Journal of perioperative practice最新文献

{"title":"Development and pilot evaluation of a nurse-led Hydration, Early mobilisation, Active breathing and Limb Assessment checklist to support postoperative recovery after abdominal surgery.","authors":"James Raj K","doi":"10.1177/17504589261468689","DOIUrl":"https://doi.org/10.1177/17504589261468689","url":null,"abstract":"<p><strong>Background: </strong>Postoperative nursing assessment plays an important role in helping detect any possible complication and enabling functional rehabilitation following the operation due to the risk associated with fluid imbalance, decreased mobility, respiratory problems, and leg complications such as deep vein thrombosis and pulmonary embolism.</p><p><strong>Aim: </strong>The aim of the study was to design and test the piloted Hydration, Early mobilisation, Active breathing and Limb Assessment Monitoring checklist developed in collaboration with the local nursing team. The study evaluated the validity and reliability of this tool.</p><p><strong>Methods: </strong>Development of the Hydration, Early mobilisation, Active breathing and Limb Assessment checklist involved conducting a focused narrative review of postoperative care literature and routine practice of nurses working in the clinical context of postoperative abdominal surgical units. The face and content validities of the items were analysed by seven experts from various professional disciplines rating the relevance and clarity of the items; content validity indices at item level and at scale level were determined according to conventional methodology. The face validity and feasibility of the checklist were tested by the clinical nurses practicing postoperative abdominal surgical care. Piloting was conducted on adult patients undergoing elective abdominal surgery. Two trained nurses independently completed the checklist for each patient. Inter-rater reliability was estimated using kappa coefficients and intraclass correlation coefficients.</p><p><strong>Results: </strong>There were high levels of agreement among experts regarding the relevance and comprehensibility of items, with high content validity indices at the scale level confirming the content validity of the Hydration, Early mobilisation, Active breathing and Limb Assessment checklist. Nurses who are currently practicing reported that the checklist is comprehensible, clinically relevant, and easy to conduct in the context of routine care delivery. The checklist generated an intraclass correlation coefficient of 0.88, with kappa coefficients at the item level falling between 0.76 and 0.91, reflecting moderate to high inter-rater reliability.</p><p><strong>Conclusion: </strong>This pilot study provides initial evidence supporting the use of the Hydration, Early mobilisation, Active breathing and Limb Assessment checklist as a valid, reliable and practicable tool led by nurses for structured postoperative monitoring after abdominal surgery. There is a need for more multicentre studies that will focus on setting appropriate Hydration, Early mobilisation, Active breathing and Limb Assessment scores and developing the corresponding patient escalation protocol.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"17504589261468689"},"PeriodicalIF":0.9,"publicationDate":"2026-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148698129","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":"Enhanced recovery after surgery protocols in resource-constrained settings: Feasibility, impact and cost-neutral prioritisation from a 15-month prospective observational study.","authors":"Rudraksh Kesharwani, Arundati Ramdas Raikar, Saurabh Raj, Sheryl Francisca Godinho, Gaddam Medha, Abhimanyu Vishnoi, Tusharindra Lal, Rehan Ali, Raj Vaghani","doi":"10.1177/17504589261464837","DOIUrl":"https://doi.org/10.1177/17504589261464837","url":null,"abstract":"<p><strong>Background: </strong>Enhanced recovery after surgery (ERAS) protocols improve postoperative outcomes in high-income settings, but evidence supporting their implementation in resource-constrained hospitals remains limited.</p><p><strong>Aim: </strong>To evaluate perioperative practices and postoperative complications following common gastrointestinal surgery and identify feasible, cost-neutral ERAS components for prioritised implementation in a resource-constrained setting.</p><p><strong>Methods: </strong>A 15-month prospective observational study was conducted in a semi-urban government teaching hospital in India. Adult patients undergoing appendectomy, cholecystectomy, hollow viscus perforation repair, or surgery for intestinal obstruction were consecutively enrolled. Perioperative practices and postoperative complications were prospectively documented. Observed deviations from evidence-based care were mapped to ERAS principles and prioritised according to preventability, feasibility, and cost neutrality.