Journal of Patient Safety最新文献

{"title":"Mediating Effects of Coping Style Between Nurse Second Victim Burnout and Hospital Patient Safety Culture in Patient Suicides.","authors":"Huifang Qiu, Yanhua Liu, Liyan Wang, Xiaohong Zhang, Na Lv, Guoping Zhang","doi":"10.1097/PTS.0000000000001415","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001415","url":null,"abstract":"<p><strong>Aim: </strong>To explore the relationship and current status of coping styles, burnout, and hospital patient safety culture in patient suicide incidents. To examine whether nurse second victim coping styles in patient suicide incidents mediate the relationship between hospital patient safety culture and burnout.</p><p><strong>Design: </strong>A cross-sectional study. The collection of information was carried out during the same period of time.</p><p><strong>Methods: </strong>The study recruited a sample of 425 nurses, second victims who had experienced patient suicides from 6 tertiary grade A hospitals (Shanxi, China). The General Information Questionnaire, the Coping Styles Scale, the Burnout Scale, and the Hospital Patient Safety Climate Scale were used to gather data. The Pearson correlation analysis was used to study the correlation among the 3, one-way ANOVA or independent samples t tests were used to compare differences in second victim burnout among nurses with different characteristics, and the model 4 in process was employed to establish structural equation modeling and test the influence paths of hospital patient safety culture, coping styles, and burnout.</p><p><strong>Results: </strong>In this study, the patient safety culture score of hospital patients was (134.43±4.84), which was at a medium level; the coping score was (68.70±4.94), which was at a medium level, with positive coping score (23.03±2.94), negative coping score (22.12±2.66), and problem solving score (23.55±3.10), which was at a high level. The burnout score is (71.19±3.83), which is at a high level. Hospital patient safety culture was positively correlated with coping styles (r=0.458, P<0.001) and negatively correlated with burnout (r=-0.754, P<0.001), and coping styles were negatively correlated with burnout (r=-0.356, P<0.001). In the mediation models, the mediating effect of coping styles between hospital patient safety culture and burnout was -0.26, which accounted for 40.63% of the total effect.</p><p><strong>Conclusions: </strong>A good hospital patient safety culture can improve the coping styles of nurse second victims and also reduce the burnout of nurse second victims. Hospital patient safety culture not only has a direct effect on burnout, but also indirectly affects burnout through coping styles, and reduces burnout by improving their coping styles; hospitals and administrators should take a variety of interventions to improve nurse second victims' coping styles and enhance hospital patient safety culture to reduce burnout.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incorporating Machine Learning Driven Factors in the Design of Electronic-triggers to Detect Diagnostic Errors in the Emergency Department.","authors":"Moein Enayati, Mahsa Khalili, Shrinath Patel, Todd R Huschka, Daniel Cabrera, Sarah J Parker, Kalyan S Pasupathy, Prashant Mahajan, Fernanda Bellolio","doi":"10.1097/PTS.0000000000001409","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001409","url":null,"abstract":"<p><strong>Objectives: </strong>Electronic health records (EHR)-based triggers (eTriggers) have been used to study diagnostic errors in the emergency department (ED), often with suboptimal performance. Our objective was to investigate incremental value of multi-factor machine learning (ML) approaches to improve eTrigger performance.</p><p><strong>Methods: </strong>Patients presenting to an academic ED were categorized into trigger-positive and trigger-negative using standard trigger (T) definitions: (T1) ED return visits resulting in admission within 10 days; (T2) care escalation from the inpatient unit to the ICU within 24 hours; and (T3) deaths within 24 hours of admission. We trained and evaluated 6 supervised ML models.</p><p><strong>Results: </strong>A total of 124,053 consecutive encounters (5791 T-positive and 118,262 T-negative) were included. Among the T-positive, 4159 (72%) were associated with T1, 1415 (24%) with T2, and 217 (4%) with T3. The T-based positive predictive values (PPV) were 5.2% for T1, 8.2% for T2, and 6.5% for T3. ML models trained and evaluated on balanced training dataset and imbalanced test set had low classification performances (accuracy: 0.72-0.95; PPV: 0.00-0.16; F1-score: 0.00-0.23). Higher performances were observed in balanced test sets (accuracy: 0.80-0.97; PPV: 0.82-1.00; F1-score: 0.79-0.97). Comparing models trained on clinically annotated data with models trained on T-based labels identified other important factors.</p><p><strong>Conclusions: </strong>Utilizing machine learning to refine e-triggers slightly improves the identification of diagnostic errors, as evidenced by an increase in PPV values. We identified new potential factors contributing to ED diagnostic errors. These findings open new avenues to construct or modify more accurate e-triggers for diagnostic error identification.