
th
in
g
s
t
h
at
ar
e
n
o
t
clea
r
an
d
r
e
m
i
n
d
s
th
e
s
c
h
ed
u
le
o
f
co
n
s
u
ltatio
n
(
if
n
ee
d
ed
)
is
i
m
p
o
r
tan
t
to
d
o
s
o
t
h
at
t
h
e
p
ati
en
t
d
o
es
n
o
t
f
o
r
g
et
i
m
p
o
r
tan
t
t
h
in
g
s
t
h
at
h
a
v
e
b
ee
n
d
escr
ib
ed
.
A
t
th
e
en
d
o
f
th
e
in
ter
v
ie
w
,
it
is
i
m
p
o
r
tan
t
f
o
r
th
e
d
o
cto
r
t
o
b
u
ild
th
e
u
n
d
er
s
ta
n
d
in
g
o
f
t
h
e
p
atie
n
t a
b
o
u
t h
i
s
co
n
d
itio
n
,
w
h
at
i
s
h
ap
p
en
in
g
an
d
w
h
at
p
lan
s
ar
e
g
o
in
g
to
b
e
d
o
n
e.
3
.
6
.
B
uil
din
g
t
he
re
la
t
io
ns
hi
p
E
f
f
ec
tiv
e
d
o
cto
r
-
p
atien
t
co
m
m
u
n
icat
io
n
is
c
h
ar
ac
ter
ized
b
y
t
h
e
in
ter
ac
tio
n
t
h
at
p
r
o
v
id
es
r
ec
ip
r
o
ca
l
in
f
o
r
m
atio
n
b
et
w
ee
n
d
o
cto
r
s
an
d
p
atien
ts
,
b
o
th
v
er
b
al
an
d
n
o
n
v
er
b
al
an
d
ca
n
b
u
ild
g
o
o
d
r
elatio
n
s
h
ip
s
w
it
h
p
atien
ts
[
3
]
.
T
h
e
FGD
d
is
cu
s
s
io
n
s
ta
ted
th
at
s
h
o
w
i
n
g
r
esp
ec
t,
atten
tio
n
,
e
m
p
ath
y
,
an
d
p
r
io
r
itizin
g
p
atien
t
co
m
f
o
r
t
ar
e
s
o
m
e
e
x
a
m
p
le
s
o
f
i
m
p
o
r
tan
t
p
o
in
ts
to
m
a
k
e
to
b
u
ild
p
atien
t
’
s
co
n
f
id
en
ce
in
t
h
e
tr
ea
ti
n
g
d
o
cto
r
,
b
esid
es th
at
t
h
e
p
atien
t
w
i
ll f
e
el
co
m
f
o
r
tab
le
an
d
ap
p
r
ec
iated
b
y
t
h
e
d
o
cto
r
.
E
m
p
ath
y
to
u
n
d
er
s
ta
n
d
co
m
m
u
n
ica
tio
n
a
n
d
ap
p
r
ec
iate
th
e
p
atien
t
'
s
f
ee
li
n
g
s
o
r
co
n
d
itio
n
ac
co
r
d
in
g
to
FGD
in
f
o
r
m
atio
n
is
i
m
p
o
r
tan
t
as
lo
n
g
as
t
h
e
d
o
cto
r
d
o
es
n
o
t
g
et
ca
r
r
ied
a
w
a
y
to
cr
y
(
s
y
m
p
at
h
y
)
,
e
m
p
ath
y
is
s
h
o
w
n
b
y
ap
p
r
o
p
r
iate
f
ac
i
al
ex
p
r
ess
io
n
s
a
n
d
w
o
r
d
s
t
h
a
t
s
h
o
w
th
a
t
t
h
e
d
o
cto
r
u
n
d
er
s
tan
d
s
th
e
p
atien
t
's
co
n
d
itio
n
.
T
h
e
e
m
p
at
h
y
s
h
o
wn
b
y
t
h
e
d
o
cto
r
to
th
e
p
atie
n
t
w
il
l
f
o
s
ter
a
p
atien
t
'
s
s
en
s
e
o
f
tr
u
s
t
in
h
i
s
d
o
cto
r
w
h
ic
h
w
ill i
n
f
lu
e
n
ce
s
at
is
f
ac
ti
o
n
an
d
p
atien
t a
d
h
er
e
n
ce
to
tr
ea
t
m
e
n
t [
2
4
]
.
