Intensive and Critical Care Nursing最新文献

{"title":"Expert consensus on research priorities for the prevention of delirium in adult ICU patients","authors":"Stef Beerens ,&nbsp;Laurens Van Steenkiste ,&nbsp;Ingrid Egerod ,&nbsp;Thomas Gargadennec ,&nbsp;Mu-Hsing Ho ,&nbsp;Peter Nydahl ,&nbsp;Jessica A. Palakshappa ,&nbsp;Brenda Pun ,&nbsp;Louise Rose ,&nbsp;Mark van den Boogaard ,&nbsp;Bart Van Rompaey ,&nbsp;Bradley Wibrow ,&nbsp;Sonia O. Labeau ,&nbsp;Stijn Blot","doi":"10.1016/j.iccn.2025.104124","DOIUrl":"10.1016/j.iccn.2025.104124","url":null,"abstract":"<div><h3>Objective</h3><div>To identify research priorities for the prevention of delirium in adult intensive care unit (ICU) patients.</div></div><div><h3>Research Methodology</h3><div>We conducted an iterative, consensus-based modified Delphi methodology combined with initial literature search to establish a prioritized research agenda. As a first round of an anonymised modified Delphi procedure, a 10-member international expert panel, selected on basis of their academic and clinical expertise, were asked to add topics they perceived missing from a list of potential research gaps regarding ICU delirium prevention. In the second round, experts rated each topic research priority using a 4-point Likert scale (very low to very high). Topics were considered a research priority if rated ‘high’ or ‘very high’ by at least 80% of experts. A third round to establish a top 3 was planned if more than 10 priorities were identified.</div></div><div><h3>Main Outcome measures</h3><div>Research priorities for delirium prevention in adult ICU patients.</div></div><div><h3>Results</h3><div>The evidence-based list comprised 44 potential research priorities with experts suggesting 9 additional topics. Of the 53 potential research priorities, 8 were unanimously rated as research priorities: ‘early mobilization’, ‘exercise interventions’, ‘sedation breaks for ventilator weaning’, ‘routine delirium surveillance’, ‘cognitive training/exercise’, ‘reducing light, noise, and care activities at night’, ‘open visiting hours’, and ‘family participation’.</div></div><div><h3>Conclusions</h3><div>We have identified 8 research priorities for delirium prevention in adult ICU patients.</div></div><div><h3>Implications for Clinical Practice</h3><div>The research agenda developed in this study provides direction for future investigations into delirium prevention in ICU patients. By highlighting expert-endorsed priorities, it supports a more focused allocation of research efforts and funding. The findings may inform the development of targeted, evidence-based prevention strategies, ultimately contributing to improved clinical outcomes in critical care settings.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"91 ","pages":"Article 104124"},"PeriodicalIF":4.9,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144288927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A retrospective records review comparing the care of patients who either avoided or were admitted to an ICU following a ward-based deterioration event","authors":"J. Ede ,&nbsp;H. Pickworth ,&nbsp;B. Kent ,&nbsp;P. Watkinson ,&nbsp;R. Endacott","doi":"10.1016/j.iccn.2025.104064","DOIUrl":"10.1016/j.iccn.2025.104064","url":null,"abstract":"<div><h3>Objectives</h3><div>To identify escalation success factors documented in care records of patients who triggered an Early Warning Score ≥ 7 in the ward, avoided an Intensive Care Unit admission and survived and compare these with ward patients who triggered an Early Warning Score ≥ 7, went to intensive care and died during their admission.</div></div><div><h3>Methods</h3><div>A multi-site, retrospective records review was conducted on 340 survivors and 50 non-survivors who were either admitted to, or who avoided intensive care.</div></div><div><h3>Results</h3><div>Non-survivors of deterioration tended to be older, earlier into their hospital admission, and had a greater number of co-morbidities at the time of their trigger event. Overall, superior care was observed in non-survivors when triangulating quality of care scores and escalation care quality metrics (escalation compliance, hourly observations, and medical re-evaluation). Survivors avoided an Intensive Care Unit admission through responding to ward management or being referred to a specialist team. However, 9.7 % (33/340) of survivors were still triggering at the time of discharge, and 54 % of these had either Covid-19 or a long-term cardiorespiratory condition.</div></div><div><h3>Conclusions</h3><div>This study found differences in how clinical staff responded to patient deterioration between survivors and non-survivors. Although non-survivors received higher-rated care and met more escalation quality indicators, their poorer outcomes were likely influenced by more severe underlying conditions. Despite both patient groups having comparable scores, staff appeared to make nuanced judgments factoring in clinical concerns not captured by the score alone (success factor).</div></div><div><h3>Implications for Clinical Practice</h3><div>Despite generating the same warning score values, there is wide variation in true patient acuity that only clinical staff can discriminate, and escalation protocols alone may not be advanced enough to address this subtlety.