</p><p><strong>Results: </strong>Among 522 patients, 68.6% underwent emergency surgery and 45.6% developed at least one postoperative complication. The most frequent complications were surgical site infection (24.3%), postoperative ileus (19.7%), sepsis (16.0%), pneumonia (13.4%), and catheter-associated urinary tract infection (9.8%). Common perioperative deviations included prolonged fasting, delayed oral intake and mobilisation, prolonged urinary catheterisation and nasogastric tube use, and incorrect timing of prophylactic antibiotics. Mapping these findings to ERAS principles identified a limited set of high-impact, cost-neutral interventions targeting the most common complications.</p><p><strong>Conclusion: </strong>Selective implementation of prioritised, cost-neutral ERAS components offers a pragmatic strategy to reduce postoperative morbidity and improve surgical outcomes in resource-constrained hospitals without increasing healthcare expenditure. Prospective interventional studies are needed to validate this approach.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"17504589261464837"},"PeriodicalIF":0.9,"publicationDate":"2026-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702055","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":"Safe surgery checklist: Barriers and facilitators for its implementation.","authors":"Vander Trindade Pereira, Simone Seixas da Cruz, Isaac Suzart Gomes-Filho, Aline Misuzaki Imoto, Débora Barbosa Ronca, Josicélia Estrela Tuy Batista, Ana Claudia Morais Godoy Figueiredo","doi":"10.1177/17504589261464832","DOIUrl":"https://doi.org/10.1177/17504589261464832","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to identify barriers and facilitators to the implementation of the Surgical Safety Checklist through a systematic review.</p><p><strong>Methods: </strong>A systematic search was conducted in PubMed, Virtual Health Library (VHL), Embase, Scopus, and Web of Science using the descriptors 'Communication Barriers', 'Patient Safety', 'Checklist', and 'Surgical Procedures'. The strategy was peer-reviewed using the Peer Review of Electronic Search Strategies tool. Data extraction included study characteristics, sample size, sociodemographic data, barriers, and facilitators. Proportion meta-analyses estimated prevalence with 95% confidence intervals.</p><p><strong>Results: </strong>Forty-three studies were included. The meta-analysis showed that 22% of professionals considered the checklist a waste of time, 44% reported resistance or disbelief in its benefits, and 14% perceived it as redundant. All outcomes demonstrated substantial heterogeneity.</p><p><strong>Conclusion: </strong>Although the Surgical Safety Checklist enhances patient safety, its implementation is hindered by institutional barriers, team resistance, and workload pressures, limiting full adherence.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"17504589261464832"},"PeriodicalIF":0.9,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674307","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":"Redesigning the general surgery gold patient protocol in a tertiary centre.","authors":"Sheheryaar Ahmed, Annabelle Johnston, Ryan Peysner, Arjun Ardeshana, Megan Brocken, Kulbir Mann","doi":"10.1177/17504589261468687","DOIUrl":"https://doi.org/10.1177/17504589261468687","url":null,"abstract":"<p><strong>Background: </strong>Emergency theatre capacity is under increasing strain due to rising demand and workforce pressures, contributing to delays and poor compliance with national targets. By prioritising patient selection for low-complexity cases/day-case discharge, we implemented a novel Golden Patient Protocol in a multi-specialty tertiary centre and assessed the impact on surgical wait times and overall theatre flow.</p><p><strong>Method: </strong>The golden patient was agreed upon between surgical/anaesthetic registrars, taking into consideration the urgency/fitness of patient and anaesthetic/technical difficulties. Eligible patients were identified early and scheduled for a huddle and sent for by 08:30. Data were collected over four cycles: 1 month before and after the Golden Patient Protocol introduction, following a 4-month 'cooling-off' (post-Golden Patient Protocol) period and at 24 months, using the trust theatre management system (TMIS). For each patient we obtained 'send time', 'time-in-anaesthetic-room', and 'start-time' aka knife-to-skin.