BJGP Open最新文献

{"title":"How gender shapes practice choices among family medicine residents and early career family physicians: a Canadian qualitative study.","authors":"Anneka Sheppard, Amanda Gormley, Lauren Mills, Madeleine McKay, Fiona Bergin, Roetka Gradstein, Catherine Moravac, Ian Scott, Ruth Lavergne","doi":"10.3399/BJGPO.2024.0158","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0158","url":null,"abstract":"<p><strong>Background: </strong>The practice choices of family medicine residents and early career family physicians shape access to primary care. A growing proportion of family physicians are women.</p><p><strong>Aim: </strong>This study examined how gender operates in shaping family physician practice choices and subsequent practice patterns.</p><p><strong>Design & setting: </strong>Qualitative interview data were analyzed.</p><p><strong>Setting: </strong>Family medicine residents and early-career family physicians from three Canadian provinces (Nova Scotia, Ontario, and British Columbia) participated in interviews.</p><p><strong>Method: </strong>Qualitative interview data was collected as part of a larger mixed methods study. Eighty-eight interviews were transcribed verbatim and coded into several node reports including one on gender. Reflexive thematic analysis was conducted to identify themes related to how gender impacts physician practice choices.</p><p><strong>Results: </strong>Many participants described multiple intersecting pathways through which it was apparent that gender shaped their career and practice choices. Others did not identify the impact of gender in this regard. Parenthood and caregiving were commonly discussed, as were clinical interests specific to women's health, however, gendered expectations of patients and colleagues were also seen to shape choices. In this way, gender shaped choices directly, but also indirectly in response to gendered experiences and expectations.</p><p><strong>Conclusion: </strong>Findings support the need for structural reforms including: increased availability of collaborative team based models, flexible work schedules, closure of gendered wage gaps, and integration of gender awareness training through academic and healthcare institutions. Consideration of how primary care policies differentially impact across clinician gender is key to future planning to support a changing workforce that meets patient needs.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of a general practitioner's perception of a patient request for antibiotics on antibiotic prescribing for respiratory tract infections: secondary analysis of a point prevalence audit survey in 18 European countries.","authors":"Julie Domen, Rune Aabenhus, Anca Balan, Emily Bongard, Femke Böhmer, Valerija Bralic Lang, Pascale Bruno, Slawomir Chlabicz, Annelies Colliers, Ana Garcia-Sangenis, Hrachuhi Ghazaryan, Anna Kowalczyk, Siri Jensen, Christos Lionis, Tycho M van der Linde, Lile Malania, Jozsef Pauer, Angela Tomacinschii, Akke Vellinga, Ihor Zastavnyy, Herman Goossens, Christopher C Butler, Alike W van der Velden, Samuel Coenen","doi":"10.3399/BJGPO.2024.0166","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0166","url":null,"abstract":"<p><strong>Background: </strong>Illness severity, comorbidity, fever, age and symptom duration influence antibiotic prescribing for respiratory tract infections (RTI). Non-medical determinants, such as patient expectations, also impact prescribing.</p><p><strong>Aim: </strong>To quantify the effect of general practitioners' (GPs') perception of a patient request for antibiotics on antibiotic prescribing for RTI and investigate effect modification by medical determinants and country.</p><p><strong>Design & setting: </strong>Prospective audit in 18 European countries.</p><p><strong>Method: </strong>Consultation data were registered of 4982 patients presenting with acute cough and/or sore throat. A mixed-effect logistic regression model analysed the effect of GPs' perception of a patient request for antibiotics. Two-way interaction terms assessed effect modification. Relevant clinical findings were added to subgroups of lower RTI (LRTI), throat infection, and influenza-like-illness (ILI).</p><p><strong>Results: </strong>GPs who perceived a patient request for antibiotics were four times more likely to prescribe antibiotics (OR: 4.4, 95%CI: 3.4-5.5). This effect varied by country: lower in Spain (OR: 0.06), Ukraine (OR: 0.15), and Greece (OR: 0.22) compared to the lowest prescribing country. The effect was higher for ILI (OR: 13.86, 95%CI: 5.5-35) and throat infection (OR: 5.1, 95%CI: 3.1-8.4) than for LRTI (OR: 2.9, 95%CI: 1.9-4.3). For ILI and LRTI, GPs were more likely to prescribe antibiotics with abnormal lung auscultation and/or increased/purulent sputum and for throat infection, with tonsillar exudate and/or swollen tonsils.</p><p><strong>Conclusion: </strong>GPs' perception of an antibiotic request and specific clinical findings influence antibiotic prescribing. Incorporating exploration of patient expectations, point-of-care testing and discussing watchful waiting into the decision-making process will benefit appropriate prescribing of antibiotics.