International journal for quality in health care : journal of the International Society for Quality in Health Care最新文献

{"title":"Peer accountability in patient safety: an under-examined determinant of team performance.","authors":"Marcos Martínez","doi":"10.1093/intqhc/mzag134","DOIUrl":"10.1093/intqhc/mzag134","url":null,"abstract":"<p><strong>Background: </strong>Patient safety has been pursued largely through systems, protocols, and checklists, yet preventable harm remains common and effective interventions are often difficult to sustain or transfer between settings. A consistent observation is that the same intervention succeeds in one unit and fails in another, the difference lying less in the tool than in how the team functions. This review argues that an under-examined determinant of that difference is peer accountability: the lateral, reciprocal responsibility of team members to uphold shared standards and address departures from them. Distinct from vertical, blame-based accountability and related to but not identical with psychological safety and relational coordination, it is treated here as an integrative facet of team functioning rather than a wholly new construct.</p><p><strong>Methods: </strong>This is a narrative, non-systematic review. Literature in organizational science, human factors, team sport, and patient safety was identified through purposive searching of PubMed, Scopus, and Google Scholar up to 2025, with citation tracking; material was selected to develop the central argument rather than to provide exhaustive coverage.</p><p><strong>Results: </strong>Across several fields, the maintenance of shared standards by peers is associated with team performance, illustrated by analogy rather than direct evidence by small-group cohesion research and peer leadership in team sport. In healthcare, the same principle underlies crew resource management, the independent check, speaking-up behaviour, and high-reliability organizing. Two factors suppress peer accountability: steep authority gradients and a misreading of just culture as the absence of accountability. Acting earlier than disciplinary processes, peer accountability can interrupt the gradual normalization of unsafe practice, which neither punitive blame nor an undifferentiated no-blame stance prevents.</p><p><strong>Conclusion: </strong>Peer accountability complements rather than competes with systems thinking. Any hospital service can strengthen it through small, stable, mutually visible teams; institutionalized independent checking; a reduced gradient for raising concerns; and a just culture that retains individual and shared responsibility. These organizational rather than technological measures require explicit measurement and study before they can be recommended as established practice.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timeliness of discharge summary and postdischarge adverse events among patients hospitalized for community-acquired pneumonia.","authors":"Anne Danjou, Magali Bouisse, Bastien Boussat, Sophie Blaise, Xavier Courtois, Patricia Pavese, Mylène Maillet, Elodie Sellier, Jacques Gaillat, Bruno Degano, Sébastien Ducki, Patrice François, Anne-Claire Toffart, Carole Schwebel, José Labarère","doi":"10.1093/intqhc/mzag116","DOIUrl":"10.1093/intqhc/mzag116","url":null,"abstract":"<p><strong>Background: </strong>Whether delayed completion of discharge summary compromises patient safety following hospitalization for community-acquired pneumonia remains unknown. The objectives of this study were to quantify the timeliness of discharge summary completion and to investigate the relationship between delayed completion of discharge summary and 30-day postdischarge outcomes.</p><p><strong>Methods: </strong>As part of a cohort study conducted in France, we analyzed a sample of 1004 patients (median age, 78 years) discharged alive after a hospitalization for pneumonia. The primary outcome was defined as a composite adverse event outcome of death or unplanned readmission within 30 days of discharge. We performed inverse probability of treatment weighting analysis based on propensity score to estimate odds ratios (ORs) of 30-day postdischarge adverse events for patients for whom a discharge summary was not completed by the day of discharge.</p><p><strong>Results: </strong>A summary was completed on the day of discharge for 305 patients [30%, 95% confidence interval (CI), 28-33]. These patients were older, had more severe pneumonia on admission, and were more likely to exhibit impaired functional independence, receive ≥5 concomitant medications, necessitate advanced care, and be clinically unstable at discharge. After inverse probability weighting, the 30-day estimates of postdischarge adverse events were 12% and 14% (OR, 1.12; 95% CI, 0.72-1.75), with unplanned readmission rates of 9.6% and 10% (OR, 1.09; 95% CI, 0.65-1.84) and all-cause mortality rates of 6.9% and 4.3% (OR, 0.61; 95% CI, 0.31-1.21) for patients with and without a summary completed on the day of discharge, respectively.</p><p><strong>Conclusions: </strong>Although this study found no association between delayed completion of discharge summaries and postdischarge adverse events, the availability of a discharge summary in the early follow-up period may enhance other aspects of the quality of care among survivors of hospitalization for pneumonia.