Journal of pain and symptom management最新文献

{"title":"The Association of Filial Piety and Financial Toxicity With Surrogate Decisional Conflict Among Adult Children of ICU Patients With Cancer","authors":"Xiaochun Wu MSN, RN ,&nbsp;Yali Tang BSc ,&nbsp;Jieling Chen PhD","doi":"10.1016/j.jpainsymman.2025.07.023","DOIUrl":"10.1016/j.jpainsymman.2025.07.023","url":null,"abstract":"<div><h3>Context</h3><div>Filial piety, a Confucian cultural value, is deeply rooted in the parent-child relationship in Chinese and many other Asian cultures. Adult children often experience decisional conflict when making decisions for their critically ill parents. However, the quantitative relationship between filial piety and surrogate decisional conflict has yet to be explored.</div></div><div><h3>Objective</h3><div>To examine the associations of both financial toxicity and filial piety with surrogate decisional conflict among adult children of intensive care unit (ICU) patients with cancer.</div></div><div><h3>Methods</h3><div>A cross-sectional survey was conducted in an ICU of a tertiary hospital in Guangzhou, China. A sample of 180 adult children serving as surrogates for patients with cancer completed the survey after the patients had been admitted to the ICU for at least 4 days. The measures included the family version of the Decision Conflict Scale, the Filial Piety Values Scale for Children of Patients with Advanced Cancer, and the Comprehensive Scores for Financial Toxicity. Multiple regression analysis was conducted to examine factors associated with surrogate decisional conflict.</div></div><div><h3>Results</h3><div>The adult children of ICU patients with cancer experienced a high level of surrogate decisional conflict. Surrogate decisional conflict was associated with more siblings (<span><math><mrow><mi>β</mi><mo>=</mo><mn>0.183</mn><mo>,</mo><mspace></mspace><mi>p</mi><mo>=</mo><mn>0.017</mn></mrow></math></span>), lower levels of filial piety (<span><math><mrow><mi>β</mi><mo>=</mo><mo>−</mo><mn>0.177</mn><mo>,</mo><mspace></mspace><mi>p</mi><mo>=</mo><mn>0.018</mn></mrow></math></span>) and severe financial toxicity (<span><math><mrow><mi>β</mi><mo>=</mo><mo>−</mo><mn>0.159</mn><mo>,</mo><mspace></mspace><mi>p</mi><mo>=</mo><mn>0.045</mn></mrow></math></span>).</div></div><div><h3>Conclusion</h3><div>Healthcare providers are recommended to provide culturally sensitive support for Chinese adult children making decisions for their parents with cancer in the ICU, such as offering strategies to mitigate the negative impact of financial toxicity and helping surrogates clarify their filial piety values to relieve decisional conflict.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages 437-446"},"PeriodicalIF":3.5,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Paradox of Palliphobia.","authors":"Juan Luis Torres-Tenor","doi":"10.1016/j.jpainsymman.2025.07.019","DOIUrl":"10.1016/j.jpainsymman.2025.07.019","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinician Perspectives on Open Notes in Oncology Palliative Care: A Mixed-Methods Study","authors":"Joanna Veazey Brooks PhD, MBE ,&nbsp;Delisia Chapman-Brown MPH ,&nbsp;Amanda Thimmesch BA ,&nbsp;Elizabeth Wulff-Burchfield MD ,&nbsp;Christian Sinclair MD ,&nbsp;Daniel English MSGH ,&nbsp;Heather Nelson-Brantley PhD, RN, NEA-BC, CNE","doi":"10.1016/j.jpainsymman.2025.07.014","DOIUrl":"10.1016/j.jpainsymman.2025.07.014","url":null,"abstract":"<div><h3>Context</h3><div>The 21st Century Cures Act Interoperability and Information Blocking Rule (IBR) has the laudable goal of increased transparency in sharing health information with patients and informed decision-making by patients, yet strategies to support IBR implementation are sparse. Without evidence-based guidelines, health systems and palliative care clinicians have been left to navigate implementation of the IBR on their own.</div></div><div><h3>Objectives</h3><div>We sought to understand clinician perspectives and experiences with the IBR in oncology and palliative care.</div></div><div><h3>Methods</h3><div>We used a convergent parallel mixed method design with clinician surveys and interviews.</div></div><div><h3>Results</h3><div>29 clinicians from one institution participated in the study. Three themes emerged from the data: 1) specialty-specific worry about harm; 2) documentation changes in response to the IBR; and 3) sharing notes as a helpful tool. We found that clinicians see benefits and concerns around the IBR. Oncology clinicians worried more about the sensitivity of test results while palliative care clinicians worried more about the sensitivity of information included in documentation of family meetings and of prognostic information.