Infection Control and Hospital Epidemiology最新文献

{"title":"Risk factors for catheter-related bloodstream infections in a high-risk cancer patient population.","authors":"Andrea Haddad, Rita Wilson Dib, Anne-Marie Chaftari, Ying Jiang, Mohamed Moussa, Hiba Dagher, Ann Philip, Ray Hachem, Issam Raad","doi":"10.1017/ice.2025.45","DOIUrl":"https://doi.org/10.1017/ice.2025.45","url":null,"abstract":"<p><p>To identify risk factors for catheter-related bloodstream infections (CRBSI) in cancer patients, we compared 200 CRBSI cases to 400 controls. Neutropenia, transplants, multiple catheters, blood products, and basilic/cephalic PICCs increased CRBSI risk, while jugular insertion was protective. Catheter site selection can reduce risk. Other targeted strategies are warranted.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-4"},"PeriodicalIF":3.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142468","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":"The association between the practice of oral care and the incidence of hospital-acquired pneumonia in intensive care medicine.","authors":"Xiaoqiang Lv, Jun Yang, Li Wang, Li Tong, Fu Ding","doi":"10.1017/ice.2025.91","DOIUrl":"https://doi.org/10.1017/ice.2025.91","url":null,"abstract":"<p><strong>Background: </strong>Hospital-acquired pneumonia (HAP) represents one of the most common nosocomial infections in intensive care units (ICUs), accounting for 25% of all hospital-acquired infections. While oral care is recommended as a preventive measure, the relationship between standardized oral care practices and HAP incidence remains incompletely characterized.</p><p><strong>Objective: </strong>To evaluate the association between oral care practice compliance and HAP incidence in ICU patients, and to identify specific aspects of oral care delivery that influence outcomes.</p><p><strong>Methods: </strong>We conducted a prospective mixed-methods observational cohort study from May 2021 across seven ICUs in a tertiary hospital in China. The study utilized a two-phase approach: (1) systematic assessment of oral care implementation through structured observation of nursing staff (n = 58), and (2) prospective evaluation of HAP outcomes in patients (n = 142). Primary outcomes included oral care compliance metrics and HAP incidence. HAP was defined according to standardized clinical criteria and confirmed by two independent physicians.</p><p><strong>Results: </strong>Among 142 unique patients, 63 (44.37%) received oral care orders. The oral care completion rate was 61.93%, and the qualification rate was 54.13%. In our analysis, HAP (including both ventilator-associated pneumonia [VAP] and non-ventilator hospital-acquired pneumonia [NVHAP]) occurred in 15/63 (23.81%) patients receiving oral care and 22/79 (27.85%) patients without oral care. Multivariate analysis revealed that incomplete oral care (adjusted OR 2.47, [95% CI, 1.15-4.45], <i>P</i> = 0.009), non-qualified care techniques (adjusted OR 3.17, [95% CI, 1.45-6.35], <i>P</i> = 0.002), and inadequate item qualification (adjusted OR 3.33, [95% CI, 1.47-6.55], <i>P</i> = 0.001) were independently associated with increased HAP risk, after adjusting for confounders. Stratified analysis showed similar associations in both VAP and NVHAP subgroups.</p><p><strong>Conclusion: </strong>Our investigation demonstrated that suboptimal oral care practices were associated with increased HAP risk in ICU patients. Implementation of evidence-based standardized protocols and improved adherence strategies may help reduce HAP incidence.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-6"},"PeriodicalIF":3.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109790","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":"Usage of oral vancomycin for acute <i>Clostridioides difficile</i> infection (CDI) resulting in later acquisitions of vancomycin-resistant enterococci (VRE).","authors":"Evgeny Rogozin, Husam Maree, Majdi Masarwi, Rozan Hasona, Herschel T Horowitz, Ruth Bouganim, Dror Marchaim","doi":"10.1017/ice.2025.81","DOIUrl":"https://doi.org/10.1017/ice.2025.81","url":null,"abstract":"<p><strong>Objective: </strong>Therapeutic guidelines for <i>Clostridioides difficile</i> infections (CDI) were revised a few years ago, promoting the usage of oral vancomycin even for primary mild infections. Vancomycin-resistant enterococci (VRE) is one of the worldwide most significant pathogens. Our study aim was to explore the independent association between oral vancomycin treatment for CDI, and subsequent VRE acquisitions.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Academic 904-bed general hospital (Shamir Medical Center, Israel).</p><p><strong>Patients: </strong>Adult (>18 yr) inpatients with primary CDI and no prior VRE.</p><p><strong>Methods: </strong>Study was conducted for calendar years 2016-2020. Logistic regression was used to model-independent predictors for VRE acquisitions. A propensity score (PS)-matched analysis (logistic regression) of the risk of receiving oral vancomycin was conducted to further eliminate potential confounders.