Journal of Telemedicine and Telecare最新文献

{"title":"Distinguishing stroke from mimics in telemedicine: How well does the TM-Score perform in a Brazilian telestroke network?","authors":"Valério Silva de Carvalho, Lincoln Faria da Silva, Carlos Augusto Moreira de Sousa","doi":"10.1177/1357633X251334433","DOIUrl":"10.1177/1357633X251334433","url":null,"abstract":"<p><p>BackgroundStroke is a leading cause of mortality and disability worldwide. In Brazil, ischemic strokes account for 85% of cases, but many hospitals lack resources for acute stroke care. Telestroke programs connect underserved hospitals to specialized centers, improving access to treatment. However, stroke mimics (SMs) pose a diagnostic challenge, potentially delaying appropriate management. The Telestroke Mimic Score (TM-Score) is a clinical tool designed to differentiate ischemic cerebrovascular disease (ICVD) from SM, but it has not been validated in South America. The objective of this study is to assess the validity of the TM-Score in distinguishing ICVD from SM in a Brazilian cohort.MethodsWe conducted a retrospective study using data from the Neurological Telemedicine Database of Hospital Pró-Cardíaco, Rio de Janeiro. Patients evaluated for suspected stroke via telemedicine (January 2019-December 2022) were classified as ICVD or SM by a telestroke neurologist. The TM-Score's performance was analyzed using receiver-operating characteristic (ROC) curves, sensitivity, specificity, and predictive values.ResultsAmong 777 patients (ICVD: 561, SM: 216), the mean TM-Score was significantly higher in ICVD (20.72 ± 6.86 vs 14.36 ± 5.73, <i>p</i> < 0.001). A score ≥25 had high specificity (96%) and PPV (95%) for ICVD, while <10 had an NPV of 0.71. The AUC was 0.755 (95% CI: 0.718-0.791).ConclusionThe TM-Score is a valuable tool for differentiating ICVD from SM in Brazil, supporting more accurate decision-making, particularly in telemedicine settings without stroke specialists.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":" ","pages":"1357633X251334433"},"PeriodicalIF":3.5,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030181","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":"Telestroke consultant use in acute stroke care: Evidence for best practices from the IMPROVE stroke care program.","authors":"Brad J Kolls, Edwin Iversen, Lisa Monk, Shreyansh Shah, Carmelo Graffagnino, Matthew E Ehrlich","doi":"10.1177/1357633X251332365","DOIUrl":"https://doi.org/10.1177/1357633X251332365","url":null,"abstract":"<p><p>BackgroundEvolving stroke care demands careful screening of stroke patients to ensure the right care is administered to the right patients in a timely manner. Telestroke has been increasingly utilized to improve access to stroke specialists to make these assessments. Here we explore the care processes at these telestroke site to determine if an optimal care process can be determined.MethodsThis is a post-hoc analysis of data collected as part a larger quality improvement program, the IMPROVE stroke care program. We rank ordered and normalized the DTN times from encounters that used telestroke services to range between 0 and 1. We used linear mixed models to assess the acute stroke care process steps most associated with improvement in thrombolytic administration times.ResultsThe dataset consisted of 21,456 acute stroke code assessments, of which 8356 (80.6%) were conducted via telestroke (TS) services. Of these TS events, 7088 (84.8%) were conducted at sites that used TS for >85% of all events. Compared to private vehicle, EMS arrival is associated with 4% improvement in DTN ranks, though when paired with prehospital notification, DTN ranks significantly improve by 25%. Key process steps associated with shorter DTN times included calling a code stroke quickly upon arrival and notifying the telestroke consultant prior to obtaining the initial CT scan.DiscussionWorking with local EMS to provide prehospital notification along with rapid code stroke activation and consultant notification prior to CT were identified as best practices for providing timely acute stroke care using telestroke providers.