Infection Control and Hospital Epidemiology最新文献

{"title":"Evaluating an urgent care antibiotic stewardship intervention: a multi-network collaborative effort.","authors":"Daniel E Park, Annie L S Roberts, Rana F Hamdy, Sabrina Balthrop, Patrick Dolan, Cindy M Liu","doi":"10.1017/ice.2024.213","DOIUrl":"10.1017/ice.2024.213","url":null,"abstract":"<p><strong>Objective: </strong>Urgent care centers (UCCs) have reported high rates of antibiotic prescribing for acute respiratory tract infections. Prior UCC studies have generally been limited to single networks. Broadly generalizable stewardship efforts targeting common diagnoses are needed. This study examines the effectiveness of an antibiotic stewardship intervention in reducing inappropriate prescribing for bronchitis and viral upper respiratory tract infections (URTIs) in UCCs.</p><p><strong>Design: </strong>A quality improvement study comparing inappropriate antibiotic prescribing rates in UCCs after the introduction of an antibiotic stewardship intervention.</p><p><strong>Setting: </strong>Forty-nine UCCs in 27 different networks from 18 states, including 1 telemedicine site.</p><p><strong>Participants: </strong>Urgent care clinicians from a national collaborative of UCCs, all members of the Urgent Care Association.</p><p><strong>Methods: </strong>The intervention included signing a commitment statement and selecting from 5 different intervention options during 3 plan-do-study-act cycles. The primary outcome was the percentage of urgent care encounters for viral URTIs or bronchitis with inappropriate prescribing, stratified by clinician engagement and diagnosis. A 3-month baseline and 9-month intervention period were compared using a regression model using a generalized estimating equation.</p><p><strong>Results: </strong>Among 15,385 encounters, the intervention was associated with decreases in inappropriate antibiotic prescribing for bronchitis (48% relative decrease, aOR = 0.52; 95% CI, 0.33-0.83) and viral URTIs (33%, aOR = 0.67; 95% CI, 0.55-0.82) among actively engaged clinicians compared to baseline. The intervention did not result in significant changes for clinicians not actively engaged.</p><p><strong>Conclusions: </strong>This intervention was associated with reductions in inappropriate prescribing among actively engaged clinicians. Implementing stewardship interventions in UCCs may reduce inappropriate antibiotic prescriptions for common diagnoses; however, active clinician engagement may be necessary.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-6"},"PeriodicalIF":3.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142948156","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":"TB or not TB? Development and validation of a clinical decision support system to inform airborne isolation requirements in the evaluation of suspected tuberculosis.","authors":"Caitlin M Dugdale, Kimon C Zachary, Rebecca L Craig, Alexandra Doms, Lindsay Germaine, Chloe V Green, Eren Gulbas, Rocio M Hurtado, Emily P Hyle, Michelle S Jerry, Jacob E Lazarus, Stephen Maxfield, Molly Paras, Katherine Swanson, Erica S Shenoy","doi":"10.1017/ice.2024.214","DOIUrl":"10.1017/ice.2024.214","url":null,"abstract":"<p><strong>Background: </strong>The study objective was to develop and validate a clinical decision support system (CDSS) to guide clinicians through the diagnostic evaluation of hospitalized individuals with suspected pulmonary tuberculosis (TB) in low-prevalence settings.</p><p><strong>Methods: </strong>The \"TBorNotTB\" CDSS was developed using a modified Delphi method. The CDSS assigns points based on epidemiologic risk factors, TB history, symptoms, chest imaging, and sputum/bronchoscopy results. Below a set point threshold, airborne isolation precautions are automatically discontinued; otherwise, additional evaluation, including infection control review, is recommended. The model was validated through retrospective application of the CDSS to all individuals hospitalized in the Mass General Brigham system from July 2016 to December 2022 with culture-confirmed pulmonary TB (cases) and equal numbers of age and date of testing-matched controls with three negative respiratory mycobacterial cultures.</p><p><strong>Results: </strong>104 individuals with TB (cases) and 104 controls were identified. Prior residence in a highly endemic country, positive interferon release assay, weight loss, absence of symptom resolution with treatment for alternative diagnoses, and findings concerning for TB on chest imaging were significant predictors of TB (all <i>P</i> < 0.05). CDSS contents and scoring were refined based on the case-control analysis. The final CDSS demonstrated 100% sensitivity and 27% specificity for TB with an AUC of 0.87.</p><p><strong>Conclusions: </strong>The TBorNotTB CDSS demonstrated modest specificity and high sensitivity to detect TB even when AFB smears were negative. This CDSS, embedded into the electronic medical record system, could help reduce risks of nosocomial TB transmission, patient-time in airborne isolation, and person-time spent reviewing individuals with suspected TB.