T
w
o
-
w
a
y
co
m
m
u
n
icatio
n
an
d
f
o
cu
s
o
n
th
e
p
atien
t
w
it
h
o
u
t
d
o
in
g
o
th
er
ac
ti
v
ities
s
u
c
h
a
s
u
s
i
n
g
a
co
m
p
u
ter
o
r
tak
in
g
n
o
tes
is
i
m
p
o
r
ta
n
t,
b
u
t
i
f
n
ec
e
s
s
ar
y
,
it
i
s
b
etter
to
ask
th
e
p
atie
n
t
'
s
p
e
r
m
is
s
io
n
f
ir
s
t.
Gi
v
e
co
m
p
lete
atten
tio
n
to
t
h
e
p
atie
n
t,
d
o
n
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t t
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p
atie
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t,
tell th
e
p
atie
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t f
ir
s
t [
2
5
]
.
Du
r
in
g
th
e
co
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u
ltatio
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p
r
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ce
s
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,
it
is
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m
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atien
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if
y
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p
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ess
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h
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y
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eg
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n
n
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n
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o
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th
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m
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tin
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to
th
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p
atien
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to
ask
an
d
r
ev
ea
l
h
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o
p
in
io
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d
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r
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n
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o
r
at
th
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en
d
o
f
co
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ltatio
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p
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.
T
h
e
d
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p
atien
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to
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at
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t
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Ko
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atien
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itie
s
f
o
r
p
atie
n
ts
to
ex
p
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ess
th
eir
v
ie
w
s
[
2
4
]
.
T
h
e
d
o
ct
o
r
-
p
atien
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co
m
m
u
n
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ater
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tic
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atte
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p
lied
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So
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Asi
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ti
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ain
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m
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atien
t
s
,
an
d
th
e
lo
w
le
v
el
o
f
ed
u
ca
tio
n
[
2
6
]
.
3
.
7
.
Str
uct
uring
t
he
inte
rv
iew
T
h
e
ab
ilit
y
to
s
tr
u
ct
u
r
e
in
ter
v
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e
w
s
ai
m
s
to
en
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r
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th
at
t
h
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co
n
s
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ltatio
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p
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s
ca
n
tak
e
p
lace
w
it
h
a
d
ef
in
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te
p
u
r
p
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e.
A
cc
o
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d
in
g
t
o
th
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t
w
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FGD
g
r
o
u
p
s
,
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lo
g
ical
s
eq
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ce
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f
th
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i
n
ter
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w
s
tr
u
ct
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r
e
is
n
ee
d
ed
if
it
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as
a
s
eq
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en
ce
f
r
o
m
o
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en
in
g
th
e
in
ter
v
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w
t
o
th
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clo
s
in
g
s
e
s
s
io
n
;
b
u
t
it
d
o
es
n
o
t
n
ee
d
to
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s
eq
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en
tial
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ter
m
s
o
f
as
k
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ar
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h
is
to
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ies
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elate
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atien
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m
p
lai
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s
lo
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g
as
t
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d
o
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ca
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u
m
m
ar
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n
d
o
f
th
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co
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s
u
ltatio
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.
A
s
eq
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en
tial
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tr
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ter
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a
t
d
o
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n
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j
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p
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q
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ask
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d
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d
m
a
k
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ier
to
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s
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an
d
s
u
m
m
ar
ize
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e
n
tire
co
n
s
u
ltatio
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p
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s
s
.
B
ased
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ter
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u
m
m
ar
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ak
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n
g
at
t
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n
d
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s
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ir
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cc
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p
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w
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t
t
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.
E
f
f
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v
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m
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b
e
ch
ar
ac
ter
ize
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ip
r
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a
g
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d
lis
ten
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th
e
u
s
e
o
f
o
p
en
q
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esti
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n
s
,
r
ef
lectio
n
,
an
d
s
u
m
m
ar
izi
n
g
t
h
e
p
atien
t
's co
n
d
itio
n
[
2
7
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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8
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6
I
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J
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P
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,
Vo
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1
0
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No
.