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of System-Theoretic Process Analysis (STPA) for Enhancing Safety in a Ventilator System.","authors":"Shinichi Yamaguchi, Tatsuo Yanagawa, Shuhei Iida, Mitsuo Shibagaki, Yoshinobu Sato","doi":"10.1097/PTS.0000000000001421","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001421","url":null,"abstract":"<p><strong>Background: </strong>In Japan, a significant number of ventilator-related medical accidents continue to be reported, with causes frequently linked to both equipment malfunctions and human errors. Conventional analytical methods often lack the methodological rigor needed for comprehensive safety analysis.</p><p><strong>Objectives: </strong>This study explores the application of System-Theoretic Process Analysis (STPA) as a novel approach to ventilator safety analysis. The goal is to identify potential hazards arising from human errors and device failures and to establish system-level safety constraints.</p><p><strong>Methods: </strong>STPA is employed to construct a control structure diagram of a ventilator system, offering a system-wide perspective to identify Unsafe Control Actions (UCAs) and resulting hazardous scenarios. This approach provides a structured analysis of system interactions to derive safety constraints aimed at reducing risks.</p><p><strong>Results: </strong>STPA successfully identified UCAs and system-level interactions that could lead to hazardous outcomes. Compared with the Critical Incident Report (CIR) by the Japan Council for Quality Health Care (JCQHC), which provides retrospective insights into ventilator-related incidents, STPA demonstrates a systematic and comprehensive methodology. It analyzed the mechanisms by which incidents could arise within the system, considering both human and technical factors. The analysis identified hazardous interactions and provided a foundation for implementing preventive measures.</p><p><strong>Conclusions: </strong>STPA offers a holistic framework for ventilator safety, surpassing traditional analysis methods by addressing complex human-technical interactions. The results contribute to enhanced ventilator safety, improved risk management, and a stronger safety culture across medical devices.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Critical Analysis of Transformational Leadership and How it Can Improve Culture and Service Outcomes Within the Health Care.","authors":"Ata Mohajer-Bastami, Sarah Moin, Ahmed R Ahmed, Bijendra Patel, Sjaak Pouwels, Shafi Ahmed, Gerhard Prager, Marion Head, Anil Lala, Christopher Bowman, Scott Shikora, Wah Yang, Miriam Khalil, David Rawaf, Ali Waleed Khalid, Ameer Khamise, Aristomenis Exadaktylos, Suhaib J S Ahmad","doi":"10.1097/PTS.0000000000001414","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001414","url":null,"abstract":"<p><p>Transformational leadership plays a major role in enhancing organizational culture and service outcomes within the health care sector. Recent reports from various health care systems worldwide have highlighted systemic issues such as blame culture and inadequate leadership training in health services. Although this paper references UK-specific reports, the discussion is applicable to health care leadership challenges on a global scale, as similar issues have been documented in other countries, including the United States, Canada, Australia, and Germany. There should be a shift from a hierarchical (vertical) to a more collaborative (horizontal) structure of leadership. This will result in intellectual stimulation, idealized influence, inspirational motivation, and individualized consideration. Health care staff should be empowered through transformative leadership to improve interdisciplinary collaboration, service provision, and foster a more supportive culture internationally, especially in the post-COVID era, where global health care systems face workforce burnout and leadership crises. While acknowledging limitations, including potential over-reliance on leaders' personalities and ethical risks, the paper advocates for leadership development as a vital tool in addressing the current challenges facing health care systems globally. Transformational leadership is positioned as a powerful catalyst for cultural change and improved health care outcomes.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Journeys: A Qualitative Assessment Exploring Patient Availability and Interest in Whole Health Services.","authors":"Martha Quinn, Jason M Engle, Karen E Fowler, Molly Harrod, David Clive, Rachel Ehrlinger, Nathan Houchens, Paul Green, Sanjay Saint","doi":"10.1097/PTS.0000000000001416","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001416","url":null,"abstract":"<p><strong>Objective: </strong>Our aim was to assess patients' availability for, and interest in, integrative holistic health offerings during a hospitalization. Although health care systems are increasingly providing holistic services in outpatient settings, limited research exists concerning expansion to inpatient settings.</p><p><strong>Methods: </strong>In this exploratory qualitative assessment using a 5-phased systems-engineering approach to improve the well-being of hospitalized patients and their clinicians, we deployed a modified engineering concept (\"customer journey\") to collect information on how patients interact with the hospital environment and their clinicians. These journeys included observing patients throughout their hospitalization and conducting semi-structured telephone interviews after discharge. Observational data, captured via field notes, was used to calculate the percentage of time various interactions occurred during a patient's hospital stay (eg, eating, idle, sleeping, clinical encounters) making them potentially available or unavailable for additional holistic or whole health offerings. Interviews, conducted to understand patient views on these offerings, were recorded, transcribed, and analyzed using content analysis.