Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen最新文献

{"title":"[Clinical testing of the updated S3-level guideline for non-specific neck pain with physiotherapists and patients: A mixed-methods approach].","authors":"Anne Jarck, Saskia Ott, Marie Lindig, Kerstin Lüdtke","doi":"10.1016/j.zefq.2026.03.005","DOIUrl":"https://doi.org/10.1016/j.zefq.2026.03.005","url":null,"abstract":"<p><strong>Introduction: </strong>Neck pain has a prevalence of 45.7 % in Germany and leads to days of incapacity for work and rehabilitation treatment. The limited access to physiotherapy due to a shortage of specialists makes evidence-based and resource-conserving care necessary. An S3-level guideline for non-specific neck pain has been developed to improve the quality of care. Part of this process is a practical test to evaluate direct clinical implementation with physiotherapists and patients.</p><p><strong>Methods: </strong>Using a mixed-methods approach, the guideline and its short version as well as the patient information were evaluated from the perspective of physiotherapists and patients in the practical test. During and after a six-week trial phase, questionnaires were completed by both physiotherapists and patients; the physiotherapists were also invited to take part in interviews. The quantitative analysis was descriptive, and the qualitative analysis followed a deductive-inductive approach using structured content analysis.</p><p><strong>Results: </strong>20 questionnaires and 11 interviews of physiotherapists and 37 patient questionnaires were included in the analysis. The quantitative data show, for the most part, a high level of consensus with the recommendations. The qualitative analysis revealed the following main physiotherapy categories: (1) Previous experience and comparisons with other guidelines, (2) Useful aspects, (3) New aspects, (4) Conflict situations, and (5) Integration into everyday practice. The physiotherapists identified supported communication, promoted interprofessionalisation, and confirmation of one's own actions as useful aspects. Conflict situations arose, for example, from deviating patient preferences. Five main categories were also identified among the patients. Patients expressed heterogeneous expectations regarding passive measures. There was a need for adaptation with regard to the information content of the patient information and the exclusion of diagnostic imaging.</p><p><strong>Discussion: </strong>The results confirm the relevance of interprofessional guidelines for promoting patient-centred care. Conflicts such as divergent patient preferences with regard to guideline recommendations are an indication of structural and communicative challenges, not primarily of deficiencies in the guideline design. With regard to patient information, the results indicate a need for differentiated education in order to promote trust and therapy acceptance.</p><p><strong>Conclusion: </strong>Both physiotherapists and patients rated the S3-level guideline for non-specific neck pain and the respective patient information as comprehensible and practical. Despite their limited generalizability, the results provide important starting points for the further development and practical implementation of the S3-level guideline for non-specific neck pain.</p>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857417","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":"Herausgeberkollegium / Editorial Board","authors":"","doi":"10.1016/S1865-9217(26)00092-9","DOIUrl":"10.1016/S1865-9217(26)00092-9","url":null,"abstract":"","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"202 ","pages":"Page ii"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147755583","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":"Ein neuer Ansatz für Versorgungsevaluationen: Erprobung des PopGroupers für Vergleichsgruppenbildung und Morbiditätsmessung am Beispiel der DMP KHK und Brustkrebs","authors":"Philipp Hengel ,&nbsp;Chrissa Tsatsaronis ,&nbsp;Reinhard Busse ,&nbsp;Wilm Quentin","doi":"10.1016/j.zefq.2026.01.002","DOIUrl":"10.1016/j.zefq.2026.01.002","url":null,"abstract":"<div><h3>Background</h3><div>The PopGrouper is a population-based classification system that was created using data from a large German statutory health insurance fund. It annually assigns each individual to one mutually exclusive, clinically meaningful, and cost-homogeneous group at different levels of aggregation. This study tests the PopGrouper for matching and as a morbidity outcome measure in healthcare evaluations.</div></div><div><h3>Methods</h3><div>Disease management programs (DMPs) for coronary heart disease (CHD) and breast cancer were analyzed in a quasi-experimental design (matching: 2021, enrolment: 2022, follow-up: 2023). Insured persons were assigned 1:1 to the intervention (IG: DMP) or to the control group (CG: usual care) using a standard propensity score matching (benchmark), a pure and an extended PopGroup matching including disease-specific variables. Morbidity was assessed by comparing PopGroup distributions between IG and CG before and after intervention.</div></div><div><h3>Results</h3><div>In the CHD sample (CG pool n = 29,680; IG n = 7,557) and breast cancer sample (n = 111,509; n = 3,321), sample sizes were reduced by up to 3% after matching. Both benchmark and extended PopGroup matching achieved good covariate balance. Follow-up showed a higher proportion of patients with active breast cancer treatment in the IG than in the CG. CHD patients in the CG more often received no CHD treatment, had no health care use/disease, or were classified as high-cost cases.