Pediatric emergency care最新文献

{"title":"Gaps in Safe Sleep Knowledge and Practices Among Parents of Infants in an Urban Children's Hospital Emergency Department.","authors":"Thomas Gilmartin, Jessica Hayes, Donald H Arnold","doi":"10.1097/PEC.0000000000003431","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003431","url":null,"abstract":"<p><strong>Objective: </strong>Sudden Unexpected Infant Death (SUID) remains a leading cause of mortality, particularly in the Southeast United States. While previous studies have examined aspects of parental safe sleep knowledge and practices, the objective of this study was to evaluate (1) knowledge and (2) practice of adherence by caretakers to all American Academy of Pediatrics (AAP) A-level recommendations related to placing an infant to sleep.</p><p><strong>Methods: </strong>Investigators administered a survey study in an urban, academic pediatric emergency department in the Southeast United States from 2022 to 2023. A convenience sample of parents of infants (≤12 mo) were surveyed regarding knowledge and practices pertaining to sleep position, safe surfaces, surface sharing, objects in bed, cardiopulmonary monitors, and pacifier use. Wilcoxon signed-rank tests were used to compare knowledge of each AAP recommendation with practice of the same recommendation.</p><p><strong>Results: </strong>Among 200 surveyed participants, most demonstrated correct knowledge of safe sleep position (183, 91.5%), surfaces (167, 83.5%), location (186, 93.0%), and crib-safe objects (177, 88.5%). Correct practices of AAP recommendations were reported for sleep position (155, 77.5%), sleep surface (155, 77.5%), location (157, 78.5%), objects in the crib (130, 65.0%), and pacifier use (73, 37.5%). For the 5 AAP recommendations, Wilcoxon signed-rank tests indicated statistically significant variance between knowledge and practice: safe sleep position (P<0.001), surfaces (P=0.040), location (P<0.001), crib-safe objects (P<0.001), and pacifier use (P=0.002).</p><p><strong>Conclusions: </strong>This research identifies gaps between safe sleep knowledge and practice for 5 of the 6 AAP recommendations related to placing an infant to sleep in a region with high SUID incidence. Addressing these modifiable risk factors during emergency department visits may decrease SUID incidence.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310300","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":"Methodological Observations on the Meta-analysis by Alsabri et al Regarding Ketorolac Use in Pediatric Acute Pain.","authors":"Javier Arredondo Montero","doi":"10.1097/PEC.0000000000003424","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003424","url":null,"abstract":"","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302715","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 National Dissemination of a Disaster Medicine Module for Pediatric Residents Through Nationally Funded Disaster Networks.","authors":"Roxanna Lefort, Rong Sang, Shana E Godfred-Cato, Yae Sul Jeong, Dennis M Ren, Myto Duong, Erica Y Popovsky, Kara B Kowalczyk, Caitlin Valentino, Nichole R Davis, Paul J Stengel, Marc A Auerbach","doi":"10.1097/PEC.0000000000003403","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003403","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate a dissemination strategy for an online pediatric disaster learning module to reach pediatric residents in programs participating in nationally funded disaster networks. A secondary aim measured the educational impacts among learners.</p><p><strong>Methods: </strong>The module included case-based scenarios, videos, interactive questions and answers with experts, and resource links. The dissemination strategy involved identifying a local champion at each of the disaster network institutions to recruit a targeted group of pediatric residents during a clinical rotation. Dissemination was evaluated using surveys of site champions and learners. The educational impact of the module was measured using retrospective pre/postsurveys.</p><p><strong>Results: </strong>Twenty-eight residency programs within the funded disaster networks were approached, and 6 additional residency programs requested to participate after learning about this project. Twenty-five programs participated with a total of 252 residents initially engaging with the module over the 2 designated dissemination weeks. Of residents, 75% started the module and completed it. Most site champions expressed interest in continuing to engage in dissemination of future modules in the curricula. A statistically significant improvement in self-reported knowledge, attitudes, and behaviors was noted for all 6 learning objectives. The mean Net Promoter Score reported by the learners was 11/100.</p><p><strong>Conclusions: </strong>Overall, the strategy of disseminating disaster curricula through the funded disaster networks with local site champions was effective, though barriers were identified for future efforts to reach all programs interested. Completion of the module was associated with self-reported achievement of all learning objectives.