Antimicrobial stewardship & healthcare epidemiology : ASHE最新文献

{"title":"Enhancing antimicrobial stewardship through IT-enabled audits: a quasi-experimental study in urology.","authors":"Kartik Bhagat, Kavita Diddi, Adel Alsisi, Mohammed Zaqout, Shyam Mohan, Shanmugavalli Ganesan, Jithin Antony, Touseef Sulaimani","doi":"10.1017/ash.2025.10212","DOIUrl":"10.1017/ash.2025.10212","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial stewardship programs (ASPs) are critical for optimizing antibiotic use and addressing antimicrobial resistance (AMR). Urinary tract infections (UTIs) frequently require antibiotics, yet inappropriate prescribing remains high.</p><p><strong>Objective: </strong>To assess how a structured audit process, supported by information technology (IT), influences antibiotic prescribing practices for UTIs in the Urology Department at Prime Hospital.</p><p><strong>Design: </strong>A 12-month quasi-experimental study was conducted in two phases: preintervention and intervention. A customized module in the electronic medical record (EMR) system monitored UTI prescriptions. Alerts for restricted antibiotics were reviewed daily by the antimicrobial stewardship (AMS) team, with immediate feedback to prescribers. The audit emphasized adherence to empirical guidelines, reducing fluoroquinolone use, promoting Access group antibiotics, and minimizing restricted agents.</p><p><strong>Patients: </strong>All adult UTI patients in the Urology Department were included; pediatric patients under 12 and pregnant women were excluded.</p><p><strong>Results: </strong>The intervention improved guideline adherence increased the use of Access group antibiotics and reduced restricted antibiotic prescriptions by approximately 50%. Daily multidisciplinary feedback reinforced rational prescribing; however, sustaining long-term behavioral change remained challenging.</p><p><strong>Conclusion: </strong>Despite growing awareness of AMR, inappropriate antibiotic use persists. IT-enabled audits, combined with multidisciplinary collaboration, effectively enhance guideline adherence, promote rational antibiotic use, and improve patient care outcomes in hospital-based UTI management.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"5 1","pages":"e342"},"PeriodicalIF":0.0,"publicationDate":"2026-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12766517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913924","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":"Clinical outcomes of carbapenem vs. non-carbapenem therapy in hospitalized adults with shigellosis.","authors":"Zach Zhang, Gregory B Tallman, Brian Kendall, Emily Fox","doi":"10.1017/ash.2026.10820","DOIUrl":"10.1017/ash.2026.10820","url":null,"abstract":"<p><strong>Background: </strong>Management of shigellosis is increasingly complicated by antimicrobial resistance, yet susceptibility testing is rarely performed, and the role of broad-spectrum empiric therapy in hospitalized adults remains unclear.</p><p><strong>Methods: </strong>We conducted a multi-center retrospective cohort study of adults hospitalized with stool-confirmed <i>Shigella</i> spp. from October 2023 to August 2024 across five hospitals in the Portland metropolitan area. The primary outcome was time from antibiotic initiation to symptom resolution (less than 3 stools in 24 h) and the secondary outcome was length of hospital stay.</p><p><strong>Results: </strong>Of 45 patients included in the outcome analyses, 29 (64%) received carbapenems and 16 (36%) received non-carbapenem antibiotics. Median time from antibiotic initiation to symptom resolution was 18 hours (IQR 9-37) in the carbapenem group and 29 hours (IQR 15-36) in the non-carbapenem group, with no significant difference between groups (<i>P</i> = .89). The median length of hospital stay was significantly longer in the carbapenem group, at 5.4 days (IQR 3.6-8.3), compared with 3.9 days (IQR 2.6-4.4) in the non-carbapenem group (<i>P</i> = .02). Only 26% of patients had susceptibility testing ordered.</p><p><strong>Conclusions: </strong>Carbapenem use was not associated with faster symptom resolution and was associated with significantly longer hospitalization. Susceptibility testing was underutilized and may be essential to guide local empiric and targeted therapy decisions.