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-9"},"PeriodicalIF":3.0,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11790336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914511","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":"Resilience: the need to address it from frontline, to organizational, and national levels.","authors":"Mohamad G Fakih","doi":"10.1017/ice.2024.225","DOIUrl":"https://doi.org/10.1017/ice.2024.225","url":null,"abstract":"","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-2"},"PeriodicalIF":3.0,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914507","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":"No \"One-Size-Fits All\": chronic \"Carryover\" diagnoses dilute antibiotic prescribing rates for sinusitis among adults in primary and urgent care settings.","authors":"Mary Smith, Marten Hawkins, Chananid Laikijrung, Emily Mui, William Alegria, Thomas Leung, Alex Zimmet, David Ha, Marisa Holubar","doi":"10.1017/ice.2024.200","DOIUrl":"10.1017/ice.2024.200","url":null,"abstract":"<p><p>International Classification of Diseases, Tenth Revision (ICD-10) billing data used in outpatient stewardship metrics is under-described for acute and chronic sinusitis. We found that different sinusitis ICD-10 definitions impacted antibiotic prescribing rates (APRs). Chronic sinusitis ICD-10s dilute overall sinusitis APR, particularly in primary care settings and should be examined separately.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-3"},"PeriodicalIF":3.0,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11790326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894247","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":"Impact of diagnostic stewardship on catheter-associated urinary tract infections and patient outcomes.","authors":"Sarah E Sansom, Audrey Goldstein, Brian D Stein, Michael E Schoeny, Alexandra Seguin, Ruth Kniuksta, Alexander Tomich, Mary K Hayden, Michael Y Lin, John Segreti","doi":"10.1017/ice.2024.209","DOIUrl":"10.1017/ice.2024.209","url":null,"abstract":"<p><strong>Background: </strong>Diagnostic stewardship of urine cultures from patients with indwelling urinary catheters may improve diagnostic specificity and clinical relevance of the test, but risk of patient harm is uncertain.</p><p><strong>Methods: </strong>We retrospectively evaluated the impact of a computerized clinical decision support tool to promote institutional appropriateness criteria (neutropenia, kidney transplant, recent urologic surgery, or radiologic evidence of urinary tract obstruction) for urine cultures from patients with an indwelling urinary catheter. The primary outcome was a change in catheter-associated urinary tract infection (CAUTI) rate from baseline (34 mo) to intervention period (30 mo, including a 2-mo wash-in period). We analyzed patient-level outcomes and adverse events.</p><p><strong>Results: </strong>Adjusted CAUTI rate decreased from 1.203 to 0.75 per 1,000 catheter-days (<i>P</i> = 0.52). Of 598 patients triggering decision support, 284 (47.5%) urine cultures were collected in agreement with institutional criteria and 314 (52.5%) were averted. Of 314 patients whose urine cultures were averted, 2 had a subsequent urine culture within 7 days that resulted in a change in antimicrobial therapy and 2 had diagnosis of bacteremia with suspected urinary source, but there were no delays in effective treatment.</p><p><strong>Conclusion: </strong>A diagnostic stewardship intervention was associated with an approximately 50% decrease in urine culture testing for inpatients with a urinary catheter. However, the overall CAUTI rate did not decrease significantly. Adverse outcomes were rare and minor among patients who had a urine culture averted. Diagnostic stewardship may be safe and effective as part of a multimodal program to reduce unnecessary urine cultures among patients with indwelling urinary catheters.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-6"},"PeriodicalIF":3.0,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894193","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":"Rapid whole genome characterization of antimicrobial-resistant pathogens using long-read sequencing to identify potential healthcare transmission.","authors":"Chin-Ting Wu, William C Shropshire, Micah M Bhatti, Sherry Cantu, Israel K Glover, Selvalakshmi Selvaraj Anand, Xiaojun Liu, Awdhesh Kalia, Todd J Treangen, Roy F Chemaly, Amy Spallone, Samuel Shelburne","doi":"10.1017/ice.2024.202","DOIUrl":"10.1017/ice.2024.202","url":null,"abstract":"<p><strong>Objective: </strong>Whole genome sequencing (WGS) can help identify transmission of pathogens causing healthcare-associated infections (HAIs). However, the current gold standard of short-read, Illumina-based WGS is labor and time intensive. Given recent improvements in long-read Oxford Nanopore Technologies (ONT) sequencing, we sought to establish a low resource approach providing accurate WGS-pathogen comparison within a time frame allowing for infection prevention and control (IPC) interventions.