Mariam Assi, Salma Abbas, Priya Nori, Michelle Doll, Emily Godbout, Gonzalo Bearman, Michael P Stevens
{"title":"Infection Prevention and Antimicrobial Stewardship Program Collaboration During the COVID-19 Pandemic: a Window of Opportunity.","authors":"Mariam Assi, Salma Abbas, Priya Nori, Michelle Doll, Emily Godbout, Gonzalo Bearman, Michael P Stevens","doi":"10.1007/s11908-021-00759-w","DOIUrl":"10.1007/s11908-021-00759-w","url":null,"abstract":"<p><strong>Purpose of review: </strong>We describe the similarities between antimicrobial stewardship programs (ASPs) and infection prevention programs (IPPs), and we discuss how these similarities lend themselves to synergy between programs. We also discuss how the COVID-19 pandemic has generated further opportunities for future collaborations that could benefit both programs.</p><p><strong>Recent findings: </strong>The COVID-19 pandemic has created new needs, such as real-time data and access to personnel important to both programs, such as information technologists and infectious diseases specialists. It has also increased concerns about rising rates of antimicrobial resistance and healthcare-associated infections, both of which overlap significantly and are key focus areas for both ASPs and IPPs. These emergent issues have highlighted the need for enhanced program infrastructure and new team models. The shift towards telecommunication and telework has facilitated the creation of enhanced infrastructures for collaboration on activities ranging from data access and reporting to providing telehealth services to remote hospitals. These enhanced infrastructures can be leveraged in future collaborative efforts between ASPs and IPPs.</p><p><strong>Summary: </strong>Collaboration between IPPs and ASPs can mitigate setbacks experienced by health systems during the current pandemic, enhance the performance of both programs in the post-pandemic era and increase their preparedness for future pandemic threats. As health systems plan for the post-pandemic era, they should invest in opportunities for synergy between ASPs and IPPs highlighted during the pandemic.</p>","PeriodicalId":48839,"journal":{"name":"Current Infectious Disease Reports","volume":"23 10","pages":"15"},"PeriodicalIF":3.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8374122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39338892","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}
{"title":"What Is the Impact of Lockdowns on Dengue?","authors":"Oliver Brady, Annelies Wilder-Smith","doi":"10.1007/s11908-020-00744-9","DOIUrl":"10.1007/s11908-020-00744-9","url":null,"abstract":"<p><strong>Purpose of review: </strong>Societal lockdowns in response to the COVID-19 pandemic have led to unprecedented disruption to daily life across the globe. A collateral effect of these lockdowns may be a change to transmission dynamics of a wide range of infectious diseases that are all highly dependent on rates of contact between humans. With timing, duration and intensity of lockdowns varying country-to-country, the wave of lockdowns in 2020 present a unique opportunity to observe how changes in human contact rates, disease control and surveillance affect dengue virus transmission in a global natural experiment. We explore the theoretical basis for the impact of lockdowns on dengue transmission and surveillance then summarise the current evidence base from country reports.</p><p><strong>Recent findings: </strong>We find considerable variation in the intensity of dengue epidemics reported so far in 2020 with some countries experiencing historic low levels of transmission while others are seeing record outbreaks. Despite many studies warning of the risks of lockdown for dengue transmission, few empirically quantify the impact and issues such as the specific timing of the lockdowns and multi-annual cycles of dengue are not accounted for. In the few studies where such issues have been accounted for, the impact of lockdowns on dengue appears to be limited.</p><p><strong>Summary: </strong>Studying the impact of lockdowns on dengue transmission is important both in how we deal with the immediate COVID-19 and dengue crisis, but also over the coming years in the post-pandemic recovery period. It is clear lockdowns have had very different impacts in different settings. Further analyses might ultimately allow this unique natural experiment to provide insights into how to better control dengue that will ultimately lead to better long-term control.</p>","PeriodicalId":48839,"journal":{"name":"Current Infectious Disease Reports","volume":"23 2","pages":"2"},"PeriodicalIF":3.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7818702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9301684","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}