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"90 ","pages":"Article 104064"},"PeriodicalIF":4.9,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging the sepsis care chasm: a multidimensional analysis of systemic barriers and pragmatic solutions in low-resource settings – Letter on Williams et al.","authors":"Cheng Xue ,&nbsp;Yunqi Fu","doi":"10.1016/j.iccn.2025.104098","DOIUrl":"10.1016/j.iccn.2025.104098","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"91 ","pages":"Article 104098"},"PeriodicalIF":4.9,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144263484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stakeholder perspectives on the reduction of opioid exposure in ICU: A modified Delphi survey","authors":"Lize-Mari Du Toit ,&nbsp;Sean M. Bagshaw ,&nbsp;John Basmaji ,&nbsp;Dipayan Chaudhuri ,&nbsp;D’Arcy Duquette ,&nbsp;Kirsten M. Fiest ,&nbsp;Kimia Honarmand ,&nbsp;Constantine J. Karvellas ,&nbsp;Sebastian Kilcommons ,&nbsp;Demetrios James Kutsogiannis ,&nbsp;Kimberley Lewis ,&nbsp;Deborah E. Lynam ,&nbsp;Chen-Hsiang Ma ,&nbsp;Sangeeta Mehta ,&nbsp;Peter Oxland ,&nbsp;Arabesque Parker ,&nbsp;Oleksa Rewa ,&nbsp;Bram Rochwerg ,&nbsp;Janek Senaratne ,&nbsp;Sameer Sharif ,&nbsp;Vincent I. Lau","doi":"10.1016/j.iccn.2025.104089","DOIUrl":"10.1016/j.iccn.2025.104089","url":null,"abstract":"<div><h3>Purpose</h3><div>The global opioid epidemic highlights the need to re-evaluate pain management strategies and find alternatives to minimize opioid exposure. Opioids are primary analgesics and sedatives in intensive care units (ICUs) but may have negative consequences for patients and families. This study aimed to identify key patient-important outcomes related to opioid reduction and the use of analgesic adjuncts (e.g., non-steroidal anti-inflammatory drugs [NSAIDs]) in critically ill adult patients through a modified Delphi study involving patients, families, and healthcare providers.</div></div><div><h3>Methods</h3><div>A modified Delphi process, including two survey rounds and one discussion round among stakeholders (patients, family members, and healthcare providers), was used to identify and rate key patient-important outcomes, evaluation time-points, and suitable tools/definitions for a potential randomized controlled trial.</div></div><div><h3>Results</h3><div>Opioid reduction was identified as a key patient-important outcome by 82% of participants across both survey rounds. Various themes emerged from surveys and stakeholder meetings, showing a preference for both pharmacological and non-pharmacological adjunctive therapies for ICU pain management. Opinions varied based on clinical or non-clinical backgrounds.</div></div><div><h3>Conclusions</h3><div>Participants agreed that reducing opioid exposure and using adjunctive pain management strategies are crucial patient-important outcomes. Further research is needed to explore the efficacy and safety of opioid alternatives and both pharmacologic and non-pharmacologic interventions.</div></div><div><h3>Implications for Clinical Practice</h3><div>This study highlights that both patients and families value reducing opioid exposure and exploring alternatives, aligning with healthcare providers’ goals. Improved communication and education about opioid use can enhance patient-centered care. These findings support the need for future trials on adjunctive analgesics to reduce opioid exposure and improve outcomes, addressing both clinical and patient-family perspectives.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"91 ","pages":"Article 104089"},"PeriodicalIF":4.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144241656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scaling patient safety: How National Early Warning Score 2 (NEWS2) drove systemic mortality reduction in an acute care setting","authors":"Yang Guo ,&nbsp;Tongyan Zhang ,&nbsp;Yanyan Ren ,&nbsp;Lingshan Dou ,&nbsp;Xiaoshu Zhu ,&nbsp;Yazhu Hou ,&nbsp;Xiumei Gao","doi":"10.1016/j.iccn.2025.104108","DOIUrl":"10.1016/j.iccn.2025.104108","url":null,"abstract":"<div><h3>Objectives</h3><div>To retrospectively assess the impact of the National Early Warning Score 2 (NEWS2) on prognosis in a single-center fever clinic.</div></div><div><h3>Methods</h3><div>This was a single-center retrospective study based on real-world data. The period from April 2020-March 2021 was used as the control group, and the period from April 2021-March 2022 was used as the NEWS group to explore the changes in the mortality rates of patients before and after the implementation of the NEWS2. After the use of the NEWS2, as the application time progressed, the changing trend in the difference in the NEWS2 between discharge and admission was explored. In addition, the impact of the difference in the NEWS2 between discharge and admission on the prognosis of patients was explored.