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":"Community-onset symptomatic urinary tract infections (SUTI) caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales: independent predictors and comparative effectiveness of oral agents.","authors":"Shani Zilberman-Itskovich, Majdi Masarwi, Eyal Levy, Moti Iflah, Inbar Levi Steinweg, Nikita Yapryntsev, Shani Mednyk, Roni Gur-Lavy, Samir Alfahel, Keren Amity, Avi Itzhaki, Dror Marchaim","doi":"10.1017/ash.2025.10267","DOIUrl":"10.1017/ash.2025.10267","url":null,"abstract":"<p><strong>Background: </strong>The incidence of community-onset (CO) symptomatic urinary tract infection (SUTI) caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales is increasing worldwide. Our study aims were to explore the independent predictors for CO-ESBL SUTI and to compare the effectiveness of several oral therapeutics, which are used for this indication in community health settings.</p><p><strong>Methods: </strong>Retrospective matched case-case-control and case-case studies, among insurers of Maccabi health maintenance organization, Shfella district, Israel (10-11/2019). Patients with CO-ESBL (<i>Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis</i>) SUTI were matched to patients with CO-non-ESBL SUTI and to uninfected controls (1:1:1). Matched analyses (logistic regressions) were used to model predictors for CO-ESBL SUTI. A composite parameter for worse SUTI outcomes was compared among patients who were managed with a single, supposedly effective (ie, in vitro), oral agent.</p><p><strong>Results: </strong>The study consisted of 1,455 patients (ie, three matched groups of 485 patients). The independent predictors for CO-ESBL SUTI were certain recent exposures: (1) hospitalization (3 months), (2) past carriage of multidrug-resistant organisms (2 years), (3) exposure to any antimicrobial (3 months), and (4) prior SUTI (6 months). Among 331 patients with CO-ESBL SUTI, resistance rates were lowest for fosfomycin (4.9%), while outcomes were worst for patients managed with oral amoxicillin-clavulanate.</p><p><strong>Conclusions: </strong>CO-ESBL SUTI independent predictors in this community region were recent hospitalization, known MDRO carriage, exposure to antimicrobials and prior SUTI. Amoxicillin-clavulanate should be avoided, even for ESBL susceptible isolates.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e15"},"PeriodicalIF":0.0,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12780795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145954060","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":"Reducing empiric piperacillin-tazobactam use for patients with community-acquired intra-abdominal infections.","authors":"Claire Wilson, Kevin Epps, Courney Willis, Julio Mendez, Joseph Kim, Jesse St Clair, J Colt Cowdell","doi":"10.1017/ash.2026.10391","DOIUrl":"https://doi.org/10.1017/ash.2026.10391","url":null,"abstract":"<p><strong>Objectives: </strong>Community-acquired intra-abdominal infections (CA-IAIs) are a leading cause of US hospitalizations. Piperacillin-tazobactam is often used to empirically treat CA-IAIs, despite national guidelines recommending narrower-spectrum antibiotics for these infections. The overuse of broad-spectrum agents such as piperacillin-tazobactam contributes to antibiotic resistance, which poses serious public health challenges. This resident-led quality improvement initiative aimed to reduce unnecessary piperacillin-tazobactam use for treating CA-IAIs measured as DOT/1,000 patient-days by 10% without adversely affecting hospital length of stay (LOS).</p><p><strong>Methods: </strong>Using the DMAIC (define, measure, analyze, improve, control) framework, we identified barriers to appropriate antibiotic use and developed a treatment algorithm for CA-IAIs that included clear guidelines and exclusion criteria. This algorithm was disseminated to internal medicine residents and emergency department physicians along with educational sessions to highlight updated CA-IAI treatment recommendations, antibiotic resistance, and appropriate antibiotic ordering via the electronic health record. Antimicrobial stewardship pharmacists provided overnight support to assist with de-escalation. Data were collected over a 10-month period spanning 2 intervention phases. The primary outcome was piperacillin-tazobactam use, measured as days of therapy (DOT) per 1,000 patient-days and DOT per patient LOS. Mean LOS served as the balancing measure.