Journal of Hospital Infection最新文献

{"title":"Impact of COVID-19 pandemic on the implementation of transmission-based precautions","authors":"K. Yap ,&nbsp;K.Z. Linn ,&nbsp;A.Y. Lim ,&nbsp;X. Huan ,&nbsp;N.B. Han ,&nbsp;L. Sun ,&nbsp;S.H. Tan ,&nbsp;K.C. Thoon ,&nbsp;B.S.P. Ang ,&nbsp;M.L. Ling ,&nbsp;S.K. Pada ,&nbsp;A. Ty ,&nbsp;D. Fisher ,&nbsp;K. Marimuthu","doi":"10.1016/j.jhin.2025.03.010","DOIUrl":"10.1016/j.jhin.2025.03.010","url":null,"abstract":"<div><h3>Background</h3><div>Multidrug-resistant organisms and hospital-acquired infections threaten patient safety. Transmission-based precautions (TBPs) are critical infection prevention and control (IPC) measures but resource intensive. The COVID-19 pandemic disrupted routine IPC practices due to resource diversion for pandemic response, straining systems and compromising TBPs for pathogens of interest (POIs).</div></div><div><h3>Aim</h3><div>To investigate the impact of the COVID-19 pandemic on the implementation of pathogen-specific TBPs in five Singapore acute hospitals before and during the COVID-19 pandemic from August 2020 to August 2021.</div></div><div><h3>Methods</h3><div>The primary outcome measure was the proportion of patients on appropriate pathogen-specific TBPs. The variables between the two cycles were compared to assess the impact of COVID-19 on the implementation of pathogen-specific IPC measures.</div></div><div><h3>Findings</h3><div>A total of 8601 patient records were reviewed (4132 in Cycle 1 and 4469 in Cycle 2). Appropriate TBP implementation decreased by 39% during Cycle 2 compared to Cycle 1 (odds ratio (OR): 0.61; 95% confidence interval (CI): 0.50–0.73; <em>P</em> &lt; 0.01). Staff unawareness of POIs emerged as the most common factor contributing to inappropriate TBP placement across both cycles. Notably, patients with meticillin-resistant <em>Staphylococcus aureus</em> only experienced a significant decrease in appropriate TBP during Cycle 2 (OR: 0.56; 95% CI: 0.44–0.71; <em>P</em> &lt; 0.01). Interestingly, hospitals with higher pre-pandemic TBP adherence rates maintained better compliance during the pandemic.</div></div><div><h3>Conclusion</h3><div>The COVID-19 pandemic adversely affected the implementation of appropriate TBPs in Singapore acute care hospitals. This study highlights the need for proactive appropriate TBP maintainance during public health emergencies.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"162 ","pages":"Pages 76-83"},"PeriodicalIF":3.9,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804882","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":"Are particle counts better than microbiological sampling to assess air supply cleanliness in operating theatres?","authors":"A. Bak ,&nbsp;P. Hoffman ,&nbsp;C. Mackintosh ,&nbsp;H. Humphreys","doi":"10.1016/j.jhin.2025.03.012","DOIUrl":"10.1016/j.jhin.2025.03.012","url":null,"abstract":"","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"160 ","pages":"Pages 128-130"},"PeriodicalIF":3.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797098","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":"Long-term within-household sharing of ESBL-producing E. coli carrying bla_CTX-M-147 that converted to bla_CTX-M-14.","authors":"H Aardema, S Rosema, M A Fliss, L Gard, A J M Lokate, C L E Hazenberg, A Voss, E Bathoorn","doi":"10.1016/j.jhin.2025.03.008","DOIUrl":"10.1016/j.jhin.2025.03.008","url":null,"abstract":"","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797101","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":"Health economic burden of refractory and recurrent Clostridioides difficile infection in the inpatient setting of the German healthcare system – the IBIS Study","authors":"S.M. Wingen-Heimann ,&nbsp;A. Ullah ,&nbsp;M.R. Cruz Aguilar ,&nbsp;S.K. Gräfe ,&nbsp;J. Conrad ,&nbsp;K. Giesbrecht ,&nbsp;K.-P. Hunfeld ,&nbsp;C. Lübbert ,&nbsp;S. Pützfeld ,&nbsp;P.A. Reuken ,&nbsp;M. Schmitz-Rode ,&nbsp;E. Schalk ,&nbsp;T. Schmidt-Wilcke ,&nbsp;S. Schmiedel ,&nbsp;P. Solbach ,&nbsp;M.J.G.T. Vehreschild","doi":"10.1016/j.jhin.2025.03.011","DOIUrl":"10.1016/j.jhin.2025.03.011","url":null,"abstract":"<div><h3>Background</h3><div><em>Clostridioides difficile</em> infections (CDIs) remain a prevalent and costly healthcare challenge, particularly affecting elderly, comorbid patients. Evidence on the health economic burden of CDI in Germany, particularly in refractory and recurrent patients is limited.