<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1816-8949</journal-id>
<journal-title><![CDATA[Anales de la Facultad de Ciencias Médicas (Asunción)]]></journal-title>
<abbrev-journal-title><![CDATA[An. Fac. Cienc. Méd. (Asunción)]]></abbrev-journal-title>
<issn>1816-8949</issn>
<publisher>
<publisher-name><![CDATA[EFACIM. Editorial de la Facultad de Ciencias Médicas - Universidad Nacional de Asunción]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1816-89492025000200025</article-id>
<article-id pub-id-type="doi">10.18004/anales/2025.058.02.25</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Contribución de la Didáctica y Evaluación para la Construcción del Razonamiento Clínico en Estudiantes de Medicina]]></article-title>
<article-title xml:lang="en"><![CDATA[Contribution of Teaching and Assessment to the Development of Clinical Reasoning in Medical Students]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Genes]]></surname>
<given-names><![CDATA[Silvia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[González]]></surname>
<given-names><![CDATA[Mayra]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Navarro]]></surname>
<given-names><![CDATA[Rodrigo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Osorio]]></surname>
<given-names><![CDATA[Fátima]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ocampos]]></surname>
<given-names><![CDATA[Sandra]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad Nacional de Asunción Facultad de Ciencias Médicas Hospital de Clínicas]]></institution>
<addr-line><![CDATA[San Lorenzo ]]></addr-line>
<country>Paraguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>08</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>08</month>
<year>2025</year>
</pub-date>
<volume>58</volume>
<numero>2</numero>
<fpage>25</fpage>
<lpage>32</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_arttext&amp;pid=S1816-89492025000200025&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_abstract&amp;pid=S1816-89492025000200025&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_pdf&amp;pid=S1816-89492025000200025&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN  Introducción:  El razonamiento clínico constituye una competencia central en la formación médica. La Facultad de Ciencias Médicas de la Universidad Nacional de Asunción implementó una innovación curricular basada en competencias, generando la necesidad de evaluar cómo las estrategias didácticas y evaluativas contribuyen al desarrollo del razonamiento clínico.  Objetivo:  Comprender de qué manera las estrategias didácticas y evaluativas aplicadas durante el proceso formativo de la carrera de Medicina impactan en la construcción y desarrollo del razonamiento clínico, desde la perspectiva de estudiantes y docentes.  Material y método:  Estudio cualitativo con enfoque hermenéutico-emancipatorio. Se realizaron tres grupos focales: uno con docentes tutores del rotatorio clínico preprofesional supervisado y dos con estudiantes (mitad y final de carrera). Se efectuó análisis documental de programas académicos del ámbito de atención y recuperación de la salud. La información se analizó mediante categorización temática y triangulación metodológica.  Resultados:  Se identificó predominio de estrategias didácticas tradicionales en ciclos básicos y mayor implementación de metodologías activas en ciclos clínicos, aunque de forma poco estructurada. Las evaluaciones se centran principalmente en exámenes escritos de opción múltiple. Los estudiantes valoran positivamente las metodologías activas pero señalan falta de retroalimentación estructurada. Los docentes reconocen la importancia del aprendizaje basado en casos y simulación, pero enfrentan limitaciones de recursos y tiempo.  Discusión:  Existe discrepancia entre el discurso pedagógico propuesto y la práctica docente efectiva. Las barreras institucionales, la sobrecarga académica y la falta de estandarización en evaluaciones limitan el desarrollo del razonamiento clínico.  Conclusiones:  Las estrategias didácticas y evaluativas muestran una transición hacia metodologías activas, pero requieren mayor sistematización y estructura. Es necesario fortalecer la retroalimentación formativa, diversificar las estrategias evaluativas y abordar las barreras institucionales para optimizar la formación del razonamiento clínico en estudiantes de medicina.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT  Introduction:  Clinical reasoning is a core competency in medical education. The Faculty of Medical Sciences at the National University of Asunción implemented a competency-based curriculum innovation, creating the need to evaluate how teaching and assessment strategies contribute to the development of clinical reasoning.  Objective:  To understand how teaching and assessment strategies applied during the medical degree program impact the construction and development of clinical reasoning, from the perspective of students and teachers.  Material and method:  Qualitative study with a hermeneutic-emancipatory approach. Three focus groups were conducted: one with teachers who were tutors in the supervised pre-professional clinical rotation and two with students (midway and at the end of their studies). A documentary analysis of academic programs in the field of health care and recovery was carried out. The information was analyzed using thematic categorization and methodological triangulation.  Results:  A predominance of traditional teaching strategies was identified in basic cycles and greater implementation of active methodologies in clinical cycles, although in a somewhat unstructured manner. Assessments focus mainly on multiple-choice written exams. Students value active methodologies positively but point out a lack of structured feedback. Teachers recognize the importance of case-based learning and simulation, but face resource and time constraints.  Discussion:  There is a discrepancy between the proposed pedagogical discourse and effective teaching practice. Institutional barriers, academic overload, and lack of standardization in assessments limit the development of clinical reasoning.  Conclusions:  Teaching and assessment strategies show a transition toward active methodologies, but require greater systematization and structure. It is necessary to strengthen formative feedback, diversify assessment strategies, and address institutional barriers to optimize the development of clinical reasoning in medical students.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Razonamiento clínico]]></kwd>