</div></div><div><h3>Discussion</h3><div>Extended PopGroup matching achieved results that are comparable to the benchmark with substantially less effort. As an outcome measure, the PopGrouper’s multidimensional morbidity mapping offers opportunities for exploratory analyses, including process quality, and can be combined with established endpoints such as mortality. The PopGrouper could contribute to a higher level of standardization in healthcare evaluations.</div></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"202 ","pages":"Pages 64-73"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147285442","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":"Palliativmedizinische Aspekte in der physiotherapeutischen Ausbildung und im Studium: Eine deutschlandweite Befragung von Ausbildungsstätten und Hochschulen","authors":"Alisa Schmitt ,&nbsp;Christian Volberg ,&nbsp;Tom Militzer ,&nbsp;Anna Elisabeth Pape ,&nbsp;Sandra Apelt ,&nbsp;Paula Vradelis","doi":"10.1016/j.zefq.2026.03.002","DOIUrl":"10.1016/j.zefq.2026.03.002","url":null,"abstract":"<div><h3>Objective</h3><div>Palliative care is becoming increasingly important, yet it is unclear to what extent it is incorporated into physiotherapy training and university education. This study systematically documents the current situation at German physiotherapy training centres and universities, analysing institutional barriers and attitudes towards future implementation.</div></div><div><h3>Methodology</h3><div>A nationwide cross-sectional survey was conducted between January and April 2024, where 278 educational institutions were contacted by mail. A standardised paper questionnaire was used to collect data on various factors, including training type, status and scope of curricular integration, teaching formats, perceived barriers, and attitudes towards future implementation. Data were evaluated descriptively; answers to open-ended questions were summarised using content analysis.</div></div><div><h3>Results</h3><div>A total of 120 institutions (43.2%) participated. Of these, 54.2% predominantly teach palliative care theoretically (98.5%), with practical (53.8%) and patient-related (24.6%) formats being used as well. The reasons for integration included legal and curricular requirements, career preparation, and improving the quality of care. Of those who did not integrate palliative care into their curriculum, 45.8% cited inconsistent nationwide legal requirements (with some federal states having no regulations), and 52.7% mentioned a lack of qualified teaching staff. Just under a third cited a lack of time in the curriculum and a lack of cooperation partners for patient-centred teaching as a reason. A total of 92.6% endorse future integration.</div></div><div><h3>Conclusion</h3><div>Currently, palliative care content is included in the curriculums at only about half of the German physiotherapy training centres and universities, and implementation, scope and timing vary greatly. There is a broad consensus on the need for future integration, indicating the necessity of nation wide uniform curricula and qualified teaching staff in order to develop palliative care skills already during the training phase and remedy structural deficits.</div></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"202 ","pages":"Pages 83-93"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692990","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":"Inhaltsverzeichnis / Table of Contents","authors":"","doi":"10.1016/S1865-9217(26)00093-0","DOIUrl":"10.1016/S1865-9217(26)00093-0","url":null,"abstract":"","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"202 ","pages":"Pages iii-iv"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147755589","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":"„Kaukasisch“ in medizinischen Studien: Ethische, rechtliche und wissenschaftliche Perspektiven am Beispiel der ophthalmologischen Studie „Low-dose AtropIne for Myopia Control in Children“ (AIM)","authors":"Hakan Kaymak ,&nbsp;Berthold Seitz","doi":"10.1016/j.zefq.2026.02.003","DOIUrl":"10.1016/j.zefq.2026.02.003","url":null,"abstract":"<div><h3>Background</h3><div>The term “Caucasian” is still used to describe study populations in medical publications, often without explicit definition or transparent operationalization. This can limit reproducibility, comparability, and external validity. As a case example, we use the first German clinical atropine trial for myopia control in children, the Low-dose AtropIne for Myopia Control in Children (AIM) study.</div></div><div><h3>Methods</h3><div>Commentary based on an analysis of publicly available documents related to the AIM trial (protocol/published information) and a structured literature and policy/statement review (PubMed and relevant guidance documents) on race/ethnicity reporting, the use of “Caucasian”, and fair participant selection.</div></div><div><h3>Results</h3><div>Using the first German clinical atropine trial for myopia control in children (AIM) as a case example, we show that the target population is described as “Caucasian”, while the definition and assignment procedures are not transparent in public materials. This affects interpretability and transferability, especially when cohorts are used for follow-up analyses (e.g., genetics).