2
,
J
u
n
e
20
21
:
3
61
–
3
69
368
3
.
8
.
Co
ns
ulta
t
io
n t
i
m
e
T
h
e
r
esu
lts
o
f
t
h
e
FGD
d
is
cu
s
s
io
n
s
tated
th
at
th
e
e
f
f
ec
ti
v
e
c
o
n
s
u
ltatio
n
ti
m
e
at
R
SMH
r
a
n
g
ed
f
r
o
m
5
-
1
5
m
in
u
te
s
.
Af
ter
b
ei
n
g
test
ed
w
ith
t
h
e
r
o
le
p
la
y
m
et
h
o
d
u
s
i
n
g
C
al
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ar
y
C
a
m
b
r
id
g
e
Gu
id
elin
e
m
o
d
i
f
icat
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s
,
it
w
as
f
o
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n
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th
at
t
h
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co
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ltatio
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m
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s
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w
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5
-
6
m
i
n
u
tes
w
i
th
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t
p
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ica
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ex
a
m
in
at
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n
.
I
n
li
n
e
w
it
h
t
h
is
,
a
r
esear
ch
co
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d
u
cted
at
Ma
k
as
s
ar
Ho
s
p
ital
,
I
n
d
o
n
e
s
i
a
r
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ar
d
in
g
p
atien
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s
atis
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ac
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in
i
m
p
le
m
e
n
ti
n
g
ef
f
ec
tiv
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p
atie
n
t
d
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co
m
m
u
n
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n
f
o
u
n
d
th
at
m
o
s
t
r
esp
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n
d
en
ts
s
p
e
n
t
6
-
1
0
m
i
n
u
te
s
f
o
r
co
n
s
u
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n
a
n
d
tr
ea
t
m
e
n
t
b
ec
au
s
e
t
h
e
n
u
m
b
er
o
f
p
atien
t
s
w
as
r
elativ
e
l
y
la
r
g
e
w
it
h
o
n
l
y
o
n
e
d
o
cto
r
s
er
v
in
g
i
n
ea
c
h
cli
n
ic.
I
n
ad
d
itio
n
,
d
o
cto
r
s
w
h
o
s
er
v
e
o
f
ten
co
m
e
late,
t
h
er
eb
y
r
ed
u
c
in
g
t
h
e
a
v
ailab
ilit
y
o
f
ti
m
e
to
s
er
v
e
p
atien
t
s
[
2
8
]
.
B
ased
o
n
r
esear
ch
in
J
ap
an
r
eg
ar
d
i
n
g
co
n
s
u
lta
tio
n
ti
m
e
an
d
it
s
i
n
f
l
u
en
ce
v
ar
iab
les,
t
h
e
o
v
er
all
a
v
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ag
e
co
n
s
u
ltatio
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ti
m
e
w
as
s
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x
m
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1
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s
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1
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%
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m
p
les
o
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tain
ed
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n
av
er
ag
e
ti
m
e
o
f
t
h
r
ee
m
i
n
u
tes
o
r
less
[
2
9
]
.
Mo
s
t
g
e
n
er
al
p
r
ac
titi
o
n
er
s
in
L
o
n
d
o
n
t
h
i
n
k
t
h
at
t
h
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l
co
n
s
u
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ti
m
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is
ar
o
u
n
d
1
0
m
in
u
tes,
b
u
t
1
0
m
i
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tes
is
n
o
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en
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g
h
f
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ch
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ca
s
es,
co
m
p
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co
n
d
itio
n
s
,
g
er
iatr
ic
p
atien
t
s
an
d
h
ea
lth
p
r
o
m
o
tio
n
tar
g
ets.
Dr
.
B
u
r
n
et
t
s
a
id
t
h
at
th
e
q
u
alit
y
o
f
th
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co
n
s
u
lta
ti
o
n
is
m
o
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i
m
p
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tan
t
t
h
an
t
h
e
q
u
an
tit
y
o
f
ti
m
e
s
p
en
t [
3
0
]
.
4
.
