Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen最新文献

{"title":"Einbindung von Pflegefachpersonen mit Hochschulabschlüssen an deutschen Universitätskliniken: Vergleich der Befragungsergebnisse 2018 und 2024","authors":"Hannah Pinnekamp ,&nbsp;Julian Bauer ,&nbsp;Jennifer Luboeinski ,&nbsp;Andrea Ellermeyer ,&nbsp;Susanne Krotsetis ,&nbsp;Jenny Heymann ,&nbsp;Louise Koppe ,&nbsp;Laura Todisco ,&nbsp;Inke Zastrow ,&nbsp;Andreas Kocks ,&nbsp;Uli Fischer","doi":"10.1016/j.zefq.2025.07.001","DOIUrl":"10.1016/j.zefq.2025.07.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Healthcare in Germany faces major challenges that require greater involvement of academically qualified nursing professionals. Despite positive trends in the academization of the nursing profession, challenges remain that require further systematic research.</div></div><div><h3>Methods</h3><div>A survey was used to collect current quantitative data on the number and proportion of nursing professionals with a university degree at German university medical centers and university hospitals and to compare these data with the results from 2018. In addition, we investigated the proportion of these professionals with positions in direct patient care, existing institutes for nursing science, job descriptions, and incentive measures for academic nursing professionals.</div></div><div><h3>Results</h3><div>The analysis comprises data from 14 university medical centers and university hospitals that provided complete data sets for 2024 and 2018. The proportion of nursing professionals with a university degree increased from 2.92 % in 2018 to 3.91 % in 2024. In direct patient care, the proportion rose from 2.14 % to 3.18 %. The proportion of nursing professionals with a university degree in direct patient care in relation to the total number of employees in nursing services in direct patient care was 3.50 % in 2024. There was considerable heterogeneity in terms of job descriptions for nursing professionals with a university degree, pay-scale grouping, and non-monetary incentives. Of the clinics included, four had an Institute of Nursing Science, three had a chair in Nursing Science, and two had a primary qualifying academic degree program in nursing.</div></div><div><h3>Discussion</h3><div>The survey results show progress towards the integration of academically qualified nursing professionals in German university hospitals, but challenges remain. At 3.18 %, the proportion of academically qualified nursing professionals in direct patient care remains well below the recommended 20 %. The study emphasizes the importance of clear job descriptions, collective pay-scale groupings, and incentives to better integrate the roles of these professionals in the healthcare system and make full use of their abilities.</div></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"197 ","pages":"Pages 62-72"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973768","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":"Analyse der Zielgruppen in der Weiterbildung Allgemeinmedizin: Ergebnisse einer Kohortenstudie im Kompetenzzentrum Weiterbildung Baden-Württemberg (KWBW)","authors":"Andreas Christian Dreher ,&nbsp;Jonathan Ko ,&nbsp;Christine Becker ,&nbsp;Christian Förster ,&nbsp;Tanja Jähnig ,&nbsp;Martina Bischoff ,&nbsp;Sandra Stengel ,&nbsp;Simon Schwill","doi":"10.1016/j.zefq.2025.06.004","DOIUrl":"10.1016/j.zefq.2025.06.004","url":null,"abstract":"<div><h3>Background</h3><div>Residents in Family Medicine (FM) decide on their FM training pathway directly at the start of their career (“direct entry”), in the course of their further training (“advanced entry”), or switch to FM from another medical specialty (“lateral entry”). The aim of this study is to characterize the participants of the Competence Center for Postgraduate Medical Training in Baden-Württemberg (Kompetenzzentrum Weiterbildung Baden-Württemberg, KWBW) in target groups (target audience).</div></div><div><h3>Methods</h3><div>An ongoing cohort study has been conducted at the KWBW since 2016. All FM trainees receive a self-designed questionnaire with 54 items on socio-demographic data and previous professional experience when they enter the program. Between 11/2020 and 12/2021, an additional questionnaire containing 21 items on motivation for FM training was used. The data was analyzed descriptively and semi-qualitatively.</div></div><div><h3>Results</h3><div>Of 929 new trainees, n = 883 took part in the survey (response rate 95.2 %). Of these, 50.9 % entered the program at an advanced stage of their training (AEs, n = 450), 24.5 % were direct entrants (DEs, n = 216), and 23.8 % were lateral entrants (LEs, n = 210). AEs more likely had children than DEs (<em>p</em> &lt; 0.001), and they were more frequently female than DEs or LEs (<em>p</em> = 0.02). The motivators for training in FM included: the continuity of FM care for patients, the compatibility of career and care work, the broad mix of patients, and difficult working conditions in hospitals.</div></div><div><h3>Discussion and conclusions</h3><div>There were life-stage-specific differences between the three subgroups entering the KWBW. The motivation for FM Spezilisation also differs between DEs, AEs and LEs. A strict separation of learners into DEs, AEs and LEs contradicts competence- and motivation-enhancing peer learning.