</div></div><div><h3>Discussion</h3><div>We discuss scientific (definition/validity), ethical (fair selection), legal (equal treatment and discrimination risks), and regulatory (target population/transferability) implications. We emphasize the need to distinguish social categories from geographic recruitment and from biological hypotheses, which require appropriate variables and explicit justification.</div></div><div><h3>Conclusion</h3><div>Population descriptors such as “Caucasian” should only be used when they are defined, justified, and transparently operationalized. More precise reporting standards and alternatives are available.</div></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"202 ","pages":"Pages 1-5"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147616952","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":"„Das ist noch nicht meine Welt“: Eine qualitative Studie zur Frage, was ältere Menschen im ländlichen Sachsen-Anhalt von der Teilnahme an einer Online Health Community halten","authors":"Jonathan Bay ,&nbsp;Lea Malin Hofmann ,&nbsp;Lea Hallbauer ,&nbsp;Julia Vorhölter ,&nbsp;Cornelia Gottschick ,&nbsp;Rafael Mikolajczyk ,&nbsp;Amand Führer ,&nbsp;Susan Langer","doi":"10.1016/j.zefq.2026.03.001","DOIUrl":"10.1016/j.zefq.2026.03.001","url":null,"abstract":"<div><h3>Background</h3><div>Digitalization can be an important strategy for upholding medical services in rural areas in the face of demographic change and a looming shortage of skilled care workers. An online health community (OHC) can strengthen self-management and health literacy and serve as a digital interface between citizens and medical service providers.</div></div><div><h3>Methods</h3><div>We investigated the viewpoints of elderly people in southern Saxony-Anhalt towards digitalization in general and their willingness (or lack thereof) to participate in a future OHC. Therefore, we conducted 20 semi-structured interviews and five focus groups with elderly people. In addition, two expert interviews were conducted to assess regional contextual factors. Data were evaluated using reflexive thematic analysis.</div></div><div><h3>Results</h3><div>Participants experience changes in their everyday life brought about by digitalization which they perceive as a source of uncertainty that threatens their identity. They fear that digital technologies will cause a loss of authenticity in their personal relationships and express concerns about sharing content digitally with unknown others. Furthermore, participants feel pressured to acquire digital skills. Yet, they also fear exclusion from participating in digital technologies. However, participants use digital technologies for pragmatic reasons and view them as potential solutions for existing problems, such as overcoming spatial distance.</div></div><div><h3>Discussion and Conclusion</h3><div>Participants‘ everyday experiences with digital technologies and their pragmatic attitudes towards using them may have a positive impact on OHC participation. In addition to known barriers such as security concerns, the pervasiveness of digitalization in everyday life, however, unsettles participants, which might have a negative impact on their participation in an OHC.</div></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"202 ","pages":"Pages 44-55"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147755587","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":"Status quo des Antibiotic Stewardship in deutschen Krankenhäusern aus der Perspektive der Krankenhausapotheker*innen – Ergebnisse der ADKA-Umfrage 2023","authors":"Gesche Först ,&nbsp;Wiltrud Probst ,&nbsp;Donald Ranft ,&nbsp;Jürgen Baumann ,&nbsp;Heike Hilgarth","doi":"10.1016/j.zefq.2026.02.002","DOIUrl":"10.1016/j.zefq.2026.02.002","url":null,"abstract":"<div><h3>Background</h3><div>The Committee for Anti-infective Therapy within the Federal Association of German Hospital Pharmacists (ADKA) regularly surveys the status of antimicrobial stewardship (AMS) implementation in German hospitals. Following the last survey in 2017, an updated S3 guideline on AMS was published. This current survey conducted by the ADKA in 2023 aimed to assess the status of AMS implementation, highlight developments over time and analyse pharmacists’ participation in AMS activities.</div></div><div><h3>Method</h3><div>From 13 March to 20 April 2023, an online survey was conducted among all chief pharmacists of hospital pharmacies in Germany. The questionnaire covered structural and process characteristics of AMS, as well as questions regarding pharmacists’ involvement. The data were evaluated descriptively and compared to data from the 2017 survey.</div></div><div><h3>Results</h3><div>Data from 226 hospitals were analysed. 85 % of the hospitals have a multidisciplinary AMS team (51 % according to the S3 guideline). However, only 9 % met the staffing level recommendations for AMS activities. Hospital pharmacists are heavily involved in AMS activities, regardless of explicit funding. The implementation rate of AMS strategies mostly correlates with AMS staffing levels.</div></div><div><h3>Discussion</h3><div>The results demonstrate a positive trend in the implementation of AMS teams and interventions. Pharmacists play a central role in conducting AMS strategies. However, staffing levels fall short of national recommendations and international standards, limiting the comprehensive implementation of AMS.