European journal of hospital pharmacy : science and practice最新文献

{"title":"Testing of parenteral drug products for visible particles: comparison of the Ph. Eur. method with an alternative method using polarised light.","authors":"Paula E Borgonje, Tom Dunnewind, Lisette Bosma, Marja Tokromo-Evegaars, P C Willem Meulenhoff, Oscar Breukels","doi":"10.1136/ejhpharm-2022-003633","DOIUrl":"10.1136/ejhpharm-2022-003633","url":null,"abstract":"<p><strong>Objectives: </strong>Parenteral drug products should be essentially free from visible particulate contamination. To ensure this, every batch produced must be subject to a 100% visual inspection. Monograph 2.9.20 of the European Pharmacopoeia (Ph. Eur.) describes a method for visual inspection of parenteral drug units in front of a black and white panel using a white light source. Nevertheless, several Dutch compounding pharmacies rely on an alternative method for visual inspection by means of polarised light. The objective of this study was to compare the performance of both methods.</p><p><strong>Methods: </strong>Trained technicians in three different hospitals inspected a predetermined set of samples using both methods for visual inspection of parenteral drugs.</p><p><strong>Results: </strong>The results of this study show that the alternative method for visual inspection yields a higher recovery than the Ph. Eur. method, while no significant difference in false positive results was found.</p><p><strong>Conclusions: </strong>Based on these findings, it can be concluded that the alternative method for visual inspection by means of polarised light can very well replace the Ph. Eur. method in pharmacy practice, provided that local validation of the alternative method is performed.</p>","PeriodicalId":12050,"journal":{"name":"European journal of hospital pharmacy : science and practice","volume":" ","pages":"447-449"},"PeriodicalIF":1.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9082922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stability of intravenous medicines - evidence of maximum temperature reached in both summer and winter within soft shell elastomeric pumps.","authors":"Susanna Maria van der Merwe, Nicholas Boyd, Simba Mavhunga","doi":"10.1136/ejhpharm-2024-004276","DOIUrl":"https://doi.org/10.1136/ejhpharm-2024-004276","url":null,"abstract":"<p><strong>Objective: </strong>Elastomeric devices or pumps are a valuable tool to deliver outpatient parenteral therapy and have been used for administration of chemotherapy, antibiotics and pain medication. A key determinant of effective treatment is to consider the stability of medicines within these devices. It is widely known that an increase in temperature positively correlates to an increase in drug degradation. The objective of our work was to measure the temperature within soft shell elastomeric devices, under simulated outpatient treatment conditions in summer and winter months, and to determine the maximum temperature reached within these periods of use.</p><p><strong>Methods: </strong>Thermocouples were inserted within soft shell Easypump II (B Braun Medical, Sheffield, UK) elastomeric pumps and the temperature was monitored under simulated outpatient conditions during cold and warm weather with different fill volumes. Temperature monitoring was also conducted with varying levels of insulation around the devices.</p><p><strong>Results: </strong>Our results show that internal temperatures remained below 32°C±1°C in winter and summer months, including during times defined as a heatwave. Fill volume and ambient temperature were shown to be significant factors affecting the internal temperatures reached.</p><p><strong>Conclusion: </strong>A soft shell Easypump II elastomeric pump, if used within its carry pouch, will maintain the internal solution below a temperature of 32°C±1°C if patients correctly adhere to handling guidance. Our results show that further improvements to the insulation material used in carry pouches can significantly restrict the rate of temperature rise within the pumps and will give more assurance in relation to preventing degradation especially considering the increases in extreme weather conditions observed in recent years due to global warming.