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148804473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medication reconciliation documentation and documented discrepancies in a tertiary Saudi hospital: a retrospective observational study.","authors":"Ashwaq H Alharthi, Marwan A Alrasheed, Yahya M Tawfik, Sara Z Almutairi, Aliyah Y Almobarak, Yousif A Asiri","doi":"10.1093/intqhc/mzag123","DOIUrl":"10.1093/intqhc/mzag123","url":null,"abstract":"<p><strong>Background: </strong>Medication reconciliation is a key patient-safety process during transitions of care, but its routine documentation and associated medication-list findings are not well described in Saudi tertiary hospital practice. This study aimed to characterize medication reconciliation documentation, documented medication discrepancies, and documented medication-list modifications at King Saud University Medical City (KSUMC).</p><p><strong>Methods: </strong>A retrospective observational study was conducted using routinely collected electronic health record data for hospitalized patients at KSUMC between June 2023 and June 2024. Eligible records contained the medication-related fields required for analysis, including home medications at admission, medications documented during hospitalization, medication reconciliation documentation status, documented discrepancy status, discharge medication information, and documented medication modification status. Patient-level outcomes used the study population denominator (N = 471), whereas medication-level modifications used the reviewed medication-record denominator (N = 2641). Descriptive statistics were calculated using R software (version 4.4.3).</p><p><strong>Results: </strong>A total of 471 patients were included. Mean age was 46.1 years (SD 18.3), and 58.6% (276/471) were male. Medication reconciliation was documented in 20.8% (98/471) of records. The mean number of home medications at admission was 4.5 (SD 3.4), and the mean number of medications documented during hospitalization was 5.3 (SD 3.8). At least one documented medication discrepancy was identified in 3.8% (18/471) of patients. Documented medication modifications were recorded for 6.5% (172/2641) of reviewed medication records.</p><p><strong>Conclusion: </strong>Medication reconciliation was documented in only one-fifth of reviewed electronic records, indicating an important documentation gap in routine practice. The distinction between patient-level discrepancies and medication-level modifications should be maintained in future audits. More standardized electronic documentation, including a mandatory reconciliation checklist at admission and discharge, may improve the visibility and auditability of medication reconciliation at KSUMC.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physician maldistribution persisted despite health system capacity expansion in Türkiye, 2002-23.","authors":"Ahmet Aykut, Leyla Merda Ekmen Aykut","doi":"10.1093/intqhc/mzag138","DOIUrl":"10.1093/intqhc/mzag138","url":null,"abstract":"<p><strong>Background: </strong>Equitable access is a core dimension of healthcare quality. Türkiye expanded health system financing, workforce, and infrastructure after the early 2000s, but whether national capacity growth was accompanied by more equitable subnational resource distribution remains unclear. This study examined national trends in health system capacity and financing between 2002 and 2023 and compared provincial resource distribution by Human Development Index group.</p><p><strong>Methods: </strong>We conducted a retrospective observational health services study using aggregated national and provincial indicators from Türkiye. National indicators included physicians, nurses, hospital beds, persons per provider, total and per-capita health expenditure, health expenditure as a percentage of gross domestic product, and the public share of total health expenditure. Descriptive trends and ordinary least-squares models were used to summarize temporal co-variation between nominal health expenditure and capacity indicators; no inflation-adjusted or causal effect was estimated. For the subnational analysis, the province with the highest and lowest Human Development Index value within each of Türkiye's seven geographic regions was selected, yielding 14 provinces. Provincial physician, nurse, and hospital bed densities were compared between high- and low-Human Development Index provinces using the exact two-sided Mann-Whitney test. Interprovincial inequality was assessed using the coefficient of variation and Gini index.</p><p><strong>Results: </strong>Between 2002 and 2023, the number of physicians increased from 91 949 to 204 223, nurses from 72 393 to 248 287, and hospital beds from 164 471 to 266 594. Persons per physician declined from 722 to 418, and persons per nurse declined from 917 to 344. Total nominal health expenditure increased from 18.774 billion Turkish Lira to 1244.24 billion Turkish Lira, while the public share of total health expenditure increased from 70.7% to 77.5%. Over time, higher nominal per-capita expenditure coincided with a larger physician workforce and fewer persons per physician. In the subnational analysis, physician density was higher in high-Human Development Index provinces than in low-Human Development Index provinces (2.86 versus 1.91 per 1000 population; P = .0262), whereas nurse and hospital bed densities did not differ significantly. Physician density showed greater interprovincial inequality than nurse or hospital bed density.</p><p><strong>Conclusion: </strong>Türkiye achieved substantial national expansion in health system capacity and public financing, but physician distribution remained unequal across provinces. Physician maldistribution should be monitored as an equity-sensitive indicator of health system quality and performance.