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":" ","pages":"1357633X251332365"},"PeriodicalIF":3.5,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046915","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":"Healthcare utilization in a cohort receiving chronic disease specialty care by video telemedicine compared to propensity-matched adults not using telemedicine.","authors":"Elizabeth D Ferucci, Rabecca I Arnold, Peter Holck","doi":"10.1177/1357633X251333514","DOIUrl":"https://doi.org/10.1177/1357633X251333514","url":null,"abstract":"<p><p>IntroductionTelemedicine use has undergone rapid transformation in recent years. We designed this study to evaluate factors associated with telemedicine use and modality and the association with telemedicine use and healthcare utilization in a post-pandemic period.MethodsThis observational study included four regions of the Alaska Tribal Health System. We used electronic health record data to evaluate a cohort of adults who had chronic disease specialty care visits, with or without telemedicine, between July 1, 2021 to December 31, 2021 for factors associated with telemedicine use and modality. We then evaluated the association between telemedicine use and healthcare utilization in 2022. We used propensity score matching to improve covariate balance between adults who had used telemedicine or not, and then estimated the effect of telemedicine on outcomes (inpatient hospitalizations, outpatient visits, and emergency department visits) using multivariable models.ResultsAdults who used telemedicine were slightly older, had more chronic conditions and clinic visits, and resided in different regions compared to those who did not, with differences also observed between telemedicine modalities. The incident rate ratio for inpatient visits (1.16, p = 0.28), outpatient visits (1.15, p = 0.13), and emergency department visits (1.12, p = 0.36) were higher but not statistically significant for adults using telemedicine when compared to individuals not using telemedicine.DiscussionWe found a non-significant association of higher rates of inpatient, outpatient, and emergency department visits in people who used telemedicine compared to propensity-matched \"controls.\" These findings should be considered in context of potential benefits of telemedicine and patient preference.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":" ","pages":"1357633X251333514"},"PeriodicalIF":3.5,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996220","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":"Bringing researchers to the consumer table: The process and outcomes of a consumer roundtable on telehealth.","authors":"Bec Jenkinson, Jo Maxwell, Alison Bell, Adrienne Young, Anthony C Smith, Anja Christoffersen, Dale Trevor, Leonie Young, Trevor Russell","doi":"10.1177/1357633X231188536","DOIUrl":"10.1177/1357633X231188536","url":null,"abstract":"<p><p>IntroductionDespite the significant expansion and rapid uptake of telehealth services as a COVID-19 response, the pandemic restricted opportunities to involve health consumers in telehealth research. Authentic consumer and community involvement in research begins with engagement in priority-setting. We report here on the process and outcomes of a consumer-led event intended to support involvement of consumers, from early in the research process.MethodsIn 2022, The University of Queensland's Consumer and Community Network hosted a Consumer Roundtable to 'bring researchers to the consumer table' and explore emerging issues and priorities for future research. The event used World Café Method, with three 20-min rounds of small group discussion centred on questions about telehealth experiences, followed by a facilitated harvest discussion about future research directions. Participants' notes from small group discussions were subjected to conventional inductive content analysis, and a visual record was created in real-time by a graphic artist.ResultsTwenty-eight consumers and 22 researchers took part. Content analysis identified three main foci from discussions: person-centred care, better access to better care, the (unrealised) potential of telehealth. Research questions prioritised by consumer vote focussed on marginalised groups and stigmatised conditions; differences between telehealth and face-to-face healthcare delivery; and the experience of conveying and receiving compassion via telehealth.DiscussionThe Consumer Roundtable created early engagement between health consumer representatives and telehealth researchers, which has yielded ongoing partnerships. World Café method proved particularly useful for seeding relationships between researchers and consumers. However, there was limited opportunity to generate consensus about research priorities.