</p><p><strong>Results: </strong>Overall, 606 patients were included (54% females), with a median age of 75 (IQR = 65-85) years. Independent predictors for VRE acquisition were oral vancomycin as a main therapy (aOR = 4.3, <i>P</i> < 0.001), exposure to systemic vancomycin in the previous 3 months (aOR = 3.2, <i>P</i> < 0.001), dependent functional status (aOR = 2.3, <i>P</i> = 0.006), and diabetes (aOR = 1.8, <i>P</i> = 0.04). After controlling for the PS, the independent association between oral vancomycin and later VRE acquisition remained significant in the regression model (aOR = 3.6, <i>P</i> < 0.01) and per PS matched-pairs analysis (aOR = 4.4, <i>P</i> < 0.01).</p><p><strong>Conclusion: </strong>Oral vancomycin administered for CDI had a strong independent association with later VRE acquisitions. This finding could promote stewardship interventions in an effort to reduce the usage of oral vancomycin for certain CDI indications, leading to improved CDI management, while curbing the continued emergence of VRE at hospitals.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-7"},"PeriodicalIF":3.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077733","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":"Reducing inappropriate antibiotic use in febrile neutropenia in hematology patients through the implementation of an antibiotic de-escalation protocol.","authors":"Jinghao Nicholas Ngiam, Victor Ling, Matthew Chung Yi Koh, Mohamed Nasar Fathima Rofina Farveen, Shi Hui Clarice Choong, Li Mei Michelle Poon, Liang Piu Koh, Nares Smitasin, Lionel Hon-Wai Lum","doi":"10.1017/ice.2025.90","DOIUrl":"https://doi.org/10.1017/ice.2025.90","url":null,"abstract":"<p><strong>Background: </strong>Broad-spectrum antibiotic use in febrile neutropenia is often driven by concerns for severe and drug-resistant infections. In select patients who do not have an active infection and improve, their prolonged and unnecessary use contributes to antimicrobial resistance, drug toxicity, and increased healthcare costs. We describe the implementation of an antibiotic de-escalation protocol to reduce inappropriate antibiotic use in febrile neutropenia among hematology patients.</p><p><strong>Methods: </strong>We conducted baseline analysis (January-June 2024) of antibiotic use in febrile neutropenia cases admitted under hematology. Interventions included the (i) development of an antibiotic de-escalation protocol to guide clinical management, (ii) a roadshow to educate and improve uptake of this protocol, and (iii) regular feedback via \"report cards\" for hematology teams. The primary outcome was the proportion of febrile neutropenia cases with inappropriate antibiotic use, with secondary measures including adverse outcomes (in-hospital mortality, <i>Clostridioides difficile</i> infection, need for intensive care).</p><p><strong>Results: </strong>Baseline data indicated inappropriate antibiotic use rates of 45.5-66.7% per month from January to June 2024, with 13-28 days of inappropriate therapy. The protocol was developed in July 2024, with a subsequent roadshow to promote its uptake. Regular feedback was provided in the form of \"report cards\" every 2-monthly thereafter. Post-intervention, inappropriate antibiotic use decreased to a median of 23.35% from July to December 2024, with no observed increase in adverse outcomes.</p><p><strong>Conclusions: </strong>The implementation of a structured de-escalation protocol, combined with frequent education and feedback, effectively reduced inappropriate antibiotic use in febrile neutropenia without compromising patient safety.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-6"},"PeriodicalIF":3.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077662","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":"Electronic clinical decision support system guided blood culture stewardship in emergency departments: response to the national blood culture media shortage.","authors":"Kullaya Takkavatakarn, Gopi Patel, Wonsuk Oh, Melissa Gitman, Michael Nowak, Brendan Connell, Jonathan Nover, Lili Chan, Girish Nadkarni, Roopa Kohli-Seth, Nicholas Gavin, Bernard Camins, Ankit Sakhuja","doi":"10.1017/ice.2025.83","DOIUrl":"https://doi.org/10.1017/ice.2025.83","url":null,"abstract":"<p><p>CDSS-guided stewardship in six EDs during national culture bottles shortage was associated with significant reduction in median daily blood culture utilization per 1,000 ED visits from 141.5 (IQR:127.6-155.3) to 77.9 (IQR:68.3-86.3) and increased diagnostic yield from 6.2%(IQR:4.7%-7.6%) to 8.8%(IQR:6.1%-11.5%), without impacting length of stay or mortality.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-4"},"PeriodicalIF":3.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077724","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":"Isolating the burden of transmission-based precautions for COVID-19: walk-in clinic-based healthcare personnel perspectives.","authors":"Rebecca A Stern, Katherine Bashaw, Thomas R Talbot","doi":"10.1017/ice.2025.84","DOIUrl":"https://doi.org/10.1017/ice.2025.84","url":null,"abstract":"","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-2"},"PeriodicalIF":3.