Brenda Moore PhD, RN-BC, CNE, Fadwa N. Alhalaiqa CNS, PhD, Ahlam Al-Zahrani PhD, Hoda Mohammed Sayed PhD
{"title":"Exploratory Survey of Simulation Use in Middle East and North African Prelicensure Nursing Programs","authors":"Brenda Moore PhD, RN-BC, CNE, Fadwa N. Alhalaiqa CNS, PhD, Ahlam Al-Zahrani PhD, Hoda Mohammed Sayed PhD","doi":"10.1016/S2155-8256(23)00089-3","DOIUrl":"10.1016/S2155-8256(23)00089-3","url":null,"abstract":"<div><h3>Background</h3><p>The National Council of State Boards of Nursing (NCSBN) Survey of Simulation Use in Prelicensure Nursing Programs tool was employed to gather descriptive information from nursing programs in the Middle East and North Africa (MENA). A total of 39 nursing programs from 10 countries participated.</p></div><div><h3>Purpose</h3><p>To benchmark the prevalence, use, and regulation of simulation in MENA nursing programs.</p></div><div><h3>Methods</h3><p>The NCSBN Survey of Simulation Use in Prelicensure Nursing Programs tool was communicated either electronically or in person to multiple nursing programs in the MENA region. Descriptive data, ideas, and opinions were collected.</p></div><div><h3>Results</h3><p>Of the 93 MENA programs contacted, 39 returned a completed survey. According to survey responses, simulation use in nursing programs is widespread. Simulation is commonly used to enhance instruction, to support skill acquisition, and as a substitute for clinical hours. Respondents viewed therapeutic communication, patient education, compassion, and demonstration of critical thinking as unsuitable for simulation.</p></div><div><h3>Conclusion</h3><p>Simulation is appreciated as a critical tool in nursing education in the MENA region. Limitations in clinical space, time, and complex patient situations and opposite gender care are driving factors for simulation use. Challenges related to space, funding, and training limit the availability of simulation in a region where more simulation is both needed and desired.</p></div>","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41410673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Simulation in Nursing Education: Advancements in Regulation, 2014–2022","authors":"Richard Smiley MS, MA, Brendan Martin PhD","doi":"10.1016/S2155-8256(23)00086-8","DOIUrl":"10.1016/S2155-8256(23)00086-8","url":null,"abstract":"<div><h3>Background</h3><p>The use of simulation-based clinical experiences in prelicensure nursing education has increased dramatically over the past 2 decades. This trend accelerated after the onset of the COVID-19 pandemic in the United States.</p></div><div><h3>Purpose</h3><p>To quantify advancements in the regulation of simulation use in nursing education since the publication of the National Simulation Study and its accompanying guidelines.</p></div><div><h3>Methods</h3><p><span>This cohort study included 61 of the National Council of State Boards of Nursing’s U.S.-based member and associate member jurisdictions. For each included jurisdiction, explicit simulation regulation information regarding either </span>registered nurse<span> (RN) or licensed practical nurse/licensed vocational nurse (LPN/LVN) programs was obtained in 2014. Comparisons were made between 2014 and 2022 nursing simulation regulations. Generalized estimating equation models were used to assess the significance of the observed changes.</span></p></div><div><h3>Results</h3><p>The number of jurisdictions with specific regulations regarding simulation use in prelicensure RN programs doubled from 21 in 2014 to 41 in 2022. Additionally, the number of nursing regulatory bodies (NRBs) that allowed a maximum substitution of up to 50% simulated clinical hours rose from 1 to 23 over the same time frame. Similarly, specific regulations regarding simulation use in LPN/LVN programs rose from 20 programs in 2014 to 36 in 2022. As with RN programs, the number of NRBs that permit a maximum of up to 50% simulation substitution for LPN/LVN programs rose from 0 to 22 during the 8-year period.</p></div><div><h3>Conclusion</h3><p>The impact of the guidelines that emerged from the National Simulation Study is evident. The proactive efforts of NRBs to adopt evidence-based best practices on simulation regulation before and shortly after the onset of the COVID-19 pandemic provided appropriate flexibility for prelicensure RN programs to respond to the global health crisis efficiently and safely.</p></div>","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49236822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Roy A. Thompson PhD, MSN, RN, Susan G. Silva PhD, Kirsten N. Corazzini PhD, FGSA, Thomas R. Konrad PhD, Michael P. Cary, Jr PhD, RN, Eleanor S. McConnell PhD, RN