</p>","PeriodicalId":12050,"journal":{"name":"European journal of hospital pharmacy : science and practice","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analytical and clinical validation of an LC-MS/MS method for carbamazepine, lamotrigine and levetiracetam in dried blood spots.","authors":"Daphne den Besten-Bertholee, Ilse Wegner, Daan J Touw, Peter G J Ter Horst","doi":"10.1136/ejhpharm-2022-003589","DOIUrl":"10.1136/ejhpharm-2022-003589","url":null,"abstract":"<p><strong>Objectives: </strong>Therapeutic drug monitoring is performed routinely in patients on anti-epileptic drugs (AEDs) for optimisation and individualisation of therapy. The dried blood spot (DBS) sampling technique is a suitable, more patient-friendly alternative for conventional venous sampling methods. However, before DBS can be used in routine care, data are needed to establish the correlation between standard plasma concentrations obtained from venous puncture and concentrations measured through DBS obtained by finger prick. This study aims to investigate the correlation between carbamazepine, lamotrigine and levetiracetam drug concentrations in venous blood and DBS samples in the same patients at the same time.</p><p><strong>Methods: </strong>Clinical validation was conducted by direct comparison of paired DBS and venous plasma samples. Method agreement was evaluated using Passing-Bablok regression analysis and Bland-Altman plots to provide insight into the relationship between the two analytically validated methods. For Bland-Altman analysis the acceptance limit required by both FDA and EMA guidelines is at least two-thirds (67%) of the paired samples within 80-120% of the mean of both methods.</p><p><strong>Results: </strong>Paired samples from 79 patients were studied. For all three AEDs, plasma and DBS concentrations correlated highly (r=0.90 for carbamazepine, r=0.93 for lamotrigine and r=0.93 for levetiracetam), indicating a linear relationship. For carbamazepine and lamotrigine, no proportional or constant bias was revealed. For levetiracetam, concentrations were higher in plasma samples than in DBS (slope 1.21), implying a conversion factor is needed. The acceptance limit was met for carbamazepine and levetiracetam with a value of 72% and 81%, respectively. For lamotrigine, this acceptance limit was not met with a value of 60%.</p><p><strong>Conclusions: </strong>The method was successfully validated and will be used for therapeutic drug monitoring in patients using carbamazepine, lamotrigine and/or levetiracetam.</p>","PeriodicalId":12050,"journal":{"name":"European journal of hospital pharmacy : science and practice","volume":" ","pages":"450-454"},"PeriodicalIF":1.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9082921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacokinetic/pharmacodynamic analysis of vancomycin in patients with <i>Enterococcus faecium</i> bacteraemia: a retrospective cohort study.","authors":"Naohiro Tochikura, Chiaki Matsumoto, So Iwabuchi, Hiroya Aso, Sakae Fukushima, Susumu Ootsuka, Nobuhiro Ooba, Masaki Ishihara, Hideto Nakajima, Hiroshi Umemura, Tomohiro Nakayama","doi":"10.1136/ejhpharm-2022-003672","DOIUrl":"10.1136/ejhpharm-2022-003672","url":null,"abstract":"<p><strong>Objectives: </strong>The trough concentration of vancomycin and the area under the concentration-time curve (AUC)/minimum inhibitory concentration (MIC) ratio are crucial in determining vancomycin efficacy against methicillin-resistant <i>Staphylococcus aureus</i>. However, the use of similar pharmacokinetic principles in determining antibiotic efficacy against other gram-positive cocci is lacking. We performed a pharmacokinetic/pharmacodynamic analysis (association of target trough concentration values and AUC/MIC with therapeutic outcome) of vancomycin in patients with <i>Enterococcus faecium</i> bacteraemia.