The journal of medicine access最新文献

{"title":"The response of the Irish pharmaceutical manufacturing sector to the COVID-19 pandemic with a focus on Lean and JIT.","authors":"Michael Howlett, Eleni Niarchou, Bernard D Naughton","doi":"10.1177/27550834241250279","DOIUrl":"10.1177/27550834241250279","url":null,"abstract":"<p><strong>Background: </strong>Just in Time (JIT) and Lean manufacturing are concepts that originated in the automotive industry and were then adopted by pharmaceutical and biopharmaceutical companies during the 1990s. However, the Covid-19 pandemic and the urgent demand for pharmaceutical treatment challenged JIT and Lean manufacturing processes. Production of Covid-19-related medicines increased, putting pressure on global supply chains and operations. This also hindered the production of medicines using the same or similar materials. Thus, questions are raised concerning JIT and Lean supply chains in the pharmaceutical industry.</p><p><strong>Objectives: </strong>The present study aimed to explore (1) if material and supply constraints occurred due to the Covid-19 pandemic, (2) how companies were impacted and managed and (3) if changes are required to future proof the JIT supply chain approach for future global events.</p><p><strong>Design: </strong>A mixed-method cross-sectional survey design was used and focused on material supply, qualification and validation in Irish pharmaceutical manufacturing sites.</p><p><strong>Methods: </strong>Employees working in the Irish pharmaceutical manufacturing industry were recruited using convenience sampling through online advertisement using the social media platform 'LinkedIn'. Quantitative data was analysed using percentages and qualitative data from free-text responses were used to add context to the quantitative survey questions.</p><p><strong>Results: </strong>A total of 41 participants were recruited. The results suggested that the pandemic had a negative effect on material availability according to 81% of participants. This translated to delays or stoppage of production activity and was mainly handled by sourcing new materials (70%). To cope with future global crises, 60% of participants recommended more flexibility in future validation processes while 78% of participants acknowledged the importance of validating additional suppliers. A hybrid model of manufacturing and supply chain management was also a preferred approach to exclusive Lean and JIT (42%).</p><p><strong>Conclusions: </strong>The production of non-Covid-19 medicines was adversely affected by the Covid-19 pandemic, but the pharmaceutical industry in Ireland demonstrated resilience and collaboration in response to these challenges. This study suggests that the JIT and Lean manufacturing model should be adjusted to ensure medicine supply chains are not disrupted during future global events.</p>","PeriodicalId":75087,"journal":{"name":"The journal of medicine access","volume":"8 ","pages":"27550834241250279"},"PeriodicalIF":0.0,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11119354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141155893","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":"Access and use of immunoglobulins in supportive cancer care: A thematic analysis of a systematic review data set.","authors":"Muireann Counihan, Larisa Cervenakova, Dominika Misztela, Maarten Van Baelen, Bernard D Naughton","doi":"10.1177/27550834241236596","DOIUrl":"10.1177/27550834241236596","url":null,"abstract":"<p><strong>Background: </strong>Secondary immunodeficiency (SID) disorders are known to occur in patients with haematological malignancies (HM) due to immunosuppressive treatments. Recurring infections causing subsequent morbidity and mortality commonly occur in this patient cohort. Immunoglobulin replacement therapy (IgRT) benefits patients with primary antibody deficiencies. However, evidence supporting their therapeutic role is not as explicit in SID-associated antibody deficiencies, which raises the questions regarding its use in SID and the knock-on effects of this use on its access and availability more generally.</p><p><strong>Objectives: </strong>This study aimed to learn about the use of immunoglobulins in SID, identify themes concerning its use and access and suggest methods for improving access.</p><p><strong>Design: </strong>This study included a thematic analysis of a published data set of 43 articles concerning immunoglobulin use and access in SID.</p><p><strong>Data sources and methods: </strong>The data set used to perform the thematic analysis is based on research articles identified from Excerpta Medica Database (EMBASE) and PubMed databases, published as part of a systematic review and part 1 of this two-part publication series.</p><p><strong>Results: </strong>A thematic synthesis was conducted to identify recurrent themes. The three primary themes included (1) the context for IgRT prescription, which included patient characteristics and cost burden of IgRT administration, and its use in different countries; (2) factors contributing to inappropriate IgRT use, including health care professionals' awareness of IgRT, disparity between guidelines and actual clinical practice, and the effect of shortages on prescription and chemotherapy-induced hypogammaglobulinemia (HGG); and (3) measures identified to improve IgRT use and access, which included multidisciplinary involvement, improved diagnostic tools and safer withdrawal and stewardship protocols.