CO
NCLU
SI
O
N
T
h
e
m
o
d
i
f
icatio
n
o
f
C
al
g
ar
y
C
a
m
b
r
id
g
e
G
u
id
e
ch
ec
k
li
s
t
d
e
v
elo
p
ed
in
th
i
s
r
esear
ch
co
n
s
i
s
ts
o
f
ei
g
h
t
m
ai
n
p
o
in
ts
an
d
elev
e
n
ef
f
ec
tiv
e
tip
s
.
T
h
is
m
o
d
if
ica
tio
n
g
u
id
elin
e
i
s
s
u
itab
le
to
b
e
u
s
ed
in
d
aily
d
o
cto
r
-
p
atien
t
co
n
s
u
ltat
io
n
an
d
co
m
m
u
n
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io
n
i
n
I
n
d
o
n
esia
co
n
c
er
n
in
g
its
p
r
ac
tical
co
n
d
itio
n
an
d
s
o
cio
-
cu
lt
u
r
a
l
co
n
tex
t
.
RE
F
E
R
E
NC
E
S
[1
]
He
rq
u
tan
t
o
e
t
a
l.
,
“
De
term
in
a
n
t
o
f
Do
c
to
r
P
a
ti
e
n
t
Kn
o
w
led
g
e
a
n
d
C
o
m
m
u
n
ica
ti
o
n
S
k
il
ls
,
”
J
o
u
rn
a
l
o
f
T
h
e
In
d
o
n
e
sia
n
M
e
d
ica
l
Asso
c
ia
ti
o
n
,
v
o
l.
6
1
,
n
o
.
5
,
p
p
.
1
9
6
-
1
9
9
,
2
0
1
1
.
[2
]
Ku
rtz
,
S
.
M
e
t
a
l.
,
“
M
a
rry
in
g
C
o
n
ten
t
a
n
d
P
ro
c
e
ss
in
Cli
n
ica
l
M
e
th
o
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T
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a
c
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g
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d
En
h
a
n
c
in
g
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Ca
lg
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Ca
m
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rid
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G
u
id
e
s,
”
Aca
d
e
mic
M
e
d
icin
e
,
v
o
l.
7
8
,
n
o
.
8
,
p
p
.
8
0
2
-
8
0
8
,
2
0
0
3
.
[3
]
A
li
. M.M
e
t
a
l.
,
“
Ef
f
e
c
ti
v
e
Do
c
to
r
P
a
ti
e
n
t
C
o
m
m
u
n
ica
ti
o
n
.
Ja
k
a
rta:
In
d
o
n
e
si
a
n
M
e
d
ica
l
Co
u
n
c
il
;
2
0
0
6
.
[4
]
F
o
n
g
Ha
.
J
,
Ho
n
s,
a
n
d
L
o
n
g
n
e
c
k
e
r,
N.
,
“
Do
c
to
r
-
P
a
ti
e
n
t
Co
m
m
u
n
ica
ti
o
n
:
A
Re
v
ie
w
,”
T
h
e
O
c
h
sn
e
r
J
o
u
rn
a
l
,
v
o
l.
1
0
,
n
o
.
1
,
p
p
.
38
-
4
2
,
2
0
1
0
.
[5
]
T
h
o
rn
e
e
t
a
l.
,
“
Ca
n
c
e
r
c
a
re
c
o
m
m
u
n
ica
ti
o
n
:
th
e
p
o
w
e
r
to
h
a
r
m
a
n
d
th
e
p
o
w
e
r
to
h
e
a
l?
,
”
Pa
ti
e
n
t
E
d
u
c
Co
u
n
s
,
v
o
l.
7
1
,
n
o
.
1
,
p
p
.
34
-
4
0
,
2
0
0
8
.
[6
]
He
rq
u
tan
t
o
,
“
O Do
c
t
o
r,
P
lea
se
Co
m
m
u
n
ica
te
,”
M
a
jelis Ked
o
k
ter
a
n
In
d
o
n
e
sia
,
v
o
l.
5
9
,
n
o
.
2
,
p
p
.
35
-
37,
2
0
0
9
.
