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Telemedicine in Sleep Apnea: A Simple Approach for Nasal Pressure (CPAP) Treatment
Telemedicina en la apnea del sueño: un abordaje simple para la presión positiva continua nasal (CPAP)
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(A) Posteroanterior chest X-ray showing a fine bilateral, symmetric micronodular pattern, predominantly in the lower lobes, producing the typical sand-storm image. Bilateral subpleural linear vertical radiolucencies, more obvious in the left side, corresponding in image B with subpleural cysts. (B–D) Chest computed tomography showing extensive ground-glass opacities, with interlobular septal and intralobular reticular thickening, mainly in the lower lobes, showing a crazy-paving pattern. Image D clearly shows confluent microcalcifications distributed primarily in the peribronchovascular space in posterior segments of the lower and subpleural lobes. (E) Remains of intra-alveolar calcospherites with a typical onion-skin image. Secondary fibrosis of the alveolar wall. 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Suarez-Giron, Marta Torres, Josep M. Montserrat" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Onintza" "apellidos" => "Garmendia" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 1 => array:3 [ "nombre" => "Monique C." 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"apellidos" => "Montserrat" "email" => array:1 [ 0 => "jmmontserrat@ub.edu" ] "referencia" => array:5 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 4 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Unitat del Son, Servei de Pneumologia, Hospital Clínic, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "CIBER Enfermedades Respiratorias, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "IDIBAPS, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Telemedicina en la apnea del sueño: un abordaje simple para la presión positiva continua nasal (CPAP)" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Continuous positive airway pressure (CPAP) therapy is the optimal treatment for obstructive sleep apnea (OSA).<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> Nevertheless, the efficacy of CPAP depends on patient's adherence.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> Indeed, although 4<span class="elsevierStyleHsp" style=""></span>h of treatment per night is required to achieve therapeutic effects,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> the more hours CPAP is used the greater the benefits of treatment,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">3</span></a> particularly with regard to systemic blood pressure.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">4,5</span></a> When addressing the problem of CPAP compliance, several studies have reported that a good adaptation to this treatment at the beginning of its application is the key factor for long-term compliance.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">6,7</span></a> Thus, patient education, follow-up and active feedback programs to provide support during the first weeks may be fundamental to increase compliance. However, the implementation of such customized programs may be expensive, as they require more resources and health staff involvement.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> Therefore, due to the current over-burden of health care services and the cost of personalized programs, the use of telemedicine strategies may be useful. Previous studies testing telemedicine programs (web platforms, apps or videoconferences) have yielded controversial results<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a> and the strategies already described have not been fully incorporated into the clinical routine. The lack of widespread application of telemedicine approaches in CPAP treatment is likely caused by their current organizational complexity, and therefore more user-friendly procedures are needed.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a> In this context, on the basis of our previous studies<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">10,11</span></a> we have developed a very simple and straightforward telemedicine procedure for supporting OSA patients, particularly along the first weeks of CPAP treatment.</p><p id="par0010" class="elsevierStylePara elsevierViewall">This model for remotely managing CPAP treatment is based on three pillars: 1. To use one of the commercially available automatic-CPAP devices (Dreamstation, Respironics) which are able to remotely transmitting data on CPAP pressure, breathing flow, air leaks, compliance and residual respiratory events to a web server providing remote monitoring to the health care provider. Interestingly, such a setting also allows changing the nasal pressure applied remotely thus performing home accurate titration/re-titration. 2. To use a specially designed smartphone application, specifically an updated version of an app previously designed and tested to promote patient self-monitoring of CPAP treatment.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a> Each other day, APPnea asks the patient eight simple questions on compliance, sleep improvement, CPAP side effects and general lifestyle perception. All answers are sent to a web server and evaluated by a specialized nurse. 3. To use a voice mail available 24/24<span class="elsevierStyleHsp" style=""></span>h which is intended to collect any patient's questions or problems. Patients are encouraged to leave voice mail messages which a specialized nurse would check and, if necessary, contact the patient.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The actual clinical feasibility and usefulness of the described approach was tested in a pilot study. First, we assessed the remote titration procedure and patient compliance. Twenty patients (AHI 54.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>22.00<span class="elsevierStyleHsp" style=""></span>events/h, BMI 30.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.0<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>, Epworth 9.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.0 and age 60.