</p><p><strong>Results: </strong>Across 86 patients (pre-Golden Patient Protocol <i>n</i> = 16; Golden Patient Protocol <i>n</i> = 24; post-Golden Patient Protocol <i>n</i> = 20; 24 months <i>n</i> = 26), median 'time-sent' improved from 08:54 pre-Golden Patient Protocol to 08:28 post-Golden Patient Protocol and remained improved at 08:41 at 24 months (<i>p</i> = 0.013). Median 'time in anaesthetic room' improved from 09:10 to 08:47 and was sustained at 08:58 at 24 months (<i>p</i> = 0.046). Significant pairwise differences persisted between pre-Golden Patient Protocol and both post-Golden Patient Protocol and 24-month cohorts. 'Knife-to-skin' showed a trend towards improvement (09:39 to 09:24; <i>p</i> = 0.244).</p><p><strong>Conclusion: </strong>The Golden Patient Protocol significantly improved early emergency theatre flow for lower-complexity cases while supporting registrar autonomy and reducing delays to first send. Although knife-to-skin improvements were modest, earlier patient preparation and anaesthetic room arrival demonstrated statistically and clinically meaningful gains that were sustained at 24-month follow-up. This low-cost, scalable intervention aligns with Getting It Right First Time priorities and represents a pragmatic strategy to improve emergency theatre efficiency and workflow sustainability.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"17504589261468687"},"PeriodicalIF":0.9,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148608234","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":"Human factors and surgical never events: A two-phase updated systematic review applying the SHEEP model.","authors":"Kris Birney","doi":"10.1177/17504589261464838","DOIUrl":"https://doi.org/10.1177/17504589261464838","url":null,"abstract":"<p><p>Surgical never events, including wrong-site surgery, retained foreign objects, and wrong implants or prostheses, persist globally despite successive patient safety frameworks. Human factors are consistently identified as contributors, yet prior systematic reviews have not applied a structured health care-specific analytical taxonomy to this evidence base. This two-phase updated systematic review searched MEDLINE, CINAHL, and specialist journals from inception to December 2025, identifying 39 studies. Human factors findings were mapped against the five domains of the SHEEP model (Systems, Human Interaction, Equipment, Environment, Personal). Human Interaction and Systems were the dominant domains, co-occurring in the majority of studies. Equipment was the least prevalent domain, indicating that technology remains an adjunct rather than a primary prevention strategy. Sustained reduction in surgical never events requires investment in checklist fidelity, speaking-up culture, and organisational responses that prioritise learning over blame rather than reliance on guidance alone.Summary of Major ThemeSurgical never events, including wrong-site surgery, retained foreign objects, and wrong implants or prostheses, represent a persistent patient safety challenge despite successive national and international policy frameworks. Human factors are consistently identified as contributory across the published literature, yet no prior systematic review has applied a structured health care-specific analytical taxonomy to this evidence base. This two-phase updated systematic review applied the Systems, Human Interaction, Equipment, Environment and Personal (SHEEP) model across 39 included studies spanning inception to December 2025, producing domain-level frequency data unavailable from prior narrative reviews. Human Interaction and Systems were identified as the dominant domains, co-occurring in 77% of studies, confirming that never events arise from the simultaneous breakdown of communication and organisational safety systems rather than from isolated individual failures. Equipment was the least prevalent domain, indicating that technology-based prevention strategies remain an adjunct to cultural and systems change.