</p><p><strong>Methods: </strong>Between January 2014 and December 2021 we performed a retrospective cohort study of patients with <i>E. faecium</i> bacteraemia treated with vancomycin. Patients who received renal replacement therapy or had chronic kidney disease were excluded. Clinical failure, the primary outcome, was defined as a composite of 30-day all-cause mortality, vancomycin-susceptible infection requiring change of treatment, and/or recurrence. AUC₂₄ was estimated using a Bayesian estimation approach based on an individual vancomycin trough concentration. The MIC for vancomycin was determined using a standardised agar dilution method. Additionally, classification was used to identify the vancomycin AUC₂₄/MIC ratio associated with clinical failure.</p><p><strong>Results: </strong>Of the 151 patients identified, 69 were enrolled. All MICs of vancomycin for <i>E. faecium</i> were ≤1.0 µg/mL. The AUC₂₄ and AUC₂₄/MIC ratio were not significantly different between the clinical failure group and the clinical success group (432±123 µg/mL/hour vs 488±92 µg/mL/hour; p=0.075). However, 7 of 12 patients (58.3%) in the clinical failure group and 49 of 57 patients (86.0%) in the clinical success group had a vancomycin AUC₂₄/MIC ratio ≥389 (p=0.041). No significant association between trough concentration or AUC₂₄ ≥600 µg/mL×hour and acute kidney injury was observed (p=0.365 and p=0.487, respectively).</p><p><strong>Conclusion: </strong>The AUC₂₄/MIC ratio is associated with the clinical outcome of vancomycin administration in <i>E. faecium</i> bacteraemia. In Japan, where vancomycin-resistant enterococcal infection is rare, empirical therapy with a target AUC₂₄ ≥389 should be recommended.</p>","PeriodicalId":12050,"journal":{"name":"European journal of hospital pharmacy : science and practice","volume":" ","pages":"440-446"},"PeriodicalIF":1.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10824400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the use of a drug-drug interaction checker on pharmacist interventions involving well-known strong interactors.","authors":"Fanny Moreau, Bertrand Décaudin, Michel Tod, Pascal Odou, Nicolas Simon","doi":"10.1136/ejhpharm-2023-004052","DOIUrl":"https://doi.org/10.1136/ejhpharm-2023-004052","url":null,"abstract":"<p><strong>Objectives: </strong>Several drug-drug interaction (DDI) checkers such as DDI-Predictor have been developed to detect and grade DDIs. DDI-Predictor gives an estimate of the magnitude of an interaction based on the ratio of areas under the curve. The objective of the present study was to analyse the frequencies of DDIs involving well-known strong interactors such as rifampicin and selective serotonin reuptake inhibitors (SSRIs), as reported by a clinical pharmacy team using DDI-Predictor, and the pharmacist intervention acceptance rate.</p><p><strong>Methods: </strong>The pharmacist intervention rate and the physician acceptance rate were calculated for DDIs involving rifampicin or the SSRIs fluoxetine, paroxetine, duloxetine and sertraline. The rates were compared with a bilateral χ² test or Fisher's exact test.</p><p><strong>Results: </strong>Of the 284 DDIs recorded, 38 (13.4%) involved rifampicin and 78 (27.5%) involved SSRIs. The pharmacist intervention rate differed significantly (68.4% for rifampicin vs 48.8% for SSRIs; p=0.045) but the physician acceptance rate did not (84.6% for rifampicin vs 81.6% for SSRIs; p=1). Pharmaceutical interventions for SSRIs were more frequent when the ratio of the area under the drug concentration versus time curve in DDI-Predictor was >2. Pharmacists were more likely to issue a pharmacist intervention for DDIs involving rifampicin because of a high perceived risk of treatment failure and were less likely to issue a pharmacist intervention for DDIs involving an SSRI, except when the suspected interaction was strong.</p><p><strong>Conclusions: </strong>DDI checkers can help pharmacists to manage DDIs involving strong interactors. DDIs involving strong inhibitors versus a strong inducer differ with regard to their intervention and acceptance rates, notably due to the estimation of the magnitude of the DDI.</p>","PeriodicalId":12050,"journal":{"name":"European journal of hospital pharmacy : science and practice","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmaceutical care in the screening process of phase I oncohaematological clinical trials.","authors":"Rosa Rodríguez-Mauriz, Monica González-Laguna, Maria Perayre-Badia, Toni Lozano-Andreu, Maria Emilia Miquel-Zurita, Salomé Cañizares-Paz, Lorena Santulario-Verdú, Marina Millan-Coll, Sandra Fontanals, Ana Clopés-Estela","doi":"10.1136/ejhpharm-2024-004168","DOIUrl":"https://doi.org/10.1136/ejhpharm-2024-004168","url":null,"abstract":"<p><strong>Objective: </strong>To determine the pharmaceutical interventions in patients eligible for phase I cancer clinical trials, focusing specifically on exclusion criteria related to medication or relevant interactions.