Joint Commission journal on quality and patient safety最新文献

{"title":"Using In Situ Simulation to Identify Latent Safety Threats Prior to the Opening of Novel Patient Care Spaces in the Emergency Department.","authors":"Briana D Miller, Andrew D Bloom, Helena Kons, Marjorie Lee White","doi":"10.1016/j.jcjq.2025.02.007","DOIUrl":"https://doi.org/10.1016/j.jcjq.2025.02.007","url":null,"abstract":"<p><strong>Background: </strong>In the era of extreme emergency department (ED) boarding, hospital systems are using novel patient care areas to provide ongoing acute care. In any new patient care environment, there is a high risk for latent safety threats (LSTs), which can negatively affect patient outcomes. A series of in situ systems-based simulations were conducted to identify potential LSTs prior to the opening of a novel mobile care unit (MCU) in a tertiary hospital.</p><p><strong>Methods: </strong>After a needs assessment in conjunction with institutional leadership, a series of in situ interprofessional simulation sessions were developed to represent realistic scenarios in the MCUs. Simulations included low-frequency high-acuity patient care scenarios as well as high-frequency day-to-day encounters. Data were collected in structured systems-based debriefing sessions via trained observers, video recordings, and participant surveys, with a primary outcome of identifying potential LSTs. The LSTs were categorized and then stratified using the Survey Analysis for Evaluating Risk (SAFER) Matrix. One simulation was repeated after mitigation strategies were employed by institutional leadership.</p><p><strong>Results: </strong>A total of 117 staff participated in five simulation sessions. In the first round of simulations, 37 LSTs were identified, primarily in the categories of Environment/Wayfinding (13/37, 35.1%) and Communication (6/37, 16.2%). LSTs risk stratified using the SAFER Matrix provided prioritized feedback for hospital leadership to guide mitigation strategies prior to the opening of the new units. One LST was initially classified as high likelihood to harm on the SAFER Matrix. The simulated scenario involving this LST was repeated two weeks later with no further high-risk LSTs identified.</p><p><strong>Conclusion: </strong>In situ simulations can serve as an effective tool to identify potential LSTs prior to the opening of novel patient care spaces.</p>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality and Return Visit Frequency Among Emergency Department Patients Who Leave Without Being Seen at a Regional Health Care System.","authors":"Joshua W Joseph, Alice K Bukhman, Da'Marcus E Baymon, Melisa W Lai-Becker, Dana D Im, Lauren M Nentwich, Paul C Chen, León D Sánchez","doi":"10.1016/j.jcjq.2025.02.008","DOIUrl":"https://doi.org/10.1016/j.jcjq.2025.02.008","url":null,"abstract":"<p><strong>Background: </strong>The rate of emergency department (ED) patients who leave without being seen (LWBS) is a commonly reported quality metric that increased across the United States in concert with COVID-19. However, it is unclear what proportion of patients leave despite an acute medical need. The authors sought to estimate the rates at which patients who leave return, including hospitalization, relative to patients who are evaluated and discharged.</p><p><strong>Methods: </strong>This was a retrospective cohort study examining adult patients presenting between January 1, 2019, and January 1, 2023, across an integrated system including 10 EDs. Demographic variables were compared using independent chi-square tests. Clinical outcomes, including rates of return visits at 72 hours and 30 days (including inpatient admission or ICU admission), and 30-day mortality were compared using multivariate logistic regression.</p><p><strong>Results: </strong>A total of 1,474,395 visits were included, of which 17,523 (1.2%) were LWBS. Patients in the LWBS group were younger (48.1 years [95% confidence interval (CI) 48.1-48.2] vs. 44.8 years [95% CI 44.6-45.1], p < 0.001), more likely to be of Hispanic ethnicity (177,895 [17.7%] vs. 3,884 [22.2%], p < 0.001), and more likely to require a translator (131,510 [13.1%] vs. 3,184 [18.2%], p < 0.001). Independent of other clinical and demographic variables, LWBS was associated with more frequent returns within 72 hours (adjusted odds ratio [AOR] 2.56, 95% CI 2.50-2.62, p < 0.001), 30-day ICU admission (AOR 1.35, 95% CI 1.27-1.66, p < 0.001), and mortality within 30 days (AOR 2.59, 95% CI 1.90-3.53, p <0.001).</p><p><strong>Conclusion: </strong>Patients who left without being seen were more likely to return, to require admission, and to die within 30 days than those discharged. High LWBS rates, most pronounced among disadvantaged groups, should be considered as a source of harm to patients.