[7
]
M
o
c
h
tar,
“
Do
c
t
o
rs A
re
Hu
m
a
n
To
o
,
”
Ja
k
a
rta:
PT
Gr
a
me
d
i
a
P
u
sta
k
a
Uta
ma
,
2
0
0
9
.
[8
]
Aw
in
d
a
,
D.,
S
y
a
k
u
ra
h
,
R.
,
a
n
d
F
a
d
il
a
h
,
M
.
,
“
A
ss
e
s
s
m
e
n
t
o
f
Do
c
to
r
-
P
a
ti
e
n
t
C
o
m
m
u
n
ica
ti
o
n
A
m
o
n
g
Re
sid
e
n
ts
i
n
In
tern
a
l
M
e
d
ici
n
e
P
o
ly
c
li
n
ic
a
t
RS
UP
Dr
.
M
o
h
a
m
m
a
d
Ho
e
sin
P
a
le
m
b
a
n
g
2
0
1
4
Us
i
n
g
S
im
p
li
f
ied
Ch
e
c
k
li
st
o
f
Ca
lg
a
r
y
C
a
m
b
rid
g
e
G
u
id
e
,
”
M
e
d
icin
u
s
,
v
o
l
.
7
,
n
o
.
6
,
p
p
.
1
8
4
-
1
9
4
,
2
0
2
0
.
[9
]
W
il
so
n
,
A
.
,
a
n
d
Ch
il
d
s,
S
.
,
“
T
h
e
re
latio
n
sh
ip
b
e
tw
e
e
n
c
o
n
su
lt
a
t
io
n
len
g
th
,
p
r
o
c
e
ss
a
n
d
o
u
tco
m
e
s
in
g
e
n
e
ra
l
p
ra
c
ti
c
e
:
a
s
y
ste
m
a
ti
c
re
v
ie
w
,
”
Br
it
ish
J
o
u
rn
a
l
o
f
Ge
n
e
ra
l
Pra
c
ti
c
e
,
v
o
l.
52
,
n
o
.
4
8
5
,
p
p
.
1
0
1
2
-
1
0
2
0
,
2
0
0
2
.
[1
0
]
S
imm
e
n
ro
th
e
t
a
l
.
,
“
P
h
y
sc
h
o
m
e
tri
c
p
ro
p
e
rt
ies
o
f
th
e
Ca
lg
a
r
y
Ca
m
b
rid
g
e
g
u
id
e
s
to
a
ss
e
ss
c
o
m
m
u
n
ica
ti
o
n
sk
il
ls
o
f
u
n
d
e
rg
ra
d
u
a
te m
e
d
ica
l
stu
d
e
n
t
s,
”
In
ter
n
a
t
io
n
a
l
J
o
u
rn
a
l
o
f
M
e
d
i
c
a
l
Ed
u
c
a
ti
o
n
,
v
o
l.
5
,
p
p
.
2
1
2
-
2
1
8
,
2
0
1
4
.
[1
1
]
Cre
ss
w
e
ll
,
J
.
W.
,
“
R
e
se
a
rc
h
De
sig
n
;
Qu
a
li
tativ
e
,
Qu
a
n
ti
tativ
e
,
a
n
d
M
ix
e
d
M
e
th
o
d
s
A
p
p
ro
a
c
h
e
s,
”
S
a
g
e
Pu
b
li
c
a
ti
o
n
s
,
L
o
s A
n
g
e
les
,
2
0
0
9
.
[1
2
]
Irw
a
n
to
,
“
F
o
c
u
se
d
G
ro
u
p
Disc
u
ss
io
n
(
F
G
D)
A
P
ra
c
ti
c
a
l
In
tr
o
d
u
c
ti
o
n
,”
Ja
k
a
rta:
Y
a
y
a
sa
n
Ob
o
r In
d
o
n
e
sia
,
2
0
0
6
.
[1
3
]
Ha
f
t
e
l
,
L.
,
“
P
a
ti
e
n
t
-
d
o
c
to
r
c
o
m
m
u
n
ica
ti
o
n
:
T
h
e
f
u
n
d
a
m
e
n
tal
sk
il
l
o
f
m
e
d
ica
l
p
ra
c
ti
c
e
,
”
M
e
d
ica
l
S
c
h
o
o
l
Un
ive
rs
it
y
o
f
M
ich
ig
a
n
,
2
0
0
8
.
