British paramedic journal最新文献

{"title":"Advanced Paramedic Paralysis in ROSC (APPiR) study.","authors":"Nick Brown, Timothy Edwards, Lauren Hennessey, Daniel Ballard, Chrissie Hymers","doi":"10.29045/14784726.2026.9.11.2.36","DOIUrl":"10.29045/14784726.2026.9.11.2.36","url":null,"abstract":"<p><strong>Introduction: </strong>Some patients who have an out-of-hospital cardiac arrest (OHCA) achieve a return of spontaneous circulation (ROSC), but many will show no signs of awareness pre-hospital. For a subset of patients who begin to show signs of awareness and distress, advanced paramedic practitioners (APPs) in critical care can administer analgesia and sedation. Additionally, for patients who have already had an endotracheal tube (ETT) placed, APPs may administer a neuromuscular blockade (NMB) agent under a patient group direction (PGD) to paralyse respiratory muscles where there is poor tolerance to the ETT and ventilatory control is required.</p><p><strong>Methods: </strong>A retrospective cohort study with quantitative descriptive and inferential statistical analysis was conducted for all occasions where APPs within one ambulance service administered an NMB agent. The study period was one year, from 1 June 2024 to 31 May 2025. PGD compliance was assessed and data were collected that informed the circumstances in which NMB occurred. Furthermore, relevant patient vital signs were scrutinised for the 10-minute period before and after administration to establish possible physiological trends in oxygen saturations, end-tidal carbon dioxide, mean arterial pressure and heart rate.</p><p><strong>Results: </strong>APPs administered NMB to 99 patients. Of those, 85 (85.9%) patients were male and the mean age was 57.6 years. Most patients had a witnessed arrest and bystander CPR. Over half the group presented with a shockable rhythm. Median time to NMB was 71 minutes from OHCA, 40 minutes post ROSC and 28 minutes prior to the arrival at hospital. All APP endotracheal intubation occurred within two attempts. In all cases the PGD indication for NMB was met. There were no statistically significant adverse physiological trends identified in the oxygen saturations, end-tidal carbon dioxide, mean arterial pressure or heart rate.</p><p><strong>Conclusion: </strong>Despite the challenges involved in managing OHCA ROSC patients, APPs were able to administer NMB within PGD and without adversely affecting physiological measurements. Comparative pre-hospital systems may find this data useful to help inform their own critical care scope of practice.</p>","PeriodicalId":72470,"journal":{"name":"British paramedic journal","volume":"11 2","pages":"36-44"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876730","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":"Paramedics in general practice in Cornwall: what roles and what work do they undertake?","authors":"Sophy Savage","doi":"10.29045/14784726.2026.9.11.2.21","DOIUrl":"10.29045/14784726.2026.9.11.2.21","url":null,"abstract":"<p><strong>Introduction: </strong>General practice faces increasing pressure, especially in deprived rural areas (Laccobucci, 2019). The Additional Roles Reimbursement Scheme (ARRS) was introduced to employ extra health professionals, including paramedics, to support the delivery of general practice services. In Cornwall, over 60% of general practices employ paramedics, as identified in a preliminary search of general practice websites by the author. However, it was unclear what roles and tasks they undertook and how they were funded. This study's aim, the first to focus on a specific rural area in the UK, was to explore these questions.</p><p><strong>Method: </strong>Data from a cross-sectional online survey were collected between June and September 2024. Respondents were HCPC-registered paramedics employed in general practice in Cornwall. They were invited to complete the survey via the Cornwall Primary Care Training Hub. Quantitative data were analysed using descriptive statistics, while qualitative free-text responses were collated and examined for patterns.</p><p><strong>Results: </strong>Of the 62 invitees, 37 provided valid responses (60%). Fourteen (38%) were non-medical prescribers. Thirteen (35%) were ARRS funded, and 13 different job titles were used. All of them saw patients identified as urgent in a clinic or at home; four (11%) were employed specifically as part of a home visiting team and four (11%) as members of a multidisciplinary hub / same-day service.</p><p><strong>Conclusion: </strong>This was the first survey to investigate the roles and work of paramedics in general practice within a specific area of the UK. It highlighted training needs and raised questions about employment models, non-medical prescribing, funding and job titles. Addressing some of these questions would provide greater clarity and increase recognition of the paramedic role in general practice, while also potentially informing workforce planning.