{"title":"Reducing Central Line Associated Bloodstream Infections (CLABSIs) by Reducing Central Line Days.","authors":"Amber Shaye McElveen Beville, Diane Heipel, Ginger Vanhoozer, Pamela Bailey","doi":"10.1007/s11908-021-00767-w","DOIUrl":"https://doi.org/10.1007/s11908-021-00767-w","url":null,"abstract":"<p><strong>Purpose of review: </strong>While reducing unnecessary days present of central venous catheters (CVCs) is part of central line associated bloodstream infection (CLABSI) best practices, there is limited information regarding compliance with this recommendation as well as addressing barriers to compliance.</p><p><strong>Recent findings: </strong>Significant work has been directed towards daily audits of necessity and improving communication between members of the medical team. Other critical interventions include utilization of the electronic health record (EHR), leadership support of CLABSI reduction goals, and avoiding CVC placement over more appropriate vascular access.</p><p><strong>Summary: </strong>Institutions have varied approaches to addressing the issue of removing idle CVCs, and more standardized approaches in checklists as well as communication, particularly on multidisciplinary rounds, will be key to CVC removal. Utilization of the EHR for reminders or appropriate documentation of necessity is a factor. Avoidance of placing a CVC or appropriateness of the CVC is also important to consider.</p>","PeriodicalId":48839,"journal":{"name":"Current Infectious Disease Reports","volume":"23 12","pages":"23"},"PeriodicalIF":3.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8562022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39596549","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}
Esther Y Golnabi, James M Sanders, Meagan L Johns, Kevin Lin, Jessica K Ortwine, Wenjing Wei, Norman S Mang, James B Cutrell
{"title":"Therapeutic Options for Coronavirus Disease 2019 (COVID-19): Where Are We Now?","authors":"Esther Y Golnabi, James M Sanders, Meagan L Johns, Kevin Lin, Jessica K Ortwine, Wenjing Wei, Norman S Mang, James B Cutrell","doi":"10.1007/s11908-021-00769-8","DOIUrl":"10.1007/s11908-021-00769-8","url":null,"abstract":"<p><strong>Purpose of review: </strong>Rapidly evolving treatment paradigms of coronavirus disease 2019 (COVID-19) introduce challenges for clinicians to keep up with the pace of published literature and to critically appraise the voluminous data produced. This review summarizes the clinical evidence from key studies examining the place of therapy of recommended drugs and management strategies for COVID-19.</p><p><strong>Recent findings: </strong>The global magnitude and duration of the pandemic have resulted in a flurry of interventional treatment trials evaluating both novel and repurposed drugs targeting various aspects of the viral life cycle. Additionally, clinical observations have documented various stages or phases of COVID-19 and underscored the importance of timing for the efficacy of studied therapies. Since the start of the COVID-19 pandemic, many observational, retrospective, and randomized controlled studies have been conducted to guide management of COVID-19 using drug therapies and other management strategies. Large, randomized, or adaptive platform trials have proven the most informative to guide recommended treatments to-date. Antimicrobial stewardship programs can play a pivotal role in ensuring appropriate use of COVID-19 therapies based on evolving clinical data and limiting unnecessary antibiotics given low rates of co-infection.</p><p><strong>Summary: </strong>Given the rapidly evolving medical literature and treatment paradigms, it is recommended to reference continuously updated, curated guidelines from national and international sources. While the drugs and management strategies mentioned in this review represent the current state of recommendations, many therapies are still under investigation to further define optimal COVID-19 treatment.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s11908-021-00769-8.</p>","PeriodicalId":48839,"journal":{"name":"Current Infectious Disease Reports","volume":"23 12","pages":"28"},"PeriodicalIF":3.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8665318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39738475","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}
