BJGP Open最新文献

{"title":"Predictors of treatment outcomes for patients with persistent physical symptoms in primary care: findings from a cluster randomised controlled trial.","authors":"Cathrine Abrahamsen, Knut Reidar Wangen, Morten Lindbaek, Erik Lønnmark Werner","doi":"10.3399/BJGPO.2024.0004","DOIUrl":"10.3399/BJGPO.2024.0004","url":null,"abstract":"<p><strong>Background: </strong>Persistent physical symptoms (PPS) are consistently prevalent among primary care patients. PPS can negatively affect quality of life, healthcare costs, and work participation. In a previous study, we found substantially improved outcomes and reduced sick leave for patients treated by a work-focused communication tool, known as the Individual Challenge Inventory Tool (ICIT), compared with a control group.</p><p><strong>Aim: </strong>To examine predictors of treatment outcome in patients who received treatment by ICIT, delivered by the patient's GP.</p><p><strong>Design & setting: </strong>This study is based on the findings of our previous cluster randomised controlled trial undertaken in Norway.</p><p><strong>Method: </strong>Regression analyses of the intervention group were used to identify predictors (all measured at baseline) of improvements in Patient Global Impression of Change (PGIC) and sick leave after 11 weeks follow-up.</p><p><strong>Results: </strong>Living alone predicted improvement in the adjusted model (odds ratio [OR] 4.03, 95% confidence interval [CI] = 1.33 to 12.25, <i>P</i> = 0.014). Receiving long-term benefits predicted improved PGIC in both the unadjusted (OR 2.30, 95% CI = 1.21 to 4.39, <i>P</i> = 0.011) and adjusted models (OR 2.46, 95% CI = 1.04 to 5.83, <i>P</i> = 0.040). In addition, living alone predicted reduced sick leave in the adjusted model (OR 3.23, 95%CI = 1.11 to 9.42, <i>P</i> = 0.032).</p><p><strong>Conclusion: </strong>In general, there were few factors to predict the outcome of the work-focused communication tool. We therefore suggest that this work-focused communication tool is applicable to most patients with PPS. GPs may consider using the ICIT for all primary care patients who exhibit ineffective coping strategies in their daily lives and work, especially those who live alone.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793740","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":"Interventions in ambulatory healthcare settings to reduce social isolation among adults aged 18-64: a systematic review.","authors":"Kavya Anchuri, Liane Steiner, Roxana Rabet, Amy Craig-Neil, Ellah San Antonio, Oluwasegun Jko Ogundele, Melanie Seabrook, Ceinwen Pope, Serina Dai, Andree Schuler, Carolyn Ziegler, Andrew David Pinto","doi":"10.3399/BJGPO.2023.0119","DOIUrl":"10.3399/BJGPO.2023.0119","url":null,"abstract":"<p><strong>Background: </strong>Social isolation is associated with increased all-cause and premature mortality, poor chronic disease management, and mental health concerns. Limited research exists on interventions addressing social isolation among individuals under 65 despite its increasing prevalence among young and middle-aged adults.</p><p><strong>Aim: </strong>To identify interventions from the extant literature that address social isolation and loneliness in ambulatory healthcare settings in adults aged 18-64 and to identify elements of successful studies for future intervention design.</p><p><strong>Design & setting: </strong>Systematic review of interventions targeting social isolation in community-dwelling adults aged 18-64 within ambulatory healthcare settings.</p><p><strong>Method: </strong>A search strategy was developed to identify relevant articles in the following databases: Ovid MEDLINE, Embase, EBM Reviews, Scopus, CINAHL, and PsychInfo. Data were extracted on study design and setting, intervention type, outcome related to social isolation/loneliness, and scale of measure used.</p><p><strong>Results: </strong>25 078 citations were identified and underwent title and abstract screening. 75 articles met our inclusion criteria and were synthesised, including an assessment of bias. Effective interventions were delivered in community health settings, incorporated a group component, and used digital technologies. They also addressed the association between mental health and social isolation using cognitive-behavioural therapy (CBT) approaches and enhanced self-management and coping strategies for chronic conditions through psycho-educational interventions.</p><p><strong>Conclusion: </strong>Future research should prioritise adults living in low-income and middle-income countries, racialised individuals, as well as those with fewer educational opportunities. There is also a need to advance research in primary care settings, where longitudinal patient-provider relationships would facilitate the success of interventions.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140959923","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":"Improving discharge summaries from hospital with a brief recommendation text box: results from a nationwide survey.","authors":"Thorbjørn H Mikkelsen, Jesper B Nielsen, Maria M Storsveen, Jens Søndergaard","doi":"10.3399/BJGPO.2024.0046","DOIUrl":"10.3399/BJGPO.2024.0046","url":null,"abstract":"<p><strong>Background: </strong>Danish hospital physicians are obliged to mark discharge summaries addressing whether the GP is recommended to follow up the patient, as well as stating suggested follow-up actions in a recommendation text box.