</div></div><div><h3>Methods</h3><div>The IBIS study was a non-interventional retrospective and prospective study conducted from August 2017 to September 2020 in 10 German hospitals to assess the health economic burden of inpatient CDI treatment. It categorized CDI episodes into initial, refractory and recurrent, following the current ESCMID guidelines. A micro-costing approach from the societal perspective was applied, considering personnel, material, and infrastructure costs for treatment on different types of hospital wards, targeted antibiotic CDI therapies, and productivity losses due to illness-related disability.</div></div><div><h3>Findings</h3><div>Mean total costs per patient were €13,607 (95% CI: €12,124–€15,171) for the initial, €19,953 (95% CI: €16,839–€23,377) refractory and €22,671 (95% CI: €16,088–€30,474; <em>P</em>&lt;0.001) for the recurrence group. Treatment on a general ward was the most important cost driver. Mean hospital length of stay in the initial, refractory group and recurrence group was 30 (95% CI: 27–33) vs 41 (95% CI: 35–46) vs 47 days (95% CI: 37–57; <em>P</em>&lt;0.001), respectively. Patients with initial, refractory and recurrent CDI required 11 (95% CI: 10–1), 15 (95% CI: 13–16) and 24 days (95% CI: 22–27; <em>P</em>&lt;0.001) of targeted antibiotic therapy for CDI.</div></div><div><h3>Conclusion</h3><div>The IBIS study contributes valuable insights to the health economic burden of refractory and recurrent CDI in the German inpatient setting and underlines the importance of effective first-line treatment to improve treatment outcomes and reduce overall costs related to CDI.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"160 ","pages":"Pages 19-25"},"PeriodicalIF":3.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797099","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":"Quality indicators for appropriate inpatient antibiotic use: results from two national surveys in Italy, 2016–2022","authors":"C. Vicentini ,&nbsp;A. Russotto ,&nbsp;R. Bussolino ,&nbsp;M. Castagnotto ,&nbsp;C. Gastaldo ,&nbsp;S. Bazzolo ,&nbsp;D. Gamba ,&nbsp;S. Corcione ,&nbsp;F.G. De Rosa ,&nbsp;F. D'Ancona ,&nbsp;C.M. Zotti ,&nbsp;Italian PPS network","doi":"10.1016/j.jhin.2025.03.007","DOIUrl":"10.1016/j.jhin.2025.03.007","url":null,"abstract":"<div><h3>Background</h3><div>To address its high antimicrobial resistance (AMR) and antibiotic consumption rates, Italy introduced a national action plan to contrast AMR (PNCAR) in 2017.</div></div><div><h3>Aim</h3><div>To investigate trends in antibiotic use, prescribing practices, and AMR rates in Italy through indicators of appropriate antibiotic use.</div></div><div><h3>Methods</h3><div>Two point prevalence surveys (PPSs), according to The European Centre for Disease Prevention and Control (ECDC) methods and definitions, were conducted in 2016 and 2022. Indicators of appropriate antibiotic use were defined and measured. Antibiotic use prevalence and AMR rates for specific pathogen–drug combinations were calculated. To account for potential confounding factors, a propensity score matching approach was applied to compare the results of the two PPS editions using prevalence rate ratio (PRR).</div></div><div><h3>Results</h3><div>Overall, 28,991 patients from 140 hospitals and 60,403 patients from 325 hospitals were included in 2016 and 2022, respectively. Patient characteristics remained stable, but patients were increasingly exposed to invasive procedures. The overall prevalence of antibiotic use decreased from 43.51 to 41.52 (PRR 0.95, 95% confidence interval, CI 0.94–0.97, <em>P</em>&lt;0.001). Improvements in some prescribing practices were identified: the proportion of surgical prophylaxis lasting &gt;1 day decreased from 55.99% to 52.15%, (PRR 0.94, 95% CI 0.90–0.98, <em>P</em>&lt;0.001) and the proportion of culture-guided hospital infection treatments increased from 33.68% to 48.57% (PRR 1.30, 95% CI 1.22–1.38, <em>P</em>&lt;0.05). Conversely, a significant rise in the proportion of last line/broad-spectrum agents was recorded for most indications.</div></div><div><h3>Conclusion</h3><div>This study provided a mapping of prescribing activity at national level, and defined measurable quality indicators, through which strengths and areas for improvement in prescribing practices were identified.