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e238"},"PeriodicalIF":0.0,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714840","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":"Point-of-care routine laboratory testing for patients with suspected viral hemorrhagic fevers.","authors":"Anne Liston Sullivan, Jessica L Jacobson, Priya Dhagat, Madeline DiLorenzo, Florence Douyon, Jamie Figueredo, Matthew Harris, Dana Mazo, Jeffrey Pacheco, Gregory Weston, Justin Chan","doi":"10.1017/ash.2026.10817","DOIUrl":"10.1017/ash.2026.10817","url":null,"abstract":"<p><p>When a suspected viral hemorrhagic fever (VHF) case presents to a healthcare facility, healthcare personnel must be able to safely provide initial stabilizing care, which may involve performing basic routine laboratory testing. Current gaps exist in the ability of frontline acute care hospitals to safely perform routine laboratory tests on patients with suspected VHFs that generate category A waste. This review outlines a potential solution for frontline acute care hospitals to perform electrolytes, hemoglobin/hematocrit, and malaria testing, in accordance with National Special Pathogens System guidelines, in the patient's isolation room. We discuss guidance on laboratory risk assessment, equipment considerations, space requirements, staffing solutions, waste management, cost estimates, and remaining challenges. Our manuscript provides frontline acute care hospitals with a potential solution to safely provide a minimum set of routine laboratory tests for patients with suspected VHF.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e237"},"PeriodicalIF":0.0,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13445462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686741","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":"Factors and outcomes of pediatric sepsis under an antimicrobial stewardship program in a tertiary care teaching hospital in Thailand: a retrospective cohort study.","authors":"Theerapong Seesin, Suvaporn Anugulruengkitt, Chankit Puttilerpong","doi":"10.1017/ash.2026.10811","DOIUrl":"10.1017/ash.2026.10811","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the factors associated with mortality and the outcomes of an antimicrobial stewardship program (ASP) in pediatric patients with sepsis.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>A tertiary care teaching hospital in Thailand.</p><p><strong>Patients: </strong>Pediatric patients with sepsis.</p><p><strong>Methods: </strong>This study reviewed electronic medical records of pediatric patients. A computer-generated random sequence was used to select 240 patients who met the inclusion criteria for the analysis.</p><p><strong>Results: </strong>Between January 1, 2021, and December 31, 2024, a total of 1,777 patients were enrolled in the ASP. Of 240 eligible patients, males accounted for 56.7% of the cohort, with a median age of 1.0 year (interquartile range 0-6). Positive blood cultures were identified in 72 patients (30.0%). ASP interventions identified antibiotic-related problems in 93 patients (38.8%), with primary physicians adhering to ASP recommendations in 55 cases (59.1%). Septic shock was the only factor significantly associated with 30-day mortality (adjusted odds ratio 4.064; 95% confident interval: CI 1.265-13.061; <i>P</i> = .019). Mortality rates were not different between groups regarding ASP compliance or blood culture results. The day of therapy/1,000 PD for vancomycin and meropenem were significantly lower in the compliance group compared to the non-compliance group (81.9 vs 135.4, <i>P</i> = .026; and 169.9 vs 260.3, <i>P</i> = .012, respectively).</p><p><strong>Conclusions: </strong>Septic shock was the only factor associated with 30-day mortality. ASP help detected antibiotic-related problems and reduced meropenem and vancomycin consumption in pediatric patients with sepsis.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e235"},"PeriodicalIF":0.0,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681406","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":"Clinical outcomes and treatment effectiveness in patients with carbapenem-resistant Enterobacterales infections: a multicenter retrospective cohort study.","authors":"Abdullah Awadh, Awadh Alhawiti, Abdulmajeed Alshehri, Mohammad Alhazmi, Ahmed Meny, Omar Arzoun","doi":"10.1017/ash.2026.10814","DOIUrl":"10.1017/ash.2026.10814","url":null,"abstract":"<p><strong>Background: </strong>Carbapenem-resistant Enterobacterales (CRE) infections carry high mortality and limited treatment options. We evaluated outcomes among adults with CRE infections at Ministry of National Guard-Health Affairs facilities in Saudi Arabia, comparing monotherapy with combination therapy.</p><p><strong>Methods: </strong>This multicenter retrospective cohort study included adults (≥18 years) with CRE infections during 2020-2024 at King Abdulaziz Medical City (Jeddah and Riyadh). CRE was defined phenotypically per CLSI criteria (first isolate per patient). Bivariate analyses, multivariate logistic regression, and Kaplan-Meier survival analysis compared monotherapy and combination therapy.</p><p><strong>Results: </strong>Among 224 patients (median age 70 years; 62.5% male), overall mortality was 43.3%, and Klebsiella pneumoniae accounted for 96.0% of isolates. Combination therapy was associated with higher mortality than monotherapy (44.5% vs. 26.7%; <i>P</i> = .047) and remained independently associated with mortality after adjustment for age, gender, and comorbidities (adjusted OR = 2.28, 95% CI: 1.08-4.83; <i>P</i> = .032). A significant treatment-mortality difference was seen in patients without solid tumors (<i>P</i> = .031) but not in those with solid tumors (<i>P</i> = 1.000). Respiratory and blood infections carried the highest mortality (58.3% and 55.3%).