</p><p><strong>Method: </strong>Descriptive, observational study conducted at a comprehensive cancer centre. Patients undergoing screening for phase I clinical trials (March 2019-December 2022) were included. The pharmacist reviewed concomitant medication and provided a recommendation.</p><p><strong>Results: </strong>The concomitant medication of 512 patients eligible to participate in 84 phase I clinical trials was analysed. In 230 (44.9%) patients, the clinical trial treatment included oral medication. The median number of concomitant medications was 5 (IQR 3-8) per patient.A total of 280 pharmaceutical interventions were performed in 140 (27.3%) patients: 240 (85.7%) were due to interactions in 124 (24.2%) patients, and 40 (14.3%) were due to exclusion criteria in 34 (6.6%) patients. Interactions and exclusion criteria were detected in 18 (3.5%) patients. The main groups of drugs involved were 68 (24.3%) antacids and antiulcer drugs, 28 (10.0%) antidepressants and 26 (9.3%) opioids. Acceptance analysis of the recommendation was applicable in 215 cases; in 208 (96.7%), the pharmaceutical intervention was accepted.Differences were identified for exclusion criteria (7 vs 27) and interactions (37 vs 87) between parenteral and oral clinical trial medication (p<0.001).</p><p><strong>Conclusion: </strong>The pharmacist's review of concomitant medication during the screening period in phase I clinical trials enables the detection of prohibited medication or relevant interactions, potentially avoiding screening failures and increasing the efficacy and safety of treatments.</p>","PeriodicalId":12050,"journal":{"name":"European journal of hospital pharmacy : science and practice","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep learning classification of drug-related problems from pharmaceutical interventions issued by hospital clinical pharmacists during medication prescription review: a large-scale descriptive retrospective study in a French university hospital.","authors":"Ahmad Alkanj, Julien Godet, Erin Johns, Benedicte Gourieux, Bruno Michel","doi":"10.1136/ejhpharm-2024-004139","DOIUrl":"https://doi.org/10.1136/ejhpharm-2024-004139","url":null,"abstract":"<p><strong>Objectives: </strong>Pharmaceutical interventions are proposals made by hospital clinical pharmacists to address sub-optimal uses of medications during prescription review. Pharmaceutical interventions include the identification of drug-related problems, their prevention and resolution. The objective of this study was to exploit a newly developed deep neural network classifier to identify drug-related problems from pharmaceutical interventions and perform a large retrospective descriptive analysis of them in a French university hospital over a 3-year period.</p><p><strong>Methods: </strong>Data were collected from prescription support software from 2018 to 2020. A classifier running in Python 3.8 and using Keras library was then used to automatically categorise drug-related problems from pharmaceutical interventions according to the coding of the French Society of Clinical Pharmacy.</p><p><strong>Results: </strong>2 930 656 prescription lines were analysed for a total of 119 689 patients. Among these prescription lines, 153 335 (5.2%) resulted in pharmaceutical interventions (n=48 202 patients; 40.2%). Pharmaceutical interventions were predominantly observed in patients aged 65 years or older (n=26 141 patients out of 53 186; 49.1%) and in patients taking five or more medications (44 702 patients out of 93 419; 47.8%). The most frequently identified types of drug-related problems associated with pharmaceutical interventions were 'Non-conformity to guidelines or contra-indication' (n=88 523; 57.7%), 'Overdosage' (16 975; 11.1%) and 'Improper administration' (13 898; 9.1%). The most frequently encountered drugs were: paracetamol (n=10 585; 6.9%), esomeprazole (6031; 3.9%), hydrochlorothiazide (2951; 1.9%), enoxaparin (2191; 1.4%), tramadol (1879; 1.2%), calcium (2073; 1.3%), perindopril (1950; 1.2%), amlodipine (1716; 1.1%), simvastatin (1560; 1.0%) and insulin (1019; 0.7%).