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077652","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":"Understanding hand hygiene adherence in neonatology: a qualitative study of behavioral determinants.","authors":"Tamara C Bopp, Yvonne Strässle, Colette Wyler, Marie-Theres Meier, Lauren Clack, Walter Zingg, Jehudith R Fontijn, Aline Wolfensberger","doi":"10.1017/ice.2025.82","DOIUrl":"https://doi.org/10.1017/ice.2025.82","url":null,"abstract":"<p><strong>Background: </strong>Hand hygiene is effective to prevent transmission of pathogens and healthcare-associated infections. Despite efforts by hospitals to improve hand hygiene adherence among healthcare practitioners (HCP), adherence in neonatology wards is often limited.</p><p><strong>Objective: </strong>Identifying determinants, i.e., facilitators and barriers, to hand hygiene adherence among frontline HCP in neonatology.</p><p><strong>Design: </strong>Qualitative implementation research study.</p><p><strong>Setting: </strong>Department of Neonatology of the University Hospital Zurich, Switzerland.</p><p><strong>Methods: </strong>Semi-structured interviews with frontline HCP and Infection Prevention and Control (IPC) experts were conducted in November 2022. Interviews were coded deductively according to the Theoretical Domains Framework (TDF) and the Capability, Opportunity, Motivation and Behavior model (COM-B), and inductively to capture nuances in the data. Determinants whose addressing was perceived to likely improve hand hygiene adherence in the current setting were rated as \"high priority\".</p><p><strong>Results: </strong>A total of 42 interviews were conducted, 27 (64%) with nurses, six (14%) with physicians, four (10%) with other professions, and five (12%) with IPC experts. Sixteen determinants were identified, twelve of which were high-priority, four in each COM-B domain. Knowledge, attention control, planning workflows, and habits & automatisms were found in \"Capability,\" workload & emergencies, invisibility of germs, role models, and being observed in \"Opportunity,\" and bad conscience, experience consequences of (non-) adherence, self-reflection, and intention to adhere to hand hygiene in \"Motivation.\"</p><p><strong>Discussion/conclusion: </strong>Facilitators from all COM-B domains and barriers from \"Capability\" and \"Opportunity\" influence hand hygiene behavior in neonatology settings. Our findings can now inform interventions to improving hand hygiene adherence in neonatal settings.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-9"},"PeriodicalIF":3.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077732","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":"Respiratory syncytial virus: an under-recognized healthcare-associated infection.","authors":"Erin B Gettler, H Keipp Talbot, Yuwei Zhu, Danielle Ndi, Edward Mitchel, Tiffanie M Markus, William Schaffner, Bryan Harris, Thomas R Talbot","doi":"10.1017/ice.2025.88","DOIUrl":"10.1017/ice.2025.88","url":null,"abstract":"<p><strong>Objective: </strong>Prior reports of healthcare-associated respiratory syncytial virus (RSV) have been limited to cases diagnosed after the third day of hospitalization. The omission of other healthcare settings where RSV transmission may occur underestimates the true incidence of healthcare-associated RSV.</p><p><strong>Design: </strong>Retrospective cross-sectional study.</p><p><strong>Setting: </strong>United States RSV Hospitalization Surveillance Network (RSV-NET) during 2016-2017 through 2018-2019 seasons.</p><p><strong>Patients: </strong>Laboratory-confirmed RSV-related hospitalizations in an eight-county catchment area in Tennessee.</p><p><strong>Methods: </strong>Surveillance data from RSV-NET were used to evaluate the population-level burden of healthcare-associated RSV. The incidence of healthcare-associated RSV was determined using the traditional definition (i.e., positive RSV test after hospital day 3) in addition to often under-recognized cases associated with recent post-acute care facility admission or a recent acute care hospitalization for a non-RSV illness in the preceding 7 days.</p><p><strong>Results: </strong>Among the 900 laboratory-confirmed RSV-related hospitalizations, 41 (4.6%) had traditionally defined healthcare-associated RSV. Including patients with a positive RSV test obtained in the first 3 days of hospitalization and who were either transferred to the hospital directly from a post-acute care facility or who were recently discharged from an acute care facility for a non-RSV illness in the preceding 7 days identified an additional 95 cases (10.6% of all RSV-related hospitalizations).</p><p><strong>Conclusions: </strong>RSV is an often under-recognized healthcare-associated infection. Capturing other healthcare exposures that may serve as the initial site of viral transmission may provide more comprehensive estimates of the burden of healthcare-associated RSV and inform improved infection prevention strategies and vaccination efforts.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-5"},"PeriodicalIF":3.