</p><p><strong>Conclusions: </strong>CRE infections carry a high mortality burden among adults in Saudi Arabia. The higher mortality with combination therapy may, in part, reflect confounding by indication, with broader-spectrum regimens prescribed for sicker patients whose severity was not captured. Prospective studies with disease-severity scoring and individualized treatment are needed, particularly for immunocompromised patients.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e236"},"PeriodicalIF":0.0,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681356","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":"Systematic review of implementing stewardship activities to promote appropriate antimicrobial use.","authors":"Virginia McKay, Emmanuel Tetteh, Kelly Bono, Collin McGovern, Mathew Sattler, Luke Zabotka, Lauren Yaeger, Harry Obeng, Joshua M Perez-Cruet, Evan Facer, Jason G Newland, Sara Malone","doi":"10.1017/ash.2026.10769","DOIUrl":"10.1017/ash.2026.10769","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review aims to describe the impact of specific antimicrobial stewardship program (ASP) strategies on implementation and stewardship-related outcomes.</p><p><strong>Design: </strong>Systematic literature review.</p><p><strong>Methods: </strong>We systematically searched multiple databases using search terms that focused on stewardship and implementation. An original search was completed on October 29, 2021, and then updated on February 26, 2025. Studies were eligible for inclusion if they were in English, reported an antimicrobial resource outcome, and using either a comparison group or a pre/post design as a minimum level of rigor. Data from articles were extracted to understand the context and design of the evaluation, the types of approaches used, and outcomes assessed.</p><p><strong>Results: </strong>Out of 2035 studies that were identified, we included 250 full-text peer-reviewed manuscripts. Of the 250 studies included, 52% were conducted in the USA. The majority (80%) of studies were conducted in inpatient settings, particularly in adult academic hospitals (29%). Programs were often implemented hospital-wide or across multiple specialties, with a focus on emergency medicine and intensive care units. Education or learning (64% of studies) and handshake stewardship (56% of studies) were by far the most common ASP strategies used. Mortality (36% of studies) and drug choice (57% of studies) were the most tracked patient and resource outcomes, respectively.</p><p><strong>Conclusions: </strong>Our review highlights the variability in approaches as part of ASPs, indicating a need for a more systematic understanding of how different approaches are implemented and their subsequent impact on antimicrobial use.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e233"},"PeriodicalIF":0.0,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13435156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674510","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":"Effectiveness of chlorine for the control of carbapenem-resistant gram-negative bacilli in the drainage network of a high-complexity healthcare facility.","authors":"Daniela Santonato, Ivana Martinelli, Roxana Sadorin, Alejandra Quevedo, Verónica Peuchot, Leonardo Fabbro, Andrea Novau, María Lucía Santos, María de Los Ángeles Cuello Mena, Wanda Cornistein","doi":"10.1017/ash.2026.10819","DOIUrl":"10.1017/ash.2026.10819","url":null,"abstract":"<p><p>We evaluated sodium hypochlorite (55,000 ppm) for controlling carbapenem-resistant gram-negative bacilli (CR-GNB) in nursing station handwash basin drains at a high-complexity hospital. Monthly pours variably reduced drain contamination; a synergistic effect with syphon interventions was observed, but sustained CR-GNB eradication was not achieved.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e234"},"PeriodicalIF":0.0,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681350","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":"Increased cost of care and length of stay due to potentially preventable catheter-related infections in US inpatient data, 2022-2023.","authors":"Laura Soloway, Tarja Kärpänen, Aaron Guy","doi":"10.1017/ash.2026.10801","DOIUrl":"10.1017/ash.2026.10801","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluated differences in total cost of care (TCC) and length of stay (LOS) among patients with potentially preventable catheter-related infections (PPCRIs).