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"17504589261464838"},"PeriodicalIF":0.9,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593692","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":"Early fascia iliaca block documentation in hip-fracture care: A retrospective perioperative pathway audit.","authors":"Mahmoud Mersal, Zahid Moon, Ali Ullah Ghauri, Aligha Purushothaman, Sara Elsaidy, Khandaker Touqeer Ahmed, Faisal Karim, David Yousefi Azimi, Ahmed Hamed","doi":"10.1177/17504589261462323","DOIUrl":"https://doi.org/10.1177/17504589261462323","url":null,"abstract":"<p><p>Fascia iliaca block is recommended as part of multimodal analgesia for patients with hip fracture, but early delivery and timestamped documentation are difficult to confirm in routine practice. This retrospective clinical audit assessed whether early delivery could be demonstrated from routine documentation in an operative hip-fracture pathway. The primary audit measure was fascia iliaca block documented within 2 h of emergency department arrival; exploratory outcomes included 48-h oral morphine equivalent dose, postoperative delirium, 30-day mortality and length of stay. Of 204 analysable episodes, 13 (6.4%; 95% confidence interval 3.8% to 10.6%) had fascia iliaca block documented within 2 h. A further 155 of 359 cleaned operative episodes (43.2%) had no recorded fascia iliaca block timing category. Exploratory outcome comparisons were underpowered because the early-delivery group was small. The findings identify a practical perioperative documentation and pathway gap requiring targeted improvement, mandatory timestamped recording and repeat audit.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"17504589261462323"},"PeriodicalIF":0.9,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585252","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":"Rethinking safety culture assessment in the operating room: From crew resource management to the Safety Attitudes Questionnaire - Operating Room Version (SAQ-OR).","authors":"Aki Enomoto","doi":"10.1177/17504589261456037","DOIUrl":"https://doi.org/10.1177/17504589261456037","url":null,"abstract":"<p><strong>Background: </strong>Patient safety in the operating room (OR) and perioperative settings relies on effective teamwork, communication, and safety culture. Over the past three decades, human factors research has contributed to the development of tools to assess safety attitudes; however, their ability to capture the unique characteristics of OR environments remains unclear.</p><p><strong>Objective: </strong>This scoping review aimed to examine the evolution of safety culture assessment in the OR, identify key trends, and explore limitations of existing approaches.</p><p><strong>Methods: </strong>A literature-informed narrative overview was conducted focusing on studies assessing safety culture in OR teams, particularly those using the Safety Attitudes Questionnaire (SAQ), its operating room version (SAQ-OR), and related instruments.</p><p><strong>Results: </strong>Nineteen studies were included. Most employed cross-sectional designs, while a limited number evaluated interventions such as surgical safety checklists and team training programmes. SAQ-based instruments were the most commonly used. Most studies originated from Europe and North America, with few from Asian health care settings.</p><p><strong>Conclusions: </strong>Safety culture research in the OR has primarily focused on measurement rather than intervention. Existing tools may not fully reflect the context-specific characteristics of OR environments. Future research should develop approaches that better reflect communication and role-related dynamics to support teamwork and safety in perioperative practice.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"17504589261456037"},"PeriodicalIF":0.9,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424706","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":"Mind over medicine - Psychological interventions for preoperative anxiety: A review of recent literature.","authors":"Diksha Deb, Shahzadi Malhotra, Arvind Kr Arya, Ajanya Ak","doi":"10.1177/17504589261462315","DOIUrl":"https://doi.org/10.1177/17504589261462315","url":null,"abstract":"<p><strong>Introduction: </strong>Preoperative anxiety is a common distressing phenomenon that negatively affects surgical outcomes and postoperative recovery. This narrative review synthesised evidence on effectiveness of non-pharmacological interventions in managing preoperative anxiety.</p><p><strong>Methodology: </strong>A structured literature search was conducted across PubMed, Hinari Research4Life, Cochrane Library, and Directory of Open Access Journals, focusing on studies evaluating non-pharmacological interventions in surgical patients, published within the last 5 years. Out of 359 total records identified, only 24 studies met inclusion criteria following structured screening process using Scale for the Assessment of Narrative Review Articles guidelines.