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":" ","pages":"430-436"},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9895032","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 and provider perspectives on telemedicine use in an outpatient gynecologic clinic serving a diverse, low-income population.","authors":"Amita Kulkarni, Ngozi Monu, Muhammad D Ahsan, Chimsom Orakuwue, Xiaoyue Ma, Auja McDougale, Melissa K Frey, Kevin Holcomb, Evelyn Cantillo, Eloise Chapman-Davis","doi":"10.1177/1357633X231197965","DOIUrl":"10.1177/1357633X231197965","url":null,"abstract":"<p><p>ObjectiveTo evaluate patient and provider experiences using telemedicine for gynecologic visits among a diverse, low-income population.MethodsPatients attending telemedicine visits at a resident-run gynecology clinic completed a modified Telemedicine Usability Questionnaire and providers completed a survey addressing satisfaction and barriers for each visit. The Telemedicine Usability Questionnaire included six subscales to assess telemedicine usability with 1-5 Likert-scale responses. Statistical analyses included Chi-square, Fisher's exact, Wilcoxon rank sum, Wilcoxon signed-rank, and two-sample <i>t</i>-test.ResultsOf 192 patients enrolled, 157 (82%) completed the surveys (87% video visits, 13% telephone visits). Most patients were ethnic minorities (non-Hispanic White-16%, Hispanic-32%, Black-28%, Asian-10%), median age was 40 years (range 18-69), and 63% reported income under $40,000. The total mean Telemedicine Usability Questionnaire score was 4.3/5. The reliability subscale score (3.72/5) was lower compared to all other subscales (<i>p</i> < 0.001). Older respondents were more likely to find telemedicine unreliable (mean age >44 vs <39, <i>p</i> = 0.02). Without telemedicine, 54% would have traveled ≥1 h to appointments, with 46% spending over $35 on travel, and 27% missing ≥ 1 workday. Patients preferred telemedicine for follow-up rather than initial visits (81% vs 33%, <i>p</i> < 0.01). Among providers, residents felt less adequately trained in telemedicine compared to nurse practitioners and fellows (54% vs 46%, <i>p</i> = 0.039).ConclusionLow-income women utilizing telemedicine for outpatient gynecologic care report positive experiences with improved access to healthcare, cost, and time savings compared to in-person visits. Provider experiences were also positive; however, teaching hospitals must evaluate whether trainee providers feel adequately trained to deliver telemedicine visits.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":" ","pages":"417-423"},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41155647","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":"Twenty-first century management of diabetes with shared telemedicine appointments.","authors":"David C Klonoff, Andrea M Yeung, Jingtong Huang, Juan C Espinoza, Jennifer K Raymond, Wei-An Andy Lee, Suneil K Koliwad, David Kerr","doi":"10.1177/1357633X231184503","DOIUrl":"10.1177/1357633X231184503","url":null,"abstract":"<p><p>This commentary article discusses the benefits of utilizing telemedicine to conduct shared medical appointments for people with type 1 diabetes and type 2 diabetes. We conducted a literature review of articles about shared medical appointments or group medical visits in people with diabetes with associated clinical data. We identified 43 articles. Models of this approach to care have demonstrated positive outcomes in adults and children with type 1 diabetes. Shared telemedicine appointments also have the potential to improve diabetes self-management, reduce the treatment burden, and improve psychosocial outcomes in adults with type 2 diabetes. Ten key recommendations for implementation are presented to guide the development of shared telemedicine appointments for diabetes. These recommendations can improve care for diabetes.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":" ","pages":"446-453"},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9869573","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":"Going into town or staying home: Rural patient experience and preference with home-based versus clinic-based telehealth.","authors":"Leslie Eiland, Jana Wardian, Harlan Sayles, Andjela Drincic","doi":"10.1177/1357633X231196919","DOIUrl":"10.1177/1357633X231196919","url":null,"abstract":"<p><p>IntroductionTelehealth is a model of care with potential to improve access, and in turn outcomes, for people living in rural areas. Since 2013, our endocrine clinic-based telehealth program has provided care at rural community hospitals in Nebraska and Iowa. At the start of the COVID-19 pandemic, when regulations around telehealth were adjusted, patients previously seen via clinic-based telehealth had the option to continue clinic-based visits or have a home-based telehealth visit. There is no literature comparing patient experiences between home-based and clinic-based telehealth. The purpose of this study was to understand