</p><p><strong>Results: </strong>Piperacillin-tazobactam use was significantly reduced (<i>P</i> < .001) after the interventions without increasing the mean LOS.</p><p><strong>Conclusion: </strong>This project raised awareness of antibiotic resistance and led to lasting improvements in reducing the inappropriate use of piperacillin-tazobactam to treat CA-IAIs, without affecting the mean LOS. This was attributed to the strong collaboration among a multidisciplinary team of infectious disease physicians, antimicrobial stewardship team members, residents, emergency department physicians, and faculty.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e122"},"PeriodicalIF":0.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13126204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824113","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":"Outcomes in skilled nursing facilities versus other locations in outpatient parenteral antimicrobial therapy among patients with substance use disorders.","authors":"Armani M Hawes, Lisa R Yanek, Megan E Buresh, Rawan Abdel-Galil, Alia Bodnar, Oluwaseun O Falade-Nwulia, Sara Condron Keller","doi":"10.1017/ash.2026.10364","DOIUrl":"https://doi.org/10.1017/ash.2026.10364","url":null,"abstract":"<p><strong>Objective: </strong>People with substance use disorder (SUD) make up an increasing proportion of patients hospitalized for infections that require outpatient parenteral antimicrobial therapy (OPAT). In many settings, patients with SUD may be unable to receive home-based OPAT, and so stay in the hospital or get discharged to skilled nursing facilities (SNF) for ongoing treatment. Our objective was to compare outcomes, especially engagement in SUD treatment, among patients with SUD who received OPAT in SNF versus other settings.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Two academic medical centers.</p><p><strong>Patients: </strong>Patients with a history of SUD and discharged on OPAT.</p><p><strong>Methods: </strong>We used a multivariate logistic regression to determine predictors of outcomes among patients discharged to SNF versus other locations.</p><p><strong>Results: </strong>Among 350 patients with SUD discharged on OPAT, 285 (81.4%) were discharged to SNF. Hospital readmissions, emergency department visits, infection relapse, catheter complications, and adverse drug events related to OPAT were similar in the two groups. Median length of stay was longer in patients discharged to SNF (16 d vs 12 d, P = .001). Being discharged to a SNF was associated with a lower likelihood of engaging in SUD treatment at 30 days postdischarge (adjusted odds ratio: 0.48, 95% confidence interval: 0.26-0.87).</p><p><strong>Conclusions: </strong>Patients with SUD requiring OPAT discharged to SNF may have decreased engagement in SUD treatment.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e121"},"PeriodicalIF":0.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13126205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824167","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":"Real-world impact of point-of-care testing for SARS-CoV-2 in an ambulatory setting of an integrated health network.","authors":"Robert J Williams, Li Dong, Josh Van Otterloo, Nancy Grisel, Payal Patel, Bert K Lopansri","doi":"10.1017/ash.2026.10362","DOIUrl":"https://doi.org/10.1017/ash.2026.10362","url":null,"abstract":"<p><strong>Objective: </strong>Point-of-care testing (POC) is an important tool for diagnosing SARS-CoV-2. This objective of this study was to evaluate the real-world performance of rapid molecular (rPCR) and rapid antigen (rAg) methods and their impact on antibiotic prescribing.</p><p><strong>Methods: </strong>We retrospectively analyzed adult patients tested for SARS-CoV-2 at outpatient clinics within an integrated health network from December 2021 to March 2023 to determine antibiotic use in settings where POC testing for SARS-CoV-2 were deployed. Patients were included if their initial test was with rPCR or rAg. We conducted a 3:1 propensity score matching analysis to compare rPCR and rAg testing outcomes. Univariate and multivariate logistic regression analyses were used to identify predictors of antibiotic use within 24 hours of a positive test.