South Dakota medicine : the journal of the South Dakota State Medical Association最新文献

{"title":"Impact of Dermatology Access on Dermatofibrosarcoma Protuberans Outcomes: A Retrospective Study in a Larger Cohort.","authors":"Joseph H Kelly, Linze Christensen, Marcus L Frohm","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Dermatofibrosarcoma protuberans (DFSP) is an aggressive rare cutaneous tumor with a relatively high rate of local recurrence. Incidence in the United States has been reported around 4 occurrences per million people per year. Local recurrences have been reported between 2 to 19% of cases. These cases are at higher risk for sarcomatous transformation, increasing the risk for metastasis. Early and accurate diagnosis, coupled with appropriate management, is essential to minimize these risks. However, early on, DFSP is often misdiagnosed as a number of benign subcutaneous growths. Misdiagnosis often leads to incorrect or delayed treatment. This study extends previous research by evaluating whether access to dermatology care influences DFSP treatment outcomes in a larger cohort and larger geographical area.</p><p><strong>Methods: </strong>This study is a retrospective review currently including 68 adults with histologically confirmed DFSP. The study evaluated three endpoints: rates of appropriate workup and diagnosis comparing dermatology and non-dermatology providers, rates of appropriate primary treatment between lesions with and without appropriate workup and diagnosis, and rates of positive margins or primary recurrence between lesions without and with appropriate primary treatment.</p><p><strong>Results: </strong>For all three endpoints, the data rejected the null hypothesis.</p><p><strong>Conclusion: </strong>These findings further support that early biopsy and high clinical suspicion for DFSP improve surgical outcomes, particularly when diagnostic biopsy is performed prior to treatment. The larger sample size reinforces the importance of dermatology access in optimizing patient care and decreasing morbidity from DFSP treatment. Increased clinical awareness and stricter adherence to diagnostic and therapeutic guidelines are recommended for improved patient outcomes in the management of DFSP.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"78 suppl 5","pages":"s30"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477177","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":"Maximizing Long-Term Care Resident Satisfaction Using the Kano Model: A Quality Improvement Project Within a South Dakota Long-Term Care Facility.","authors":"Carly Haring, Dan Rath","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>With the growing demand for long-term care facilities, understanding residents' values is critical to delivering high-quality care and enhancing their quality of life. This project aimed to identify the quality-of-life features most valued by residents to optimize resource allocation and maximize satisfaction.</p><p><strong>Methods: </strong>A survey assessing 11 quality-of-life features was conducted with residents at a South Dakota nursing home. Participation was voluntary, excluding residents unable to communicate verbally or hear the interviewer. Survey responses were analyzed using the Kano Model, which categorizes features as \"mustbe,\" \"performance,\" \"attractive,\" or \"indifferent,\" reflecting their impact on satisfaction and prioritization. \"Must-be\" features represent expectations essential to satisfaction, while \"performance\" features influence satisfaction proportionally. \"Attractive\" features offer added value by improving satisfaction, without reducing it when absent. \"Indifferent\" features provide opportunities to reallocate resources toward higherpriority needs.</p><p><strong>Results: </strong>Thirty-three residents participated in the survey, and analysis of their responses revealed distinct categorizations for the quality-of-life features. Features identified as \"must-be\" included permission to leave, autonomy in sleep schedules, help when needed, shared decision-making, and security of possessions. Features categorized as \"performance\" were organized activities, religious activities, and comfortable room temperature. \"Attractive\" features consisted of enjoying food and staff taking personal interest, while private phone calls were classified as \"indifferent.\" To add prioritization within these categories, importance scores from the survey were incorporated. Based on these scores, the features were ranked in the following order to maximize satisfaction: help when needed, security of possessions, permission to leave, shared decision-making, autonomy in sleep schedules, room temperature, religious activities, organized activities, enjoying food, staff taking personal interest, and private phone calls.</p><p><strong>Conclusions: </strong>The findings highlight the importance residents assign to quality-of-life features and demonstrate which features residents value most. This allows administrators to make data-driven decisions to efficiently enhance resident satisfaction.