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital at Home vs conventional hospitalization: good clinical outcomes with lower cost and nosocomial complications.","authors":"Eulalia Balbina Villegas Bruguera, Ana María Torres Corts, Sergio Oleaga Pérez Mendiguren, Joan Enric Torra Bou, Joan Blanco Blanco","doi":"10.1093/intqhc/mzag099","DOIUrl":"10.1093/intqhc/mzag099","url":null,"abstract":"<p><strong>Background: </strong>Hospitalization at home (HAH) is a care model that is safe and cost-effective as an alternative to conventional hospitalization (CH). HAH reduces hospital admissions and length of stay in the wards with comparable clinical outcomes. Published studies exhibit significant heterogeneity in data analysis methods, patient profiles, health outcomes and economic costs.</p><p><strong>Methods: </strong>A retrospective observational study conducted on patients treated by our HAH service over 2 years (988 in 2019 and 1335 in 2023), analyzing epidemiological and clinical aspects, savings in CH beds utilization, and a comparative analysis with CH of nosocomial complications, use of complementary explorations and cost differences between both resources.</p><p><strong>Results: </strong>Over 2 years, HAH activity increased while maintaining lower complication and readmission rates compared to CH. Over 90% of HAH patients were discharged home. Although the average length of stay was longer in HAH, the cost per patient per day was significantly lower in HAH (€86 vs. €215 in 2019 and €118 vs. €257 in 2023), and freed up 23-31 inpatient beds daily, improving hospital efficiency. Annual savings from HAH utilization amounted to €1.1 million in 2019 and €1.5 million in 2023. Additionally, reduced use of hospital resources (laboratory, CT and MRI) in HAH saved more than €58 000 in 2019 and €100 000 in 2023.</p><p><strong>Conclusions: </strong>For selected patients, including frail elderly people with multiple comorbidities, HAH is an excellent alternative to CH that provides hospital-level medical care at home, avoiding nosocomial complications while maintaining care quality and generating substantial economic savings for the healthcare system.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148595321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetes care guided by quality indicators: a cost-effectiveness analysis in the Brazilian public health system.","authors":"Yasmin Vitória Andrade de Castro Alves, Márcio Galvão de Oliveira, Leonardo Régis Leira Pereira, Lara de Souza Oliveira, Priscila Ribeiro de Castro, Erlan Canguçu Aguiar, Pablo Maciel Brasil Moreira, Sóstenes Mistro","doi":"10.1093/intqhc/mzag098","DOIUrl":"10.1093/intqhc/mzag098","url":null,"abstract":"<p><strong>Background: </strong>Diabetes mellitus (DM) is one of the most common non-communicable diseases worldwide and is associated with a substantial increase in the healthcare burden due to high rates of morbidity, mortality, and long-term complications. Evidence on the economic impact of quality of care for diabetes management based on structured assessment indicators in real-world primary care settings is scarce. This study aimed to evaluate the cost-effectiveness of providing qualified care to individuals with diabetes in primary healthcare settings based on quality-of-care indicators.</p><p><strong>Methods: </strong>A cost-effectiveness analysis was conducted using a Markov based model from the perspective of a municipal health manager in Brazil. Data were collected from 114 patients aged 60 years or older with type 2 diabetes mellitus in Vitória da Conquista. Patients were grouped based on whether 15 or more structured quality-of-care indicators were assessed during follow-up visits. The model simulated health state transitions over a 10-year time horizon, incorporating probabilities of complications, quality-adjusted life years, and direct costs. Sensitivity and probabilistic analyses were performed to test model robustness.</p><p><strong>Results: </strong>Data mining techniques were used to identify a stronger association between the assessed items and a lower probability of having complications. It was found that in the group with 15 or more items assessed during visits, 17.4% had complications, and in the group with fewer than 15 items assessed during visits, this percentage was 37.14%. Therefore, these groups were used as comparators in the economic model. The cost-effectiveness analysis showed that the most comprehensive assessment was the dominant strategy, with an incremental cost-effectiveness ratio of -US$9742.51. The factors that most influenced the model were quality-adjusted life years, the probability of experiencing complications, and the cost of diabetes.</p><p><strong>Conclusion: </strong>Qualified care with a comprehensive approach during follow-up visits was shown to be a cost-effective strategy for improving the quality of life for people with DM.