</div></div><div><h3>Conclusion</h3><div>Findings from our study indicate that clinicians’ experience with the IBR is more nuanced than the initial worry expressed by clinicians in editorials. Additionally, our study shows the importance of capturing specialty-specific experiences with the IBR, as concerns can differ. Future research should continue to examine clinician and organizational practices around implementation of the IBR to identify best practices for maximizing patient and clinician benefit while minimizing unintended harm.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages 410-421"},"PeriodicalIF":3.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standardized Assessment of Patient Experience in Pediatric Palliative Care: A National Collaboration","authors":"Ashley K. Autrey MD ,&nbsp;Stacey Rifkin-Zenenberg DO ,&nbsp;Tracy Hills DO ,&nbsp;Jennifer Salant MD ,&nbsp;Rachna May MD ,&nbsp;Elliot Rabinowitz MD ,&nbsp;Chelsea Heneghan CNP ,&nbsp;Laura Drach DO, MSN ,&nbsp;Emma Jones MD, MA ,&nbsp;Rachel Thienprayoon MD","doi":"10.1016/j.jpainsymman.2025.07.011","DOIUrl":"10.1016/j.jpainsymman.2025.07.011","url":null,"abstract":"<div><h3>Background</h3><div>Use of patient reported outcome measures (PROMs) are crucial to providing patient-centered care. In 2022, the Pediatric Palliative Improvement Network developed a project to standardize the assessment of patient experiences with PPC services.</div></div><div><h3>Measures</h3><div>By December 31, 2022, we aimed for: 10 participating sites, 50% of eligible PPC patient experiences assessed, and 25% response rate.</div></div><div><h3>Intervention</h3><div>Project leaders provided guidance for study processes, accurate timely data gathering, and collaborative learning. Data was collected from January to December, 2022. Sites utilized two standardized key indicator questions, including one National Quality Forum-endorsed palliative care PROM.</div></div><div><h3>Results</h3><div>Fourteen sites participated with 69% of patients (1631/2360) surveyed and 304 responses (19% response rate) gathered. Patients/Families felt heard and understood and would recommend PPC.</div></div><div><h3>Conclusions/Lessons learned</h3><div>Standardized assessments of patient experience with PPC are feasible and informative. PROMs can ensure that PPC services meet patient needs, identify opportunities for improvement, and demonstrate value.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages e299-e304"},"PeriodicalIF":3.5,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization of the No One Dies Alone Program to Support Dying Patients","authors":"Austin Chen MD, MS ,&nbsp;Ketki Sathe MBBS, MS ,&nbsp;Yixuan C. Zhang BA ,&nbsp;Lyndia C. Brumback PhD ,&nbsp;Addy L. Elketami MS ,&nbsp;Jamie T. Nomitch MD, MS ,&nbsp;Timothy J. Shipe MDiv ,&nbsp;Cynthia M. Thelen BA ,&nbsp;Katherine G. Hicks MD ,&nbsp;Ann L. Jennerich MD, MS","doi":"10.1016/j.jpainsymman.2025.07.013","DOIUrl":"10.1016/j.jpainsymman.2025.07.013","url":null,"abstract":"<div><h3>Context</h3><div>The No One Dies Alone (NODA) program has utilized trained volunteers to provide support to dying patients for over 20 years.</div></div><div><h3>Objectives</h3><div>Evaluating program utilization at a large, urban medical center can provide insights to guide expansion and address unmet needs.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of hospitalized patients enrolled in the NODA program at Harborview Medical Center (HMC), a level I trauma center in Seattle, WA. The NODA program has been operating at HMC since 2012, and our cohort includes data through 2020. We extracted patient demographics, admission characteristics, and program utilization metrics from the electronic health record and used descriptive statistics to summarize the data from decedents.</div></div><div><h3>Results</h3><div>During the study period, 245 patients were referred to the NODA program, and data were available for 234 hospitalized patients. The average length of time spent in the program was four days (SD 6), with 37% of patients enrolled for only a single day. Most patients received a visit from NODA volunteers, although 22% had no volunteer visits. In cases where a volunteer did not visit, the most common reason was patient death prior to volunteer arrival (92%). Many patients had family visit during the hospitalization (56%).</div></div><div><h3>Conclusion</h3><div>The NODA program was utilized for patients with and without family support. Some patients were unable to benefit from the program due to timing of referral relative to death, highlighting the importance of early consultation to maximize program benefits.