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"78 suppl 5","pages":"s28"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477182","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":"Dual Antiplatelet Therapy: A Concise Review of Evidence for the Practicing Clinician.","authors":"Mustafa Shehzad, Dawood Shehzad, Logan Johnke, Dawlat Khan, Hammad Shabir Chaudhry, Sanjana Manimaran","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This review article examines the importance of dual antiplatelet therapy (DAPT) in managing thrombotic events related to cardiovascular atherosclerotic disease. DAPT typically includes aspirin and a P2Y12 inhibitor and is used to mitigate complications from cardiovascular atherosclerotic disease. The article details the pharmacological profiles of common antiplatelet agents. Evidence from randomized controlled trials informs DAPT's application in various clinical contexts, demonstrating clear benefits in chronic coronary syndrome and acute coronary syndrome. However, its role in primary prevention is unproven. The review highlights the need for individualized treatment strategies, particularly concerning the duration of therapy following procedures like percutaneous coronary intervention, coronary artery bypass grafting and post transcatheter aortic valve implantation. Considering the ubiquitousness of these medications clinicians should be aware of the underlying induction, and evidence surrounding their use. Ongoing research is essential to refine antiplatelet strategies, ultimately improving patient outcomes while minimizing adverse effects. This review highlights the importance of individualized assessments in optimizing DAPT for various cardiovascular conditions.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"78 5","pages":"227-233"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477112","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":"Impacts of Medical Education in High School on Healthcare Career Determination.","authors":"Jason Kemnitz, Jessica Linke, Lucas Goetz, Madeline Melanson, Molly Lien, Bailey DeJong, Abbey Rieber","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>There is a growing shortage of healthcare workers in the United States, particularly in rural areas. Nearly two-thirds of healthcare provider shortages occur in rural regions, and this deficit is projected to worsen. Recruitment into healthcare careers has become increasingly difficult due to multiple factors, including distrust in the medical system and the financial burden of higher education. Early exposure to healthcare-related topics may play a critical role in fostering interest in these careers. We hypothesize that engaging high school students in structured lessons on anatomy, physiology, and pathology can increase their interest in healthcare professions.</p><p><strong>Methods: </strong>More than 200 high school students from rural and urban South Dakota were recruited to participate in a semester-long program consisting of weekly lessons on human anatomy, physiology, pathology, and relevant clinical applications. Lessons were tailored to students' interests and delivered both in person and virtually. Pre- and post-program surveys assessed students' interest in healthcare careers and human biology-related topics.</p><p><strong>Results: </strong>Preliminary data indicate an increase in students expressing interest in healthcare careers by the end of the semester. Additionally, students demonstrated a greater enthusiasm for human body-related topics compared to baseline. While further data collection and analysis are needed, initial findings suggest a positive correlation between structured healthcare education and increased interest in healthcare professions.</p><p><strong>Conclusion: </strong>This study highlights the potential benefits of incorporating structured healthcare-related education in high school curricula. Schools that lack funding for dedicated anatomy or physiology courses could use these findings to support grant applications and advocate for additional resources. Increasing early exposure to healthcare topics may be a viable strategy for addressing workforce shortages, particularly in rural communities.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"78 suppl 5","pages":"s26"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477178","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":"Indigenous Skin Wellness Study: Exploring Skin Cancer Awareness and Understanding Among Native Americans: A Cross-Section Study.","authors":"Kianna Thelen, Megan Schenk, Leah Naasz, Marcus L Frohm","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Skin cancer disproportionately affects certain populations, with Native Americans ranking as the second most likely group to develop skin cancer after Caucasians. However, there is a significant lack of data and understanding regarding their UV protection habits and skin cancer awareness. This knowledge gap underscores the need for targeted educational and preventative interventions. The Indigenous Skin Wellness Study seeks to explore the beliefs, habits, and knowledge of Native American populations related to UV exposure and skin cancer prevention, aiming to identify opportunities to promote effective prevention practices in this underserved group.</p><p><strong>Methods: </strong>A survey was developed and distributed among Native American populations to assess personal UV exposure habits, beliefs about skin cancer, and knowledge of prevention methods. The survey included questions about sunscreen use, protective clothing habits, perceived risks, and understanding of early signs of skin cancer. Participants were recruited through community outreach efforts and partnerships with local organizations. Data collected will provide a baseline understanding of current practices and attitudes, which will be analyzed to identify areas for educational intervention and targeted outreach strategies.</p><p><strong>Results: </strong>Preliminary data collection indicates variability in awareness and prevention habits, with some participants demonstrating knowledge gaps in recognizing skin cancer risks and the importance of UV protection. Early trends suggest limited use of sunscreen and protective clothing in daily activities, coupled with misconceptions about skin cancer susceptibility. The study aims to correlate these findings with demographic factors and environmental exposures to refine the focus of future educational campaigns.