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12169951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustainability and spread of best practices for peri-operative antimicrobial stewardship following discontinuation of mandatory public reporting: perceptions from the Society for Healthcare Epidemiology in America research network.","authors":"Jacquelyn Pendergast, Hillary Mull, Marlena Shin, Ryann Engle, A Rani Elwy, Judith Strymish, Samuel Golenbock, Kierstin Hederstedt, Rory Ostrow, Matthew Bidwell Goetz, Mary Hawn, Westyn Branch-Elliman","doi":"10.1017/ice.2025.61","DOIUrl":"https://doi.org/10.1017/ice.2025.61","url":null,"abstract":"<p><strong>Background: </strong>A Joint Commission national program, the surgical care improvement project (SCIP), supported the adoption of evidence-based peri-operative antimicrobial use practices, including administration of antimicrobials prior to incision and early discontinuation after skin closure. With high compliance, in 2015, the public reporting requirement that provided external pressure to support practice improvements was discontinued. Since discontinuation, few studies have assessed the sustainment of best antimicrobial use practices and what procedures were developed to maintain improvements within facilities.</p><p><strong>Objective: </strong>The aim of this study was to measure perceptions among antimicrobial stewardship experts about which policies and practices have been important and effective for sustainment.</p><p><strong>Design: </strong>A 15-min survey was administered to the Society for Hhealthcare Epidemiology in America (SHEA) research network over the summer of 2023. The survey included questions about different SCIP measures such as prophylactic antibiotic use pre and post-surgery and about local policies and procedures that were implemented to support best practices. Simple descriptive statistics were utilized to analyze results.</p><p><strong>Results: </strong>The survey was distributed to 112 members of the SHEA research network, with a 41% response rate. Most respondents perceived high rates of ongoing compliance with both pre- and post-operative prophylaxis guidelines, although ongoing surveillance and measurement is limited. Respondents perceived that the most important internal factors associated with ongoing compliance were electronic order sets, facility policies, time outs, and automatic stop orders. Substantial spread of best practices (eg, to surgical procedures and specialties not covered until the SCIP program) was reported.</p><p><strong>Conclusions: </strong>Despite discontinuation of mandated reporting, antimicrobial stewards perceived ongoing compliance with SCIP measures. Local policies and procedures implemented to support initial uptake of best practices have supported ongoing sustainment of practice improvements.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-6"},"PeriodicalIF":3.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077684","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":"Characterizing presenteeism among healthcare personnel at an academic medical center across eras of the COVID-19 pandemic.","authors":"Amanda Brown Marusiak, Emily Sickbert-Bennett, Hilary Babcock, Daniel Westreich, Justin Lessler, David Weber","doi":"10.1017/ice.2025.69","DOIUrl":"https://doi.org/10.1017/ice.2025.69","url":null,"abstract":"<p><strong>Objective: </strong>To assess the frequency of and motivations for acute respiratory illness (ARI) presenteeism in healthcare personnel (HCP) during two waves of COVID-19.</p><p><strong>Design: </strong>Survey.</p><p><strong>Setting: </strong>Large academic medical center, both ambulatory and acute care settings.</p><p><strong>Participants: </strong>All HCPs (n = 11,429) at the University of North Carolina Medical Center were eligible for two voluntary, electronic surveys: pre-Omicron (n = 591, recall period March 2020 - December 2021) and Omicron BA.1 (n = 385, recall period January - April 2022).</p><p><strong>Methods: </strong>We compared self-reported ARI presenteeism (working despite feeling feverish plus cough and/or sore throat) and motivators across time and demographics. We also estimated effects of workplace perceptions and culture on ARI presenteeism with log-binomial regression, adjusting for age, gender, HCP role, and patient interaction.</p><p><strong>Results: </strong>In the pre-Omicron and Omicron BA.1 eras, 24% and 34% of respondents respectively reported at least one instance of ARI presenteeism. In both eras, clinical frontline HCP were more likely to report ARI presenteeism than other roles, as were HCP primarily providing direct patient care vs not. Pre-Omicron motivators included disciplinary action and sick leave concerns, whereas workplace culture predominated during Omicron. Feeling professional obligation to attend work and observing colleague presenteeism increased ARI presenteeism in both eras. During Omicron, COVID-19 burnout, fatigue, and unclear call-out procedures increased ARI presenteeism.</p><p><strong>Conclusions: </strong>ARI presenteeism was common and had diverse motivations, including workplace culture, disciplinary action, and sick leave. Efforts to reduce presenteeism should address these factors and prioritize frontline clinical personnel with direct patient interaction.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-9"},"PeriodicalIF":3.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077710","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}