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages e311-e317"},"PeriodicalIF":3.5,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initial Long-Term Opioid Prescriptions Among Veterans With and Without Kidney Disease","authors":"Jessica E. Ma MD, MHSc ,&nbsp;Shiqi Zhang MS ,&nbsp;Ariadna Garcia MS ,&nbsp;Karleen F. Giannitrapani PhD ,&nbsp;Derek Boothroyd PhD ,&nbsp;Selen Bozkurt PhD ,&nbsp;Anne C. Black PhD ,&nbsp;Manjula Kurella Tamura MD, MPH ,&nbsp;Amanda Midboe PhD ,&nbsp;Lara Troszak MA ,&nbsp;C. Barrett Bowling MD, MSPH ,&nbsp;William Becker MD ,&nbsp;Karl A. Lorenz MD, MSHS","doi":"10.1016/j.jpainsymman.2025.07.012","DOIUrl":"10.1016/j.jpainsymman.2025.07.012","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 4","pages":"Pages e287-e290"},"PeriodicalIF":3.5,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Co-Designing a Quality of Life Survey for Mesothelioma: Qualitative and Cognitive Interview Findings","authors":"Clare O’Callaghan BSW, MMus, PhD ,&nbsp;Joanne Brooker PhD ,&nbsp;Sanuki Tissera BiomedSc, MClinRes ,&nbsp;Dani Samankula BSc, MNSc, MPH ,&nbsp;B. Healy ,&nbsp;K. Healy ,&nbsp;Vicki Hamilton OAM ,&nbsp;Jennifer Philip BMBS, MM, PhD ,&nbsp;Rob Stirling BSc, MBBChBAO, MPH ,&nbsp;John Zalcberg MBBS, PhD ,&nbsp;Penny Schofield BSc, PhD ,&nbsp;Susan Harden BMBCh, MA, DM(Oxon)","doi":"10.1016/j.jpainsymman.2025.07.004","DOIUrl":"10.1016/j.jpainsymman.2025.07.004","url":null,"abstract":"<div><h3>Context</h3><div>Mesothelioma is a rare, incurable, and aggressive cancer and “patient-reported outcome” (PRO) data from people living with mesothelioma (PLM) are lacking.</div></div><div><h3>Objectives</h3><div>To examine PLM’s views about, and cognitive processes whilst answering, a draft quality of life and care survey, to inform survey refinements and implementation into the Victorian Mesothelioma Outcome Registry (VMOR), Australia.</div></div><div><h3>Methods</h3><div>Constructivist (qualitative) and co-designed study. An expert-developed draft PRO survey comprised the: EORTC QLQ-C30 health-related quality of life question-set, Australian Hospital Patient Experience Question Set (AHPEQS), and demographic / mesothelioma background questions. Telephone semi-structured and “think aloud” interviews examined PLM’s survey views and cognitive processes during responses. Concurrent inductive thematic analysis (survey views) and deductive content analysis (cognitive processes) proceeded.</div></div><div><h3>Results</h3><div>PLM believed that the survey would produce information important for improving PLM healthcare but made many content and layout suggestions to reduce respondent confusion, inappropriate answers, and burden. Free-text response options were strongly recommended. Survey content was generally nondistressing but could elicit challenging memories and need for support. Several PLM displayed challenges in executing cognitive processes during survey responses, notably on whether EORTC-QL30 referred to general or mesothelioma-only related health and which hospital care experience the AHPEQS referred to.</div></div><div><h3>Conclusion</h3><div>A refined co-designed VMOR PRO survey should yield patient-meaningful qualitative and quantitative evidence to guide the Registry’s leadership in what issues are important to patients and their clinical team. While co-designed “viewpoint seeking” and cognitive interviewing studies can improve valid survey outcomes, PRO responses may also be affected by extraneous circumstances, including comorbidities.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 5","pages":"Pages 401-409"},"PeriodicalIF":3.5,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding and Predicting End-of-Life Care Preferences Among Urban-Dwelling Older Adults in China","authors":"Chuqian Chen Ph.D. ,&nbsp;Robert Jiqi Zhang Ph.D.","doi":"10.1016/j.jpainsymman.2025.07.009","DOIUrl":"10.1016/j.jpainsymman.2025.07.009","url":null,"abstract":"<div><h3>Context</h3><div>Understanding older adults’ preferences for end-of-life care (EoLC) is vital for respecting their wishes and informing effective service planning and policy development. Previous research has examined factors influencing different dimensions of EoLC preferences separately, but few studies have explored these dimensions as interconnected patterns and viewed older adults as heterogeneous using a person-centered approach.</div></div><div><h3>Objectives</h3><div>This study aims to: 1) identify heterogeneous latent patterns across seven dimensions of EoLC preferences among Chinese older adults; 2) describe and explain these patterns; and 3) predict membership within these patterns.