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310301","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 Benefits and Evolutions of Shared Research Cores: A Novel Pediatric Emergency Department Research Program.","authors":"Brandon Kappy, Bobbe Thomas, Monika Goyal, Ioannis Koutroulis","doi":"10.1097/PEC.0000000000003430","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003430","url":null,"abstract":"<p><p>Shared research cores are centralized facilities that provide investigators with advanced equipment and services under fee-for-service arrangements. By pooling costs among investigators, cores offer access to otherwise cost-prohibitive technology and allow researchers to utilize specialized staff without taking on retraining costs. The structure of shared cores promotes a team-based approach to research where users can learn technical skills and collaborate with investigators from different fields. Research cores have become an essential part of universities and academic healthcare centers, providing the infrastructure for some of the most important scientific innovations of the past decade. Recently, shared cores have expanded to include clinical research programs that offer investigators improved access to translational services and study scalability, with some cores specializing in unique patient populations and disease processes. Yet, as most clinical cores are embedded in outpatient facilities, they often exclude patients who experience trauma and acute illnesses. This article discusses a novel pediatric emergency department research core-like program and the value that such a program brings to investigators studying emergent symptoms, underserved populations, and acute presentations of chronic diseases. As emergency departments are always open, they offer expanded recruitment windows and can embed interventions into existing patient flow processes. Housing a research core or core-like program within the department of emergency medicine also allows the program to subsidize internal projects and collaborate with other divisions across the institution.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286041","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":"Evaluating a Triage Screen in a Pediatric Emergency Department to Improve Appropriate Identification of Immigrant Populations.","authors":"Leen Bakdash, Amy Zeidan, Anna Q Yaffee","doi":"10.1097/PEC.0000000000003428","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003428","url":null,"abstract":"<p><strong>Objectives: </strong>One in 4 children in the United States is part of an immigrant family. Children in immigrant families (CIFs) experience significant disparities in health care quality and access in the pediatric emergency department (PED). Insufficient utilization of interpreters for those with non-English language preference contributes to these disparities. CIFs are often excluded from clinical research studies, impairing efforts to improve their health care access. We evaluated an immigration and language triage screen in a PED to better identify CIF.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of attitudes toward a triage screen identifying country of origin and language preference. Caregivers who entered the assessment/triage room of an urban PED were asked about the caregiver's and child's country of birth, year of arrival to the US, and preferred language. Patients who were born outside the United States or had a caregiver born outside the United States were identified as CIF. Caregivers of CIF were asked to participate in a survey to understand their attitudes toward the screen. Demographics and attitudes toward the triage screen were then analyzed using basic descriptive statistics.</p><p><strong>Results: </strong>CIF were identified in 252 or 21.9% of screened encounters. In 51.2% (n=129) of these encounters, caregivers completed a survey. Ninety-two percent of surveyed families were comfortable with the triage screen. In contrast, almost one third of families endorsed that they would have felt uncomfortable had they been asked their immigration status directly. Eighteen percent of families who needed an interpreter did not have this need identified until after the triage screen.</p><p><strong>Conclusions: </strong>Our findings suggest that a language and immigration triage screen in a PED is feasible and acceptable to improve the identification of CIF and their language needs in electronic medical records with the goal of improving the quality of health care and research for this population.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286040","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 Influence of Social Media on Pediatric Emergency Medicine Fellowship Applicant Recruitment.","authors":"Amelia Bray-Aschenbrenner, Susan May Wiltrakis","doi":"10.1097/PEC.0000000000003422","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003422","url":null,"abstract":"<p><strong>Background: </strong>The shift from in-person to virtual interviews for medical trainees since the COVID-19 pandemic has resulted in an increase in residency and fellowship program social media (SoMe) accounts. The views of PEM applicants and PEM fellowship program directors (PDs) toward program SoMe are unknown.</p><p><strong>Methods: </strong>Surveys evaluating PEM fellowship applicants and PEM fellowship PD attitudes and perceptions of program SoMe accounts were reviewed and approved by the AAP Section of Emergency Medicine (SOEM) Subcommittee of Fellowship Director's Survey Committee. The survey link was distributed to 90 PEM fellowship PDs via the AAP SOEM Subcommittee of Fellowship Directors listserv, who distributed the survey to matched fellows from the 2024 NRMP fellowship match cycle. Data from the 2 surveys were analyzed via simple proportions and descriptive statistics.