</p><p><strong>Results: </strong>The findings suggest that various psychological interventions, including virtual reality, music therapy, mindfulness-based approaches, and cognitive-behavioural techniques, are associated with reductions in preoperative anxiety in several patient populations. These interventions offer non-invasive and potentially accessible means of improving perioperative care in well-resourced settings. However, variability in study design, intervention protocols, and outcome measures limits direct comparison across studies. As a narrative synthesis, the findings should be interpreted with consideration of these methodological differences.</p><p><strong>Conclusion: </strong>Non-pharmacological interventions, particularly virtual reality and mindfulness, are effective alternatives/adjuncts to pharmacological methods for reducing preoperative anxiety. However, heterogeneity of interventions and outcome measures limits generalisability. Future research should include large-scale randomised controlled trials, standardisation of outcome measures, and culturally adapted studies in different populations.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"17504589261462315"},"PeriodicalIF":0.9,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424656","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":"Neuroanaesthesia in traumatic brain injury with morbid obesity: Perioperative strategy.","authors":"Albinus Yunus Cobis, Dewi Yulianti Bisri, Iwan Abdul Rachman","doi":"10.1177/17504589251388894","DOIUrl":"10.1177/17504589251388894","url":null,"abstract":"<p><p>Traumatic brain injury in morbidly obese patients (body mass index ⩾ 35 kg/m²) presents complex perioperative challenges due to compounded respiratory, cardiovascular, and metabolic dysfunctions. Reduced functional residual capacity, obstructive sleep apnoea, and increased thoracoabdominal pressures impair oxygenation and elevate intracranial pressure. Cardiovascular comorbidities such as hypertension and arrhythmias further compromise cerebral perfusion. Altered pharmacokinetics in obesity demand weight-adjusted anaesthetic dosing to avoid over- or under-sedation. This narrative review highlights the need for a structured, evidence-based approach involving preoperative optimisation, advanced airway planning, lung-protective ventilation, and invasive haemodynamic monitoring to maintain cerebral perfusion pressure. Postoperative strategies should include cautious extubation, continuous positive airway pressure or high-flow nasal oxygen, multimodal analgesia, and close neurological monitoring. Dexmedetomidine offers neuroprotective advantages with minimal respiratory depression. Multidisciplinary collaboration among anaesthesia, neurosurgery, and intensive care teams is critical to minimising perioperative risks and improving outcomes in this high-risk population.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"418-423"},"PeriodicalIF":0.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145565722","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":"Implementing a multidisciplinary perioperative pathway in a public hospital: First-year outcomes and lessons from real-world practice.","authors":"Patrícia Sousa, Jhonny Abreu, Ricardo Rodrigues, Catarina Lemos, Mariana Luís","doi":"10.1177/17504589261440246","DOIUrl":"10.1177/17504589261440246","url":null,"abstract":"<p><p>BackgroundMultidisciplinary perioperative pathways are associated with improved outcomes in colorectal surgery, but evidence on real-world implementation is still scarce, especially in limited-resource settings.</p><p><strong>Methods: </strong>An audit was conducted targeting first-year outcomes after implementation of the Optimised Recovery Programme in Colorectal Surgery at a tertiary public hospital since February 2024. Results were compared with a historical pre-implementation cohort treated in 2022. Outcomes and quality indicators were analysed using descriptive statistics.</p><p><strong>Results: </strong>Despite a higher proportion of patients with severe systemic disease in the optimised recovery cohort, mean hospital length of stay decreased substantially, as well as readmission rates, with no increase in 30-day mortality.</p><p><strong>Conclusions: </strong>Real-world implementation of a multidisciplinary perioperative pathway was feasible and safe, even in a high comorbidity population and limited-resource setting. These findings support the value of structured perioperative systems of care and multidisciplinary coordination in routine clinical practice.</p>","PeriodicalId":35481,"journal":{"name":"Journal of perioperative practice","volume":" ","pages":"449-456"},"PeriodicalIF":0.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783576","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}