</p><p><strong>Methods: </strong>WGS was prospectively performed on pathogens at increased risk of potential healthcare transmission using the ONT MinION sequencer with R10.4.1 flow cells and Dorado basecaller. Potential transmission was assessed via Ridom SeqSphere+ for core genome multilocus sequence typing and MINTyper for reference-based core genome single nucleotide polymorphisms using previously published cutoff values. The accuracy of our ONT pipeline was determined relative to Illumina.</p><p><strong>Results: </strong>Over a six-month period, 242 bacterial isolates from 216 patients were sequenced by a single operator. Compared to the Illumina gold standard, our ONT pipeline achieved a mean identity score of Q60 for assembled genomes, even with a coverage rate as low as 40×. The mean time from initiating DNA extraction to complete analysis was 2 days (IQR 2-3.25 days). We identified five potential transmission clusters comprising 21 isolates (8.7% of sequenced strains). Integrating ONT with epidemiological data, >70% (15/21) of putative transmission cluster isolates originated from patients with potential healthcare transmission links.</p><p><strong>Conclusions: </strong>Via a stand-alone ONT pipeline, we detected potentially transmitted HAI pathogens rapidly and accurately, aligning closely with epidemiological data. Our low-resource method has the potential to assist in IPC efforts.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-7"},"PeriodicalIF":3.0,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11790330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894248","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":"Assessing and upgrading the cleanliness of the emergency department brief title: upgrading the emergency room's cleanliness.","authors":"Elisheva Levine, Samar Abo-Gush, Bath Sheva Ezagui, Ruth David, Puah Kopuit, Naama Bagrish, Todd Zalut, Marc V Assous, Yossi Freier-Dror, Amos M Yinnon, Shmuel Benenson","doi":"10.1017/ice.2024.177","DOIUrl":"10.1017/ice.2024.177","url":null,"abstract":"<p><strong>Objective: </strong>To upgrade cleaning and disinfection of patient rooms in a crowded emergency department (ED).</p><p><strong>Setting: </strong>Tertiary referral hospital.</p><p><strong>Design: </strong>Prospective, 3-component, before-and-after intervention study.</p><p><strong>Methods: </strong>Phase 1 consisted of a 4-week baseline determination of ED patient-room cleanliness, using two means: (1) the fluorescence spray, applied before cleaning and assessed subsequently with an ultraviolet lamp. Results are expressed as % of removed spots/all spots (≥7/10 cleaned spots/room was considered clean; (2) ATP swabs obtained after cleaning, which test for presence of residual organic material; readings <45 were considered clean. Phase 2 consisted of revision and reorganization of established cleaning practices. Phase 3 consisted of adding one cleaning person in afternoon/evening shifts, for 4-weeks, during which room cleanliness was assessed as previously described.</p><p><strong>Results: </strong>Cleanliness of the 79 patient rooms, for which fluorescence tests were available from before and after cleaning for all three phases of the study, increased from a baseline of 50% ± 35 removed spots/all spots, to 61% ± 36 after the first intervention (CI95 -0.6 - 21, <i>P</i> = 0.54) and to 68% ± 35 after the second intervention (CI95 5 - 31, <i>P</i> = 0.004, as compared to the baseline). Subanalysis showed that evening shifts improved most remarkably, from 47% ± 32 (n = 45), to 60% ± 33 (n = 49) to 76%±29 (n = 29), respectively, from baseline through the second and third phase (<i>P</i> = 0.001). ATP testing appeared less sensitive for assessment of cleanliness but confirmed the assessment by fluorescence for overall cleanliness (CI95 1 - 14, <i>P</i> = 0.018).</p><p><strong>Conclusions: </strong>Our data demonstrate that a two-step intervention significantly improves cleaning in a busy ED.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-6"},"PeriodicalIF":3.0,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11790328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894187","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":"Bad habits that stick: adhesive tape use practices and beliefs.","authors":"Julia Fischer, Reva Kleppel, Manju Mathew, Morgan Gilmore, Laura Hegarty-Moore, Michele Maryanski, Stacey Peters, Kristin Smith, Steven Roncaioli, Jacob Smith, Megan C Gallagher, Esteban DelPilar-Morales, Sarah Haessler","doi":"10.1017/ice.2024.175","DOIUrl":"https://doi.org/10.1017/ice.2024.175","url":null,"abstract":"<p><p>Tape rolls are often used for multiple patients despite recommendations by manufacturers for single-patient use. We developed a survey to query Health Care Personnel about their tape use practices and beliefs and uncovered behaviors that put patients at risk for hospital-acquired infections due to tape use.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-3"},"PeriodicalIF":3.