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"160 ","pages":"Pages 34-44"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782089","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":"Surgery and sustainability: time for multi-disciplinary collaboration to reduce the carbon footprint while not compromising infection prevention","authors":"H. Humphreys ,&nbsp;A.D.K. Hill","doi":"10.1016/j.jhin.2025.01.001","DOIUrl":"10.1016/j.jhin.2025.01.001","url":null,"abstract":"","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"158 ","pages":"Pages 69-70"},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973385","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":"Nosocomial bloodstream infection in critically ill patients: is extracorporeal membrane oxygenation a relevant factor?","authors":"A. Martínez ,&nbsp;M. Martín-Cerezuela ,&nbsp;C. Carrasco ,&nbsp;J. Frasquet ,&nbsp;R. Gimeno ,&nbsp;F. Perez-Esteban ,&nbsp;F. Álvarez ,&nbsp;J. Pemán ,&nbsp;Á. Castellanos ,&nbsp;P. Ramirez","doi":"10.1016/j.jhin.2025.03.004","DOIUrl":"10.1016/j.jhin.2025.03.004","url":null,"abstract":"<div><h3>Background</h3><div>Nosocomial bloodstream infection (BSI) in critically ill patients can cause clinical deterioration, prolong intensive care unit (ICU) stays, and increase mortality risk. Extracorporeal membrane oxygenation support (ECMO) is a known risk factor for BSI, and infections in these patients are assumed to have a worse prognosis.</div></div><div><h3>Aim</h3><div>To compare risk factors for BSI between ECMO and non-ECMO patients.</div></div><div><h3>Methods</h3><div>A three-year prospective observational study was conducted in a 24-bed medical ICU. Consecutive nosocomial BSI episodes were recorded, and BSIs in mechanically ventilated patients were analysed based on ECMO treatment status.</div></div><div><h3>Findings</h3><div>A total of 98 BSI episodes were included: 30 (30.6%) in ECMO and 68 (69.3%) in non-ECMO patients. The total number of ECMO patients during the study period was 110, with a bacteraemia rate of 27.7% (20.26 episodes per 1000 treatment-days). In non-ECMO patients, the BSI rate was 7.9% (<em>P</em> &lt; 0.001). ECMO patients were younger and had fewer comorbidities. BSI type and aetiology were similar between groups, but severity was higher in ECMO patients. Although multidrug-resistant micro-organisms were more frequent in ECMO patients, the appropriate treatment rate was similar. ICU mortality was 66.6% in ECMO patients and 30.8% in non-ECMO patients (<em>P</em> &lt; 0.001). However, continuous renal replacement therapy (odds ratio (OR): 3.67), Sepsis Organ Failure Assessment score (OR: 1.54), and COVID-19 diagnosis (OR: 1.54) were the only independent risk factors associated with mortality in BSI patients.</div></div><div><h3>Conclusion</h3><div>Although BSI was more frequent and severe in ECMO patients, ECMO support was not independently related to mortality in patients with healthcare-associated BSI.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"161 ","pages":"Pages 19-24"},"PeriodicalIF":3.9,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756021","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":"Implementation considerations for integrated face and respiratory protection: a qualitative study","authors":"L. Cordeiro ,&nbsp;A. Price ,&nbsp;N.A. de Oliveira ,&nbsp;C.L. Ciofi-Silva ,&nbsp;G. Girelli ,&nbsp;Y.L. Lin ,&nbsp;A.S. Levin ,&nbsp;F. Tumietto ,&nbsp;M.C. Padoveze","doi":"10.1016/j.jhin.2025.02.022","DOIUrl":"10.1016/j.jhin.2025.02.022","url":null,"abstract":"<div><h3>Background</h3><div>The implementation of an innovative form of personal protective equipment (PPE) as an infection and prevention control measure for respiratory transmissible diseases is complex, with several elements to be addressed.</div></div><div><h3>Aim</h3><div>To make considerations for integrated face and respiratory protection implementation in clinical settings.</div></div><div><h3>Methods</h3><div>This was a multi-site qualitative study with 87 health workers that compared traditional PPE or powered air-purifying (PAPR) respirators with lightweight PAPR (L-PAPR). Semi-structured interviews were performed based on the Consolidated Framework for Implementation Research (CFIR).</div></div><div><h3>Findings</h3><div>Insights into L-PAPR implementation were found. The advantages include enhanced sense of protection, pleasant ventilation, good visibility for both health worker and patient, no fogging of the visor interior, no movement restriction, and easy disinfection process. To enhance usability some barriers should be tackled: reduction of facial pressure; better accommodation for glasses and corrective lenses; reduction of number of steps for assembling the device; infrastructure provision for storage, charging and disinfection of the device; training of health workers for assembling, donning and doffing; and the cost benefit of implementation.</div></div><div><h3>Conclusion</h3><div>L-PAPR was overall perceived with advantages by many participants, and can be considered a potential option of PPE to be implemented to protect health workers during outbreaks of respiratory transmissible diseases.