</div></div><div><h3>Conclusion</h3><div>Hospital pharmacists play a crucial role in AMS. There is a sufficient number of qualified pharmacists. To ensure widespread establishment of AMS programmes in German hospitals, however, investment in human resources and infrastructure is necessary.</div></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"202 ","pages":"Pages 25-33"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147575775","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":"Von der Fallanalyse zu Handlungssicherheit: Evaluation der Morbiditäts- und Mortalitätskonferenzen an einem Universitätsklinikum mittels Mixed-Methods-Ansatz","authors":"Anke Ricarda Warmbier ,&nbsp;Sophia Freya Ulrike Blum ,&nbsp;Maria Eberlein-Gonska ,&nbsp;Jochen Schmitt ,&nbsp;Christian Kirsch","doi":"10.1016/j.zefq.2026.02.006","DOIUrl":"10.1016/j.zefq.2026.02.006","url":null,"abstract":"<div><h3>Background</h3><div>Morbidity and mortality conferences (M&amp;MCs) are structured interprofessional meetings to review specific treatment courses and deaths, aiming to learn from errors to improve patient care and safety. They integrate medical education, quality improvement, and risk management. With the rising importance of safety culture in German healthcare, the relevance of standardized M&amp;MCs is also growing. Other examples of safety culture include an open error culture and critical incident reporting systems. This study analyzed facilitating and inhibiting factors of structured M&amp;MCs, their impact on the derivation of improvement measures, and their influence on participants’ professional activities and confidence to act.</div></div><div><h3>Methods</h3><div>A mixed-methods study involving participant observation and quantitative surveys of all M&amp;MC participants was conducted at Dresden University Hospital. Data from participant observation was analyzed using Grounded Theory approach; correlation analyses supplemented the perceived effects of derived measures.</div></div><div><h3>Results</h3><div>During the study period (February 2019 to December 2020), 32 M&amp;MCs were visited in 16 departments of Dresden University Hospital (response rate 69.3 %; 400/577 questionnaires). Structured M&amp;MCs promoted systematic case analysis and consistent presentation quality of treatment courses. Derived improvement measures correlated with better understanding of internal departmental processes, increased clarity, and confidence to act.</div></div><div><h3>Conclusion</h3><div>The study highlights the importance of moderated interprofessional and multiprofessional M&amp;MCs. It suggests that M&amp;MCs can promote learning processes and participants’ confidence to act in patient care, thereby improving the quality of medical care.</div></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"202 ","pages":"Pages 14-24"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640130","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":"Mehr Versorgung für Patient*innen dank nutzerfreundlicher Praxissoftware? Eine explorative Studie","authors":"Doreen Müller ,&nbsp;Michael Erhart ,&nbsp;Jakob Holstiege ,&nbsp;Dominik Graf von Stillfried","doi":"10.1016/j.zefq.2026.02.005","DOIUrl":"10.1016/j.zefq.2026.02.005","url":null,"abstract":"<div><h3>Background</h3><div>Given the increasing demand for care and limited physician time, this study investigates whether the usability of practice management systems (PMS) is associated with the performance of medical practices. It analyzes whether more user-friendly PMS enable a higher number of treatment cases and greater service volumes (primary hypotheses), depending, in particular, on case load or service volume (secondary hypotheses).</div></div><div><h3>Methods</h3><div>A total of 24,140 individual practices (number of treatment cases) and 24,434 individual practices (service volume in euros) of office-based physicians were analyzed in 2024. Using linear multilevel models, it was tested whether the number of treatment cases or the service volume was associated with the usability of the PMS, both for the total sample and separately for practices above and below the mode of the dependent variable. In a sensitivity analysis, patient characteristics as well as regional socioeconomic deprivation and physician structure were taken into account.</div></div><div><h3>Results</h3><div>In the multilevel models of the total sample (concerning the primary hypotheses), no significant association was found between usability (β = 7.9; 90% confidence interval (CI) [–4.6; 20.4]) or the number of treatment cases or service volume (β = 505.4; 90% CI [–226.5; 1,237.7]). However, in practices below the mode, higher usability was significantly associated with higher service volumes (β = 530.1; 90% CI [13.9; 1,046.8]), even after sensitivity analysis, adjusted for patient-level factors of the practice and regional structures (β = 518.1; 90% CI [9.6; 1,027.3]).</div></div><div><h3>Conclusions</h3><div>The study highlights the potential of PMS to increase efficiency, especially where capacities are not fully utilized. The findings may encourage developers to further improve PMS usability and better tailor systems to everyday practice needs.</div></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"202 ","pages":"Pages 6-13"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624065","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}