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.0 years; m<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SE) were subjected to home CPAP titration, which was carried out along 5 consecutive nights and was supported through APPnea and the voice mail. Home titration was compared with in-hospital full polysomnography (PSG) titration (crossover protocol), with the result that no significant differences were found in the fixed recommended nasal pressure (8.95<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.57 and 8.55<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.32<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>H<span class="elsevierStyleInf">2</span>O for in-hospital PSG and remote home titration, respectively (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.389). The performance of the telemedicine approach was also tested in terms of CPAP compliance after 3-months of treatment. To this end, the group of patients within the telemedicine procedure was compared with a group of 60 patients (matched 1:3 by AHI and age) who conventionally followed-up at the hospital during the same year period. No significant differences in compliance were found between the telemedicine group (6.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.6<span class="elsevierStyleHsp" style=""></span>h/night) and the control group (5.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.8<span class="elsevierStyleHsp" style=""></span>h/night) (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.691). Taking into account the work hours employed by the involved sleep technician, nurse and physician and the use of devices and consumable materials, our analysis found that telematic approach was less expensive since the in-hospital PSG titration incurred in a 60% higher cost.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In addition to considering cost evaluation, assessment the patient's perspective is fundamental when testing a new clinical management approach. A first question that arises when trying to introduce the use of new technologies to a group of patients who are potentially not be familiar with them (in this case the use of Apps) is to what extend OSA patients (most of them in an age segment not belonging to the digital generation) are prone to accept and perform the internet tools. In this connection it is worth noting that we carried out a preliminary test by asking 10 patients with limited knowledge of the use of Internet and mobile applications to test the APPnea tool at home, with the result that 9 of them we able to use it correctly, thus demonstrating the feasibility of telemedicine approach and confirming published reports on the ability of digitally illiterate patients to learn on the basic use of health applications.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a> Of particular importance is the patient's opinion on the use of telemedicine on sleep apnea management. To this end, using a focus group methodology we asked 14 OSA patients under CPAP treatment that had experienced both the in-hospital and the telemedicine approaches to talk freely about their experience when distributed into two focus groups (8 and 6 patients). The interviews highlighted the importance of: (1) flexibility of the consultations, (2) savings on work hours and trips to the hospital, and (3) chance to follow the progress of the therapy especially with regard to the residual AHI. Most patients reported that, according to their actual practical experience, the telemedicine approach was an innovative and straightforward way of controlling their treatment. Our experience after working with the patient's focus group confirmed our initial opinion that patient's opinion is of capital importance when designing future clinical procedures studies aimed at personalized treatment.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The simple telemedicine procedure we propose is feasible even in patients with limited knowledge of Internet or mobile applications and it reduces costs with patient satisfaction. However, bearing in mind that this telemedicine procedure does not replace the whole care of patients, especially in the more complex ones, it seems reasonable that telemedicine is progressively included in the clinical management programs for patients with sleep breathing disorders. Large follow-up and multicenter studies are needed to support these very promising results.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0065" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.E. Sullivan" 1 => "F.G. Issa" 2 => "M. Berthon-Jones" 3 => "L. Eves" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Lancet" "fecha" => "1981" "volumen" => "318" "paginaInicial" => "862" "paginaFinal" => "865" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0070" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Educational, supportive and behavioral interventions to improve usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.R. Wozniak" 1 => "T.J. Lasserson" 2 => "I. Smith" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2014" "volumen" => "1" "paginaInicial" => "CD007736" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0075" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T.E. Weaver" 1 => "G. Maislin" 2 => "D.F. Dinges" 3 => "T. Bloxam" 4 => "C.F. George" 5 => "H. Greenberg" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Sleep" "fecha" => "2007" "volumen" => "30" "paginaInicial" => "711" "paginaFinal" => "719" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17580592" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0080" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term effect of continuous positive airway pressure in hypertensive patients with sleep apnea" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Spanish Sleep and Breathing Group" "etal" => true "autores" => array:6 [ 0 => "F. Barbé" 1 => "J. Durán-Cantolla" 2 => "F. Capote" 3 => "M. de la Peña" 4 => "E. Chiner" 5 => "J.F. Msa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.200901-0050OC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2010" "volumen" => "181" "paginaInicial" => "718" "paginaFinal" => "726" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20007932" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0085" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.A. Martínez-García" 1 => "F. Capote" 2 => "F. Campos-Rodríguez" 3 => "P. Lloberes" 4 => "M.J. Díaz de Atauri" 5 => "M. Somoza" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2013.281250" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2013" "volumen" => "310" "paginaInicial" => "2407" "paginaFinal" => "2415" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24327037" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0090" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term