</p><p><strong>Aim: </strong>To investigate GPs' experiences with the recommendation text box in discharge summaries.</p><p><strong>Design & setting: </strong>A questionnaire was sent to a representative sample of GPs in Denmark in January 2021.</p><p><strong>Method: </strong>A questionnaire was prepared for GPs based on background material, focus group interviews, and discussions with GPs and hospital physicians. It was subsequently pilot-tested by fellow researchers and GPs, and revised before the survey.</p><p><strong>Results: </strong>Seventy-two per cent of the GPs surveyed 'totally agree' or 'partly agree' that the recommendation text box is easy to find. In addition, our results show significant differences on how difficult the recommendation box is to find on different software. Sixty-three per cent 'totally agree' or 'partly agree' that the recommendation text box provides brief and precise information about the recommended follow-up.</p><p><strong>Conclusion: </strong>GPs generally find that the recommendation text box provides them with brief and precise information about the recommended follow-up. In addition, the software used by the GPs has a significant influence on how the recommendation text box is to find.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879621","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":"Glaucoma treatment and deprivation: time-series analysis of general practice prescribing in England.","authors":"Jeremy Hooper, Cecilia Helen Fenerty, James Roach, Robert Anthony Harper","doi":"10.3399/BJGPO.2024.0005","DOIUrl":"10.3399/BJGPO.2024.0005","url":null,"abstract":"<p><strong>Background: </strong>Despite advances in glaucoma management, topical eyedrop treatment has been paramount, with prostaglandin analogues (PGAs) being first-line agents. While late presentation is linked with deprivation, there is no recent research examining associations between deprivation and prescribing within primary care.</p><p><strong>Aim: </strong>To explore PGA prescribing in general practice over a 6-year timeline, assessing associations with deprivation.</p><p><strong>Design & setting: </strong>Analysis of NHS Business Services Authority (NHSBSA) data for general practice prescribing in England from April 2016-March 2022.</p><p><strong>Method: </strong>Glaucoma treatments by GP prescribers were extracted, identifying ~9.11-9.58 million prescriptions/annum. Data were linked to Index of Multiple Deprivation (IMD) quintiles of GP practices. Crude rates per 1000 population were calculated using population data from NHS Digital. Time-series analyses facilitated comparison in prescribing nationally and in deprived areas. Autoregressive Integrated Moving Average (ARIMA) modelling facilitated measurement of synchrony between time series using cross correlation.</p><p><strong>Results: </strong>PGAs and fixed combination eyedrops accounted for approximately two-thirds of glaucoma-related prescribing. Prescriptions per month increased slightly over a 6-year timeline, but rates per 1000 population reduced in 2020-2021 during the COVID-19 pandemic. The number of PGA prescriptions dispensed in deprived areas was lower than all other quintiles. Cross-correlation analysis indicates a lag of ~12 months between average PGA prescribing nationally versus more deprived areas.</p><p><strong>Conclusion: </strong>The rate of PGA prescribing in primary care was substantially lower in deprived versus affluent areas, with delayed uptake of PGAs in more deprived areas of ~12 months. Further research is needed to explore reasons for this discrepancy, permitting strategies to be developed to reduce unwarranted variation.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162614","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":"Symptomatic diagnoses in primary care: an observational cohort study.","authors":"Mika T Lehto, Timo Kauppila, Hannu Kautiainen, Merja K Laine, Ossi Rahkonen, Kaisu H Pitkälä","doi":"10.3399/BJGPO.2023.0234","DOIUrl":"10.3399/BJGPO.2023.0234","url":null,"abstract":"<p><strong>Background: </strong>It can be impossible to assign a definitive diagnosis for symptoms reported or observed by primary health care patients. In these situations, symptomatic diagnoses are often used.</p><p><strong>Aim: </strong>The aim of the present study was to examine the proportion of symptomatic diagnoses among primary health care patients. We also explored which symptomatic diagnoses were most frequently recorded, as well as their distribution by age and sex.</p><p><strong>Design & setting: </strong>This is a register-based study carried out in the public primary health care service of the city of Vantaa, Finland.</p><p><strong>Method: </strong>Diagnoses were entered according to the 10th revision of the International Classification of Diseases (ICD-10). The data consisted of every diagnosis entered into the electronic health record between 1 January 2016 and 31 December 2018. Both absolute numbers and relative proportions of various symptomatic diagnosis recordings (chapter 'R') were reported.