</div><div>The differentiation of FM trainees into AEs, DEs and LEs helps understand different life circumstances and learning needs and fosters target group-specific support. Internal differentiation in the program enables target group-specific and learner-centered offers and thus increases the attractiveness of a Competence Center for Postgraduate Medical Training for all FM trainees.</div></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"197 ","pages":"Pages 55-61"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973774","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":"Kultursensitive Übersetzung des Instruments „Confidence Of Midwifery students on selected midwifery Competencies at completion of Education“ (COMICE) zur Selbsteinschätzung von Kompetenzen und Selbstvertrauen bei Hebammenstudierenden in Deutschland","authors":"Kristina Vogel ,&nbsp;Claudia Hellmers ,&nbsp;Nicola H. Bauer","doi":"10.1016/j.zefq.2025.05.007","DOIUrl":"10.1016/j.zefq.2025.05.007","url":null,"abstract":"<div><h3>Background</h3><div>Professional self-confidence is a key competency for midwives, as it influences practical skills. The COMICE study (Confidence Of Midwifery students on selected midwifery Competencies at completion of Education) uses a questionnaire to examine the self-confidence of over 2,000 midwifery students in Sweden, India and seven African countries, identifying challenges and factors that influence self-confidence.</div></div><div><h3>Objective</h3><div>For the study ’The impact of augmented reality-based training on the professional self-confidence of midwifery students in emergency situations’, the widely used but unvalidated questionnaire was translated into German and culturally adapted.</div></div><div><h3>Methods</h3><div>The translation of the COMICE questionnaire from English into German followed the ‘Guidelines for the process of cross-cultural adaptation of self-report measures’ by Beaton et al. (2000). The six translation stages were partially modified. Independent forward and backward translations were conducted, followed by two pre-tests. The first pre-test assessed comprehensibility and relevance, while the second, using the think-aloud method, evaluated linguistic clarity.</div></div><div><h3>Results</h3><div>The first pre-test (n = 31) indicated an average completion time of 30 minutes and provided 13 content-related comments, primarily concerning questionnaire length and country-specific topics. Based on these findings, redundant items were excluded, and the questionnaire was reduced to three core questions. The second pre-test (n = 3) did not reveal any remaining comprehension difficulties. A validation was not performed.</div></div><div><h3>Conclusions</h3><div>The multi-stage translation and adaptation process presented challenges in terms of technical terminology and cultural differences. Translation quality was ensured by involving both experts and native speakers. The cross-cultural adaptation ensured comprehensibility for midwifery students in Germany and provided the basis for international comparisons.</div></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"197 ","pages":"Pages 1-9"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545456","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":"Liste der Affiliierten Institute und Fachgesellschaften / List of Affiliations","authors":"","doi":"10.1016/S1865-9217(25)00192-8","DOIUrl":"10.1016/S1865-9217(25)00192-8","url":null,"abstract":"","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"197 ","pages":"Page OBC"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050508","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":"Chancen und Herausforderungen der Digitalisierung der Arzneimittelversorgung: eine qualitative Studie mit relevanten ExpertInnen","authors":"Christopher Johannes Preetz,&nbsp;Michaela Hesse,&nbsp;Martin Mücke,&nbsp;Gülay Ateş","doi":"10.1016/j.zefq.2025.06.003","DOIUrl":"10.1016/j.zefq.2025.06.003","url":null,"abstract":"<div><h3>Background</h3><div>The supply of pharmaceuticals is undergoing structural change due to internet mail orders, a shortage of skilled workers, and the decreasing density of community pharmacies. Since January 1, 2024, Germany also has an electronic prescription procedure, the e-prescription. This study aims to answer the question how digitalization has changed access to pharmaceuticals.</div></div><div><h3>Methods</h3><div>Semi-structured expert interviews were conducted between September 2023 and March 2024. Relevant experts were identified and surveyed about their experience with the influence of digitalization that has so far been observed, about its practicality, and their expectations and outlook regarding the consequences for the supply of medicines. Therefore, only experts from self-governing bodies, the Gematik GmbH, payers, and patient representatives were selected. The interviews were recorded and transcribed. The transcripts were analyzed using MAXQDA.