Sarah M Michienzi, Mario Barrios, Melissa E Badowski
{"title":"Evidence Regarding Rapid Initiation of Antiretroviral Therapy in Patients Living with HIV.","authors":"Sarah M Michienzi, Mario Barrios, Melissa E Badowski","doi":"10.1007/s11908-021-00750-5","DOIUrl":"10.1007/s11908-021-00750-5","url":null,"abstract":"<p><strong>Purpose of review: </strong>Rapid initiation of antiretroviral therapy (ART) is increasingly more common among clinics serving people living with human immunodeficiency virus (PLWH). It is recommended by major guidelines and is especially important in achieving the Getting to Zero (GTZ) goals by 2030. Patients should be offered the option to initiate ART as soon as possible, preferably at time of HIV diagnosis, with the goal of reducing transmission, morbidity, and mortality.</p><p><strong>Recent findings: </strong>Three published randomized controlled trials, and several other observational, prospective, and retrospective studies, demonstrated superior rates of viral suppression (VS) with initiation of rapid ART compared to standard of care. Improved time to VS and retention in care were also observed. Based on the regimens studied, a tenofovir backbone combined with an integrase strand transfer inhibitor or protease inhibitor is recommended for rapid start initiation. Since ART is started earlier compared with standard of care, there is opportunity to achieve VS at a much faster rate, especially in the setting of starting on the day of diagnosis. What requires further evaluation is whether or not VS is sustained over time with quicker linkage and initiation of HIV care.</p><p><strong>Summary: </strong>Initiating rapid ART in newly diagnosed PLWH provides a promising approach to achieving GTZ. When offered rapid ART, virologic suppression is improved compared to standard of care, which may reduce transmission and, ultimately, new HIV infections.</p>","PeriodicalId":48839,"journal":{"name":"Current Infectious Disease Reports","volume":"23 5","pages":"7"},"PeriodicalIF":3.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8016613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25565714","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}
{"title":"Host Diagnostic Biomarkers of Infection in the ICU: Where Are We and Where Are We Going?","authors":"Aaron J Heffernan, Kerina J Denny","doi":"10.1007/s11908-021-00747-0","DOIUrl":"https://doi.org/10.1007/s11908-021-00747-0","url":null,"abstract":"<p><strong>Purpose of review: </strong>Early identification of infection in the critically ill patient and initiation of appropriate treatment is key to reducing morbidity and mortality. On the other hand, the indiscriminate use of antimicrobials leads to harms, many of which may be exaggerated in the critically ill population. The current method of diagnosing infection in the intensive care unit relies heavily on clinical gestalt; however, this approach is plagued by biases. Therefore, a reliable, independent biomarker holds promise in the accurate determination of infection. We discuss currently used host biomarkers used in the intensive care unit and review new and emerging approaches to biomarker discovery.</p><p><strong>Recent findings: </strong>White cell count (including total white cell count, left shift, and the neutrophil-leucocyte ratio), C-reactive protein, and procalcitonin are the most common host diagnostic biomarkers for sepsis used in current clinical practice. However, their utility in the initial diagnosis of infection, and their role in the subsequent decision to commence treatment, remains limited. Novel approaches to biomarker discovery that are currently being investigated include combination biomarkers, host 'sepsis signatures' based on differential gene expression, site-specific biomarkers, biomechanical assays, and incorporation of new and pre-existing host biomarkers into machine learning algorithms.</p><p><strong>Summary: </strong>To date, no single reliable independent biomarker of infection exists. Whilst new approaches to biomarker discovery hold promise, their clinical utility may be limited if previous mistakes that have afflicted sepsis biomarker research continue to be repeated.</p>","PeriodicalId":48839,"journal":{"name":"Current Infectious Disease Reports","volume":"23 4","pages":"4"},"PeriodicalIF":3.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11908-021-00747-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25395062","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}
Martin Ottolini, Blake Cirks, Kathleen B Madden, Michael Rajnik