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148538092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A perspective on value-based healthcare implementation: successes and challenges.","authors":"Azhar Ali, Reem Fahad AlBunyan, David Greenfield","doi":"10.1093/intqhc/mzag095","DOIUrl":"10.1093/intqhc/mzag095","url":null,"abstract":"","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148612355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the effectiveness of the 'patient transport' app in improving healthcare quality, patient safety, and workflow efficiency.","authors":"Roisin O'Malley, Cybele Abad, Paul O'Connor","doi":"10.1093/intqhc/mzag096","DOIUrl":"10.1093/intqhc/mzag096","url":null,"abstract":"","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148538091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Access and timeliness of acute stroke reperfusion after cluster-wide protocol standardization: an interrupted time-series study in Hong Kong.","authors":"Hoi-Lun Koo, Bun Sheng, Lilly D Engineer","doi":"10.1093/intqhc/mzag106","DOIUrl":"10.1093/intqhc/mzag106","url":null,"abstract":"<p><strong>Background: </strong>Protocol standardization is widely used to improve the quality and consistency of acute stroke reperfusion, but evidence from routine public hospital practice remains limited, particularly on whether gains are sustained during later periods of service stress. We evaluated changes in access to and timeliness of intravenous thrombolysis after cluster-wide protocol standardization in a Hong Kong public hospital cluster and examined whether these performance domains changed during a later Omicron-related service shock.</p><p><strong>Methods: </strong>In this interrupted time-series study, we analysed acute ischaemic stroke care in the Kowloon West Cluster, Hong Kong, from 1 January 2017 to 31 December 2024. Prespecified breakpoints were implementation of a unified reperfusion protocol in July 2019 and the Omicron-related service shock in February 2022. Primary monthly outcomes were intravenous thrombolysis rate, median door-to-needle time, and the proportion treated within 60 min. Secondary process outcomes were door-to-computed tomography time and imaging-to-needle interval. Secondary quarterly patient-centred outcomes were early neurological improvement at 24 h and 3-month functional outcome measured using the modified Rankin Scale.</p><p><strong>Results: </strong>Protocol implementation was associated with an immediate increase in intravenous thrombolysis access. Median door-to-needle time showed a more complex pattern, with an immediate worsening after protocol implementation followed by a favourable post-implementation trend. The proportion treated within 60 min improved after protocol implementation. During the Omicron period, thrombolysis access remained stable, but treatment timeliness deteriorated progressively. Decomposition of the reperfusion pathway suggested that this later erosion was driven mainly by prolongation of the downstream imaging-to-needle interval rather than by deterioration in initial imaging access. Early neurological improvement showed post-protocol improvement but attenuated during sustained service stress. Favourable 3-month functional outcome remained broadly stable, with sensitivity analyses yielding similar estimates despite declining follow-up completeness in the post-shock period.</p><p><strong>Conclusion: </strong>Cluster-wide protocol standardization was associated with improved access to intravenous thrombolysis and a mixed pattern in treatment timeliness. Implementation effects on timeliness were not linear and included early disruption, subsequent improvement, and later deterioration during prolonged service stress. Preserved treatment access should not be assumed to indicate preserved treatment speed. Quality evaluation of acute stroke services should distinguish access from timeliness and use pathway-level measurement to identify workflow segments most vulnerable to disruption.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148672027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The power of collaboration: the untold story of World Blood Donor Day and World Patient Safety Day.","authors":"Neelam Dhingra","doi":"10.1093/intqhc/mzag135","DOIUrl":"10.1093/intqhc/mzag135","url":null,"abstract":"<p><p>Global health days endorsed by the World Health Assembly (WHA) play a distinctive role in elevating priority issues, mobilizing political commitment, and catalyzing collective action. Among them, World Blood Donor Day (WBDD) and World Patient Safety Day (WPSD) stand out as landmark initiatives that emerged not only from technical necessity but also through sustained collaboration among Member States, WHO, and key partners including international organizations, professional bodies, civil society, and advocates. More than symbolic observances, they serve as governance instruments that confer legitimacy, engage stakeholders, and sustain momentum for health system strengthening. WBDD and WPSD have become influential global platforms for advancing safety, solidarity, and health system action. Yet the processes behind their establishment, including the consultations, negotiations, consensus building, and collaborative efforts that culminated in their adoption through WHA resolutions, remain largely undocumented. In this story, I offer a first-hand account of how these two global health days were conceived, negotiated, and established, drawing on more than two decades of leadership and programme coordination in blood safety (2000-2014) and patient safety (2014-2024) at WHO headquarters in Geneva, Switzerland. The article examines collaboration as the critical enabler of success and distils lessons for global health governance. While both initiatives involved extensive contributions from Member States, WHO, international organizations, professional bodies, civil society, and advocates, this article covers their development trajectory and highlights the strategies that transformed evidence, ambition, and shared purpose into global commitments.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13584835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}