</p><p><strong>Results: </strong>Of 104,364 patients that underwent testing with a rapid test in the ambulatory setting, 24,133 (29.0%) tested positive for SARS-CoV-2. Molecular testing had the highest percent positive compared to antigen testing (26.2% vs 20.8%). Overall, antibiotics were prescribed to 10% of positive cases, with higher rates following rAg testing (13% vs 10%, P < .001). Chronic lung disease (OR: 1.4 [1.2-1.7], P < .001) and white non-Hispanic race (OR: 1.5 [1.1-2.1], P = .014) were associated with an increased odds of receiving antibiotics while a rPCR test (OR: 0.8 [0.7-1.0], P = .03) was associated with a significantly decreased odds or receiving antibiotics.</p><p><strong>Conclusions: </strong>POC molecular testing outperformed antigen testing in SARS-CoV-2 detection and was associated with lower antibiotic prescribing, supporting its role in antimicrobial stewardship.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e120"},"PeriodicalIF":0.0,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13126208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824136","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":"The impact of tele-stewardship on rural and suburban pediatric ambulatory antibiotic prescribing.","authors":"Matthew James Peworchik, Ritu Banerjee, Henry Domenico, Sophie E Katz","doi":"10.1017/ash.2026.10353","DOIUrl":"https://doi.org/10.1017/ash.2026.10353","url":null,"abstract":"<p><strong>Objective: </strong>Developing, implementing, and evaluating the effectiveness of outpatient pediatric antimicrobial stewardship interventions via tele-stewardship.</p><p><strong>Design: </strong>Baseline data collected between January and December 2022. Intervention data collected from February 2023 to December 2024. Interrupted time series with regression discontinuity analysis used to compare rates of antibiotic prescription between the periods.</p><p><strong>Setting: </strong>Three pediatric primary care clinics and three emergency departments associated with Vanderbilt University Medical Center that served rural and suburban communities.</p><p><strong>Participants: </strong>All encounters with patients less than 18 years of age at participating sites.</p><p><strong>Interventions: </strong>Intervention bundle included patient/caregiver educational materials, antibiotic use commitment posters, prescriber education through quarterly teaching sessions on common pediatric infections, communication skills training, app-based microlearning modules, access to local guidelines using the Firstline app, and quarterly audit and feedback with peer comparison on guideline-concordant antibiotic use.</p><p><strong>Results: </strong>Among a total of 147,357 encounters (43,157 baseline, 100,200 intervention), overall percent of encounters with one or more antibiotics prescribed decreased from 12.4% to 11.9% (<i>P</i> = .01). Percent change varied by site and patient demographics. Overall guideline-concordant prescribing increased significantly for acute otitis media (77.7% baseline vs 85.7% intervention, <i>P</i> < .001), streptococcal pharyngitis (73.8% baseline vs 81.7% intervention, <i>P</i> < .001), and urinary tract infections (41.9% baseline vs 57.1% intervention <i>P</i> < .001). Five-day antibiotic courses increased significantly (6.3% baseline vs 19.7% intervention, <i>P</i> < .001). There was a significant decrease in rapid streptococcal testing (10.9% baseline vs 7.6% intervention, <i>P</i> < .001).</p><p><strong>Conclusions and relevance: </strong>Tele-stewardship interventions were effective in outpatient pediatric primary care and emergency department settings, but effectiveness varied by site.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e119"},"PeriodicalIF":0.0,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13104536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790674","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":"Pneumococci detected in sterile body fluids of pediatric patients postpandemic trends from a single center.","authors":"Gülnihan Üstündağ, Eda Karadağ Öncel, Aslıhan Şahin, Ayşegül Elvan Tüz, Yıldız Ekemen Keleş, Selin Taşar Karabulut, Nesli Ağralı Eröz, Güliz Doğan, Dilek Yılmaz, Nisel Yılmaz, Gülşen Hasçelik, Mehmet Ceyhan","doi":"10.1017/ash.2026.10314","DOIUrl":"https://doi.org/10.1017/ash.2026.10314","url":null,"abstract":"<p><p>This study assessed pediatric invasive pneumococcal disease (IPD) post-COVID-19. No cases appeared in the first two pandemic years, but 12 were diagnosed after 2022. Identified serotypes included 3, 6B, 19, and untypeable G. Despite PCV13, infections persist, especially serotype 3, notable for its robust capsule.