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013425","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":"Increasing engagement with liver disease management across the UK: a follow-up cross-sectional survey.","authors":"Helen Jarvis, Charlotte Berry, Jonathan Worsfold, Vanessa Hebditch, Stephen Ryder","doi":"10.3399/BJGPO.2024.0142","DOIUrl":"10.3399/BJGPO.2024.0142","url":null,"abstract":"<p><strong>Background: </strong>Liver disease is an increasing cause of premature mortality. Early detection of liver disease in primary care gives opportunity to intervene and change outcomes. Engagement in liver disease care by NHS bodies responsible for primary care pathway development could drive improvements. The formation of integrated care systems (ICS) in England provides an opportunity to reassess engagement with liver disease nationally.</p><p><strong>Aim: </strong>To update the level of engagement with community chronic liver disease management among ICSs and health authorities across the UK.</p><p><strong>Design & setting: </strong>A cross-sectional follow-up survey to ICS and UK health boards.</p><p><strong>Method: </strong>Questions used for a previous survey in 2020 were adapted and sent electronically to NHS bodies responsible for health care across the UK, using a freedom of information request. Quantitative analysis was undertaken using Microsoft Excel.</p><p><strong>Results: </strong>There were 67 responses from 68 possible ICS and health board areas, representing 99% UK coverage. Twenty-seven per cent had a named individual responsible for liver disease. Monitoring of local liver disease health statistics happened in 34% of all UK areas. Comprehensive care pathways were available in <i>n</i> = 24/67 (36%) of areas, an increase from 26% in the 2020 survey. Areas with no liver pathways in place fell from 58% to 36% between the two surveys. Regional variations persist, with Wales and Scotland moving towards comprehensive coverage. Almost double the number of areas were making use of transient elastography within community pathways of care, up from 25% to 46%.</p><p><strong>Conclusion: </strong>The results of this re-survey highlight improvements, but emphasise the need to build on regional success to further reduce inequality in care commissioning.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297462","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":"Barriers to and facilitators of women general practitioners' careers: a systematic review.","authors":"Laura Jefferson, Elin Webster, Su Golder, Katie Barnett, Nicola Greenwood, Veronica Dale, Karen Bloor","doi":"10.3399/BJGPO.2024.0282","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0282","url":null,"abstract":"<p><strong>Background: </strong>Despite women comprising 52% of full-time equivalent general practitioners (GPs) in England, a significant gender pay gap persists (15% after adjustments). Further understanding of the barriers and facilitators impacting women GPs' careers is needed.</p><p><strong>Aim: </strong>To identify and synthesise research evidence exploring barriers to and facilitators of women GPs' careers.</p><p><strong>Design & setting: </strong>Systematic review of qualitative and quantitative studies. Studies were included of general practitioners conducted in the UK NHS general practice setting.</p><p><strong>Method: </strong>Review methods followed Cochrane and PRISMA guidelines to systematically search MEDLINE, Embase, HMIC and Google Scholar to identify studies that explored gendered barriers and facilitators to GP careers. An inductive thematic analysis was used to synthesise the evidence.</p><p><strong>Results: </strong>21 articles were included in this review, with varied study designs. No relevant intervention studies were identified. There was a lack of recent research evidence; over half of the studies were conducted over 20 years ago. Most met quality criteria, though there were some problems with reporting and adjustment for potential confounders. Studies found barriers at personal, socio-cultural and system levels that inhibit women GPs' careers. While some positive changes have been documented across studies that span some thirty years, many challenges remain.</p><p><strong>Conclusion: </strong>Despite general practice being a medical specialty where women outnumber men, barriers at personal, socio-cultural and system levels continue to inhibit women GPs' careers.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013403","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":"Evaluation of the personality disorder positive outcomes programme (PDPOP) in general practice.","authors":"Hayley Trueman, Matt Williams, Robin Schafer, Fiona Blyth","doi":"10.3399/BJGPO.2024.0196","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0196","url":null,"abstract":"<p><strong>Background: </strong>GPs and primary care services have been identified as crucial to the care of people with personality disorder. Individuals living with personality disorder frequently face stigma and difficulties when accessing healthcare. Primary care staff often describe feeling demoralised, incompetent, hurt or angry after difficult interactions with patients.</p><p><strong>Aim: </strong>To evaluate the effect of PDPOP training delivered to 10 GP practices in 2022-23.</p><p><strong>Design & setting: </strong>PDPOP is a co-produced training course aimed at all staff within GP surgeries to help teams, including administrative, reception and clinical staff, to feel confident and skilled when interacting with patients who may have personality disorder.</p><p><strong>Method: </strong>The New World Kirkpatrick Model was used to evaluate the training, through questionnaires pre- training, post-training, at follow-up, and semi-structured interviews.