</div></div><div><h3>Results</h3><div>A total of 18,979 patients were included (6,699 in the control group and 12,280 in the NEWS group). The mortality rates in the control group were higher than those in the NEWS group at all time points (0.54 % vs. 0.22 % at 24 h, P &lt; 0.001), (1.06 % vs. 0.55 % at 7 days, P &lt; 0.001), and (1.57 % vs. 0.77 % at 28 days, P &lt; 0.001). The results of multivariate logistic regression indicate that the outcomes remain significant after controlling for confounding factors. The NEWS2 difference increased from April 2021 to March 2022 (−0.64 ± 1.77 vs −0.91 ± 1.68). When the difference in the NEWS between discharge and admission &lt;  − 1, the mortality risk decreased.</div></div><div><h3>Conclusions</h3><div>Implementing NEWS2 in fever clinics reduced mortality and NEWS2 scores, providing valuable insights for optimizing patient management and enhancing clinical outcomes in fever clinics.</div></div><div><h3>Implications for Clinical Practice</h3><div>Incorporating NEWS2 into the routine of fever clinics allows rapid and accurate assessment of patients’ conditions. Taking action on the basis of this assessment may contribute to effective resource allocation and personalized care, ultimately improving patient outcomes.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"90 ","pages":"Article 104108"},"PeriodicalIF":4.9,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144243546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mandatory vaccination against COVID-19 and Influenza for ICU personnel? Yes!","authors":"Jodie Langbeen ,&nbsp;Dirk Vogelaers ,&nbsp;Stijn Blot","doi":"10.1016/j.iccn.2025.104082","DOIUrl":"10.1016/j.iccn.2025.104082","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"89 ","pages":"Article 104082"},"PeriodicalIF":4.9,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mandatory vaccination against COVID-19 and Influenza for ICU personnel? No!","authors":"Armand R.J. Girbes","doi":"10.1016/j.iccn.2025.104083","DOIUrl":"10.1016/j.iccn.2025.104083","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"89 ","pages":"Article 104083"},"PeriodicalIF":4.9,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Family satisfaction with intensive care and preexisting family and patient characteristics: equivalence analysis of cross-sectional surveys","authors":"Marco Riguzzi ,&nbsp;Lotte Verweij ,&nbsp;Rahel Naef","doi":"10.1016/j.iccn.2025.104106","DOIUrl":"10.1016/j.iccn.2025.104106","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to demonstrate that family satisfaction with intensive care and decision-making is independent of sociodemographic family member and patient characteristics and the patient outcomes of mortality and length of stay.</div></div><div><h3>Methods</h3><div>Cross-sectional survey data from two independent samples of a total of 233 family members of adult patients treated in six ICUs of a Swiss university hospital were analyzed. The FS-ICU-24 questionnaire was used to measure the satisfaction of family members of intensive care unit (ICU) patients with ICU care and decision-making. Equivalence analysis methodology (TOST) was used to demonstrate the non-existence of moderate or greater associations between family satisfaction and routinely collected sociodemographic family member and patient characteristics and patient outcomes.</div></div><div><h3>Results</h3><div>The non-existence of such associations between family (age, gender, relationship, education, travel distance, previous ICU experience) or patient characteristics (age, sex, unplanned ICU admission) or outcomes (length of stay, death) and FS-ICU-24 or its subscales was demonstrated (p^TOST ≤ 0.003).</div></div><div><h3>Conclusions</h3><div>Our results show that family satisfaction with ICU care is independent of sociodemographic family member and patient characteristics and patient outcomes that are available from routine documentation. It is highly unlikely that family satisfaction can be meaningfully predicted this way.</div></div><div><h3>Implications for Clinical Practice</h3><div>Early identification of families at risk of having an unsatisfactory ICU experience is important because (dis)satisfaction with care is a care-related factor for post-ICU anxiety, depression, and post-traumatic stress. Several studies have failed to demonstrate a relevant association with characteristics from routine documentation. Our study shows that this approach is unlikely to yield useful results. Therefore, it is crucial to focus research on care-related factors and their impact on family (dis)satisfaction and to build capacity for family-centered care in the ICU.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"90 ","pages":"Article 104106"},"PeriodicalIF":4.9,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144243316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a structured educational intervention on the prevention of ocular surface disorders in critically ill patients: A non-randomized clinical trial","authors":"Pedro Arevalo-Buitrago ,&nbsp;Manuel Romero Saldaña ,&nbsp;Mª Esther Rincón Recio ,&nbsp;Francisco Javier Dorante López ,&nbsp;Francisco José Cabello Montoro ,&nbsp;María José Bermejo Collado ,&nbsp;Raquel Cordón Villarejo ,&nbsp;Ángel Gutiérrez Martínez ,&nbsp;Encarnación Quero Díaz ,&nbsp;Antonio Alexis Mena Gomáriz ,&nbsp;Gumersindo Emilio Calvo García ,&nbsp;Pablo Jesús LÓPEZ-SOTO","doi":"10.1016/j.iccn.2025.104107","DOIUrl":"10.1016/j.iccn.2025.104107","url":null,"abstract":"<div><h3>Introduction</h3><div>Ocular surface disorders (OSDs) are common in intensive care unit (ICU) patients, with incidence rates ranging from 13.2% to 59.4%. Risk factors include impaired eyelid closure, reduced blink reflexes, and systemic inflammation, exacerbated by sedation and mechanical ventilation. Despite these risks, ICU nurses often lack standardized ocular care training, leading to inconsistent practices and suboptimal patient outcomes.