use of continuous positive airway pressure therapy in coronary artery disease patients with nonsleepy obstructive sleep apnea" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "F.S. Luyster" 1 => "P.J. Strollo Jr." 2 => "E. Thunström" 3 => "Y. Pekere" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/clc.22827" "Revista" => array:6 [ "tituloSerie" => "Clin Cardiol" "fecha" => "2017" "volumen" => "40" "paginaInicial" => "1297" "paginaFinal" => "1302" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29243273" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0095" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictors of long-term adherence to continuous positive airway pressure therapy in patients with obstructive sleep apnea and cardiovascular disease in the SAVE study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.L. Chai-Coetzer" 1 => "Y.M. Luo" 2 => "N.A. Antic" 3 => "X.L. Zhang" 4 => "B.Y. Chen" 5 => "Q.Y. He" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5665/sleep.3232" "Revista" => array:6 [ "tituloSerie" => "Sleep" "fecha" => "2013" "volumen" => "36" "paginaInicial" => "1929" "paginaFinal" => "1937" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24293768" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0100" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Motivational enhancement for increasing adherence to CPAP: a randomized controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.P. Bakker" 1 => "R. Wang" 2 => "J. Weng" 3 => "M.S. Aloia" 4 => "C. Toth" 5 => "M.G. Morrical" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.chest.2016.03.019" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2016" "volumen" => "150" "paginaInicial" => "337" "paginaFinal" => "345" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27018174" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0105" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Telemedicine: a key tool for improving CPAP adherence in sleep apnea patients?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Farré" 1 => "D. Navajas" 2 => "J.M. Montserrat" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.201709-1791ED" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2018" "volumen" => "197" "paginaInicial" => "12" "paginaFinal" => "14" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28926279" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0110" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A Bayesian cost-effectiveness analysis of a telemedicine-based strategy for the management of sleep apnoea: a multicentre randomised controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Isetta" 1 => "M.A. Negrín" 2 => "C. Monasterio" 3 => "J.F. Masa" 4 => "N. Feu" 5 => "A. Álvarez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/thoraxjnl-2015-207032" "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "2015" "volumen" => "70" "paginaInicial" => "1054" "paginaFinal" => "1061" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26310452" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0115" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A New mHealth application to support treatment of sleep apnoea patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Isetta" 1 => "M. Torres" 2 => "K. González" 3 => "C. Ruiz" 4 => "M. Dalmases" 5 => "C. Embid" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/1357633X15621848" "Revista" => array:6 [ "tituloSerie" => "J Telemed Telecare" "fecha" => "2017" "volumen" => "23" "paginaInicial" => "14" "paginaFinal" => "18" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26672606" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0120" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Telehealth for “the digital illiterate” – elderly heart failure patient's experiences" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Lind" 1 => "D. Karlsson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Stud Health Technol Inform" "fecha" => "2014" "volumen" => "205" "paginaInicial" => "353" "paginaFinal" => "357" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25160205" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack364953" "titulo" => "Acknowledgements" "texto" => "<p id="par0030" class="elsevierStylePara elsevierViewall">Supported by Philips Respironics, SOCAP, SES and FIS PI14/00416.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005400000009/v1_201809020413/S1579212918302684/v1_201809020413/en/main.assets" "Apartado" => array:4 [ "identificador" => "49861" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005400000009/v1_201809020413/S1579212918302684/v1_201809020413/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212918302684?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 33 | 19 | 52 |
| 2024 September | 43 | 22 | 65 |
| 2024 August | 64 | 41 | 105 |
| 2024 July | 30 | 28 | 58 |
| 2024 June | 43 | 25 | 68 |
| 2024 May | 61 | 25 | 86 |
| 2024 April | 36 | 34 | 70 |
| 2024 March | 27 | 14 | 41 |
| 2024 February | 22 | 17 | 39 |
| 2023 March | 7 | 6 | 13 |
| 2023 February | 34 | 25 | 59 |
| 2023 January | 25 | 36 | 61 |
| 2022 December | 43 | 40 | 83 |
| 2022 November | 50 | 25 | 75 |
| 2022 October | 60 | 38 | 98 |
| 2022 September | 26 | 21 | 47 |
| 2022 August | 31 | 46 | 77 |
| 2022 July | 32 | 42 | 74 |
| 2022 June | 23 | 48 | 71 |
| 2022 May | 30 | 34 | 64 |
| 2022 April | 24 | 30 | 54 |
| 2022 March | 38 | 50 | 88 |
| 2022 February | 41 | 28 | 69 |
| 2022 January | 38 | 43 | 81 |
| 2021 December | 40 | 44 | 84 |
| 2021 November | 55 | 50 | 105 |
| 2021 October | 47 | 54 | 101 |
| 2021 September | 24 | 56 | 80 |
| 2021 August | 19 | 36 | 55 |
| 2021 July | 23 | 27 | 50 |
| 2021 June | 29 | 65 | 94 |
| 2021 May | 33 | 60 | 93 |
| 2021 April | 121 | 86 | 207 |
| 2021 March | 41 | 18 | 59 |
| 2021 February | 31 | 28 | 59 |
| 2021 January | 28 | 14 | 42 |
| 2020 December | 33 | 21 | 54 |
| 2020 November | 43 | 17 | 60 |
| 2020 October | 33 | 17 | 50 |
| 2020 September | 15 | 13 | 28 |
| 2020 April | 1 | 0 | 1 |
| 2020 March | 13 | 11 | 24 |
| 2020 February | 30 | 15 | 45 |
| 2020 January | 44 | 27 | 71 |
| 2019 December | 24 | 9 | 33 |
| 2019 November | 27 | 19 | 46 |
| 2019 October | 29 | 18 | 47 |
| 2019 September | 13 | 13 | 26 |
| 2019 August | 22 | 10 | 32 |
| 2019 July | 26 | 25 | 51 |
| 2019 June | 18 | 12 | 30 |
| 2019 May | 32 | 24 | 56 |
| 2019 April | 29 | 27 | 56 |
| 2019 March | 22 | 23 | 45 |
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