{"title":"Pediatric Infectious Diseases Encountered During Wartime-Part 1: Experiences and Lessons Learned From Armed Conflict in the Modern Era.","authors":"Martin Ottolini, Blake Cirks, Kathleen B Madden, Michael Rajnik","doi":"10.1007/s11908-021-00770-1","DOIUrl":"10.1007/s11908-021-00770-1","url":null,"abstract":"<p><strong>Purpose of review: </strong>Armed conflicts occur globally, with some regions experiencing heightened instability for many years. A better understanding of the infectious disease impact on children in armed conflict will allow aid organizations to anticipate and mitigate the most serious problems.</p><p><strong>Recent findings: </strong>Armed conflicts are estimated to have caused approximately 30 million civilian deaths during the past 27 years, with two-thirds occurring in women and children. Children are extremely vulnerable to the mass population displacements, experiencing a combined loss of safety, nutrition, shelter, hygiene, and health care. Under these circumstances, the emergence and prevalence of multiple infectious diseases can result in heightened morbidity and mortality long after active conflict ceases.</p><p><strong>Summary: </strong>Factors leading to increased infectious diseases in populations in crisis due to armed conflict and lessons learned from recent outbreaks are discussed in detail. Acute respiratory infections, diphtheria, measles, varicella, and cholera are a few of the more common infectious diseases that take advantage of populations displaced or disrupted by conflict. Key issues include the ability of countries or non-governmental organizations (NGOs) to keep up with basic childhood immunizations, and how rapidly disease outbreaks are recognized and addressed with disease-specific interventions.</p>","PeriodicalId":48839,"journal":{"name":"Current Infectious Disease Reports","volume":"23 12","pages":"27"},"PeriodicalIF":3.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8656442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39585268","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}
Theodore S Rader, Michael P Stevens, Gonzalo Bearman
{"title":"Syndromic Multiplex Polymerase Chain Reaction (mPCR) Testing and Antimicrobial Stewardship: Current Practice and Future Directions.","authors":"Theodore S Rader, Michael P Stevens, Gonzalo Bearman","doi":"10.1007/s11908-021-00748-z","DOIUrl":"10.1007/s11908-021-00748-z","url":null,"abstract":"<p><strong>Purpose of review: </strong>Syndromic multiplex polymerase chain reaction (mPCR) panels offer the antimicrobial steward a rapid tool for optimizing and de-escalating antimicrobials. In this review, we analyze the role of syndromic mPCR in respiratory, gastrointestinal, and central nervous system infections within the context of antimicrobial stewardship efforts.</p><p><strong>Recent findings: </strong>For all mPCR syndromic panels, multiple studies analyzed the pre-and-post implementation impact of mPCR on antimicrobial utilization. Prospective studies and trials of respiratory mPCR stewardship interventions, including diagnostic algorithms, educational efforts, co-testing with procalcitonin, and targeted provider feedback currently exist. For gastrointestinal and cerebrospinal fluid mPCR, fewer peer-reviewed reports exist for the use of mPCR in antimicrobial stewardship. These studies demonstrated an inconsistent trend towards decreasing antibiotic use with mPCR. This is further limited by a lack of statistical significance, the absence of controlled, prospective trials, and issues with data generalizability.</p><p><strong>Summary: </strong>Antibiotic overuse may improve when mPCR is coupled with electronic medical record algorithm-based approaches and direct provider feedback by an antimicrobial stewardship professional. mPCR may prove a useful tool for antimicrobial stewardship but future studies are needed to define the best practice for its utilization.</p>","PeriodicalId":48839,"journal":{"name":"Current Infectious Disease Reports","volume":"23 4","pages":"5"},"PeriodicalIF":3.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7909367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25444347","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}