</div></div><div><h3>Aim</h3><div>To evaluate the impact of a structured educational intervention on ICU nurses’ regarding ocular care in critically ill patients.</div></div><div><h3>Method</h3><div>A non-randomized clinical trial was conducted in a tertiary hospital in Spain, including 161 ICU patients (80 pre-intervention; 81 post-intervention) requiring ≥ 48-hour mechanical ventilation and sedation. The study involved a pre-intervention observational phase followed by a structured educational program for ICU nurses on evidence-based ocular care consisting of a one-hour in-person session combining theoretical content, bedside demonstration, and distribution of supporting visual materials. Clinical outcomes and adherence to care protocols were analysed using chi-square tests, t-tests, and logistic regression.</div></div><div><h3>Results</h3><div>The incidence of OSDs decreased from 76.3 % pre-intervention to 38.3 % post-intervention (p &lt; 0.001). Significant reductions were observed in dry eye (40 % to 9.9 %), lagophthalmos (43.8 % to 19.8 %), red eye (38.8 % to 12.3 %), and ocular oedema (48.8 % to 29.6 %). Early ocular care implementation increased from 33.8 % to 71.6 % (p &lt; 0.001), and adherence to evidence-based care protocols improved from 80 % to 93.8 % (p &lt; 0.01). Post-intervention care was strongly associated with a lower OSD risk (adjusted OR: 0.21; 95 % CI: 0.11–0.43; p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>A structured educational intervention significantly reduced the incidence of OSDs and improved adherence to evidence-based ocular care practices in ICU settings.</div></div><div><h3>Implication for clinical practice</h3><div>Integrating evidence-based ocular care protocols into ICU routines reduces OSD incidence and enhances patient outcomes. Nurses training and institutional support are essential for sustaining adherence, improving patient safety, and minimizing preventable ocular complications in critically ill patients.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"90 ","pages":"Article 104107"},"PeriodicalIF":4.9,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144243317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Workload in ICU nurses: A systematic review and meta-analysis of the Nursing Activities Score","authors":"Lei Li ,&nbsp;Xiaoyin Zou ,&nbsp;Hua Chen","doi":"10.1016/j.iccn.2025.104086","DOIUrl":"10.1016/j.iccn.2025.104086","url":null,"abstract":"<div><h3>Aim</h3><div>Intensive care units (ICUs) are high-demand environments where nurse workload management is critical for ensuring quality patient care and nurse well-being. The Nursing Activities Score (NAS) is widely used to quantify nursing workload, yet individual studies report heterogeneous findings. This systematic review and <em>meta</em>-analysis aimed to synthesize global data on ICU nursing workload using the NAS.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted in multiple databases without language restrictions, identifying studies reporting mean NAS scores. Data were extracted by two independent reviewers, and a random-effects <em>meta</em>-analysis was performed to pool NAS values. Subgroup analyses and <em>meta</em>-regression were conducted to explore sources of heterogeneity.</div></div><div><h3>Results</h3><div>A total of 70 observational studies, encompassing data from 56,042 ICU patients, were included. The <em>meta</em>-analysis revealed a pooled mean NAS of 66.2% (95% CI: 62.6–69.8%), indicating that, on average, ICU nurses spend nearly two-thirds of their shift on direct patient care for a single patient. Higher NAS values were observed during patient admission and the morning shift, with a significant increase during the COVID-19 period compared to pre-pandemic levels.</div></div><div><h3>Conclusion</h3><div>Our analysis revealed that ICU nurses spend a substantial part of their shift on direct patient care, especially during high-demand periods. These findings challenge traditional nurse-to-patient ratios, suggesting the need for flexible staffing models.</div></div><div><h3>Implications for Clinical Practice</h3><div>The current nursing staff level within ICU settings may not be adequate for the average nursing workload in some countries. Consideration should be given to dynamic staffing models that can consider increased nursing workload.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"91 ","pages":"Article 104086"},"PeriodicalIF":4.9,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144241657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}