</p><p><strong>Results: </strong>Eleven patients from 2 Midwestern hospitals were observed for a total of 115 hours. Observations revealed that patients have substantial idle time during hospital stays, especially in the late afternoon between 3:00 and 5:00 pm. Follow-up interviews with 7 of these patients showed that patients have an interest in holistic health offerings (eg, massage therapy, aromatherapy, and music options) and believe that they could benefit from these services.</p><p><strong>Conclusions: </strong>Our study revealed that patients have the time, the interest, and the belief that they may benefit from whole health offerings during a hospital stay.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of the Statutory Duty of Candour in the Management of Patient Safety Events: Systematic Review and Narrative Synthesis.","authors":"Reema Harrison, Corey Adams, Nabila Binte Haque, Jennifer Morris, Liat Watson, Ashfaq Chauhan, Thrivedi Sesha Sai Danthakani, Sarah Ameen, Peter Hibbert, Elizabeth Manias, Nicole Youngs, Lanii Birks, Ramesh Walpola, Jeffrey Braithwaite","doi":"10.1097/PTS.0000000000001420","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001420","url":null,"abstract":"<p><strong>Objective: </strong>With limited evidence to date about the application of Statutory Duty of Candour, we sought to synthesize evidence of the application of this legislation in health service organisations and determine its impacts on patients, families and staff.</p><p><strong>Methods: </strong>A search strategy was developed and applied to 6 electronic databases, along with relevant websites, to identify evidence in published and gray literature. Eligible articles were published from 2010 onwards, reported primary or secondary analysis of data of the application of the Statutory Duty of Candour in relation to patient safety events in countries that have enacted the Duty. Two reviewers independently extracted data and assessed the risk of bias. Narrative synthesis was conducted using the Synthesis Without Meta-Analysis (SWiM) guideline. The certainty of evidence was rated by the Grading of Recommendations Assessment and Evaluation (GRADE) approach.</p><p><strong>Results: </strong>Included articles (n=15) originated from the United Kingdom (n=14) and Ireland (n=1); 9 were retrieved from the electronic and 6 from the gray literature search. Findings predominantly focused on the implementation of duty of candour, including understanding requirements and thresholds for use (12 articles), with limited evidence of staff (2 articles), health service (2 articles), and particularly patient and carer outcomes (1 article).</p><p><strong>Conclusions: </strong>Limited evidence is available about the use and impacts of the duty of candour despite 10 years passing since its initial implementation in the United Kingdom. Few peer-reviewed studies have captured primary evaluative data, none of the scale and breadth in terms of health care providers required to draw conclusions about the use or effectiveness of the duty of candour for achieving open and honest communication about health care incidents.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the \"Never Event\": A Qualitative Content Analysis of Ongoing Nasogastric Tube Position Testing Incidents.","authors":"Kate Glen, Christine E Weekes, Agi McFarland, Merrilyn Banks, Grace Xu, Jayesh Dhanani, Mary Hannan-Jones","doi":"10.1097/PTS.0000000000001417","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001417","url":null,"abstract":"<p><strong>Objective: </strong>Clinicians are encouraged to report all health care incidents, but only those causing serious harm are routinely reviewed to improve patient care. There is no consensus on the best method of confirming ongoing nasogastric tube (NGT) position, leading to variation in practice. The aim of this study is to evaluate the clinical contexts of incidents related to ongoing NGT position testing and assess the efficacy of current clinical practices.</p><p><strong>Method: </strong>Incident databases in Queensland Health, Australia and NHS England were searched by data custodians for incidents mentioning NGTs. A multidisciplinary team compared the extracted incidents to the inclusion and exclusion criteria. Qualitative content analysis (where incidents were coded into themes) was used to evaluate the incidents.</p><p><strong>Results: </strong>Five of 27 Queensland incidents, 24 of 412 English incidents, and 2 of 26 English Never Events met the inclusion criteria. No incidents in Queensland resulted in harm. The 2 Never Events resulted from a displaced NGT being used. Three of the 24 incidents in England resulted in low-level harm, but were not related to NGT displacement. The themes identified: (1) outcomes related to ongoing NGT position testing, such as missing medications due to inconclusive pH testing, (2) staff interpersonal relationships impacting their ability to follow local procedures, (3) nonadherence to local procedures, and (4) poor quality of incident reports.