</p><p><strong>Results: </strong>Twenty-eight percent of applicants (56/200) and 34% of PEM Fellowship PDs (31/90) responded. Most applicants used SoMe (98%), with the majority using Instagram (83%). Seventy-nine percent of applicants reported visiting the SoMe accounts of some or all programs they applied to. Applicants reported minimal influence of SoMe on their decision to apply (73% responding negatively) or rank programs (77% responding negatively). Most programs have a fellowship or division SoMe presence (71%), predominantly on Instagram (91%). Of fellowship-specific SoMe, 76% were created in the past 3 years, with the primary purpose of fellowship recruitment (70%). Almost half of the PD respondents felt that SoMe had little to no influence on applicants' decision to apply or rank a program, with 46% and 49% respectively responding negatively.</p><p><strong>Conclusions: </strong>This study demonstrates that SoMe is a popular way for PEM fellowship applicants to engage with programs before applying, though it may be less impactful in applicants' decisions to apply to or match rank a program. Fellowship PDs can use these data to tailor content toward more meaningful recruitment efforts.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249152","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":"Predicting Pancreatitis in Children With Blunt Abdominal Trauma.","authors":"Matthew S Marks, Anna Liveris, Stephen M Blumberg, Srinivas H Reddy, James A Meltzer","doi":"10.1097/PEC.0000000000003421","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003421","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the characteristics of children presenting with blunt abdominal trauma who have pancreatitis, and to describe the performance of the Pediatric Emergency Care Applied Research Network (PECARN) prediction rule in identifying pancreatitis.</p><p><strong>Methods: </strong>This was a secondary analysis of data collected by the PECARN Intra-abdominal Injury Study Group. The data set included 12,044 patients <18 years who presented to the Emergency Department with blunt abdominal trauma. Risk factors were evaluated for association with pancreatic injury using bivariate analysis.</p><p><strong>Results: </strong>Of the children with blunt abdominal trauma, 7384 (61%) were males, and the median age was 11 years (interquartile range, 5 to 15 years); 761 (6%) had an intra-abdominal injury and 105 (1%) had pancreatitis. Children with pancreatitis were more likely to be hospitalized [85 (81%) vs. 5906 (49%), P <0.001], require surgery [21 (20%) vs. 111 (1%), P<0.001], or die within 30 days [4 (4%) vs. 96 (1%), P=0.01], than those without. Pancreatic enzyme testing was ordered inconsistently in the Emergency Department [5889 (49%)]. Computed tomography was performed in 37 (35%) patients with pancreatitis, but was positive in only 29 (78%). The PECARN prediction rule, when applied to pancreatitis, demonstrated a sensitivity of 99% (95% CI, 95%-100%) and a specificity of 42% (95% CI, 41%-43%).</p><p><strong>Conclusions: </strong>Traumatic pancreatitis is uncommon but associated with significant morbidity and mortality. Pancreatic enzyme testing is not ordered consistently. Computed tomography misses about a quarter of cases of pancreatitis. Utilizing the PECARN prediction rule can help identify children at risk for pancreatic injuries, potentially leading to improved management and outcomes.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234783","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":"Emergency Medical Services Clinician Accuracy Using the Pediatric Observation Priority Score.","authors":"Caleb E Ward, Trang Ha, Graeme Morland-Tellez, Haroon Shaukat, Damian Roland, James M Chamberlain","doi":"10.1097/PEC.0000000000003425","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003425","url":null,"abstract":"<p><strong>Objectives: </strong>One barrier to including low-acuity children in alternative EMS disposition programs is a lack of triage tools to identify children at low risk of deterioration. The Pediatric Observation Priority Score (POPS) is a triage tool developed in the United Kingdom, incorporating vital signs, clinical observations, and medical history. Our objectives were to determine (1) whether US EMS clinicians can accurately assign a POPS in a controlled setting and (2) whether there is a difference in accuracy between paramedics and emergency medical technicians (EMTs).</p><p><strong>Methods: </strong>We conducted an observational study with EMS clinicians. Participants were provided with an overview of the POPS and then reviewed 10 patient videos. Participants calculated a POPS for each case. Physicians with expertise in pediatric EMS and medical education independently assigned the reference POPS. We calculated the proportion of assigned POPS within 2 points of the reference score and compared the accuracy of paramedics and EMTs.</p><p><strong>Results: </strong>We recruited 50 participants (32% paramedics, 68% EMTs). The proportion of assigned POPS within 2 points of the reference was 0.99 (95% CI: 0.97-0.99), and for individual scenarios ranged from 0.94 (0.84-0.98) to 1.0 (0.93-1.0). The component with the greatest deviation from the reference score was Gestalt clinician concern. There was no significant difference in accuracy between paramedics and EMTs.