</p>","PeriodicalId":72470,"journal":{"name":"British paramedic journal","volume":"11 2","pages":"21-28"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876792","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 weight of the elephant(s): rethinking the tyranny of tradition in modern paramedic education.","authors":"James Brogan","doi":"10.29045/14784726.2026.9.11.2.2","DOIUrl":"10.29045/14784726.2026.9.11.2.2","url":null,"abstract":"","PeriodicalId":72470,"journal":{"name":"British paramedic journal","volume":"11 2","pages":"2-4"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876863","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":"In patients with cardiopulmonary resuscitation-induced consciousness in cardiac arrest in the pre-hospital setting, does the use of pharmacological interventions impact mortality compared to standard care? A systematic review.","authors":"Nora Prokop, Alan Rice, Mark Durham","doi":"10.29045/14784726.2026.9.11.2.29","DOIUrl":"10.29045/14784726.2026.9.11.2.29","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiopulmonary resuscitation-induced consciousness (CPRIC) is the term commonly used to refer to signs of life displayed by patients during resuscitation. This phenomenon presents a challenge, as these signs of life can interfere with resuscitative efforts. International resuscitation guidelines currently do not recommend a specific treatment strategy. This systematic review aimed to ascertain whether pharmacological management of adult cardiac arrest patients with CPRIC in the pre-hospital setting had an impact on mortality rates compared to standard care. The review also aimed to identify any association between use of specific pharmacological agents and mortality.</p><p><strong>Methods: </strong>Studies that reported on adult cardiac arrest patients presenting with CPRIC who received pharmacological management and were resuscitated in the pre-hospital setting were included. The literature search excluded studies that did not provide mortality data. The search was conducted using PubMED, CINAHL and Embase. A narrative synthesis approach was used to report the results.</p><p><strong>Results: </strong>Two studies were identified by the literature search. Both articles were Australian retrospective observational cohort studies that included a total of 39,569 patients, of which 164 presented with CPRIC. Patients with CPRIC were found to be more likely to survive than those without. Patients who were managed with medications had a lower survival rate than those who were not. Due to limited and heterogeneous data, a meta-analysis was not conducted.</p><p><strong>Conclusion: </strong>The evidence produced included a significant number of confounding factors, limiting both internal and external validity of this review. Overall, the confidence in the results is low and the findings cannot be generalised to clinical practice. This review did, however, highlight the need for further research on the pre-hospital management of CPRIC. This is especially emphasised by increases in mortality in those treated with midazolam and by the fact that the only available evidence pertains to midazolam, despite an increasing prevalence of other agents being used.</p>","PeriodicalId":72470,"journal":{"name":"British paramedic journal","volume":"11 2","pages":"29-35"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876805","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":"Service evaluation of pre-hospital lyophilised plasma delivery by a hazardous area response team: the HART PLAsMa project.","authors":"Timothy Wallace, Matthew Metcalf, Timothy Godfrey, Matthew Turnock, Owen Hammett, Pippa Hall, Craig Wilkins, Philip Cowburn","doi":"10.29045/14784726.2026.9.11.2.54","DOIUrl":"10.29045/14784726.2026.9.11.2.54","url":null,"abstract":"<p><strong>Introduction: </strong>Major haemorrhage is a leading cause of preventable death following major trauma. In the United Kingdom (UK), pre-hospital blood products are typically delivered by helicopter emergency medical services, enhanced and critical care teams (ECCTs) and physician-led models; however, these teams may be unable to access the highest-risk areas of complex or major incidents. The Manchester Arena Inquiry recommended exploring whether hazardous area response team (HART) paramedics could deliver lyophilised plasma (Lyoplas) to address this gap. This study describes the implementation and service evaluation of a HART-delivered Lyoplas capability.</p><p><strong>Methods: </strong>This prospective service evaluation was conducted over 12 months, from 1 April 2023 to 31 March 2024, within a UK ambulance service. Sixty-one HART paramedics were trained to deliver Lyoplas under a major haemorrhage protocol (MHP) requiring critical care medical advisor authorisation. Outcome measures included frequency and context of Lyoplas use. Process measures assessed adherence to the MHP and balancing measures examined effects on routine care, safety events and resource use. Cases were independently audited using anonymised clinical records against predefined criteria.</p><p><strong>Results: </strong>Twenty MHP activations occurred; 18 were authorised and Lyoplas was administered in 17 cases. HART initiated transfusion in 11 incidents and supported ECCT transfusion in six, delivering a total of 30 units. Authorisation was sought in 100% of cases and indications were appropriate in 94%. Correct unit dosing occurred in 88%, and calcium chloride supplementation compliance was 81%, with deviations largely clinically justified. Delivery of standard major-haemorrhage interventions was preserved. No transfusion reactions or safety-related incidents were identified. Lyoplas wastage was low (3.1%), and annual running costs were modest.</p><p><strong>Conclusion: </strong>Lyoplas was successfully implemented within HART practice, with high protocol adherence and no identified safety concerns. No major incidents occurred during the evaluation period; therefore, findings are limited to routine operational use. However, this service evaluation indicates that a pre-hospital blood-product capability can be integrated into HART operations and may help address the care gap identified by the Manchester Arena Inquiry. Further multi-site evaluation, including in major incident contexts, is warranted.