</p><p><strong>Conclusions: </strong>Qualitative content analysis successfully identified themes relevant to clinical practice, despite the low quality of individual incident reports. Harm from displaced NGTs was rare but delays from procedural inconsistencies warrant review of current practices, particularly the reliance on pH testing.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physician Burnout and Fatigue: The Hidden Threat to Patient Safety.","authors":"Keertan Khemani, Ghazi Uddin Ahmed, Izma Faisal Raza, Manahil Ahmed","doi":"10.1097/PTS.0000000000001422","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001422","url":null,"abstract":"","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applying High-reliability Principles to Infusion Pump Safety: A Case Study at a Multisite Health System.","authors":"Ann M West, Nicole L Schueler, Rachel A Moody, Merissa T Andersen, Jill S Dinsmore, David B Miller, Charles D Wickens, Pauline M Byom, Andrea Y Lehnertz, Kannan Ramar","doi":"10.1097/PTS.0000000000001395","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001395","url":null,"abstract":"<p><strong>Objectives: </strong>A framework of high-reliability principles was used to identify, investigate, and mitigate infusion pump safety concerns at a large, multisite health care system. We developed a systematic approach to address challenges associated with overinfusions, underinfusions, and the inability to clear upstream occlusion alarms. We identified 112,875 upstream occlusion events for 389,604 infusion starts (failure rate, 29%) within 6 months.</p><p><strong>Methods: </strong>Five high-reliability principles were applied to infusion pump management. Preoccupation with failure emphasized reporting safety concerns and performing appropriate clinical and bench tests. Deference to expertise prompted the development of a multidisciplinary team with internal and external partners. Sensitivity to operations prompted assessment of human factors design, with simulations and analysis of medication-specific factors (e.g., viscosity; infusion rates). Reluctance to simplify prompted assessment of tubing characteristics (e.g., concentricity; wall thickness) with micro-computed tomography and process development for removing faulty equipment. Practice of resilience ensured ongoing engagement and commitment to a culture of safety and patient advocacy.</p><p><strong>Results: </strong>The multidisciplinary oversight team prompted a national recall, removal of malfunctioning pumps, and development of system-wide training and mitigation protocols. Despite ongoing pump challenges, our team optimized internal patient safety systems and processes. The cause of these malfunctions remains under investigation, but serious patient harm has been prevented.</p><p><strong>Conclusions: </strong>Key strategies for enhancing patient safety were continuous vigilance, interdisciplinary collaboration, and embracing complexity in a large health care organization. Future directions involve deeply integrating these high-reliability principles across all aspects of health care delivery to continue improving safety and quality outcomes.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety Investigation Incident Reports in Social and Health Care: Analysis of Contributing Factors in Finland.","authors":"Merja Sahlström, Hanna Tiirinki, Mari Liukka","doi":"10.1097/PTS.0000000000001419","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001419","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to explore contributing factors identified in serious incident investigations conducted by internal, independent multidisciplinary teams.</p><p><strong>Methods: </strong>A total of 166 serious incident investigation reports, conducted between 2018 and 2023 in 11 integrated social and health care organizations in Finland, were analyzed. The reports were classified by incident type and contributing factor, which were analyzed using the WHO's Conceptual Framework for the International Classification for Patient Safety.</p><p><strong>Results: </strong>The results indicate considerable variation in the structure and content of serious incident investigation reports, with none specifying the investigation method used. The investigation reports of serious incidents revealed that in 79 (47.6%) cases, the consequences for the client or patient were fatal. The highest number of contributing factors was identified in investigations related to medication errors and errors related to treatment or monitoring. The number of contributing factors per investigation ranged from 1 to 16, with an average of 4.6. Most of the contributing factors were organizational or staff factors.</p><p><strong>Conclusions: </strong>Investigating serious safety incidents provides valuable insights into event chains and helps organizations learn from past damages. Effectively promoting client and patient safety requires standardized methods and practices for examining adverse events. This requires a shared perspective and clear definitions of best practices. Consistent and effective investigation processes demand national and international collaboration to enhance safety and strengthen organizational learning.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}