rural patient preferences regarding endocrinology home-based versus clinic-based telehealth visits.MethodsThis was a survey study of adult, rural patients who experienced both a clinic-based and home-based telehealth visit with their established endocrinology provider. Respondents were asked about demographics, their reason for visit, preference for home versus clinic-based telehealth, and how they would have received care if telehealth were not an option.ResultsForty-two patients (40.8%) responded to the survey, with 27 patients (64.3%) preferring home-based telehealth. There were no significant differences between the groups. However, 47.5% of patients would not have sought specialty care if telehealth were not an option.DiscussionThis survey of endocrine patients experienced in both clinic-based and home-based telehealth indicates that, while most respondents preferred home-based telehealth, there are distinct advantages to each model and patients appreciate having options. We believe it is important to maintain both lines of service to provide patient-centered care and improve access to specialty care.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":" ","pages":"424-429"},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10153041","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":"Design and development of a Telemedicine Assessment Toolkit (TAT) for the assessment of audiovisual telemedicine encounters.","authors":"Raphael Agbali, E Andrew Balas, Vahe Heboyan, Jeane Silva, Steven Coughlin, Francesco Beltrame, Gianluca De Leo","doi":"10.1177/1357633X231194381","DOIUrl":"10.1177/1357633X231194381","url":null,"abstract":"<p><p>Although the use of audiovisual telemedicine has grown in recent years especially during recent COVID-19-related lockdowns, evidence shows there is still a lack of tools that can be used for the assessment of telemedicine encounters. The few validated questionnaires that are available for assessing telemedicine encounters are not often used. Non-validated questionnaires dominate research, leading to results that cannot be compared or extrapolated to other research or medical sites. Development of standard measures for the assessment of telemedicine encounters has been advocated by stakeholders. The objective of this study is to provide a comprehensive set of measures by developing a conceptual approach and a preliminary Telemedicine Assessment Toolkit (TAT) for the assessment of audiovisual telemedicine encounters. A two-step conceptual approach was used to identify potential domains and sub-domains by qualitative analysis of a pool of questions from studies published from 2016 to 2021. Questions were adopted from validated questionnaires or generated to represent the underlying concept of each sub-domain, resulting in a core block of comprehensive questions. A toolkit is proposed with question-measures that cover the sub-domains relevant to the assessment of telemedicine encounters. This study recommended 11 domains to be used for the assessment of telemedicine encounters: \"usability,\" \"patient satisfaction,\" \"patient-provider interaction,\" \"patient perspectives,\" \"telemedicine readiness,\" \"qualitative feedback,\" \"comparison to standard (in-person) care,\" \"privacy,\" \"technology,\" \"patient feeling,\" and \"patient costs.\" Of the 11 domains, 26 underlying sub-domains were created. From the subdomains, a 30-question core block was proposed. The core-block together with a precursor block aimed to retrieve demographic/patient characteristics and, together with a customizable clinical outcomes block, complete the comprehensive toolkit. The toolkit, upon testing and validation, would enable researchers and system owners to assess patient-oriented aspects of audiovisual telemedicine encounters more accurately and accelerate the adoption of common audiovisual telemedicine assessment measures.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":" ","pages":"437-445"},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10059647","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":"Equity in virtual care: A mixed methods study of perspectives from physicians.","authors":"Timothy C Guetterman, Emily Koptyra, Olivia Ritchie, Liz B Marquis, Reema Kadri, Anna Laurie, Vg Vinod Vydiswaran, Jiazhao Li, Lindsay K Brown, Tiffany C Veinot, Lorraine R Buis","doi":"10.1177/1357633X231194382","DOIUrl":"10.1177/1357633X231194382","url":null,"abstract":"<p><p>BackgroundVirtual care expanded rapidly during the COVID-19 pandemic, and how this shift affected healthcare disparities among subgroups of patients is of concern. Racial and