</p>","PeriodicalId":72470,"journal":{"name":"British paramedic journal","volume":"11 2","pages":"54-63"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876883","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":"FPHC Wellbeing: pregnancy, maternity and return-to-work guidelines.","authors":"Heather Storey, Suzy Stokes, Katy Surman, Pamela Hardy, Sarah Morton","doi":"10.29045/14784726.2026.9.11.2.64","DOIUrl":"10.29045/14784726.2026.9.11.2.64","url":null,"abstract":"<p><strong>Introduction: </strong>In 2022, the Faculty of Pre-hospital Care (FPHC) report on 'Valuing staff, valuing patients' was published, outlining the need to 'seek out and remedy secondary stressors', such as training burdens or financial costs. As part of developing an FPHC well-being charter addressing such stressors, focus groups and survey responses identified the lack of guidelines surrounding maternity, pregnancy and return to work as a key stressor in the pre-hospital setting. The aim of this study is therefore to outline the FPHC guidelines for pregnancy, maternity and return to work following this.</p><p><strong>Methods: </strong>Questionnaire and focus group responses, alongside a literature search, were utilised. This was led by the FPHC Wellbeing Group. Additionally, responses from conferences and author contacts were incorporated. Participants were sought from a range of pre-hospital organisations, including National Health Service ambulance trusts, air ambulance organisations and voluntary organisations such as Mountain Rescue, to ensure representation. This guidance has been reviewed by the FPHC executive board.</p><p><strong>Results: </strong>All pre-hospital organisations require a maternity and parental-leave policy to be in place. Individualised risk assessments are required, and maternal preferences should be incorporated where practicable. Personalised return-to-work programmes for individuals after a period of maternity or parental leave should exist. Legal requirements relating to breastfeeding on the return to work must also be met.</p><p><strong>Conclusion: </strong>The FPHC pregnancy, maternity and return-to-work guidelines outline recommendations for pre-hospital organisations to perform risk assessments, manage risk and promote maternal choice for pregnant pre-hospital employees.</p>","PeriodicalId":72470,"journal":{"name":"British paramedic journal","volume":"11 2","pages":"64-73"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876779","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":"Development and internal validation of a caller-reported triage decision-support tool for children aged 0-4 years presenting with breathing problems.","authors":"Adam Nicholls, Luke Watkins","doi":"10.29045/14784726.2026.9.11.2.45","DOIUrl":"10.29045/14784726.2026.9.11.2.45","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to develop and internally validate the Paediatric Respiratory Emergency Prioritisation (PREP) score, a caller-reported decision-support tool for children aged 0-4 years presenting with breathing problems, and to explore its potential role in supporting clinician-led risk stratification during emergency calls.</p><p><strong>Methods: </strong>This service evaluation analysed routinely collected operational data from children aged 0-4 years with Medical Priority Dispatch System (MPDS) code 06E01 ('Breathing problems') within the Welsh Ambulance Service University NHS Trust between September 2022 and May 2025. Caller-reported features (consciousness level, airway status, respiratory rate, signs of respiratory distress, relevant medical history and MPDS diagnostic suffix) were evaluated using logistic regression and structured into the PREP score - a candidate, additive, decision-support score developed using pre-alert activation as an operational proxy for clinician-recognised urgency. Model development used a training dataset, with internal validation performed on an independent test dataset. Performance was assessed using discrimination, calibration and classification metrics.</p><p><strong>Results: </strong>A total of 5935 incidents were included. The PREP model demonstrated moderate discrimination (area under the curve 0.73), with good calibration (Brier score 0.093). At the optimised probability threshold (0.14) sensitivity was 53%, specificity 81%, precision 26% and negative predictive value 93%. The F1 score was 0.35. Retrospective application showed that 38% of children scored zero, indicating no high-risk indicators on the basis of caller-reported information.</p><p><strong>Conclusion: </strong>Within this service evaluation, the PREP score demonstrated promising internal performance as a clinician-facing decision-support tool for early risk stratification of young children with breathing problems during emergency calls. The high negative predictive value suggests potential utility for identifying children less likely to trigger pre-alert activation within existing clinician-led triage pathways. Prospective evaluation of downstream outcomes, safety and external validity is required before implementation.