</p><p><strong>Results: </strong>Evaluation found that practice teams were highly satisfied with PDPOP training and found it relevant, engaging and useful. Results demonstrated that staff felt more confident and skilled when interacting with patients who may have personality disorder through use of the training's core concepts. Increased confidence in managing distress, crisis and participant's own emotions, was associated with reduced impact on staff at interview. Practices also demonstrated action taken post-training to reduce dependency on primary care services.</p><p><strong>Conclusion: </strong>By including lived-experience trainers and introducing core concepts, PDPOP has demonstrated a sustained positive impact on primary care teams. Further expansion of this type of training may help to increase the confidence of healthcare staff in delivering care to patients with personality disorder and similar complex emotional needs.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013410","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":"Diabetes complications in people with alcohol use disorder and type 2 diabetes.","authors":"Sarah Cook, Sonia Saxena, Rohini Mathur, Thomas Beaney, Shamini Gnani, Ana Luisa Neves, Arti Maini, Ravi Parekh, Kate Walters, David Osborn, Jennifer K Quint","doi":"10.3399/BJGPO.2024.0133","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0133","url":null,"abstract":"<p><strong>Background: </strong>People living with alcohol use disorder (AUD) who develop Type 2 Diabetes (T2DM) may be at higher risk of diabetes-complications.</p><p><strong>Aim: </strong>Our aims were to compare diabetes-monitoring and incidence of diabetes-complications between people with and without AUD prior to T2DM diagnosis attending primary care in England.</p><p><strong>Design & setting: </strong>We used the Clinical Practice Research Datalink (CPRD) Aurum linked with Hospital Episode Statistics (HES) and Office for National Statistics (ONS) mortality data. The target population was people with incident T2DM diagnosed between 2004-2019.</p><p><strong>Method: </strong>We defined AUD from codes indicating i) clinical diagnosis; ii) alcohol withdrawal; or iii) chronic alcohol-related harm. Outcomes were end stage renal disease (ESRD), lower limb amputation, myocardial infarction (MI), stroke, cardiovascular disease (CVD) mortality and all-cause mortality. We compared yearly HbA1c, creatinine and cholesterol monitoring activities for the first 5 years post T2DM diagnosis.</p><p><strong>Results: </strong>The study population was 543,509 people, of whom 15 237(2.8%) had a code for AUD. Adjusting for measured confounders, people with AUD had higher rates of ESRD (IRR 1.95 95% CI 1.71, 2.23), lower limb amputation (IRR 1.78 95% CI 1.50, 2.21), stroke (IRR 1.35 95% CI 1.25, 1.46), CVD mortality (IRR 1.74 95% 1.63, 1.86) and all-cause mortality (IRR 2.10 95% CI 2.04, 2.17) but not MI (IRR 0.91 95% CI 0.82, 1.00) compared with people without AUD. Laboratory diabetes-monitoring was high in people with (83.5-91.1%) and without (83.7-92.4%) AUD.</p><p><strong>Conclusion: </strong>People with AUD had nearly double the rates of most of the diabetes-complications investigated than people without AUD.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013406","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":"GP remote consultations with marginalised patients and the importance of place during care: a qualitative study of the role of place in GP consultations.","authors":"Ada Humphrey, Steven Cummins, Carl May, Fiona Stevenson","doi":"10.3399/BJGPO.2024.0050","DOIUrl":"10.3399/BJGPO.2024.0050","url":null,"abstract":"<p><strong>Background: </strong>Since the COVID-19 pandemic, there has been an increase in the use of remote consultations in general practice in the UK. This leads to the displacement of the consultation outside of the physical general practice, and its 'emplacement' elsewhere, with underexplored consequences for inequities of health care in marginalised groups.</p><p><strong>Aim: </strong>To examine the place-making demands that remote consultations make on patients, and the ways that these affect their experiences of care, with a focus on the impact on patients from marginalised groups.</p><p><strong>Design & setting: </strong>Ethnography and interview study (<i>n</i> = 15) undertaken at three fieldwork sites in London: a foodbank, a community development organisation, and a drop-in advice centre for migrants. Additionally, GPs (<i>n</i> = 5) working at practices in deprived areas of London, Digital Health Hub staff (<i>n</i> = 4), and staff at fieldwork sites (<i>n</i> = 3) were interviewed.</p><p><strong>Method: </strong>Ethnographic observation was undertaken for 84 hours at the fieldwork site services, and semi-structured interviews (<i>n</i> = 27) took place with service users and service providers. Interviews were conducted in-person and over the phone, and data were analysed through reflexive thematic analysis.</p><p><strong>Results: </strong>The core themes emerging from the data included challenges securing privacy during remote consultations and the loss of formal healthcare spaces as important places of care. These findings were closely tied to resource access, leading to inequities in experiences of care.