{"title":"Examining Human Capital Among Foreign- and U.S.-Educated Nurses in Long-term Care","authors":"Roy A. Thompson PhD, MSN, RN, Susan G. Silva PhD, Kirsten N. Corazzini PhD, FGSA, Thomas R. Konrad PhD, Michael P. Cary, Jr PhD, RN, Eleanor S. McConnell PhD, RN","doi":"10.1016/S2155-8256(23)00088-1","DOIUrl":"10.1016/S2155-8256(23)00088-1","url":null,"abstract":"<div><h3>Background</h3><p>Recruiting foreign-educated nurses (FENs) is a strategy to reduce staffing shortages of registered nurses (RNs) practicing in long-term care (LTC) in the United States. However, little is known about how FENs compare to U.S.-educated nurses (USENs) in their innate abilities and skills, also known as human capital.</p></div><div><h3>Purpose</h3><p>To compare human capital among FENs and USENs practicing in LTC.</p></div><div><h3>Methods</h3><p>This cross-sectional study used data from the 2018 National Sample Survey of Registered Nurses to compare human capital scores between FENs and USENs. Human capital scores consisting of highest nursing qualification, skill-based certifications, number of state licensures, years of experience, multi-state employment, and multilingual ability were constructed and compared using analysis of covariance. Covariates were race, ethnicity, marriage/partnership, adults at home, children at home, direct patient care, and practice scope.</p></div><div><h3>Results</h3><p><span>The sample included 1,887 RNs (92.8% USENs and 7.2% FENs). Most RNs were female (92.3%), were aged ≥50 years (56.4%), were non-Hispanic White (78.3%), were married/partnered (68.0%), provided direct care (44%), and had full practice scope (71.7%). FENs versus USENs had a higher proportion reporting full scope of practice (80.7% vs. 71.0%, </span><em>p</em> = .0155). The mean human capital score for the total sample was 9.8 ± 1.3. Human capital scores were higher among FENs (<em>M</em> = 11.3, <em>SD</em> = 1.2) than USENs (<em>M</em> = 9.6, <em>SD</em> = 1.3, <em>p</em> < .0001).</p></div><div><h3>Conclusion</h3><p>FENs bring a higher level of human capital to LTC settings, which suggests that they have an increased capacity to provide the needed person-centered care to positively impact care quality and improve outcomes in LTC.</p></div>","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44494473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anna van der Gaag MSc, PhD, Robert Jago BA, MPhil (Cantab), Ann Gallagher SRN, MRN, BA, MA, PhD, Kostas Stathis PhD, Michelle Webster BA, MSc, PhD, Zubin Austin BScPhm, MBA, MISc, PhD, FCAHS
{"title":"Artificial Intelligence in Health Professions Regulation: An Exploratory Qualitative Study of Nurse Regulators in Three Jurisdictions","authors":"Anna van der Gaag MSc, PhD, Robert Jago BA, MPhil (Cantab), Ann Gallagher SRN, MRN, BA, MA, PhD, Kostas Stathis PhD, Michelle Webster BA, MSc, PhD, Zubin Austin BScPhm, MBA, MISc, PhD, FCAHS","doi":"10.1016/S2155-8256(23)00087-X","DOIUrl":"10.1016/S2155-8256(23)00087-X","url":null,"abstract":"<div><h3>Background</h3><p>Artificial intelligence (AI) refers to a broad group of technologies that are increasingly commonplace in everyday life; however, they have had only limited application in regulatory practice.</p></div><div><h3>Purpose</h3><p>The present study explored nursing regulators’ perceptions of the role and value of AI in regulation and potential barriers and facilitators to the uptake and implementation of AI.</p></div><div><h3>Methods</h3><p>Three facilitated focus group sessions with 28 representatives of regulators from Australia, the United Kingdom, and the United States were conducted. Content analysis of verbatim transcripts was completed.