[1
4
]
Ro
sh
a
n
,
R.
a
n
d
Ra
o
,
A
P
.
,
“
A
stu
d
y
o
f
r
e
lativ
e
c
o
n
tri
b
u
ti
o
n
s
o
f
th
e
h
isto
ry
,
P
h
y
sic
a
l
e
x
a
m
in
a
ti
o
n
a
n
d
in
v
e
stig
a
ti
o
n
s in
m
a
k
in
g
m
e
d
ica
l
d
iag
n
o
sis
,”
J
o
u
rn
a
l
Asso
c
ia
ti
o
n
P
h
y
sic
ia
n
s I
n
d
i
a
,
v
o
l
.
4
8
,
n
o
.
8
,
p
.
7
7
1
,
2
0
0
0
.
[1
5
]
Hill
e
n
,
H.C.
B
.
,
“
T
h
e
IT
a
n
a
m
n
e
s
is?
Dia
g
n
o
sin
g
so
f
t
w
a
re
re
q
u
irem
n
e
ts,
”
T
h
e
sis,
Ra
d
b
o
u
d
Un
iv
e
rsity
Nij
m
e
g
e
n
,
2
0
1
2
.
[1
6
]
A
ro
ra
,
N.K
.,
“
In
tera
c
ti
n
g
w
it
h
c
a
n
c
e
r
p
a
ti
e
n
ts:
th
e
sig
n
if
ica
n
c
e
o
f
p
h
y
sic
ian
s’
c
o
m
m
u
n
ica
ti
o
n
b
e
h
a
v
io
u
r,
”
S
o
c
ia
l
S
c
ien
c
e
&
M
e
d
icin
e
,
v
o
l.
5
7
,
n
o
.
5
,
p
p
.
7
9
1
-
8
0
6
,
2
0
0
3
.
[1
7
]
Co
n
su
m
e
r
He
a
lt
h
F
o
r
u
m
o
f
A
u
stra
li
a
.
In
f
o
rm
e
d
c
o
n
se
n
t
in
h
e
a
lt
h
c
a
re
:
A
n
Iss
u
e
s P
a
p
e
r
,
1
-
1
4
,
2
0
1
3
.
[1
8
]
T
h
e
M
in
ister
o
f
He
a
lt
h
Re
p
u
b
l
ic
In
d
o
n
e
sia
.
Re
g
u
latio
n
o
f
T
h
e
M
in
ister
o
f
He
a
lt
h
Re
p
u
b
li
c
In
d
o
n
e
sia
No
.
2
9
0
/M
e
n
k
e
s/
P
e
r
III/
2
0
0
8
p
a
sa
l
9
c
o
n
c
e
rn
in
g
A
p
p
ro
v
a
l
o
f
M
e
d
ica
l
A
c
ti
o
n
.
Ja
k
a
rta,
2
0
0
8
.
[1
9
]
G
u
w
a
n
d
i
,
“
M
e
d
ica
l
Err
o
r
a
n
d
M
e
d
i
c
a
l
L
a
w
,
”
Ja
k
a
rta
,
Pu
b
li
sh
e
r
Ce
n
ter
fo
r
th
e
Fa
c
u
l
ty
o
f
M
e
d
ici
n
e
,
Un
iv
e
rsity
o
f
In
d
o
n
e
sia
,
2
0
0
6
.
[2
0
]
Ba
il
e
e
t
a
l.
,
“
S
P
IKES
-
a
six
ste
p
p
ro
t
o
c
o
l
f
o
r
d
e
li
v
e
rin
g
b
a
d
n
e
w
s:
a
p
p
li
c
a
ti
o
n
to
t
h
e
p
a
ti
e
n
t
w
it
h
c
a
n
c
e
r
,”
T
h
e
On
c
o
lo
g
ist
,
v
o
l
.
5
,
n
o
.
4
,
p
p
.
3
0
2
-
3
1
1
,
2
0
0
0
.
[2
1
]
Na
ti
o
n
a
l
Qu
a
li
ty
F
o
r
u
m
.