</p><p><strong>Conclusion: </strong>Remote GP consultations are not 'place-less' encounters, and inequities in access to suitable spaces may lead to inequities in experiences of care. Attention should be given to ensuring that patients without appropriate spaces for remote consultations are offered in-person care, or consultation times made more specific to allow for organisation of private space.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793738","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":"Chronic kidney disease and the alternative labels used by GPs in Australia: a qualitative interview study.","authors":"Michelle Guppy, Esther Joy Bowles, Paul Glasziou, Jenny Doust","doi":"10.3399/BJGPO.2024.0031","DOIUrl":"10.3399/BJGPO.2024.0031","url":null,"abstract":"<p><strong>Background: </strong>Guidelines for terminology defining chronic kidney disease (CKD) have been in use for 20 years. Age is not currently considered in the guideline definition of CKD. In previous studies, GPs have been reluctant to give older patients the label of CKD.</p><p><strong>Aim: </strong>To determine what language GPs are using to describe or label CKD with their older patients, and to explore the reasons for their use of alternative language.</p><p><strong>Design & setting: </strong>This was a descriptive qualitative interview study of Australian GPs.</p><p><strong>Method: </strong>Twenty-seven GPs were recruited via email and interviewed regarding their management of CKD. GPs were asked what language and terminology they used when discussing a diagnosis of CKD with their older patients.</p><p><strong>Results: </strong>'Labelling of CKD', the language that GPs use when talking about CKD with their patients, emerged as a major theme from the initial GP interviews. Sub-themes emerged, including types of alternative labels and rationale for alternative labels. GPs used descriptions of 'reduced kidney function' to explain CKD to their patients, either in parallel with the diagnosis of CKD or instead of it. GPs had concerns about the words 'chronic' and 'disease', and used different terminology to explain these words to patients when diagnosing them with CKD.</p><p><strong>Conclusion: </strong>GPs use alternative descriptions to explain mild decrease in kidney function with older patients. Alternative labels that denote level of risk to older patients, without creating unnecessary concern about normal age-related kidney function, need to be explored.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898490","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":"Realities of opioid and gabapentinoid deprescribing in socioeconomically disadvantaged communities: a qualitative evaluation.","authors":"Charlotte L Parbery-Clark, Jennie Sofia Portice, Sarah Sowden","doi":"10.3399/BJGPO.2024.0160","DOIUrl":"10.3399/BJGPO.2024.0160","url":null,"abstract":"<p><strong>Background: </strong>Opioid and gabapentinoid prescribing has increased substantially in recent years despite having limited effectiveness in treating chronic primary pain. This is concerning, with the prescribing rates and adverse effects of these medications being higher in more socioeconomically disadvantaged groups. Guidance for prescribing and deprescribing these medications exists but the understanding of how deprescribing is operationalised, especially in areas of socioeconomic disadvantage, is limited.</p><p><strong>Aim: </strong>To explore primary healthcare professionals' views and experiences of designing and implementing an intervention to reduce opioid and gabapentinoid prescribing.</p><p><strong>Design & setting: </strong>A qualitative evaluation, using participant observation and semi-structured interviews with primary healthcare professionals, working in practices serving areas of substantial socioeconomic disadvantage in the North East of England.</p><p><strong>Method: </strong>Interviewees were purposively recruited with subsequent snowballing with participant observation of the peer-support meetings. Interview transcripts and notes from the participant observation were inductively coded and thematically analysed.</p><p><strong>Result: </strong>Thirteen healthcare professionals from five practices were interviewed. Person-centred care with shared decision-making was strived for, which was time-consuming owing to the complexity of the problem and patients. Where shared decision-making was not possible, owing to patient refusal or non-engagement, risk was used to determine the appropriate action. This work involved an emotional toll on staff and patients, but was at times conversely easier and more rewarding than expected. Ultimately, demedicalising pain with a culture change is required to ensure patients are not prescribed these medications for inappropriate reasons or doses.</p><p><strong>Conclusion: </strong>This study demonstrates key operational aspects to consider when undertaking opioid and gabapentinoid deprescribing in primary care, such as funding dedicated time to enable deprescribing.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141761468","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":"Potentially inappropriate prescribing in middle-aged adults: a significant problem with a lack of action and evidence to address it.","authors":"Michael Naughton, Frank Moriarty, Patrick Redmond","doi":"10.3399/BJGPO.2023.0209","DOIUrl":"10.3399/BJGPO.2023.0209","url":null,"abstract":"","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733283","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}