</p>","PeriodicalId":72470,"journal":{"name":"British paramedic journal","volume":"11 2","pages":"45-53"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876728","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":"Investigating the impact of community first responders on out-of-hospital cardiac arrest outcomes in the North East of England: a retrospective cohort study.","authors":"Owen Finney","doi":"10.29045/14784726.2026.9.11.2.5","DOIUrl":"10.29045/14784726.2026.9.11.2.5","url":null,"abstract":"<p><strong>Introduction: </strong>Community first responders (CFRs) are integrated within UK ambulance services to deliver early life-saving interventions prior to the arrival of emergency medical services (EMS). Although CFR attendance is associated with earlier cardiopulmonary resuscitation (CPR) and defibrillation, evidence regarding their independent impact on survival following out-of-hospital cardiac arrest (OHCA) remains mixed, and regional data from North East England are limited. The aim of this study was to evaluate the association between CFR attendance and survival outcomes following OHCA attended by a single NHS ambulance service.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using anonymised adult OHCA data from the North East Ambulance Service NHS Foundation Trust for the period between November 2020 and October 2025. The analytic cohort included all cases receiving advanced life support and basic life support - only cases that achieved return of spontaneous circulation represented viable resuscitation attempts. Cases were categorised by CFR attendance. The primary outcome was survival to hospital discharge. Secondary outcomes included OHCA characteristics, bystander interventions and EMS treatments. Multivariable logistic regression was used to adjust for established Utstein predictors and system-level factors.</p><p><strong>Results: </strong>A total of 7916 OHCA cases were included, of which 177 (2.2%) involved CFR attendance. CFR-attended cases were more likely to occur in rural locations and were associated with longer ambulance response times. Public-access defibrillation was more frequent in CFR-attended cases (20.3% vs 12.2%, p = 0.001), while bystander CPR rates were similar between groups. Survival to hospital discharge did not differ significantly between CFR and non-CFR cases (9.6% vs 10.2%, p = 0.797). After adjustment, CFR attendance was not independently associated with survival to hospital discharge (adjusted OR 1.15, 95% CI 0.51-2.61).</p><p><strong>Conclusion: </strong>CFR attendance was associated with improved early resuscitation processes but not with increased survival to hospital discharge after adjustment. These findings suggest that CFRs strengthen the early links of the chain of survival, while longer-term outcomes remain influenced by downstream system and clinical factors. Further research incorporating more granular CFR-specific data is required to better characterise their contribution to OHCA outcomes.</p>","PeriodicalId":72470,"journal":{"name":"British paramedic journal","volume":"11 2","pages":"5-13"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876812","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":"Closing the gap: staff perspectives on the effectiveness of teleconsultation in pre-hospital emergency care - a qualitative study.","authors":"Joe Frankland, Rebecca Randell","doi":"10.29045/14784726.2026.9.11.2.14","DOIUrl":"10.29045/14784726.2026.9.11.2.14","url":null,"abstract":"<p><strong>Introduction: </strong>Teleconsultation is increasingly used within pre-hospital emergency care to provide remote clinical support for paramedics and patients. Despite its growing integration into healthcare systems, there is limited empirical research exploring paramedics' lived experiences of teleconsultation and the factors shaping its effectiveness in practice. The aim of this study is to explore paramedics' perspectives on teleconsultation in pre-hospital care and to identify the mechanisms influencing its effectiveness.</p><p><strong>Methods: </strong>A qualitative study was conducted using semi-structured interviews with 12 paramedics working in critical care and clinical advisory roles within a large NHS ambulance trust in England. The study was grounded in Bhaskarian transcendental realism, commonly referred to as critical realism in applied health research. Data were analysed using a critical realist thematic approach, combining reflexive thematic analysis with abductive and retroductive reasoning to identify underlying mechanisms.</p><p><strong>Results: </strong>Three interrelated mechanisms were identified. First, a 'teleconsultation competence gap' reflected insufficient preparation for remote consultation within paramedic education and training. Second, 'environmental determinism' highlighted the influence of organisational culture, leadership and workload on practitioners' experiences. Third, an 'autonomy-governance balance' captured tensions between clinical autonomy and oversight, particularly where governance processes were perceived as punitive rather than supportive. These mechanisms operated differently across contexts, shaping both practitioner confidence in and engagement with teleconsultation.</p><p><strong>Conclusion: </strong>Teleconsultation in pre-hospital care is shaped by interacting educational, organisational and governance mechanisms. Addressing these collectively, through targeted training, supportive working environments and transparent governance, may enhance paramedic confidence, improve service effectiveness and support patient-centred care.</p>","PeriodicalId":72470,"journal":{"name":"British paramedic journal","volume":"11 2","pages":"14-20"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876781","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 letter to the Editor.","authors":"Mark Hodkinson","doi":"10.29045/14784726.2026.9.11.2.74","DOIUrl":"10.29045/14784726.2026.9.11.2.74","url":null,"abstract":"","PeriodicalId":72470,"journal":{"name":"British paramedic journal","volume":"11 2","pages":"74-75"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876692","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}