</div></div><div><h3>Results</h3><div>A total of 9 interviews were conducted. Regarding the effects of digitalization on patient care provided by community and mail order pharmacies, the experts overall regarded mail order pharmacies as high-performance companies that comply with the safety principles required in the pharmaceutical trade. All experts could see the mail order trade’s impact on the density of community pharmacies. The shortage of skilled workers was confirmed by all experts, and digitalization can help mitigate this problem. However, an excessive expansion of mail order companies can disadvantage patients. Concerning e-prescriptions, the expert interviews revealed that e-prescriptions and the telematics infrastructure (TI) are still experiencing difficulties. Despite the costs, the experts surveyed believe that improvements in patient care and patient safety will enhance patient rights.</div></div><div><h3>Discussion</h3><div>Digitization has a beneficial effect by increasing access to pharmaceutical care. People can access medicines more easily through mail orders and e-prescriptions depending on how they are dispensed. However, some groups of people do not benefit from the new advantages, resulting in the need to further reduce this imbalance in the future. The preservation of community pharmacies for the purpose of individual advice and emergency pharmacy services is another challenge that we have to face as a result of digitalization.</div></div><div><h3>Conclusion</h3><div>The e-prescription still has its shortcomings and is currently testing the patience of doctors, pharmacists, and prescription recipients. If stable, it will improve both patient care and patient safety. Future studies will need to demonstrate that the access-to-medicines gap can be filled and technical difficulties further reduced.</div></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"197 ","pages":"Pages 10-18"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643828","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":"Erhebung der Arbeitsbelastung in der hausärztlichen Versorgung während der SARS-CoV-2-Pandemie – eine „Proof-of-Concept“-Studie","authors":"Thomas Kloppe ,&nbsp;Jan Hendrik Oltrogge-Abiry ,&nbsp;Maren Ehrhardt,&nbsp;Dagmar Lühmann,&nbsp;Thomas Zimmermann,&nbsp;Martin Scherer","doi":"10.1016/j.zefq.2025.07.003","DOIUrl":"10.1016/j.zefq.2025.07.003","url":null,"abstract":"<div><h3>Objective</h3><div>One of the conclusions from the experience with the SARS-CoV-2 pandemic of 2020 to 2022 was the requirement for data on primary care/ambulatory care to assess the severity of the pandemic in a timely manner. Since most patients with COVID-19 in Germany had been primarily cared for by general practitioners, the question arose whether the incidence course of a pandemic can be mapped by means of a regular evaluation of GP workload and number of patients.</div></div><div><h3>Methods</h3><div>From January 2021 to June 2021, 12 replicative, internet-based cross-sectional surveys were conducted fortnightly. Invitations were sent out to all members of the German Society of General Practice/Family Medicine (DEGAM) and selected federal/regional member organizations of the German Association of General Practitioners. They were asked about increases in personal workload, number of patients with COVID-19, and other conditions of patient care.</div></div><div><h3>Results</h3><div>On average, 697 general practitioners (GPs) participated in each survey and completed a total of 8,369 questionnaires. The composition of participants remained consistent across the 12 survey periods, with 82.9–87.2 % being practice owners and 32.0–40.7 % working in group practices. Over time, the proportion of physicians reporting an increased workload reached a minimum of 24.2 % in February 2021; from March 2021 onward, there was a trend reversal with a peak (88.1 %) in May 2021. The change in the GPs’ workload developed in phases that ran parallel to the official RKI reporting data on the COVID-19 incidence. The reported increase in the care deficit for patients with chronic diseases or social problems did not show a temporal dynamic comparable to the reported incidence trend.</div></div><div><h3>Discussion</h3><div>A replicative survey among GPs conducted between January 2021 and June 2021 revealed changes in the workload of general practitioners under pandemic conditions. The progression of the SARS-CoV-2 pandemic during the same period and the observed change in workload developed in parallel. The methodology used (an internet-based, replicative survey among GPs) could therefore be a low-threshold, resource-saving approach to assessing the course of a pandemic. Despite the increasing workload during the different waves of the pandemic, the care for chronically ill patients reported by the GPs was not subject to any pandemic-related dynamics.