</div></div><div><h3>Methods</h3><div><em>:</em> Survey data from 646 urban-dwelling older adults aged 60 and above across 26 provincial-level administrative divisions in Mainland China were analyzed. EoLC preferences regarding willingness to know diagnosis, willingness to know prognosis, decision-maker, treatment goals, place of care, caregiver, and setting advance directives were assessed alongside demographics, resources, knowledge and attitudes, and caregiving/bereavement experiences. Latent class analysis (LCA), 3-step regressions, and Catboost machine learning models were employed to identify subgroups, examine between-group differences, and predict subgroup membership, respectively.</div></div><div><h3>Results</h3><div>LCA identified three latent patterns: “low self-determination, quality-goal, family-oriented care” (9.1%), “high self-determination, quality-goal, family-oriented care” (54.0%), and “high self-determination, quantity-goal, professional-oriented care” (36.9%). Significant between-group differences were found in education, marital status, living arrangements, family income, social support, EoLC knowledge, general trust, and professional-patient trust. Machine learning models revealed that high general trust predicts membership in the high self-determination, quality-goal, family-oriented care group, while low filial piety expectations predict membership in the high self-determination, quantity-goal, professional-oriented care group.</div></div><div><h3>Conclusion</h3><div>Among Chinese older adults, three EoLC preference patterns were found, which were characterized by low family connections, low trust in professionals combined with adequate resources, and extensive knowledge, respectively. High general trust and low filial piety expectations were key predictors for two of the three patterns.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 4","pages":"Pages 379-391.e3"},"PeriodicalIF":3.5,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Buprenorphine-Naloxone for Chronic Cancer-Related Pain in a Palliative Care Clinic","authors":"Yoko Tarumi MD, PhD ,&nbsp;Vickie Baracos PhD ,&nbsp;Sonya Lowe MD, PhD ,&nbsp;Ayoola Ademola PhD ,&nbsp;Allison Chabassol MD ,&nbsp;Tracy Wildeman MN, NP ,&nbsp;Megan Sellick MD ,&nbsp;Jennifer Dutka BSc, Pharm ,&nbsp;Vincent Ha BSc, Pharm ,&nbsp;Sharon M. Watanabe MD","doi":"10.1016/j.jpainsymman.2025.07.006","DOIUrl":"10.1016/j.jpainsymman.2025.07.006","url":null,"abstract":"<div><h3>Context</h3><div>Long-term opioid therapy (LTOT) for chronic cancer-related pain can lead to negative consequences.</div></div><div><h3>Objectives</h3><div>To describe the use of buprenorphine, a pharmacologically unique opioid, combined with naloxone (Bup-Nal) for chronic cancer-related pain requiring LTOT.</div></div><div><h3>Methods</h3><div>Retrospective descriptive study conducted in a tertiary cancer center-based palliative care clinic. Routinely collected data were analyzed.</div></div><div><h3>Results</h3><div>A total of 47 persons with advanced cancer underwent switches to Bup-Nal from previous opioids. Mean/median ages were 56.2/56.5 years old. All were on disease-modifying treatment. Mean/median duration in months of previous opioid use prior to switch were 18.3 (standard deviation [SD]: 15.0)/14.0 (interquartile range [IQR]: 6.0–24.0). Mean/median oral morphine equivalent daily dose (MEDD) in mg prior to switch were 122.4 (SD: 98.8)/100.0 (IQR: 54.0–165.0). Mean/median total daily dose of buprenorphine in mg at stable pain control were 4.6 (SD: 4.9)/2.0 (IQR: 1.0–6.5). Mean/median dose conversion ratios for oral MEDD:sublingual buprenorphine were 39.4 (SD: 19.4)/35.8 (IQR: 26.6–50.0). Mean/median durations of Bup-Nal use in months were 6.7 (SD: 7.9)/4.0 (IQR: 2.0–8.0). Analysis of variance revealed that mean Edmonton Symptom Assessment System-Revised pain score diminished over time (chi-square: 36.0, <em>P</em>-value ≤0.001). Bup-Nal use &gt;three months had greater pain score reduction over the 12-week observation period.</div></div><div><h3>Conclusion</h3><div>This retrospective descriptive study demonstrates that persons with advanced cancer and chronic cancer-related pain requiring LTOT could be successfully switched from other opioids to Bup-Nal, with a statistically significant decrease in pain over time, which was more pronounced in those on Bup-Nal for &gt;three months. Prospective studies are warranted.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 4","pages":"Pages e250-e261"},"PeriodicalIF":3.5,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Losing the Appetite for Megestrol Acetate: A Case of Medication-Induced Adrenal Insufficiency","authors":"Mackenzie Coyne BA ,&nbsp;Ryan Anderson MD ,&nbsp;Tristan N. Tyger PharmD ,&nbsp;Justin Kullgren PharmD ,&nbsp;Julia L. Agne MD","doi":"10.1016/j.jpainsymman.2025.07.008","DOIUrl":"10.1016/j.jpainsymman.2025.07.008","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 4","pages":"Pages e284-e286"},"PeriodicalIF":3.5,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}