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"160 ","pages":"Pages 1-11"},"PeriodicalIF":3.9,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702344","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":"Risk factors for infection in patients undergoing hip replacement: a systematic review and meta-analysis","authors":"B. Yang ,&nbsp;Y. Lei ,&nbsp;Y. Zeng ,&nbsp;M. Luo ,&nbsp;Z. Li ,&nbsp;K. Lei ,&nbsp;Y. Wang ,&nbsp;Q. Xiao ,&nbsp;J. Wen ,&nbsp;W. Yan ,&nbsp;H. Yan","doi":"10.1016/j.jhin.2025.02.021","DOIUrl":"10.1016/j.jhin.2025.02.021","url":null,"abstract":"<div><div>A meta-analysis was conducted to determine the risk of infection following hip replacement and risk factors were identified for surgical site infection. PubMed/Medline, Embase and Cochrane Library databases were systematically searched, as well as the reference lists of previous systematic reviews and meta-analyses. The pooled odds ratio (OR) was estimated using a random effects model for each investigated factor. The evidence of observational studies was classified as high quality (class I), moderate quality (class II or III) or low quality (class IV) based on the GRADE system. A total of 25,383 potential articles met the inclusion criteria in the database search. After reviewing the titles, abstracts, and full texts, 27 articles were included in the final analysis, encompassing 699,473 patients who underwent hip arthroplasty. High-quality evidence shows that BMI (≥30 kg/m²) (OR 2.16; 95% CI 1.72–2.70), male sex (OR 1.39; 95% CI 1.26–1.53), operation time (≥120 min) (OR 1.72; 95% CI 1.39–2.14), American Society of Anesthesiologists (ASA) class ≥3 (OR 2.05; 95% CI 1.49–2.83), diabetes (OR 1.33; 95% CI 1.23–1.43), and heart disease (OR 1.99; 95% CI 1.48–2.68) are associated with a greater risk of infection. The meta-analysis revealed that age and renal disease were not associated with infection. In conclusion, this meta-analysis identified significant risk factors for infection after hip-replacement surgery, including BMI, male sex, operation time, heart disease, diabetes, and ASA class.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"160 ","pages":"Pages 60-73"},"PeriodicalIF":3.9,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702345","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":"Impact of single-use oral care sets on reducing ventilator-associated pneumonia among intensive care unit patients: a multi-centre study","authors":"A. Unahalekhaka ,&nbsp;P. Uirungroj ,&nbsp;C. Saenjum","doi":"10.1016/j.jhin.2025.03.005","DOIUrl":"10.1016/j.jhin.2025.03.005","url":null,"abstract":"<div><h3>Background</h3><div>Ventilator-associated pneumonia (VAP) is a serious hospital-associated infection among mechanically ventilated patients. Proper oral care is a critical intervention for reducing VAP incidence.</div></div><div><h3>Aim</h3><div>To evaluate the effectiveness of single-use oral care sets in reducing VAP incidence and assessing ICU nurses' perspectives on their use.</div></div><div><h3>Methods</h3><div>A multi-centre study was conducted in the ICUs of 14 tertiary-care hospitals. Single-use oral care sets were used for cleaning patients' oral cavities following a standardized oral care protocol. VAP rates and cost of VAP antibiotic treatment were compared before and after implementing the oral care sets. ICU nurses' opinions on the oral care sets were collected using a self-administered questionnaire.</div></div><div><h3>Findings</h3><div>Before implementing the oral care sets, there were 269 VAP cases over 34,731 ventilator-days, with a VAP rate of 7.74 per 1000 ventilator-days. The total antibiotic cost for VAP treatment was 5,137,622 Thai baht. After implementation, VAP cases decreased to 182 over 34,309 ventilator-days, with a significantly reduced VAP rate of 5.30 per 1000 ventilator-days – a 31.52% reduction (<em>P</em>&lt;0.05). Antibiotic treatment costs also declined significantly to 2,101,940 Thai baht (<em>P</em>&lt;0.05). Among 220 ICU nurses surveyed, 96.3% agreed or strongly agreed that the oral care sets helped prevent healthcare-associated infections (HAIs). Over 85% reported improved ease of use, increased patient comfort, and better adherence to evidence-based guidelines.</div></div><div><h3>Conclusion</h3><div>The use of single-use oral care sets within a standardized oral care protocol effectively reduces VAP incidence and associated costs. ICU nurses expressed high satisfaction with the oral care sets, highlighting their potential to enhance patient safety, improve adherence to guidelines, and reduce healthcare costs. Routine integration of single-use oral care sets into oral care protocols for mechanically ventilated patients is recommended.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"160 ","pages":"Pages 12-18"},"PeriodicalIF":3.9,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702330","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}