</p></div><div><h3>Results</h3><p>Key themes that emerged included (a) interest in how AI could enhance sustainability and improve cost-effectiveness of certain regulatory processes and (b) concerns regarding how the term “artificial intelligence” itself could be problematic. Specific barriers to the uptake of AI in regulation included concerns regarding codification of system bias, negative public perception, and lack of clarity around accountability for decision-making. Facilitators to implementation included enhancing the consistency of processes and improving the decision-making and utility in supporting trend analyses and audit functions.</p></div><div><h3>Conclusion</h3><p>Additional work in exploring how best to incorporate evolving AI technologies in regulatory practice—and what they should be named—is required, but these findings suggest that promising outcomes may lie ahead.</p></div>","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46801998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kathleen Leslie PhD, JD, RN, Sophia Myles PhD, Sarah Stahlke PhD, Catharine J. Schiller PhD, JD, RN, Jacob J. Shelley SJD, Karen Cook PhD, MSc (A), BSN, Jennifer Stephens MA, PhD, RN, OCN, CCNE, Sioban Nelson PhD, RN, FAAN, FCAHS
{"title":"Regulating During Crisis: A Qualitative Comparative Case Study of Nursing Regulatory Responses to the COVID-19 Pandemic","authors":"Kathleen Leslie PhD, JD, RN, Sophia Myles PhD, Sarah Stahlke PhD, Catharine J. Schiller PhD, JD, RN, Jacob J. Shelley SJD, Karen Cook PhD, MSc (A), BSN, Jennifer Stephens MA, PhD, RN, OCN, CCNE, Sioban Nelson PhD, RN, FAAN, FCAHS","doi":"10.1016/S2155-8256(23)00066-2","DOIUrl":"10.1016/S2155-8256(23)00066-2","url":null,"abstract":"<div><h3>Background</h3><p>The COVID-19 pandemic placed intense pressure on nursing regulatory bodies to ensure an adequate healthcare workforce while maintaining public safety.</p></div><div><h3>Purpose</h3><p>Our objectives were to analyze regulatory bodies’ responses during the pandemic, examine how nursing regulators conceptualize the public interest during a public health crisis, and explore the influence of a public health crisis on the balancing of regulatory principles. We aimed to develop a clearer understanding of regulating during a crisis by identifying themes within regulatory responses.</p></div><div><h3>Methods</h3><p>We conducted a qualitative comparative case study examining the pandemic responses of eight nursing regulators in three Canadian provinces and three U.S. states. Data were collected from semi-structured interviews with 19 representatives of nursing regulatory bodies and 206 publicly available documents and analyzed thematically.</p></div><div><h3>Results</h3><p>Five themes were constructed from the data: (1) risk-based responses to reduce regulatory burden; (2) agility and flexibility in regulatory pandemic responses; (3) working with stakeholders for a systems-based approach; (4) valuing consistency in regulatory approaches across jurisdictions; and (5) the pandemic as a catalyst for innovation. Specifically, we identified that the meaning of “public interest” in the context of high workforce demand was a key consideration for regulators.</p></div><div><h3>Conclusion</h3><p>Our results demonstrate the intensity of effort involved in nursing regulatory responses and the significant contribution of nursing regulation to the healthcare system’s pandemic response. Our results also indicate a shift in thinking around broader public interest issues, beyond the conduct and competence of individual nurses, to include pressing societal issues. Regulators are beginning to grapple with these longer-term issues and policy tensions.</p></div>","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10074059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9386850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michele H. Talley PhD, ACNP-BC, FAANP, FNAP, FAAN, Penni Watts PhD, RN, CHSE-A, FSSH, FAAN, Jill Stewart DNP, RN, CNOR, LSSGB, Jennie R. Alspach DNP, CRNP, FNP-BC, Terri L. Poe DNP, RN, NE-BC, Linda Moneyham PhD, RN, FAAN, Peggy Sellers Benson MSN, RN, MSHA, NE-BC, Maria Shirey PhD, MBA, RN, NEA-BC, ANEF, FACHE, FNAP, FAAN, Doreen C. Harper PhD, RN, FAAN