</p><p><strong>Conclusions: </strong>Both paramedics and EMTs accurately assigned POPS in this controlled setting. Further research is needed to determine whether EMS clinicians can accurately assign the POPS to actual patients and identify POPS thresholds to guide patient disposition.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226271","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":"Epidemiology, Intent, and Severity of Nonpowder Firearm Injuries in Patients Presenting to Pediatric Emergency Departments.","authors":"Lauren M Ameden, Elizabeth R Alpern, Monika K Goyal, Lawrence J Cook, Katie A Donnelly","doi":"10.1097/PEC.0000000000003426","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003426","url":null,"abstract":"<p><strong>Objective: </strong>To describe the epidemiology, intent, and severity of nonpowder firearm injuries in pediatric emergency department (ED) visits.</p><p><strong>Methods: </strong>This was a review of visits by patients 0 to 17 years old who presented to EDs within the Pediatric Emergency Care Applied Research Network (PECARN) Registry with a potential nonpowder firearm injury between 2012 and 2019. Visits were identified by International Classification of Diseases (ICD) codes, with review of discrete and narrative data, including demographics, affected body region, intent of injury, age of the person inflicting the injury, interventions in the ED, and disposition.</p><p><strong>Results: </strong>Eight hundred three potential ED visits for nonpowder firearm injuries were identified, with 774 meeting inclusion criteria. The average age of the patient injured was 11.7 years, and most were male (86.7%). Common body parts injured were the eye (34.0%), upper extremity (19.9%), and face (14.7%). In total, 14.6% of injuries were reported as assaultive, and 60.6% were reported as accidental. The shooter was identified as a child or adolescent in 66.5% and an adult in 2.8% of narratives. In the ED, 74.2% of patients had imaging studies obtained, 73.0% had sub-specialists consulted, and 23.9% had procedures performed. 1 in 5 injuries resulted in either admission (11.7%), emergent operative treatment (6.9%), or death (0.1%).</p><p><strong>Conclusions: </strong>Nonpowder firearms remain a source of preventable injuries in children and involve substantial health care resources. Most commonly, these injuries are inflicted by children and are accidental, though assaults also account for at least 1 in 7 injuries. These data emphasize the need for further injury prevention efforts directed at nonpowder firearms.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216563","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":"Trends in the Management of Complex Febrile Seizures Across Children's Hospitals.","authors":"James F Buscher, Chelsey R McConnell, Laura A Ortmann, Courtney McLean, Ellen Kerns, Ricky Flores, Elizabeth Lyden, Jihyun Ma, Jina Yi, Nathaniel P Goodrich, Kari Simonsen, Ashley Deschamp, Sookyong Koh, Aleisha M Nabower","doi":"10.1097/PEC.0000000000003413","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003413","url":null,"abstract":"<p><strong>Background and objectives: </strong>Resource use for managing simple febrile seizures decreased after the publication of guidelines. Less is known about resource use for complex febrile seizures (CFS), for which no guidelines exist. The objective of this study was to evaluate trends in management of CFS.</p><p><strong>Methods: </strong>Using the Pediatric Health Information System (PHIS) Database, we retrospectively reviewed encounters of children 6 months to 6 years old presenting to the emergency department for a first encounter for CFS between January 1, 2009 and December 31, 2021. Data were compared between 3 distinct periods as follows: (1) before release of the simple febrile seizures guidelines-January 1, 2009 to January 31, 2011, and 2 subsequent 5-year time periods postguideline release; (2) February 1, 2011 to January 31, 2016; and (3) February 1, 2016 to December 31, 2021. The primary outcome was use of medical resources. Demographic and outcomes data were collected, including ultimate diagnosis with serious condition, including central nervous system infection, trauma, intracranial mass, or stroke.</p><p><strong>Results: </strong>A total of 17,865 encounters from 36 children's hospitals were included for analysis. The mean age of participants was 1.89 years, 0.3% were coded as having status epilepticus, and 4.7% were admitted to the pediatric intensive care unit. The percentages of children admitted and receiving neuroimaging, labs, lumbar puncture, or EEG decreased over time, while drug screens and HSV testing increased. Fewer children received antiseizure medications, antibiotics, or acyclovir across the time periods. Median length of stay decreased in period 3 relative to period 1 (1.33 vs. 1.55 days). New serious diagnosis after presentation remained low at 0.2%. There was significant variation in resource use across hospitals.</p><p><strong>Conclusion: </strong>Resource use for CFS decreased across most domains since 2009 without an increase in serious medical diagnoses. These findings highlight a potential opportunity to standardize resource use when managing CFS.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209124","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}