</p>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Engagement in Safety: Are We There Yet?","authors":"Tejal Gandhi, Urmimala Sarkar","doi":"10.1016/j.jcjq.2025.02.006","DOIUrl":"https://doi.org/10.1016/j.jcjq.2025.02.006","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modeling Incremental Benefit of Medication Reconciliation on ICU Outcomes.","authors":"Helen A Harris, David M Chan, Laura Ellwein Fix, Melissa Chouinard, Teresa M Salgado, Le Kang, Gonzalo Bearman","doi":"10.1016/j.jcjq.2025.02.001","DOIUrl":"https://doi.org/10.1016/j.jcjq.2025.02.001","url":null,"abstract":"<p><strong>Background: </strong>Medication errors such as medication discrepancies can occur in patients who are hospitalized and may result in adverse drug events (ADEs). Pharmacist-led medication reconciliation (MR) is an intervention that can be used to address medication discrepancies. Estimating the impact of MR in a medical setting is challenging to do experimentally. In this study, researchers implemented a mathematical model for estimating impact.</p><p><strong>Methods: </strong>The authors modeled the effects of a series of incremental changes in MR completion on ADEs and conducted a cost-effectiveness analysis using a Markov chain model.</p><p><strong>Results: </strong>In a 28-bed ICU, increasing the MR completion rate resulted in decreases in the total number of yearly ADEs by as many as 106, varying by the baseline ADE rate. The financial implications of increasing MR completion ranged from $27,808 in additional costs to $1,818,440 in savings on a yearly basis, depending on the baseline ADE rate and cost per ADE.</p><p><strong>Conclusion: </strong>For institutions with low ADE rates, as MR completion increases and ADEs decrease, MR (though clinically beneficial) may not be financially worthwhile. However, MR implementation was found to produce significant savings for hospitals with average or high ADE rates.</p>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leveraging Approaches and Tools of Implementation Science and Configurational Comparative Methods in Quality Improvement","authors":"Gabrielle Matias MD (Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL),&nbsp;Nandita R. Nadig MD, MSCR, ATSF (Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL),&nbsp;Reiping Huang PhD (Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, Please address correspondence to Reiping Huang)","doi":"10.1016/j.jcjq.2025.02.003","DOIUrl":"10.1016/j.jcjq.2025.02.003","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 4","pages":"Pages 239-240"},"PeriodicalIF":2.3,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143704883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Safety Event Risk and Language Barriers: A Scoping Review.","authors":"Lucy B Schulson, Jorge A Rodriguez, Ricardo Cruz, David Flynn, Alicia Fernandez","doi":"10.1016/j.jcjq.2025.02.002","DOIUrl":"https://doi.org/10.1016/j.jcjq.2025.02.002","url":null,"abstract":"<p><p>Patients who experience language barriers (LBs) may be at risk for patient safety events (PSEs). We conducted a scoping review of the literature to understand the risk for and type of PSEs in those who experience LBs. We searched PubMed, Web of Science, and Embase in October 2023. The search was organized into the following concepts: language barriers and patient safety. We included English language studies where risk of a PSE was compared in patients who experience to those who do not experience LBs or where types/characteristics of PSEs were compared in patients who are and are not at risk for LBs. We identified 22 studies for inclusion. Studies were primarily based in the United States and inpatient focused. Multiple methods were used to define patients who experience LBs and to identify PSEs. Patients who experienced LBs appeared to be at risk for communication-sensitive safety events, including medication-related adverse events and events related to vaginal deliveries, but at equal or lower risk for other types of events. Studies that did not rely solely on PSEs identified by clinician/staff report were more likely to identify disparities. We found few studies on PSE risk and LBs, a reflection of the dearth of research in this area and data sources with patient language. Studies had mixed results in part due to the multiple methods used to identify patients who experience LBs and PSEs. Interventions to reduce PSEs for patients who experience LBs should focus on events resulting from communication breakdowns.