British Journal of General Practice最新文献

{"title":"Antipsychotic management in general practice: serial cross-sectional study (2011-2020).","authors":"Alan Woodall, Alex Gampel, Lauren E Walker, Frances S Mair, Sally Sheard, Pyers Symon, Iain Buchan","doi":"10.3399/BJGP.2024.0367","DOIUrl":"10.3399/BJGP.2024.0367","url":null,"abstract":"<p><strong>Background: </strong>Long-term use of antipsychotics confers increased risk of cardiometabolic disease. Ongoing need should be reviewed regularly by psychiatrists.</p><p><strong>Aim: </strong>To explore trends in antipsychotic management in general practice, and the proportions of patients prescribed antipsychotics receiving psychiatrist review.</p><p><strong>Design and setting: </strong>Serial cross-sectional study using linked general practice and hospital data in Wales (2011-2020).</p><p><strong>Method: </strong>Participants were adults (aged ≥18 years) registered with general practices in Wales. Outcome measures were prevalence of patients receiving ≥6 antipsychotic prescriptions annually, the proportion of patients prescribed antipsychotics receiving annual psychiatrist review, and the proportion of patients prescribed antipsychotics who were registered on the UK serious mental illness, depression, and/or dementia registers, or not on any of these registers.</p><p><strong>Results: </strong>Prevalence of adults prescribed long-term antipsychotics increased from 1.055% (95% confidence interval [CI] = 1.041 to 1.069) in 2011 to 1.448% (95% CI = 1.432 to 1.464) in 2020. The proportion receiving annual psychiatrist review decreased from 59.6% (95% CI = 58.9 to 60.4) in 2011 to 52.0% (95% CI = 51.4 to 52.7) in 2020. The proportion of overall antipsychotic use prescribed to patients on the serious mental illness register decreased from 50.0% (95% CI = 49.4 to 50.7) in 2011 to 43.6% (95% CI = 43.0 to 44.1) by 2020.</p><p><strong>Conclusion: </strong>Prevalence of long-term antipsychotic use is increasing. More patients are managed by GPs without psychiatrist review and are not on monitored disease registers; they thus may be less likely to undergo cardiometabolic monitoring and miss opportunities to optimise or deprescribe antipsychotics. These trends pose risks for patients and need to be addressed urgently.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301477","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":"Supporting patients to use online services in general practice: focused ethnographic case study.","authors":"Jennifer Newbould, Carol Bryce, Stephanie Stockwell, Bethan Mair Treadgold, John Campbell, Christine Marriott, Emma Pitchforth, Laura Sheard, Rachel Winder, Helen Atherton","doi":"10.3399/BJGP.2024.0137","DOIUrl":"https://doi.org/10.3399/BJGP.2024.0137","url":null,"abstract":"<p><p>Background In England online services in general practice encompass a range of provision from ordering repeat medication to having a consultation. Some groups of individuals may find accessing and/or using such services difficult and may require 'digital facilitation', that is the range of processes, procedures, and personnel which seeks to support NHS patients in their uptake and use of online services. Aim To gain insight, from the perspective of general practice staff and patients/carers, into how and why digital facilitation might lead to benefits, and the key processes involved in supporting patients to use online services. Design and setting Eight general practices across England with varied geographical and socio-demographic characteristics. Methods Focused ethnographic case study of observations and interviews (n=69). Results Typically, digital facilitation was delivered in an ad hoc fashion to individual patients. Online services were delivered via multiple systems each working differently, and creating a need for support so that patients could access them. Younger practice staff were expected to deliver support on account of their age, despite there being no evidence of age-related training and experience. It was understood by practice staff that patients with challenging personal circumstances may require specific support to access online services. Conclusion At present patient use of online services is supported by digital facilitation which is primarily delivered by reception staff. Supporting patients to use online services requires review of how many services are provided and what for, and consideration for the time and effort needed to support patients to use them.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689779","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":"Future Health Today: A pragmatic cluster randomised trial of quality improvement activities in general practice for patients at risk of undiagnosed cancer.","authors":"Sophie Chima, Javiera Martinez Gutierrez, Barbara Hunter, Adrian Laughlin, Patty Chondros, Natalie Lumsden, Douglas Boyle, Craig Nelson, Paul Amores, An Duy Tran, Jo-Anne Manski-Nankervis, Jon Emery","doi":"10.3399/BJGP.2024.0491","DOIUrl":"https://doi.org/10.3399/BJGP.2024.0491","url":null,"abstract":"<p><p><b>Background:</b> Diagnosing cancer in general practice is complex, given the non-specific nature of many presenting symptoms and the overlap of potential diagnoses. This trial evaluated the effectiveness of a technology, Future Health Today (FHT), which provides clinical decision support, auditing, and quality improvement monitoring, on the appropriate follow-up of patients at risk of undiagnosed cancer.