{"title":"Innovations in Academic/Clinical Partnerships During COVID-19 to Prepare a Ready Nursing Workforce","authors":"Michele H. Talley PhD, ACNP-BC, FAANP, FNAP, FAAN, Penni Watts PhD, RN, CHSE-A, FSSH, FAAN, Jill Stewart DNP, RN, CNOR, LSSGB, Jennie R. Alspach DNP, CRNP, FNP-BC, Terri L. Poe DNP, RN, NE-BC, Linda Moneyham PhD, RN, FAAN, Peggy Sellers Benson MSN, RN, MSHA, NE-BC, Maria Shirey PhD, MBA, RN, NEA-BC, ANEF, FACHE, FNAP, FAAN, Doreen C. Harper PhD, RN, FAAN","doi":"10.1016/S2155-8256(23)00069-8","DOIUrl":"10.1016/S2155-8256(23)00069-8","url":null,"abstract":"<div><p>Management of the COVID-19 pandemic required healthcare leaders and frontline workers to rapidly innovate and adjust to a new reality that has forever transformed nursing education and practice. Throughout the pandemic, key stakeholders in Alabama lobbied for transformations in clinical training practice that ultimately improved students’ exposure to clinical environments and alleviated the pressure on practicing nurses and other healthcare workers during pandemic hospitalization surges. The present article highlights the key partners and regulatory innovations that led to these successes in Alabama.</p></div>","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10074065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9327591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Richard A. Smiley MS, MA, Richard L. Allgeyer PhD, Yetty Shobo PhD, Karen C. Lyons PhD, APRN, NEA, Rayna Letourneau PhD, RN, Elizabeth Zhong PhD, Nicole Kaminski-Ozturk PhD, Maryann Alexander PhD, RN, FAAN
{"title":"The 2022 National Nursing Workforce Survey","authors":"Richard A. Smiley MS, MA, Richard L. Allgeyer PhD, Yetty Shobo PhD, Karen C. Lyons PhD, APRN, NEA, Rayna Letourneau PhD, RN, Elizabeth Zhong PhD, Nicole Kaminski-Ozturk PhD, Maryann Alexander PhD, RN, FAAN","doi":"10.1016/S2155-8256(23)00047-9","DOIUrl":"https://doi.org/10.1016/S2155-8256(23)00047-9","url":null,"abstract":"<div><p><strong>Background:</strong><span> Every two years, the National Council of State Boards of Nursing (NCSBN) and the National Forum of State Nursing Workforce Centers (Forum) conduct the only national-level survey focused on the entire U.S. nursing workforce. The survey generates data on the supply of registered nurses (RNs) and licensed practical nurses/licensed vocational nurses (LPNs/LVNs). These data are especially crucial in providing information on emerging nursing issues, which in 2022, was the impact of the (COVID-19) pandemic on the nursing workforce. </span><strong>Purpose:</strong> To provide data critical to planning for enough adequately prepared nurses and ensuring a safe, diverse, and effective healthcare system. <strong>Methods:</strong> This study used a mixed-mode approach, involving mailing a national, randomized sample survey to licensed RNs and LPNs/LVNs in most jurisdictions, supplemented by a national, randomized sample survey emailed to licensed RNs and LPNs/LVNs in four jurisdictions and data from the e-Notify nurse licensure notification system for five jurisdictions. Data from RN and LPN/LVN respondents were collected between April 11, 2022, and September 30, 2022. Data included nurse demographics, educational attainment, employment, practice characteristics, and trends. <strong>Results:</strong> The total number of active RN and LPN/LVN licenses in the United States were 5,239,499 and 973,788, respectively. The median age of RNs was 46 years and 47<!