</p><p><strong>Conclusion: </strong>Native American populations face a unique and underserved challenge in skin cancer prevention and education. By identifying key gaps in UV protection practices and awareness through this study, we aim to design culturally tailored interventions that promote skin wellness and reduce the risk of skin cancer in these communities. The findings will serve as a foundation for larger-scale public health efforts, bridging the gap in knowledge and fostering improved skin health outcomes for Native American populations.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"78 suppl 5","pages":"s38"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477179","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":"Examining the Relationships Between Work Environment and Stress Coping Mechanisms With Burnout in Medical Students.","authors":"Oluwafunke O Ogunremi, Ethan Noble, Valeriy Kozmenko","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Throughout the duration of medical training, learners are oftentimes overworked and faced with high levels of stress and pressure; this can decrease quality of life for many individuals. The goal of this study was to gain an understanding of how work environments and stress coping mechanisms play a role in the amount of burnout experienced by medical students.</p><p><strong>Methods: </strong>Data was collected from medical students at the University of South Dakota Sanford School of Medicine by using a 22 question Qualtrics survey. The survey remained open until a 50% response rate was achieved from the student body. The results of the survey were analyzed by using 2 sample t-tests and ANOVA tests as appropriate.</p><p><strong>Results: </strong>No statistically significant differences were found in total burnout ratings, coping mechanisms, and perception of the work environment between the different cohorts of medical students. Students who had healthier behaviors, such as following CDC recommendations on sleep, exercise, and fruit and vegetable consumption or practicing meditation and mindfulness, had lower levels of burnout compared to those who did not. Students who stated on the survey that they were experiencing burnout had a lower overall score on the survey, indicating higher levels of burnout.</p><p><strong>Conclusions: </strong>Some medical students may recognize when they are burning out, so providing resources to help them incorporate healthier behaviors into their lifestyles may help aid in burnout recovery. Finding effective ways to help students deal with stressors and develop coping mechanisms improves their own quality of life and can hence improve patient outcomes.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"78 suppl 5","pages":"s33-s34"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477076","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":"Enhancing Surgical Skill Acquisition: Assessment of a Novel 3D Printed Laparoscopic Trainer (Non-Inferiority Trial).","authors":"Olivia Heinecke, Lisa MacFadden","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>As laparoscopic operations yield reliable outcomes across specialties, the need for specialized skills underscores the importance of effective, accessible, and affordable training devices. The acquisition of these techniques is typically tied to hands-on instruction in the operating theater or simulation labs that house costly training equipment. Outside of these opportunities, student exposure is limited to observation. Current literature describes \"do-it-yourself\" trainers that attempt to mitigate costs; however, material pricing, ease of use, and simulation realism can still be improved. This study aims to validate a novel 3D (three dimensional)-printed laparoscopic trainer designed to provide training outcomes comparable to those of commercial simulators at a fraction of the cost. In this IRB-approved study, we designed a 3D-printed laparoscopic trainer prioritizing affordability, portability, and accessibility. Our device was modeled using Autodesk Fusion 360 software and printed with PLA (polylactic acid) material. To test its functionality, twenty medical students (M1-M4) with no prior laparoscopic training were randomized into two groups to train on either a commercial simulator (SIMULAB LapTrainer) or the 3D-printed trainer. Participants were taught a threading technique and timed on task completion before and after a one-hour training session. A paired one-sided t-test revealed no significant differences in task completion times between the two devices for both pre-training (p > 0.05) and post-training (p > 0.05) trials, indicating comparable effectiveness. Additionally, all participants demonstrated improved task completion times in their post-training trials. These findings validate the potential of 3D-printed trainers as cost-effective alternatives for basic aparoscopic skills training. Future iterations will focus on improving ergonomics and realism to better replicate surgical environments, promote wider accessibility, and advance medical education in resourcelimited areas.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"78 suppl 5","pages":"s20"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477121","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":"Rare Large Intestinal Lesions: A Case Series of Colonic Leiomyomas.","authors":"Kennedy Forest, Rafia I Waheed, Jyotroop Kaur, Ahmed T Kurdi","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Colonic leiomyomas are benign smooth muscle tumors of the large intestine. Although more commonly seen in the esophagus, leiomyomas of the colon are occasionally discovered during colonoscopies with the large intestine accounting for only 3% of gastrointestinal leiomyomas. Appropriate excision and staining can differentiate them from similar mesenchymal growths. Current guidelines do not offer recommendations on follow-up for this type of lesion, but recurrence rates are low based on reported cases. The purpose of this case series is to report 10 cases of this rare form of colonic lesion and investigate their recommended follow-up timelines and recurrence rates.