</div></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"197 ","pages":"Pages 38-46"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973777","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(25)00184-9","DOIUrl":"10.1016/S1865-9217(25)00184-9","url":null,"abstract":"","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"197 ","pages":"Pages iii-iv"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050650","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":"Taking a look behind the scenes: Updating health information on Gesundheitsinformation.de","authors":"Milly Schröer-Günther,&nbsp;Klaus Koch,&nbsp;Inger Scheike","doi":"10.1016/j.zefq.2025.04.002","DOIUrl":"10.1016/j.zefq.2025.04.002","url":null,"abstract":"<div><div>The website Gesundheitsinformation.de and its English sister website InformedHealth.org are a service of the Institute for Quality and Efficiency in Health Care<span> (IQWiG). IQWiG has the legal mandate to provide all citizens with independent and scientifically proven free health information. The website currently comprises information on more than 300 diseases and health issues (“topics”). Evidence-based medicine (EBM) forms the base of Gesundheitsinformation.de. Regular updates are therefore an important quality criterion. Usually, the information is updated every three years. The paper will describe a major update process of the individual topics on Gesundheitsinformation.de. The major process includes 10 steps (e.g., evidence search, medical writing, editorial revisions, and translation). The updating process is currently being reviewed to see whether the effort required for individual tasks can be reduced. The aim is to update/produce more health information with the same resources and without any loss of quality.</span></div></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"197 ","pages":"Pages 73-76"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080278","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(25)00183-7","DOIUrl":"10.1016/S1865-9217(25)00183-7","url":null,"abstract":"","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"197 ","pages":"Page ii"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050649","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":"Gut und kosteneffektiv palliativ versorgt in Westfalen-Lippe – aber warum? Ergebnisse einer Mixed-Methods Studie","authors":"Anastasia Suslow ,&nbsp;Nino Chikhradze ,&nbsp;Bianka Ditscheid ,&nbsp;Chantal Giehl ,&nbsp;Horst Christian Vollmar ,&nbsp;Antje Freytag ,&nbsp;Ina Carola Otte","doi":"10.1016/j.zefq.2025.06.001","DOIUrl":"10.1016/j.zefq.2025.06.001","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The organization of palliative care in Germany varies from region to region. Previous studies show that palliative care in Westphalia-Lippe (WL) – measured by quality and cost indicators – performs better than in other regions. The Westphalian model for outpatient care emphasizes a close cooperation between general practitioners (GPs) and palliative care consultation services (PCS). The basis is a contractual regulation of general and specialized care within a joint outpatient palliative care contract according to Sect. 140a SGB V. The VESPAL study (on the &lt;em&gt;Quality of care in outpatient palliative care based on the example of Westphalia-Lippe&lt;/em&gt;), which was funded by the Professional Association of Palliative Care Physicians in Westfalen-Lippe (Berufsverband der Palliativmediziner in Westfalen-Lippe e.V.) and the Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung Westfalen-Lippe e.V.), was conducted between 02/2022 and 07/2023 and examined which characteristics of outpatient palliative care in WL could be identified from the correlation of quantitative key figures with qualitative interview quotes that might contribute to high-quality care and cost-effectiveness.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A complex mixed-methods design was applied. Quantitative and qualitative data were collected and analyzed simultaneously, were used as a basis for further qualitative research, and then merged (QUAL+QUAN → QUAL). The quantitative data were derived from a routine data analysis on the utilization and quality of palliative care from data of deceased patients who had been covered by the BARMER health insurance, while qualitative data were obtained using five non-participant observations, interviews with 50 care providers (general practitioners, palliative care physicians, coordinators, nurses), and three focus groups. Both data sets were analyzed independently, with the quantitative results being complemented by qualitative insights to provide a more comprehensive understanding of the WL care model.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The quantitative parameters used to measure the quality of care included, in particular: the hospital as place of death, the number of hospital cases, and the number of ambulance call-outs in the last 30 days of life. The qualitative study results show that these parameters can be improved by a close cooperation and specific arrangements with emergency services and nursing homes. According to the interviewees, the typical Westphalian organization of cooperation between doctors and PCS enables providers to respond quickly and provide care which is focused on the needs of patients and their relatives and can be flexibly “ramped up and down”. Providers emphasized the flexibility of the model, the close cooperation, and the lack of competitive pressure from each other as reasons for the high quality of care perceived.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The r","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"197 ","pages":"Pages 19-29"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643827","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}