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864321","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":"Efficacy of copper-impregnated antimicrobial surfaces against <i>Clostridioides difficile</i> spores.","authors":"Thanuri Navarathna, Piyali Chatterjee, Hosoon Choi, John D Coppin, Brandon Corona, Emma Brackens, Lynn Mayo, Munok Hwang, Marjory Williams, Morgan Bennett, Chetan Jinadatha","doi":"10.1017/ice.2024.219","DOIUrl":"10.1017/ice.2024.219","url":null,"abstract":"<p><strong>Objective: </strong><i>Clostridioides difficile</i> (<i>C. difficile</i>) is one of the most common causes of healthcare-associated infections (HAIs). Elimination of <i>C. difficile</i> spores is difficult as they are resistant to common hospital-grade disinfectants. Copper-impregnated surfaces provide continuous reduction of multiple pathogens, potentially lowering the risk of infections. This manuscript aims to evaluate the efficacy of copper-impregnated surfaces on <i>C. difficile</i> spores.</p><p><strong>Methods: </strong>Control (no copper) coupons and copper coupons containing 20% copper-oxide were inoculated with <i>C. difficile</i> spore loads ranging from 10⁵ to 10⁷ spores, with or without 5% fetal bovine serum soil load. After 4 hours of contact time, the <i>C. difficile</i> spores were recovered, plated on <i>C. difficile</i> growth media, and colony forming units were counted. The efficacy of copper (log₁₀ kill) was estimated using a Bayesian latent variables model.</p><p><strong>Results: </strong>After 4 hours, unsoiled copper bedrail and copper table coupons at mean spore inoculation resulted in a 97.3% and 96.8% reduction in spore count (1.57 and 1.50 log₁₀ kill, respectively). That of soiled bedrail and table coupons showed a 91.8% and 91.7% reduction (1.10 and 1.10 log₁₀ kill, respectively).</p><p><strong>Conclusions: </strong>Copper coupons can substantially reduce <i>C. difficile</i> spores after 4 hours, but results vary depending on the initial spore concentration and presence or absence of organic material. Higher initial spore loads or excess organic material may prevent spores from contact with copper surfaces, thus decreasing kill efficacy. Continuous sporicidal effect of copper-impregnated surfaces may decrease spore burden and help prevent transmission of spores.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-7"},"PeriodicalIF":3.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11790332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864335","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":"Mixed-methods multicenter assessment of healthcare workers' knowledge, perceptions, and practices related to blood culture utilization in hospitalized adults.","authors":"Valeria Fabre, Sara E Cosgrove, Aaron M Milstone, Alejandra B Salinas, Kathleen O Degnan, Erin B Gettler, Laurel J Glaser, J Kristie Johnson, Rebekah W Moehring, George E Nelson, Barry Rittmann, Guillermo Rodriguez-Nava, Jonathan H Ryder, Jorge L Salinas, Gregory M Schrank, Thomas T Talbot, Trevor C Van Schooneveld, Anastasia Wasylyshyn, Anping Xie","doi":"10.1017/ice.2024.208","DOIUrl":"https://doi.org/10.1017/ice.2024.208","url":null,"abstract":"<p><strong>Objective: </strong>To understand healthcare workers' (HCWs) beliefs and practices toward blood culture (BCx) use.</p><p><strong>Design: </strong>Cross-sectional electronic survey and semi-structured interviews.</p><p><strong>Setting: </strong>Academic hospitals in the United States.</p><p><strong>Participants: </strong>HCWs involved in BCx ordering and collection in adult intensive care units (ICU) and wards.</p><p><strong>Methods: </strong>We administered an anonymous electronic survey to HCWs and conducted semi-structured interviews with unit staff and quality improvement (QI) leaders in these institutions to understand their perspectives regarding BCx stewardship between February and November 2023.</p><p><strong>Results: </strong>Of 314 HCWs who responded to the survey, most (67.4%) were physicians and were involved in BCx ordering (82.3%). Most survey respondents reported that clinicians had a low threshold to culture patients for fever (84.4%) and agreed they could safely reduce the number of BCx obtained in their units (65%). However, only half of them believed BCx was overused. Although most made BCx decisions as a team (74.1%), a minority reported these team discussions occurred daily (42.4%). A third of respondents reported not usually collecting the correct volume per BCx bottle, half were unaware of the improved sensitivity of 2 BCx sets, and most were unsure of the nationally recommended BCx contamination threshold (87.5%). Knowledge regarding the utility of BCx for common infections was limited.</p><p><strong>Conclusions: </strong>HCWs' understanding of best collection practices and yield of BCx was limited.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-9"},"PeriodicalIF":3.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864341","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}