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e118"},"PeriodicalIF":0.0,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13104523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790581","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":"A pseudo-outbreak of <i>Yersinia enterocolitica</i> in sputum cultures among 4 hospitalized pneumonia patients in Allegheny County, Pennsylvania, 2024.","authors":"Nottasorn Plipat, Jennifer Fiddner, Shannon McGinnis, Mabel Kamweli Aworh, Sameh Boktor, Sameera Sayeed, Lisa Carp, Brian Graper, Louise K François Watkins","doi":"10.1017/ash.2026.10381","DOIUrl":"https://doi.org/10.1017/ash.2026.10381","url":null,"abstract":"","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e111"},"PeriodicalIF":0.0,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13104573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790697","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":"Qualitative assessment of antibiotic stewardship teams' efforts to perform prospective audit-and-feedback at hospital discharge.","authors":"DeShauna Dinese Jones, Emily E Chasco, Cody Poe, Daniel Livorsi","doi":"10.1017/ash.2026.10366","DOIUrl":"https://doi.org/10.1017/ash.2026.10366","url":null,"abstract":"<p><strong>Objective: </strong>How antibiotic stewardship programs can effectively reduce antibiotic overuse at hospital discharge is unclear. In this study, we assessed barriers and facilitators to performing prospective audit-and-feedback at this transition of care.</p><p><strong>Design: </strong>A qualitative study using semi-structured interviews.</p><p><strong>Setting: </strong>Ten acute-care hospitals participating in a stepped-wedge cluster-randomized trial, including three Veteran's Health Administration hospitals, two academic medical centers and five community hospitals.</p><p><strong>Participants: </strong>Fourteen antimicrobial stewards in participating hospitals across the United States.</p><p><strong>Methods or interventions: </strong>A semi-structured interview guide was created applying the RE-AIM framework to focus on perceptions of implementing the intervention. All interviews were audio recorded, transcribed, and coded in a three-person team. Using thematic analysis, codes were developed and collapsed into themes.</p><p><strong>Results: </strong>Half of the intervention sites struggled to identify patients at discharge, limiting the stewardship teams' ability to conduct prospective audit-and-feedback at discharge. In contrast, strong provider-stewardship relationships and existing hospital initiatives, such as handshake stewardship and discharge planning meetings, facilitated implementation. Stewardship teams at four sites also reported not needing to guide antibiotic use for patients with Infectious Disease (ID) consults, as they agreed with the documented recommendations from the ID specialists.</p><p><strong>Conclusions: </strong>Our findings underscore the importance of accounting for the hospital and organizational context when implementing discharge-focused audit-and-feedback interventions, paying particular attention to existing policies, procedures, and the dynamics between antibiotic stewardship teams and front-line prescribers.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e113"},"PeriodicalIF":0.0,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13104581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790628","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":"Adhesion of antibiotic-resistant bacteria to patient-applied thermoplastic medical devices.","authors":"Catherine Brock, Dev Mehta, Terrence Ravine","doi":"10.1017/ash.2026.10367","DOIUrl":"https://doi.org/10.1017/ash.2026.10367","url":null,"abstract":"<p><p>Adhesion of antibiotic-resistant bacteria to medical device thermoplastics was evaluated by removal sampling at 1 and 24 hours. Vancomycin-resistant <i>Enterococcus faecalis</i> was removed in greater numbers than either methicillin-resistant <i>Staphylococcus aureus</i> or extended-spectrum beta-lactamase <i>Escherichia coli</i>, suggesting less adhesion and greater potential for transfer to patients wearing contaminated devices.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":"6 1","pages":"e114"},"PeriodicalIF":0.0,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13104538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790711","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}