</p><p><strong>Conclusions: </strong>The deep neural network classifier used met the challenge of automatically classifying drug-related problems from pharmaceutical interventions from a large database without mobilising significant human resources. The use of such a classifier can lead to alerting caregivers about certain risky practices in prescription and administration, and triggering actions to improve patients' therapeutic outcomes.</p>","PeriodicalId":12050,"journal":{"name":"European journal of hospital pharmacy : science and practice","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term stability of esketamine in polypropylene syringes at 5 ± 3°C.","authors":"Amélie Kinet-Poleur, Marie-Lise Colsoul, Emilie Catry, Benoît P Bihin, Barbara E Sneyers, Justine Hubert, Jacques Jamart, Laura Soumoy, Laurence M Galanti, Jean-Daniel Hecq, Mélanie Closset","doi":"10.1136/ejhpharm-2024-004227","DOIUrl":"https://doi.org/10.1136/ejhpharm-2024-004227","url":null,"abstract":"<p><strong>Objective: </strong>Esketamine (Vesierra) is a molecule, used alone or in combination, to induce and maintain general anaesthesia and to relieve pain in emergency medicine. The aim of this study is to evaluate the long-term physicochemical stability of a 1 mg/mL solution of esketamine diluted in 0.9% sodium chloride (NaCl) and stored in polypropylene syringes at 5±3°C during 65 days (64+1 day at 22±3°C) and 72 hours at 22±3°C (room temperature), in order to centralise preparation under aseptic conditions in hospital pharmacy.</p><p><strong>Methods: </strong>Ten syringes were prepared under aseptic conditions. Five syringes were stored at 22±3°C for 3 days, and the five others were stored at 5±3°C for 64 days (+ 1 day at room temperature). The stability was periodically investigated. Particle appearance or colour changes were checked by visual inspection. A research of crystals was performed under the microscope. pH was followed to assess its stability. The turbidity of the solutions was estimated by a measure of optical densities at 350, 410 and 550 nm. The molecule concentrations were measured by ultra-high performance liquid chromatography (UHPLC) coupled with a photodiode array detection (PDA), using a newly developed method.</p><p><strong>Results: </strong>Based on microscopic examination, no crystals were observed, during the observation period. pH and absorbances at 350, 410 and 550 nm were also stable. Macroscopically, there was no change in colour and appearance of opacity, turbidity or precipitation. Statistical analysis indicates that 1 mg/mL esketamine solutions were chemically stable under these conditions, given that less than 5% of the solutions have lost more than 10% of their initial content during the study based on the prediction interval.</p><p><strong>Conclusions: </strong>One mg/mL solutions of esketamine hydrochloride are physically and chemically stable after production, for at least 72 hours at 22±3°C and 64 days at 5±3°C (+ 1 day at room temperature).</p>","PeriodicalId":12050,"journal":{"name":"European journal of hospital pharmacy : science and practice","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Appropriate therapeutic drug monitoring of vancomycin improves outcomes of patients with bacterial infection in ICU.","authors":"Xiaohua Zhou, Hongjian Ji","doi":"10.1136/ejhpharm-2024-004299","DOIUrl":"https://doi.org/10.1136/ejhpharm-2024-004299","url":null,"abstract":"","PeriodicalId":12050,"journal":{"name":"European journal of hospital pharmacy : science and practice","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond conventional dosing: tailoring antimicrobial regimens for cachexia.","authors":"Emine Ecem Kilinc, Izgi Bayraktar, Emre Kara, Kutay Demirkan, Murat Akova","doi":"10.1136/ejhpharm-2024-004250","DOIUrl":"https://doi.org/10.1136/ejhpharm-2024-004250","url":null,"abstract":"","PeriodicalId":12050,"journal":{"name":"European journal of hospital pharmacy : science and practice","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}