</p><p><strong>Case series: </strong>We report the cases of 10 histologically proven colonic leiomyomas identified between the years 2015 and 2025 within one hospital system. Eighty percent of these were discovered on screening colonoscopy in asymptomatic patients. Staining of these leiomyomas to confirm diagnosis included a positive actin and/or desmin stain and a negative CD34, CD117, DOG1 and/or S100-protein stain to rule out similar appearing gastrointestinal stromal tumors. The average follow-up recommendation made for these patients to repeat colonoscopy or imaging was 3.35 years. There are no documented recurrences of leiomyomas within these cases to date.</p><p><strong>Conclusion: </strong>Although colonic leiomyomas are benign, these lesions should be excised and appropriately stained to differentiate them from similar appearing smooth muscle tumors. Although there are no current guidelines on the timeline to follow up, exploration of cases and investigation of recurrence rates can contribute to the development of specific follow-up recommendations when endoscopists encounter these rare lesions.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"78 suppl 5","pages":"s25-s26"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477184","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":"Experience of the First Epilepsy Monitoring Unit in South Dakota.","authors":"Colton Carlson, Kaitlyn Schaunaman, Kaitlyn Gonzalez Otarula","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Long term video-electroencephalographic (EEG) monitoring in an epilepsy monitoring unit (EMU) is considered the gold standard for diagnosis of seizure disorders and differentiating epileptic seizures from non-epileptic events. EMUs provide 24-hour monitoring with specially trained staff, mounted cameras for seizure observation, the ability to withdraw anti-epileptic medication and the ability to utilize seizure provoking techniques such as hyperventilation and sleep deprivation. These benefits allow EMUs to obtain a definitive diagnosis in as many as 88% of visits. South Dakota opened its first EMU in January of 2024 allowing more patients to remain in-state for seizure diagnosis and increasing the quality of epilepsy care in South Dakota.</p><p><strong>Methods: </strong>A retrospective analysis was performed of patients undergoing elective vEEG monitoring in South Dakota's first EMU from January 2024 to October 2024. Data points were recorded including patient demographics, reason for admission, adverse events during admission and outcome of the study.</p><p><strong>Results: </strong>Thirty-six vEEG studies were conducted between January 1, 2024, and October 11, 2024. The median age of patient was 34.5 years with 21 females (58.3%) and 15 males (41.7%) served. Hispanic and Native American were the highest represented minorities, each forming 8.3% of patients. The median length of study was 93 hours. Twenty-seven studies (75.0%) were considered diagnostically conclusive while capturing a clinical event or recording epileptiform EEG activity that aided in diagnosis. Twenty-six EMU visits (72.2%) resulted in a medication change prior to discharge. Only 5 studies (13.9%) conducted in the EMU experienced adverse events including status epilepticus, rash, UTI and agitation.</p><p><strong>Conclusion: </strong>The EMU has been an invaluable addition to medical care in South Dakota. It provides a safe and reliable diagnostic study that allows for better diagnosis and improved treatment of seizure patients while staying closer to home.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"78 suppl 5","pages":"s22"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477077","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":"Core Muscle Recruitment during Horseback Riding: A Pilot Study.","authors":"Jacob J Miller, Aarabhi Gurumoorthy","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Horseback riding is a common activity performed worldwide. Although core muscle strengthening is frequently promoted as beneficial for horseback riding, little is known about muscle activation during riding gaits. We examined activation of four core muscles (erector spinae, gluteus maximus, gluteus minimus, and rectus abdominis) during horseback riding compared with ground exercises.</p><p><strong>Methods: </strong>Nine active members (seven females and two males) of the South Dakota State University Rodeo Club volunteered for the study. Target muscle contraction was measured by surface electromyography (sEMG) using the Delsys Trigno Wireless Biofeedback system. Subjects performed a series of ground exercises to establish a maximal voluntary contraction, followed by horseback riding in a walk, trot, and lope (canter). Muscle activation during the various riding gaits was then compared with maximal voluntary contraction and expressed as a percentage.</p><p><strong>Results: </strong>All core muscles examined were active during horseback riding, with rectus abdominis showing the greatest activity. There was a positive correlation between percent maximal voluntary contraction and riding gait speed in all core muscles.</p><p><strong>Conclusion: </strong>Core musculature is utilized during horseback riding, and activation increases with riding gait speed. This study informs protocols for riding rehabilitation and deepens understanding of riding benefits for athletic training and hippotherapy.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"78 5","pages":"204-209"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477073","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}