</p><p><strong>Results: </strong>Of all the recorded diagnoses (<i>n</i> = 503 001), the proportion of R-diagnoses was 13.5% (<i>n</i> = 67 905). Diagnoses of symptoms and signs involving the digestive system and abdomen (R10-19) (3.7% of all; <i>n</i> = 18 550), the circulatory and respiratory systems (R00-09) (3.5%; <i>n</i> = 17 426), general symptoms and signs (R50-69) (3.0%; <i>n</i> = 15 165), and the skin and subcutaneous tissue (R20-23) (2.0%; <i>n</i> = 9812) were most prevalent. Age was also a major factor determining how symptomatic diagnoses were distributed between men and women. Overall, symptomatic diagnoses were more common among women than men (14.1% and 12.4%, respectively). The major categories of symptoms and signs involving the digestive system and abdomen, the skin and the subcutaneous tissue, and general symptoms and signs, were more predominant among women, while symptoms and signs involving the circulatory and respiratory systems were more common among men.</p><p><strong>Conclusion: </strong>A symptomatic diagnosis code was recorded in about one eighth of GP appointments, although there were significant sex differences in the prevalence within and between diagnosis groups.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141427818","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":"Primary care contact, clinical management, and suicide risk following discharge from inpatient mental health care: a case-control study.","authors":"Rebecca Musgrove, Matthew J Carr, Nav Kapur, Carolyn A Chew-Graham, Faraz Mughal, Darren M Ashcroft, Roger T Webb","doi":"10.3399/BJGPO.2023.0165","DOIUrl":"10.3399/BJGPO.2023.0165","url":null,"abstract":"<p><strong>Background: </strong>Evidence is sparse regarding service usage and the clinical management of people recently discharged from inpatient psychiatric care who die by suicide.</p><p><strong>Aim: </strong>To improve understanding of how people discharged from inpatient mental health care are supported by primary care during this high-risk transition.</p><p><strong>Design & setting: </strong>A nested case-control study, utilising interlinked primary and secondary care records in England for people who died within a year of discharge between 2001 and 2019, matched on age, sex, practice-level deprivation, and region with up to 20 living discharged people.</p><p><strong>Method: </strong>We described patterns of consultation, prescription of psychotropic medication, and continuity of care for people who died by suicide and those who survived. Mutually adjusted relative risk estimates were generated for a range of primary care and clinical variables.</p><p><strong>Results: </strong>More than 40% of patients who died within 2 weeks of discharge and >80% of patients who died within 1 year of discharge had at least one primary care consultation within the respective time periods. Evidence of discharge communication from hospital was infrequent. Within-practice continuity of care was relatively high. Those who died by suicide were less likely to consult within 2 weeks of discharge (adjusted odds ratio [AOR] 0.61 [95% confidence interval {CI} = 0.42 to 0.89]), more likely to consult in the week before death (AOR 1.71 [95% CI = 1.36 to 2.15]), be prescribed multiple types of psychotropic medication (AOR 1.73 [95% CI = 1.28 to 2.33]), experience readmission, and have a diagnosis outside of the 'severe mental illness' definition.</p><p><strong>Conclusion: </strong>Primary care clinicians have opportunities to intervene and should prioritise patients experiencing transition from inpatient care. Clear communication and liaison between services is essential to provide timely support.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141311847","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":"GPs' reflections on prescribing addictive hypnotics to older people: a qualitative study.","authors":"Holgeir Skjeie, Mette Brekke, Trygve Skonnord","doi":"10.3399/BJGPO.2024.0157","DOIUrl":"10.3399/BJGPO.2024.0157","url":null,"abstract":"<p><strong>Background: </strong>The European guideline for the diagnosis and treatment of insomnia recommends, for all age groups, only restrictive, short-term, and periodic use of potentially addictive hypnotics. As in other European countries, in Norway, actual practice involving older patients differs substantially from this recommendation, as shown by the persistent high frequency of regular prescriptions of addictive hypnotics.</p><p><strong>Aim: </strong>To explore experienced Norwegian GPs' views of the regular prescription of addictive hypnotics to patients aged >70 years living at home.</p><p><strong>Design & setting: </strong>In-depth individual interviews of a purposive sample of experienced specialists in family medicine at GP offices in Southern Norway.</p><p><strong>Method: </strong>The interviews used a semi-structured interview guide and were performed between June 2022 and January 2023. Reflexive thematic cross-case analysis was used to analyse the data.