S
a
fe
P
ra
c
ti
c
e
s f
o
r
b
e
tt
e
r
h
e
a
lt
h
c
a
re
.
W
a
sh
in
g
to
n
,
DC:
Na
ti
o
n
a
l
Qu
a
li
ty
F
o
ru
m
;
2
0
0
7
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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t.
J
.
P
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Hea
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Sci.
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N:
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Mo
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ifica
tio
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o
f Ca
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a
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d
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ts
…
(
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ya
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369
[2
2
]
M
a
z
o
r
,
KM
e
t
a
l.
,
“
He
a
lt
h
p
lan
m
e
m
b
e
rs'
v
ie
ws
a
b
o
u
t
d
isc
l
o
su
re
o
f
m
e
d
ica
l
e
rro
rs,
”
An
n
a
ls
o
f
I
n
ter
n
a
l
M
e
d
i
c
in
e
,
v
o
l.
1
4
0
,
n
o
.
6
,
p
p
.
4
0
9
-
1
8
,
2
0
0
4
,
d
o
i:
1
0
.
7
3
2
6
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0
0
3
-
4
8
1
9
-
1
4
0
-
6
-
2
0
0
4
0
3
1
6
0
-
00
0
0
6
.
[2
3
]
Be
a
g
leh
o
le
e
t
a
l.
,
“
I
m
p
ro
v
in
g
th
e
re
v
e
n
ti
o
n
a
n
d
m
a
n
a
g
e
m
e
n
t
o
f
c
h
ro
n
ic
d
ise
a
se
in
lo
w
-
in
c
o
m
e
a
n
d
m
id
d
le
in
c
o
m
e
c
o
u
n
tr
ies
:
a
p
ri
o
rit
y
f
o
r
p
rim
a
r
y
h
e
a
lt
h
c
a
re
,
”
L
a
n
c
e
t
,
v
o
l.
3
7
2
,
n
o
.
9
6
4
2
,
p
p
.
9
4
0
-
9
4
9
,
2
0
0
8
.
[2
4
]
Kim
a
n
d
P
a
rk
,
“
P
a
ti
e
n
t
-
p
e
rc
e
iv
e
d
c
o
m
m
u
n
ica
ti
o
n
sty
les
o
f
p
h
y
s
icia
n
s
in
re
h
a
b
il
i
tatio
n
:
T
h
e
e
f
fe
c
t
o
n
p
a
ti
e
n
t
sa
ti
sfa
c
ti
o
n
a
n
d
c
o
m
p
li
a
n
c
e
in
Ko
re
a
,
”
Ame
ric
a
n
J
o
u
rn
a
l
o
f
Ph
y
si
c
a
l
M
e
d
icin
e
&
Reh
a
b
il
it
a
ti
o
n
,
v
o
l.
8
7
,
n
o
.
1
2
,
p
p
.
9
9
8
-
1
0
0
5
,
2
0
0
8
.
[2
5
]
P
a
m
u
n
g
k
a
sa
ri
e
t
a
l.
,
“
C
o
m
m
u
n
ica
ti
o
n
S
k
il
ls
1
Co
n
n
e
c
t
S
e
n
se
,”
De
p
a
rtme
n
t
o
f
P
u
b
li
c
He
a
lt
h
,
Bi
o
c
h
e
m
ica
l,
a
n
d
Nu
tri
ti
o
n
ts
S
c
ie
n
c
e
F
a
c
u
lt
y
o
f
M
e
d
icin
e
Un
iv
e
rsitas
S
e
b
e
las
M
a
re
t,
S
u
ra
k
a
rta
,
2
0
1
2
.
[2
6
]
Clara
m
it
a
e
t
a
l.
,
“
Do
c
to
r
-
p
a
ti
e
n
t
c
o
m
m
u
n
ica
ti
o
n
in
a
S
o
u
t
h
e
a
st
A
sia
n
s
e
tt
in
g
:
th
e
c
o
n
f
li
c
t
b
e
twe
e
n
id
e
a
l
a
n
d
re
a
li
t
y
,”
Ad
v
a
n
c
e
s in
He
a
lt
h
S
c
ie
n
c
e
s E
d
u
c
a
ti
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