</p>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Scholarly Upside to MOC4","authors":"Glenn Seela (is a Medical Student, University of Minnesota Medical School.),&nbsp;David Satin MD (is an Associate Professor, Department of Family Medicine and Community Health, University of Minnesota Medical School, and Affiliate Faculty Center for Bioethics, University of Minnesota.),&nbsp;Cathy Centola (is Division Administrator, Department of Pediatrics, University of Minnesota Medical School.),&nbsp;Sameer Gupta MD, MBA (is an Associate Professor, Department of Pediatrics, University of Minnesota Medical School.),&nbsp;Paul Hodges MPP (is Director of Process Improvement and Clinical Quality, M Health Fairview, University of Minnesota Medical Center.),&nbsp;Jeff Louie MD (is an Associate Professor, Department of Pediatrics, University of Minnesota Medical School.),&nbsp;Tanya E. Melnik MD, MS (is an Associate Professor, Department of Medicine, University of Minnesota Medical School.),&nbsp;David Pelletier MSE, ICBB (is Principal Consultant, Quality Improvement, M Health Fairview.),&nbsp;Christina Russell MD (is an Assistant Professor, Department of Pediatrics, University of Minnesota Medical School.),&nbsp;Andrew Thompson MBA, MBB (Principal Consultant, Performance Improvement, M Health Fairview.),&nbsp;Jordan Marmet MD (is an Associate Professor, Department of Pediatrics, University of Minnesota Medical School. Please address correspondence to Jordan Marmet)","doi":"10.1016/j.jcjq.2024.10.014","DOIUrl":"10.1016/j.jcjq.2024.10.014","url":null,"abstract":"<div><h3>Background</h3><div>Many medical boards require quality improvement (QI) projects for Maintenance of Certification Part IV (MOC4) credits. The American Board of Medical Specialties (ABMS) allows health care organizations that can demonstrate sufficient QI standards to become Portfolio Program Sponsors. This enables internal review and approval of QI projects, crediting all sufficiently contributing physicians. The University of Minnesota's M Health Fairview MOC4 Review Board (MMRB) was approved as an ABMS Portfolio Program Sponsor; the impact was surveyed from inception in 2016 to 2022. The objective was to examine the impact of a Portfolio Sponsor program on scholarship, sustainability, and spread of QI projects.</div></div><div><h3>Methods</h3><div>The authors developed and validated an eight-question survey directed at MOC4 principal investigators (PIs) who were awarded credits through the MMRB from 2016 to 2022. Participants reported on numbers of peer-reviewed publication or presentation, and their perception of increased preparedness for scholarship due to the application process. They also reported on sustainment or spread following their original QI project.</div></div><div><h3>Results</h3><div>Fifty projects were reviewed over a seven-year span. Of these, 44 were approved as demonstrating sufficient QI rigor per ABMS standards. Of 41 PIs, 27 (65.9%) responded to the survey; 15 (55.6%) agreed that the MMRB process helped prepare them for scholarly dissemination, 19 (70.4%) delivered oral or poster presentations, and 10 (37.0%) submitted a total of 14 manuscripts for publication, 10 of which were accepted. A total of 23 QI projects (85.2%) were sustained, and 10 (37.0%) had spread.</div></div><div><h3>Conclusion</h3><div>In addition to generating essential MOC4 credits for participating physicians, an MMRB process can help PIs prepare for scholarship, project sustainment, and spread.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 2","pages":"Pages 101-107"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of the Revised American Academy of Pediatrics Clinical Practice Guidelines for Hyperbilirubinemia Decreases Necessity for Serum Bilirubin and Phototherapy","authors":"Matthew R. Michienzi DO (is Pediatric Resident, Department of Pediatrics, Brooke Army Medical Center, San Antonio, Texas.),&nbsp;Dakota K. Tomasini DO (is Neonatology Fellow, Department of Pediatrics, Brooke Army Medical Center.),&nbsp;Carleigh C. Fisher DO (is Pediatric Resident, Department of Pediatrics, Brooke Army Medical Center.),&nbsp;Adharsh P. Ponnapakkam MD (is Pediatric Resident, Department of Pediatrics, Brooke Army Medical Center. Please address correspondence to Matthew Michienzi)","doi":"10.1016/j.jcjq.2024.10.013","DOIUrl":"10.1016/j.jcjq.2024.10.013","url":null,"abstract":"<div><h3>Background</h3><div>The initial hyperbilirubinemia management recommendations published by the American Academy of Pediatrics (AAP) in 2004 and updated in 2009 led to wide variations in clinical practice among providers, with variable results. In August 2022 AAP published updated clinical practice guidelines for the management of hyperbilirubinemia. The aim of this project was to determine the effect of adaptation of the AAP guidelines on laboratory testing, readmission rates, and phototherapy.</div></div><div><h3>Methods</h3><div>Existing institutional protocol was updated to incorporate the revised AAP guidelines. The primary outcome was percentage of serum bilirubin labs obtained. Balancing measures included monthly readmission rate, need for escalation of care, and percentage of patients requiring additional labs or phototherapy. Statistical process control charts measured changes in quality over time. Chi-square analysis evaluated differences between pre- and postintervention periods.