<kwd lng="es"><![CDATA[educación médica]]></kwd>
<kwd lng="es"><![CDATA[estrategias didácticas]]></kwd>
<kwd lng="es"><![CDATA[evaluación educacional]]></kwd>
<kwd lng="es"><![CDATA[competencias profesionales]]></kwd>
<kwd lng="es"><![CDATA[currículo.]]></kwd>
<kwd lng="en"><![CDATA[Clinical reasoning]]></kwd>
<kwd lng="en"><![CDATA[medical education]]></kwd>
<kwd lng="en"><![CDATA[teaching strategies]]></kwd>
<kwd lng="en"><![CDATA[educational assessment]]></kwd>
<kwd lng="en"><![CDATA[professional competencies]]></kwd>
<kwd lng="en"><![CDATA[curriculum]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Casanova Romero]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Canquiz Rincón]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Paredes Chacín]]></surname>
<given-names><![CDATA[Í]]></given-names>
</name>
<name>
<surname><![CDATA[Inciarte González]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Visión general del enfoque por competencias en Latinoamérica.]]></article-title>
<source><![CDATA[Rev Cienc Soc.]]></source>
<year>2018</year>
<volume>24</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>114-25</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="book">
<collab>Facultad de Ciencias Médicas</collab>
<source><![CDATA[Proyecto de innovación curricular]]></source>
<year>2015</year>
<publisher-loc><![CDATA[Asunción ]]></publisher-loc>
<publisher-name><![CDATA[FCM-UNA]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Cooper]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Frain]]></surname>
<given-names><![CDATA[J.]]></given-names>
</name>
</person-group>
<source><![CDATA[Introduction to clinical reasoning. In: Cooper N, Frain J, editors. ABC of clinical reasoning. 2 nd ed]]></source>
<year>2023</year>
<page-range>p.1-6</page-range><publisher-loc><![CDATA[Chichester ]]></publisher-loc>
<publisher-name><![CDATA[John Wiley &amp; Sons Ltd]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Eva]]></surname>
<given-names><![CDATA[KW.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[What every teacher needs to know about clinical reasoning.]]></article-title>
<source><![CDATA[Med Educ.]]></source>
<year>2005</year>
<volume>39</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>98-106</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ocampos Benedetti]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Vuyk]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Ortiz Galeano]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Al término de la primera implementación de la malla curricular innovada 2015: cohorte de médicos egresados (2017-2023). Historia, fortalezas, debilidades y nuevos desafíos.]]></article-title>
<source><![CDATA[An Fac Cienc Méd.]]></source>
<year>2023</year>
<volume>56</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>85-102</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Graber]]></surname>
<given-names><![CDATA[ML]]></given-names>
</name>
<name>
<surname><![CDATA[Franklin]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Gordon]]></surname>
<given-names><![CDATA[R.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Diagnostic error in internal medicine.]]></article-title>
<source><![CDATA[Arch Intern Med.]]></source>
<year>2005</year>
<volume>165</volume>
<numero>13</numero>
<issue>13</issue>
<page-range>1493-9</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Graber]]></surname>
<given-names><![CDATA[ML.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The incidence of diagnostic error in medicine.]]></article-title>
<source><![CDATA[BMJ Qual Saf.]]></source>
<year>2013</year>
<volume>22</volume>
<numero>Suppl 2</numero>
<issue>Suppl 2</issue>
<page-range>ii21-7</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Tehrani]]></surname>
<given-names><![CDATA[ASS]]></given-names>
</name>
<name>
<surname><![CDATA[Lee]]></surname>
<given-names><![CDATA[HW]]></given-names>
</name>
<name>
<surname><![CDATA[Mathews]]></surname>
<given-names><![CDATA[SC]]></given-names>
</name>
<name>
<surname><![CDATA[Shore]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Makary]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
<name>
<surname><![CDATA[Pronovost]]></surname>
<given-names><![CDATA[PJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[25-year summary of US malpractice claims for diagnostic errors 1986-2010: an analysis from the National Practitioner Data Bank.]]></article-title>
<source><![CDATA[BMJ Qual Saf.]]></source>
<year>2013</year>
<volume>22</volume>
<numero>8</numero>
<issue>8</issue>
<page-range>672-80</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Daniel]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Rencic]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Durning]]></surname>
<given-names><![CDATA[SJ]]></given-names>
</name>
<name>
<surname><![CDATA[Holmboe]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Santen]]></surname>
<given-names><![CDATA[SA]]></given-names>
</name>
<name>
<surname><![CDATA[Lang]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Clinical reasoning assessment methods: a scoping review and practical guidance.]]></article-title>
<source><![CDATA[Acad Med.]]></source>
<year>2019</year>