</p><p><strong>Results: </strong>Most of the 11 GPs interviewed had more than 10 older patients who were prescribed hypnotics for daily use and the same number for intermittent prescription. Almost all prescriptions were of z-hypnotics. The GPs knew this was contrary to the guideline. Many were at ease with this fact. They emphasised the need to avoid creating new dependencies. The GPs considered these patients a selected minority within this age group with serious sleep problems, for whom few realistic alternatives were available and whose tolerance over time was better than expected. This logic of pragmatic practice reflected a patient-centred approach and respect for the patient's view in a shared decision-making process, combined with challenges of limited alternatives and resources.</p><p><strong>Conclusion: </strong>A 'zero vision' on the prescription of addictive hypnotics to older people may neither be prudent nor realistic in the context of general practice.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141727907","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":"Factors influencing multiple non-utilised healthcare appointments from patients' and healthcare providers' perspectives: a qualitative systematic review of the global literature.","authors":"Asrar Aldadi, Kathryn A Robb, Andrea Williamson","doi":"10.3399/BJGPO.2024.0075","DOIUrl":"10.3399/BJGPO.2024.0075","url":null,"abstract":"<p><strong>Background: </strong>The term 'non-utilised appointments' emerged in 2019 but lacks a clear definition. We focus on multiple non-utilised appointments owing to recent advances in understanding 'missingness' in UK health care. Studies on missed appointments show conflicting results regarding interventions such as text messaging owing to oversight of occasional versus repeated missed appointments. Understanding patient and healthcare-related factors in multiple non-utilised appointments is crucial for improving interventions and patient engagement.</p><p><strong>Aim: </strong>To identify factors influencing multiple non-utilised appointments from patients' and healthcare providers' perspectives.</p><p><strong>Design & setting: </strong>A systematic review of qualitative research identifying factors that influence multiple non-utilised appointments across diverse global healthcare settings.</p><p><strong>Method: </strong>The review employed a qualitative systematic approach, encompassing diverse papers from multiple databases, irrespective of patient or healthcare provider age, location, or setting. Data analysis followed Thomas and Harden's thematic synthesis method. Themes are presented in alignment with both the health service and patient perspective aspects of the Levesque access model.</p><p><strong>Results: </strong>Ten thousand and eighty-six records were retrieved. Five studies met the inclusion criteria and were analysed. Six key themes influenced appointment utilisation. Healthcare system determinants highlighted provider-patient relationship and professionalism, and healthcare organisation factors role in appointment utilisation. Patient experience and decision making explored personal factors. Additionally, communication, support, and engagement delved into challenges with communication and language, family and social support, and socio-familial barriers to appointment utilisation. Health and wellbeing factors encompassed medical conditions, mental and emotional factors, and psychosocial determinants affecting appointment utilisation. Moreover, financial constraints and socioeconomic factors were identified as significant contributors. Lastly, healthcare access and barriers addressed transportation challenges, accessibility issues, and geographical barriers impacting healthcare access.</p><p><strong>Conclusion: </strong>The analysis reveals complex factors influencing multiple non-utilised appointments. Strong provider-patient relationships improve care accessibility. Flexible scheduling and patient-centred approaches are pivotal, alongside addressing workplace discrimination. Tailored healthcare services and overcoming geographical barriers are essential. Ensuring safety, accessibility, and communication, while supporting vulnerable groups and mental health needs, are necessary. Equitable access to services and alternative transportation solutions are essential for comprehensive healthcare delivery.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141761467","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":"The future of peer review: an editorial.","authors":"Adam Grice, Hajira Dambha-Miller","doi":"10.3399/BJGPO.2024.0285","DOIUrl":"10.3399/BJGPO.2024.0285","url":null,"abstract":"","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808269","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":"Integrating public health and primary care: a framework for seamless collaboration.","authors":"Luke N Allen, Bernd Rechel, Dan Alton, Luisa M Pettigrew, Martin McKee, Andrew David Pinto, Josephine Exley, Eleanor Turner-Moss, Kathrin Thomas, Jacqueline Mallender, Dheepa Rajan, Toni Dedeu, Simon Bailey, Nicholas Goodwin","doi":"10.3399/BJGPO.2024.0096","DOIUrl":"10.3399/BJGPO.2024.0096","url":null,"abstract":"","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629716","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}