</p><p><strong>Methods: </strong>Pragmatic, cluster randomised trial in Australian general practice. Practices were randomly assigned to receive recommendations for follow-up investigations for cancer (FHT cancer module) or the active control. Algorithms were applied to the electronic medical record and used demographic information and abnormal test results that are associated with risk of undiagnosed cancer (anaemia/iron-deficiency, thrombocytosis and raised PSA) to identify patients requiring further investigation and provide recommendations for care. The intervention consisted of the FHT cancer module, a case-based learning series and ongoing practice support. Using intention-to-treat approach, between arms difference in the proportion of patients with abnormal test results followed-up according to guidelines was determined at 12-months.</p><p><strong>Results: </strong>7555 patients were identified as at risk of undiagnosed cancer. At 12-months post-randomisation, 76.2% of patients in the intervention arm had received recommended follow-up (21 practices, n=2820/3709), compared to 70% in the control arm (19 practices, n=2693/3846; estimated between arm difference in percentages=2.6%, 95% CI -2.8% to 7.9%; odds ratio=1.15, 95% CI 0.87-1.53; p=0.332).</p><p><strong>Conclusions: </strong>The FHT cancer module intervention did not increase the proportion of patients receiving guideline-concordant care. The proportion of patients receiving recommended followed-up was high, suggesting a possible ceiling effect for the intervention.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683587","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":"Relationship between research activity and the performance of English general practices: cross-sectional and longitudinal analyses.","authors":"Jonathan Gibson, Evangelos Kontopantelis, Matthew Sutton, Annette Boaz, Paul Little, Christian Mallen, Richard McManus, Sophie Park, Juliet Usher-Smith, Peter Bower","doi":"10.3399/BJGP.2024.0111","DOIUrl":"10.3399/BJGP.2024.0111","url":null,"abstract":"<p><strong>Background: </strong>Research activity usually improves outcomes by being translated into practice; however, there is developing evidence that research activity itself may improve the overall performance of healthcare organisations. Evidence that these relationships represent a causal impact of research activity is, however, less clear. Additionally, the bulk of the existing evidence relates to hospital settings, and it is not known if those relationships would also be found in general practice, where most patient contacts occur.</p><p><strong>Aim: </strong>To test 1) whether there are significant relationships between research activity in general practice and organisational performance; and 2) whether those relationships are plausibly causal.</p><p><strong>Design and setting: </strong>National data were analysed between 2008 and 2019, using cross-sectional and longitudinal analyses on general practices in England.</p><p><strong>Method: </strong>Cross-sectional, panel, and instrumental variable analyses were employed to explore relationships between research activity (including measures from the National Institute for Health and Care Research Clinical Research Network and the Royal College of General Practitioners) and practice performance (including clinical quality of care, patient-reported experience of care, prescribing quality, and hospital admissions).</p><p><strong>Results: </strong>In cross-sectional analyses, different measures of research activity were positively associated with several measures of practice performance, but most consistently with clinical quality of care and accident and emergency attendances. The associations were generally modest in magnitude; however, longitudinal analyses did not support a reliable causal relationship.</p><p><strong>Conclusion: </strong>Similar to findings from hospital settings, research activity in general practice is associated with practice performance. There is less evidence that research is causing those improvements, although this may reflect the limited level of research activity in most practices. No negative impacts were identified, suggesting that research activity is a potential marker of quality and something that high-quality practices can deliver alongside their core responsibilities.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141472861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What helps or hinders the communication of poor prognosis between secondary and primary care? A systematic review with narrative synthesis.","authors":"Lucy Pocock, Tanuka Palit, Adam McDermott, Sam Creavin, Emma Gilbert, Samuel Wd Merriel, Steven Moore, Sarah Purdy, Stephen Barclay, Lucy E Selman","doi":"10.3399/BJGP.2023.0341","DOIUrl":"10.3399/BJGP.2023.0341","url":null,"abstract":"<p><strong>Background: </strong>The communication of poor prognosis from secondary to primary care helps to ensure that patients with life-limiting illness receive appropriate coordinated care in line with their preferences. However, little is known about this information-sharing process.</p><p><strong>Aim: </strong>To determine how poor prognosis is communicated from secondary care to primary care.</p><p><strong>Design and setting: </strong>This was an international systematic review and narrative synthesis of studies published in English.