{"title":"2021 Update on the Clinical Management and Diagnosis of Kawasaki Disease.","authors":"Frank Zhu, Jocelyn Y Ang","doi":"10.1007/s11908-021-00746-1","DOIUrl":"https://doi.org/10.1007/s11908-021-00746-1","url":null,"abstract":"<p><strong>Purpose of review: </strong>Provide an updated review of the clinical management and diagnosis of Kawasaki disease with inclusion of potential diagnostic difficulties with multisystem inflammatory syndrome in children (MIS-C) given the ongoing COVID-19 pandemic.</p><p><strong>Recent findings: </strong>Adjunctive corticosteroid therapy has been shown to reduce the rate of coronary artery dilation in children at high risk for IVIG resistance in multiple Japanese clinical studies (most notably RAISE study group). Additional adjunctive therapies (etanercept, infliximab, cyclosporin) may also provide limited benefit, but data is limited to single studies and subgroups of patients with cardiac abnormalities. The efficacy of other agents (atorvastatin, doxycycline) is currently being investigated. MIS-C is a clinically distinct entity from KD with broad clinical manifestations and multiorgan involvement (cardiac, GI, hematologic, dermatologic, respiratory, renal). MIS-C with Kawasaki manifestations is more commonly seen in children < 5 years of age.</p><p><strong>Summary: </strong>The 2017 American Heart Association (AHA) treatment guidelines have included changes in aspirin dosing (including both 80-100 mg/kg/day and 30-50 mg/kg/day treatment options), consideration of the use of adjuvant corticosteroid therapy in patients at high risk of IVIG resistance, and the change in steroid regimen for refractory KD to include both pulse-dose IVMP and longer course of prednisolone with an oral taper. A significant proportion of children diagnosed with MIS-C, a post-infectious syndrome of SARS-CoV-2 infection, meet criteria for Kawasaki disease. Further investigation is warranted to further delineate these conditions and optimize treatment of these conditions given the ongoing COVID-19 pandemic.</p>","PeriodicalId":48839,"journal":{"name":"Current Infectious Disease Reports","volume":"23 3","pages":"3"},"PeriodicalIF":3.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11908-021-00746-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39945524","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}
Anna Maria Peri, Adam Stewart, Anna Hume, Adam Irwin, Patrick N A Harris
{"title":"New Microbiological Techniques for the Diagnosis of Bacterial Infections and Sepsis in ICU Including Point of Care.","authors":"Anna Maria Peri, Adam Stewart, Anna Hume, Adam Irwin, Patrick N A Harris","doi":"10.1007/s11908-021-00755-0","DOIUrl":"https://doi.org/10.1007/s11908-021-00755-0","url":null,"abstract":"<p><strong>Purpose of review: </strong>The aim of this article is to review current and emerging microbiological techniques that support the rapid diagnosis of bacterial infections in critically ill patients, including their performance, strengths and pitfalls, as well as available data evaluating their clinical impact.</p><p><strong>Recent findings: </strong>Bacterial infections and sepsis are responsible for significant morbidity and mortality in patients admitted to the intensive care unit and their management is further complicated by the increase in the global burden of antimicrobial resistance. In this setting, new diagnostic methods able to overcome the limits of traditional microbiology in terms of turn-around time and accuracy are highly warranted. We discuss the following broad themes: optimisation of existing culture-based methodologies, rapid antigen detection, nucleic acid detection (including multiplex PCR assays and microarrays), sepsis biomarkers, novel methods of pathogen detection (e.g. T2 magnetic resonance) and susceptibility testing (e.g. morphokinetic cellular analysis) and the application of direct metagenomics on clinical samples. The assessment of the host response through new \"omics\" technologies might also aid in early diagnosis of infections, as well as define non-infectious inflammatory states.</p><p><strong>Summary: </strong>Despite being a promising field, there is still scarce evidence about the real-life impact of these assays on patient management. A common finding of available studies is that the performance of rapid diagnostic strategies highly depends on whether they are integrated within active antimicrobial stewardship programs. Assessing the impact of these emerging diagnostic methods through patient-centred clinical outcomes is a complex challenge for which large and well-designed studies are awaited.</p>","PeriodicalId":48839,"journal":{"name":"Current Infectious Disease Reports","volume":"23 8","pages":"12"},"PeriodicalIF":3.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11908-021-00755-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39249337","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}