<volume>94</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>902-12</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Dougnac]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Santelices]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Chávez]]></surname>
<given-names><![CDATA[A.]]></given-names>
</name>
</person-group>
<source><![CDATA[Tutoría y razonamiento clínico: sus desafíos pedagógicos]]></source>
<year>2016</year>
<publisher-loc><![CDATA[Santiago ]]></publisher-loc>
<publisher-name><![CDATA[Ediciones Universidad Finis Terrae]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Trullàs]]></surname>
<given-names><![CDATA[JC]]></given-names>
</name>
<name>
<surname><![CDATA[Blay]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Sarri]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Pujol]]></surname>
<given-names><![CDATA[R.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Effectiveness of problem-based learning methodology in undergraduate medical education: a scoping review]]></article-title>
<source><![CDATA[BMC Med Educ.]]></source>
<year>2022</year>
<volume>22</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>104</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lermanda]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Aprendizaje basado en problemas (ABP): una experiencia pedagógica en medicina.]]></article-title>
<source><![CDATA[Rev Estud Exper Educ.]]></source>
<year>2016</year>
<volume>6</volume>
<numero>11</numero>
<issue>11</issue>
<page-range>127-43</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Cook]]></surname>
<given-names><![CDATA[DA]]></given-names>
</name>
<name>
<surname><![CDATA[Hatala]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Brydges]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Zendejas]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Szostek]]></surname>
<given-names><![CDATA[JH]]></given-names>
</name>
<name>
<surname><![CDATA[Wang]]></surname>
<given-names><![CDATA[AT]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Technology-enhanced simulation for health professions education: a systematic review and meta-analysis.]]></article-title>
<source><![CDATA[JAMA]]></source>
<year>2011</year>
<volume>306</volume>
<numero>9</numero>
<issue>9</issue>
<page-range>978-88.</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lopreiato]]></surname>
<given-names><![CDATA[JO.]]></given-names>
</name>
</person-group>
<source><![CDATA[Healthcare Simulation Dictionary]]></source>
<year>2016</year>
<numero>17</numero>
<edition>AHRQ Publication No. 16</edition>
<issue>17</issue>
<page-range>0043.</page-range><publisher-loc><![CDATA[Rockville, MD ]]></publisher-loc>
<publisher-name><![CDATA[Agency for Healthcare Research and Quality]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Guba]]></surname>
<given-names><![CDATA[EG]]></given-names>
</name>
<name>
<surname><![CDATA[Lincoln]]></surname>
<given-names><![CDATA[YS.]]></given-names>
</name>
</person-group>
<source><![CDATA[Naturalistic inquiry]]></source>
<year>1985</year>
<publisher-loc><![CDATA[Beverly Hills ]]></publisher-loc>
<publisher-name><![CDATA[SAGE Publications]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mamede]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Schmidt]]></surname>
<given-names><![CDATA[HG]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The structure of reflective practice in medicine.]]></article-title>
<source><![CDATA[Med Educ.]]></source>
<year>2004</year>
<volume>38</volume>
<numero>12</numero>
<issue>12</issue>
<page-range>1302-8</page-range></nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Charlin]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Roy]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Brailovsky]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Goulet]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[van der Vleuten]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The script concordance test: a tool to assess the reflective clinician]]></article-title>
<source><![CDATA[Teach Learn Med.]]></source>
<year>2000</year>
<volume>12</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>189-95</page-range></nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Archer]]></surname>
<given-names><![CDATA[J.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[State of the science in health professional education: effective feedback]]></article-title>
<source><![CDATA[Med Educ.]]></source>
<year>2010</year>
<volume>44</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>101-8</page-range></nlm-citation>
</ref>
<ref id="B19">
<label>19</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ende]]></surname>
<given-names><![CDATA[J.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Feedback in clinical medical education.]]></article-title>
<source><![CDATA[JAMA]]></source>
<year>1983</year>
<volume>250</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>777-81</page-range></nlm-citation>
</ref>
<ref id="B20">
<label>20</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ryznar]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Levine]]></surname>
<given-names><![CDATA[RB.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Twelve tips for mindful teaching and learning in medical education]]></article-title>
<source><![CDATA[Med Teach]]></source>
<year>2022</year>
<volume>44</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>249-56</page-range></nlm-citation>
</ref>
<ref id="B21">
<label>21</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mann]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Gordon]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[MacLeod]]></surname>
<given-names><![CDATA[A.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Reflection and reflective practice in health professions education: a systematic review.]]></article-title>
<source><![CDATA[Adv Health Sci Educ.]]></source>
<year>2009</year>
<volume>14</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>595-621</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