</p><p><strong>Method: </strong>Four electronic databases were searched from 1 January 2000 to 17 May 2021, supplemented by hand-searching of key journals. One-quarter of titles and abstracts were independently screened by a second reviewer. Two reviewers undertook data extraction and quality appraisal, independently using the Mixed Methods Appraisal Tool. Data were analysed using narrative synthesis. Reporting follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance.</p><p><strong>Results: </strong>Searches identified 23 853 unique studies of which 30 met the inclusion criteria. Few studies had a focus on the interprofessional communication of poor prognosis. Information about prognosis was not commonly communicated from secondary to primary care and was more likely to occur if death was imminent. Lack of identification of poor prognosis by secondary care teams was a barrier. Facilitators included shared electronic records and direct clinician-clinician contact. GPs welcomed this information from secondary care and felt it was vital for continuity of care.</p><p><strong>Conclusion: </strong>Although the communication of poor prognosis from secondary to primary care is highly valued it is rare and associated with cultural and systemic challenges. Further research is necessary to understand the information needs of GPs and to explore the challenges facing secondary care clinicians initiating this communication.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141163103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges to quality in contemporary, hybrid general practice: a multi-site longitudinal case study.","authors":"Rebecca Payne, Francesca Dakin, Ellen MacIver, Nadia Swann, Tabitha Pring, Aileen Clarke, Asli Kalin, Lucy Moore, Emma Ladds, Joseph Wherton, Sarah Rybczynska-Bunt, Laiba Husain, Nina Hemmings, Sietse Wieringa, Trisha Greenhalgh","doi":"10.3399/BJGP.2024.0184","DOIUrl":"10.3399/BJGP.2024.0184","url":null,"abstract":"<p><strong>Background: </strong>Since 2022, general practice has shifted from responding to the acute challenges of COVID-19 to restoring full services using a hybrid of remote, digital, and in-person care.</p><p><strong>Aim: </strong>To examine how quality domains are addressed in contemporary UK general practice.</p><p><strong>Design and setting: </strong>Multi-site, mostly qualitative longitudinal case study, placed in UK national policy context.</p><p><strong>Method: </strong>Data were collected from longitudinal ethnographic case studies of 12 general practices (2021-2023), multi-stakeholder workshops, stakeholder interviews, patient surveys, official reports, and publicly accessible patient experience data. Data were coded thematically and analysed using multiple theories of quality.</p><p><strong>Results: </strong>Quality efforts in UK general practice occur in the context of cumulative impacts of financial austerity, loss of resilience, increasingly complex patterns of illness and need, a diverse and fragmented workforce, material and digital infrastructure that is unfit for purpose, and physically distant and asynchronous ways of working. Providing the human elements of traditional general practice (such as relationship-based care, compassion, and support) is difficult and sometimes even impossible. Systems designed to increase efficiency have introduced new forms of inefficiency and have compromised other quality domains such as accessibility, patient-centredness, and equity. Long-term condition management varies in quality. Measures to mitigate digital exclusion (such as digital navigators) are welcome but do not compensate for extremes of structural disadvantage. Many staff are stressed and demoralised.</p><p><strong>Conclusion: </strong>Contemporary hybrid general practice features changes (digitalisation, physical distancing, extension of roles, and protocolisation) that have had the unintended effect of dehumanising, compromising, and fragmenting care. Policymakers and practices should urgently address the risks to patients and the traditional core values of general practice should be urgently addressed.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The social determinants of distress in South Asian men with long-term conditions: a qualitative study.","authors":"Hassan Awan, Nadia Corp, Tom Kingstone, Carolyn A Chew-Graham","doi":"10.3399/BJGP.2024.0386","DOIUrl":"https://doi.org/10.3399/BJGP.2024.0386","url":null,"abstract":"<p><strong>Background: </strong>People with long-term physical conditions are more likely to experience distress, depression or anxiety. Physical-mental comorbidity is associated with lower quality of life, poorer clinical outcomes, and increased mortality than physical conditions alone. South Asians (SAs) are the largest minority group in the UK, and more likely to have long-term conditions (LTCs) such as diabetes and heart disease.</p><p><strong>Aim: </strong>To explore how men of SA origin with LTCs understand and experience emotional distress as well as the experiences of GPs supporting them.</p><p><strong>Design and setting: </strong>UK qualitative study interviewing SA men with diabetes or coronary heart disease, and GPs working at practices with higher proportions of SAs.</p><p><strong>Method: </strong>Online semi-structured interviews with SA men and GPs. Data were analysed via reflexive thematic analysis. Topic guides were modified iteratively as data collection and analysis progressed. An ethnically appropriate patient advisory group of SA men was involved in all stages of the research.