</div></div><div><h3>Results</h3><div>A total of 2,301 infants were evaluated, 1,662 of which were included in the postintervention analysis. A clinically and statistically significant decrease was seen in the percentage of patients with serum bilirubin evaluation, from 21.3% to 8.8% (<em>p</em> &lt; 0.001). There was a decrease in need for phototherapy, from 4.2% to 1.4% (<em>p</em> &lt; 0.001), but duration of treatment was longer when initiated. The authors simultaneously saw no changes in readmission rate or additional laboratory evaluation, with no incidence of bilirubin-induced encephalopathy or escalation of care.</div></div><div><h3>Conclusion</h3><div>Implementation of the revised 2022 AAP guidelines was associated with a decrease in serum bilirubin evaluation and phototherapy initiation. This integrated protocol may represent a sustainable standardized approach to management of hyperbilirubinemia.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 2","pages":"Pages 95-100"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simulation-Debriefing Enhanced Needs Assessment to Address Quality Markers in Health Care: An Innovation for Prospective Hazard Analysis","authors":"Lisa T. Barker MD, MHPE (is Clinical Associate Professor of Emergency Medicine, OSF HealthCare, University of Illinois College of Medicine at Peoria, and Medical Director, Jump Simulation, an OSF HealthCare and University of Illinois College of Medicine at Peoria Collaboration.),&nbsp;William F. Bond MD, MS (is Professor of Clinical Emergency Medicine, University of Illinois College of Medicine at Peoria, and Director of Research, Jump Simulation.),&nbsp;Ann M. Willemsen-Dunlap CRNA, PhD (is Director of Education Development, Jump Simulation.),&nbsp;Kimberly L. Cooley MSN, RN, CCRC (is Research Education Facilitator, OSF HealthCare.),&nbsp;Jeremy S. McGarvey MS (is Senior Statistician, Division of Healthcare Analytics, OSF HealthCare.),&nbsp;Rebecca L. Ruger (is Graduate Student, Department of Psychology, Pennsylvania State University.),&nbsp;Adam Kohlrus MS, CPHQ, CPPS (is Partner and Business Designer, Do Tank, Springfield, Illinois.),&nbsp;Michael J. Kremer PhD, CRNA, CHSE, FAAN (is Professor and Interim Chair, Department of Adult Health and Gerontological Nursing, College of Nursing, and Co-Director, Rush Center for Clinical Skills and Simulation, Rush University.),&nbsp;Michelle Sergel MD (is Co-Director, Rush Center for Clinical Skills and Simulation, Rush University and Assistant Professor of Emergency Medicine, Rush Medical College.),&nbsp;John A. Vozenilek MD (is Vice President and Chief Medical Officer for Innovation, OSF HealthCare. Please address correspondence to Lisa T. Barker)","doi":"10.1016/j.jcjq.2024.10.004","DOIUrl":"10.1016/j.jcjq.2024.10.004","url":null,"abstract":"<div><div>Simulation-Debriefing Enhanced Needs Assessment (SDENA) is a simulation-based approach to prospective hazard analysis that uses simulation and debriefing as a unit-level diagnostic tool. Scenarios address failure modes for health care improvement targets, and debriefing explores unit-specific barriers and resiliencies. Debriefing guides are structured to explore how six drivers of a behavior engineering framework (data, tools/resources, incentives, knowledge/skills, capacity, motivation) influence clinical behaviors. Illinois Hospital Association members who deployed SDENA to address specific hospital-acquired conditions found motivation to be a more significant barrier than anticipated before deployment. SDENA represents a novel approach to improving safety and may refine intervention targets.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 2","pages":"Pages 144-158"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Do We Know When We Have Done Enough? Ensuring Sufficient Patient Notification Efforts After a Large-Scale Adverse Event","authors":"David Alfandre MD, MSPH (is an Internist and Senior Health Care Ethicist, US Department of Veterans Affairs (VA) National Center for Ethics in Health Care, and Associate Professor, Departments of Medicine and Population Health, New York University Grossman School of Medicine.),&nbsp;Mary Beth Foglia PhD, MA, RN (is Health Care Ethicist, VA National Center for Ethics in Health Care, and Affiliate Faculty, Department of Bioethics and Humanities, School of Medicine, University of Washington.),&nbsp;Mark Holodniy MD (is Director, VA Public Health National Program Office and Public Health Reference Laboratory, and Professor, Department of Medicine, Stanford University School of Medicine.),&nbsp;A. Rani Elwy PhD, MSc (is Research Career Scientist, Center for Health Optimization and Implementation Research, VA Boston Healthcare System, and VA Bedford Healthcare System, and Professor, Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University. Please address correspondence to David Alfandre)","doi":"10.1016/j.jcjq.2024.10.010","DOIUrl":"10.1016/j.jcjq.2024.10.010","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 2","pages":"Pages 159-163"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}