</p><p><strong>Methods: </strong>A retrospective cohort analysis was conducted using the Premier Healthcare Database for calendar years 2022 and 2023. PPCRI cases and at-risk non-PPCRI cases were identified using the Solventum Potentially Preventable Complications (PPC) v38 grouper methodology, which identifies complications occurring during inpatient stays while applying clinical exclusions to avoid capturing progression of preexisting conditions. Each PPCRI case was matched to an at-risk non-PPCRI case based on age, race, sex, diagnosis-related group, and severity of illness.</p><p><strong>Results: </strong>PPCRI cases experienced significantly higher TCC and LOS in both study years. Mean TCC for PPCRI cases was approximately $162,000 in 2022 and $187,000 in 2023, compared with $44,000 and $40,000 for non-PPCRI cases, respectively (<i>P</i> < .0001). Average excess LOS was 38 days in 2022 and 44 days in 2023 for PPCRI cases, versus 6 and 5 days for non-PPCRI cases (<i>P</i> < .0001). LOS exceeded expected values in 97% of PPCRI cases compared with 63% of non-PPCRI cases in both years. Mortality was significantly higher among PPCRI cases (17% vs 6% in 2022; 12% vs 2% in 2023; <i>P</i> < .0001). Discharge to home occurred more frequently in non-PPCRI cases (48% vs 21% in 2022; 52% vs 23% in 2023; <i>P</i> < .0001).</p><p><strong>Conclusions: </strong>PPCRIs are associated with substantial excess LOS, which drives markedly higher TCC. Targeted prevention of PPCRIs could yield savings of approximately $100,000 per case.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e232"},"PeriodicalIF":0.0,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13435149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674540","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":"Impact of hemo-alert program on appropriate antimicrobial therapy in hospitalized patients with bacteremia: a quasi-experimental study.","authors":"Siwakan Phuetphaichit, Surangkana Samanloh, Witchuda Kamolvit, Pinyo Rattanaumpawan","doi":"10.1017/ash.2026.10757","DOIUrl":"10.1017/ash.2026.10757","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the impact of the HemoAlert program-a notification system providing pathogen identification and antimicrobial susceptibility results-on the time to initiation of appropriate antimicrobial therapy in patients with bacteremia.</p><p><strong>Design: </strong>Pre-post-quasi-experimental study.</p><p><strong>Setting: </strong>Siriraj Hospital, the largest tertiary care hospital in Bangkok, Thailand.</p><p><strong>Patients: </strong>Adult hospitalized patients with at least one positive blood culture between December 2021-February 2022.</p><p><strong>Methods: </strong>A quasi-experimental study was conducted to assess the impact of the HemoAlert program, which delivered SMS notifications of final microbiology results to the responsible physician and updated the patient's medical record. The primary outcome was the time to appropriate antimicrobial therapy. Secondary outcomes included appropriateness of antimicrobial therapy at 72 and 120 hours, favorable clinical outcome, 28-day mortality, and length of hospital stay.</p><p><strong>Results: </strong>A total of 150 patients were included in both periods. Demographics and pathogen distribution were similar between groups. The most common pathogens were <i>Escherichia coli, followed by Klebsiella pneumoniae</i>, and <i>Staphylococcus aureus.</i> The postimplementation group also showed a trend toward a shorter time to appropriate antimicrobial therapy (81.38 ± 61.38 vs 66.17 ± 51.81 h; <i>P</i> = .08). Patients in the postimplementation group were more likely to receive appropriate therapy within the first 72 hours (34.0% vs 22.7%; <i>P</i> = .03). Favorable clinical response was more frequent after implementation (74.0% vs 85.3%; <i>P = .02</i>), whereas 28-day mortality was similar (24.0% vs 18.0%; <i>P = .20</i>).</p><p><strong>Conclusion: </strong>The HemoAlert program improved the timeliness and appropriateness of antimicrobial therapy and enhanced clinical response in patients with bacteremia, supporting the utility of simple notification systems in optimizing management.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e220"},"PeriodicalIF":0.0,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13419442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632922","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":"Erratum: Implementation of the Early-Onset Sepsis Calculator in a Tertiary Care NICU - CORRIGENDUM.","authors":"Walid Hussain, Deborah Bondi, Pooja Shah, Elzbieta Kalata, Kelli Skvarenina, Simon Parzen-Johnson","doi":"10.1017/ash.2026.10764","DOIUrl":"10.1017/ash.2026.10764","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1017/ash.2026.10363.].</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e226"},"PeriodicalIF":0.0,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13419417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632948","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}