ethnic minorities, older adults, individuals with less education, and lower-income households have lower rates of home broadband, smartphone ownership, and patient portal adoption, which may directly affect access to virtual care. Because primary care is a major access point to healthcare, perspectives of primary care providers are critical to inform the implementation of equitable virtual care.ObjectiveThe aim of this mixed methods study was to explore primary care physician experiences and perceptions of barriers and facilitators to equitable virtual care.DesignWe used an explanatory sequential mixed methods design, which consists of first collecting and analyzing quantitative survey data, then using those results to inform a qualitative follow-up phase to explain and expand on results.ParticipantsPrimary care physicians in a family medicine department at an academic medical center responded to surveys (<i>n</i> = 38) and participated in interviews (<i>n</i> = 16).ApproachParticipants completed a survey concerning frequency and preferences about video visits, pros and cons of video visits, communication aspects, and sufficiency of the technology. A purposeful sample of participants completed semi-structured interviews about their virtual care experiences with a focus on equity for subpopulations.Key ResultsThe results indicated that physicians have observed equity issues for unique patient populations. The results add to the understanding of nuanced ways in which virtual care can increase and decrease healthcare access for unique populations. Patients with limited English proficiency were particularly affected by inequity in virtual care access.ConclusionAdditional research and interventions are needed to improve portal access for those with limited English proficiency. Improvements should focus on health system interventions that expand access without requiring increased patient burden.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":" ","pages":"408-416"},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10166143","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":"Digital divide or digital exclusion? Do allied health professionals' assumptions drive use of telehealth?","authors":"Renee Cook, Helen M Haydon, Emma E Thomas, Elizabeth C Ward, Julie-Anne Ross, Clare Webb, Michael Harris, Carina Hartley, Clare L Burns, Angela P Vivanti, Phillip Carswell, Liam J Caffery","doi":"10.1177/1357633X231189846","DOIUrl":"10.1177/1357633X231189846","url":null,"abstract":"<p><p>IntroductionTelehealth use within allied health services currently lacks structure and consistency, ultimately affecting who can, and cannot, access services. This study aimed to investigate the factors influencing allied health professionals' (AHP) selection of consumers and appointments for telehealth.MethodsThis study was conducted across 16 allied health departments from four Australian hospitals. Semi-structured focus groups were conducted with 58 AHPs. Analysis was underpinned by Qualitative Description methodology with inductive coding guided by Braun and Clarke's thematic analysis approach.ResultsSix themes were identified that influenced AHPs' evaluation of telehealth suitability and selection of consumers. These included the following: (1) ease, efficiency and comfort of telehealth for clinicians; (2) clear benefits of telehealth for the consumer, yet the consumers were not always given the choice; (3) consumers' technology access and ability; (4) establishing and maintaining effective therapeutic relationships via telehealth; (5) delivering clinically appropriate and effective care via telehealth; and (6) external influences on telehealth service provision. A further theme of 'assumption versus reality' was noted to pervade all six themes.DiscussionClinicians remain the key decision makers for whether telehealth is offered within allied health services. Ease and efficiency of use is a major driver in AHP's willingness to use telehealth. Assumptions and pre-conceived frames-of-reference often underpin decisions to not offer telehealth and present major barriers to telehealth adoption. The development of evidence-based, decision-support frameworks that engage the consumer and clinician in determining when telehealth is used is required. Services need to actively pursue joint decision-making between the clinician and consumer about service delivery preferences.</p>","PeriodicalId":50024,"journal":{"name":"Journal of Telemedicine and Telecare","volume":" ","pages":"376-385"},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9943999","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}