</p><p><strong>Results: </strong>Seventeen SA men with LTCs and 18 GPs were interviewed. Participants described contextualising distress including the interaction between having a LTC and distress, and the intersections of social determinants of distress including ethnicity, poverty and perceptions of prejudice. Participants understood distress as different to depression with the need to negotiate multiple identities as well as alternative paradigms of health.</p><p><strong>Conclusion: </strong>This study highlights the influence of social determinants of distress in SA men with LTCs. It provides an insight into how primary care has the potential to address health inequalities by considering the intersection of these factors.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633295","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":"Barriers to diagnosing and treating vulval lichen sclerosus: a survey study.","authors":"Arabella Crew, Rheanne Leatherland, Louise Clarke, Caroline Owen, Rosalind Simpson","doi":"10.3399/BJGP.2024.0360","DOIUrl":"https://doi.org/10.3399/BJGP.2024.0360","url":null,"abstract":"<p><p>Background  Vulval lichen sclerosus (VLS) is a chronic inflammatory condition that is frequently misdiagnosed and under-recognised. To date, qualitative research focuses on lived experience of VLS, with women attributing diagnostic delay to poor interactions with health care professionals (HCPs) often due to lack of knowledge. In the UK, women with VLS are most likely to present to primary care.  Aim  To establish HCPs perspectives on identification, management and education of vulval skin disease, with a focus on VLS.  Design and Setting  A survey was distributed to HCPs working in primary care.  Method The survey was distributed via professional networks and at events. Analysis comprised of descriptive statistics, Spearman's rank correlations, and thematic analysis.  Results   Of 122 respondents, 53 were General Practitioners (GPs) and 59 were GP trainees. 37.7% of respondents had never participated in teaching nor learning on vulval skin disease. Confidence in the identification of vulval skin disease positively correlated with experience, exposure and female gender. The top identified barriers to diagnosis and treatment included lack of knowledge, embarrassment, and absence of VLS diagnostic criteria. Almost all participants (97.5%) felt VLS diagnostic criteria would be helpful in clinical practice.  Conclusion   This study provides insight into the barriers to diagnosing and treating VLS in primary care. HCPs recognise deficiencies in training, referral pathways and lack of tools to support VLS diagnosis. Training should include skills to address stigma and embarrassment. This study highlights the importance of developing interventions to overcome barriers, expediting diagnosis and treatment, such as reproducible diagnostic criteria.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633293","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":"Paramedic or GP consultations in primary care: prospective study comparing costs and outcomes.","authors":"William Hollingworth, Nouf S Gadah-Jeynes, Hazel Taylor, Kirsty Garfield, Sarah Voss, Matthew Booker","doi":"10.3399/BJGP.2024.0469","DOIUrl":"https://doi.org/10.3399/BJGP.2024.0469","url":null,"abstract":"<p><strong>Background: </strong>General Practice faces pressures due to increased demand and a shortage of GPs. Paramedics in General Practice (PGPs), increasingly contribute to managing minor illnesses, conducting home visits, and providing urgent consultations.</p><p><strong>Aim: </strong>Explore the impact of paramedic-consultations on patient-reported experience, safe management and NHS costs.</p><p><strong>Design & setting: </strong>Prospective cohort study comparing PGP with GP consultations at 34 GP sites in England.</p><p><strong>Methods: </strong>Eligible participants had a consultation with a PGP (25 PGP sites) or GP (9 non-PGP sites) between May 2022 and February 2023. Questionnaires were provided after the initial consultation and 30 days later. Questionnaires assessed patient experience, outcomes and perceived safety (PCOQ and PREOS-PC), quality of life (EQ-5D-5L) and health care use.</p><p><strong>Results: </strong>Of 715 participants recruited, 489 completed the 30-day questionnaire. We found no evidence that PGP-consultations resulted in greater improvement/deterioration in patient-reported health and wellbeing; confidence in health provision; health knowledge; or confidence in the health plan over the 30-day period. However, the PGP group reported lower confidence in health provision, poorer perceptions of practice engagement in safety promotion and more communication problems with staff immediately after the initial consultation. Patients receiving PGP-consultations reported fewer GP appointments during the 30-day period, however savings to the NHS were offset by higher use of other healthcare professionals.</p><p><strong>Conclusion: </strong>Well-designed training and supervision are needed to ensure PGPs have the right knowledge and can clearly convey health care plans to patients. While PGPs may reduce GP workload pressure, they do not necessarily reduce NHS costs.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633294","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":"Cardiovascular disease - risk assessment and reduction: NICE 2023 update for GPs.","authors":"Emily Williams, Thomas Round, Nicholas R Jones","doi":"10.3399/bjgp24X739905","DOIUrl":"10.3399/bjgp24X739905","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"74 748","pages":"523-526"},"PeriodicalIF":5.3,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11526735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}