--> <span>years for LPNs/LVNs, which reflects a decrease of 6 years for each cohort from the 2020 data. This decline was associated with estimated losses to the workforce of at least 200,000 experienced RNs and 60,000 experienced LPNs/LVNs. An average of 89% of all nurses who maintain licensure are employed in nursing with roughly 70% working full-time. Hospitals and nursing/extended care facilities continue to be the primary practice setting for RNs and LPNs, respectively. Increased proportions of male and Hispanic/Latino nurses have introduced greater racial diversity in the nursing workforce. The nursing workforce is becoming increasingly more educated with more than 70% of RNs holding a baccalaureate degree or higher. More than one-quarter of all nurses report that they plan to leave nursing or retire over the next 5 years. Increased demand from the COVID-19 pandemic and inflation led nursing incomes to rise significantly across the country. Nurses were also specifically asked how the COVID-19 pandemic impacted them, and more than 60% of all nurses reported an increase in their workload because of the pandemic. </span><strong>Conclusion:</strong><span> In the wake of the COVID-19 pandemic, the nursing workforce has undergone a dramatic shift with the loss of hundreds of thousands of experienced RNs and LPNs/LVNs. The nursing workforce has become younger and more diverse with increases reflected for Hispanic/Latino and male nurses. An increasing proportion of the ","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49879357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Virtual Clinical Simulation Adoption and Use by Licensed Practical Nurse/Licensed Vocational Nurse Education Programs During the COVID-19 Pandemic","authors":"Nicole Kaminski-Ozturk PhD, Brendan Martin PhD","doi":"10.1016/S2155-8256(23)00065-0","DOIUrl":"10.1016/S2155-8256(23)00065-0","url":null,"abstract":"<div><h3>Background</h3><p>In the early stages of the COVID-19 pandemic, as clinical site restrictions were implemented, education programs leading to licensed practical nurse/licensed vocational nurse (LPN/LVN) degrees increasingly relied on virtual simulation-based experiences to provide clinical training to their students. However, scant evidence exists regarding the extent of this change and the various modalities employed by LPN/LVN programs across the United States.</p></div><div><h3>Purpose</h3><p>We sought to identify the degree to which virtual clinical simulation was adopted by LPN/LVN education programs during the early stages of the COVID-19 pandemic to address clinical site restrictions. In addition, we hoped to identify the practices and activities that educators included under the broad umbrella definition of virtual clinical simulation.</p></div><div><h3>Methods</h3><p>All active U.S. prelicensure LPN/LVN nursing education programs were contacted in September 2020. Program leaders were asked to estimate the proportion of clinical hours completed in virtual clinical simulation before the pandemic and the proportion anticipated for the fall 2020 term. Descriptive statistics were generated, with repeated measures analysis of covariance applied to evaluate the average change in virtual simulation within programs stratified by reported clinical restrictions.</p></div><div><h3>Results</h3><p>Representatives from 265 LPN/LVN programs in 44 U.S. jurisdictions responded to the survey. Responding programs significantly increased the proportion of clinical hours completed in virtual clinical simulation between fall 2019 (<em>M</em> = 10.7, <em>SD</em> = 15.3) and fall 2020 (<em>M</em> = 35.3, <em>SD</em> = 27.6, <em>p</em> < .001). Furthermore, there was an interaction between clinical site restrictions and term, with a more pronounced uptick in virtual simulation usage among programs that indicated they found identifying clinical sites “very difficult” (<em>M</em> = 41.1, <em>SD</em> = 28.9) relative to those who found it “somewhat more difficult” (<em>M</em> = 23.9, <em>SD</em> = 18.8, <em>p</em> < .001). Programs adopted a range of modalities, including simply watching videos and participating in virtual or augmented reality, online software packages, or other forms of screen-based learning.</p></div><div><h3>Conclusion</h3><p>As the adoption of virtual simulation increases, clear definitions of what constitutes clinical virtual simulation must be established. Additionally, rigorous inquiry to support evidence-based regulatory guidelines is needed.</p></div>","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10074064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9386847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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