</p><p><strong>Conclusions: </strong>IgRT use is increasing in HM as a supportive therapy but without comprehensive clinical guidelines and appropriate prescribing recommendations, medication wastage may occur with consequences for immunoglobulin access.</p>","PeriodicalId":75087,"journal":{"name":"The journal of medicine access","volume":"8 ","pages":"27550834241236596"},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10981255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337960","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":"Improving access to medicines to reduce marketing and use of substandard and falsified medicines in Africa: Scoping review.","authors":"Mende Mensa Sorato, Majid Davari, Abbas Kebriaeezadeh","doi":"10.1177/27550834241236598","DOIUrl":"10.1177/27550834241236598","url":null,"abstract":"<p><strong>Background: </strong>Both constrained access to essential medicines and combatting marketing of substandard and falsified (SF) medicines are unmet health sector goals in Africa.</p><p><strong>Objective: </strong>To answer the question of how improved access can reduce the continuous surge of SF medicines in Africa.</p><p><strong>Design: </strong>We conducted a scoping review based on standard protocol.</p><p><strong>Methods: </strong>We searched articles published in the English language from PubMed/Medline, Cochrane Library, Embase, Scopus, Web of Science, and Google Scholar by using a systematic search query.</p><p><strong>Results: </strong>Seventy-one articles were included in this review. Access to quality essential medicines is still a major problem in developing countries in Africa and will continue as a threat for the next decade of health care. Ensuring access to quality medicines and preventing SF medicines in Africa need a systematic approach to address their underlying causes. Failure to ensure access to medicines is the major reason for the availability of SF medicines. Improving access to quality medicines can reduce SF medicine marketing and use. Manipulating the entire supply chain for efficiency, avoiding trade agreements that could reduce access, using compulsory licensing provisions, and pharmaceutical price control, providing incentives for drug development, and promoting rational use of medicines can improve access.</p><p><strong>Conclusion: </strong>Ensuring access to medicines and preventing SF medicine marketing cannot be achieved in the planned period in developing countries in Africa unless a comprehensive strategy is used. Improving access to quality medicines can reduce SF medicine marketing and use, that is, ensuring access through uninterrupted supply, improved efficiency, enhanced local production, preventing SF medicine entry, improved medication use system, and improved affordability. Therefore, it is essential to improve supply chain capability, address challenges of the supply chain, improve leadership and governance, establish country-specific anti-counterfeiting and anti-substandardization committees, and collaborate with all relevant stakeholders.</p>","PeriodicalId":75087,"journal":{"name":"The journal of medicine access","volume":"8 ","pages":"27550834241236598"},"PeriodicalIF":0.0,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10929061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140112403","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":"Cross-sectional survey of health literacy among health science students in Singapore","authors":"Kenrick Y Cheong, Syed Munauwwar B Syed Mahmud, Nicole W Chng, Geralyn J Kwek, Clement C Yan, Meredith T Yeung","doi":"10.1177/27550834231222382","DOIUrl":"https://doi.org/10.1177/27550834231222382","url":null,"abstract":"Background: Health literacy proficiency is essential for health care professionals to provide quality patient care. There is limited research exploring health literacy proficiency among undergraduate health science students. Objectives: To determine health literacy among health science students in Singapore using the electronic Health Literacy Questionnaire (HLQ). Design: A cross-sectional survey using purposive sampling was conducted among undergraduate health science students. Methodology: This study hypothesises that health literacy is influenced by gender, and it increases with the level of health science education, attributed to the increased exposure to the health care system and health care education as undergraduates progress through the years of study. Eligible students from the 4-year entry-level programmes of diagnostic radiography, dietetics, occupational therapy, physiotherapy, radiation therapy and speech and language therapy, aged from 21 to 50, were invited. Exclusion criteria were students who were no longer studying due to dropping out or having immediately graduated from these programmes and students in the accelerated programmes whose studies would be completed in less than 4 years. Results: In total, 111 respondents (72 females and 37 males) completed surveys (response rate, 7.7%) returned from physiotherapy (n = 69), occupational therapy (n = 25), diagnostic radiography (n = 12) and dietetics (n = 5), with nil from radiation therapy and speech and language therapy. All participants were English literate. Female participants demonstrated higher HLQ with a mean total score of 30.67 (standard deviation (SD) = 0.61) versus male participants 29.83 (SD = 0.53). Year 2, 3 and 4 students generally scored higher than Year 1 across all nine HLQ scales. Overall, dietetics students had the highest total score on the HLQ, while the diagnostic radiography students had the lowest scores for all the nine HLQ scales. Conclusion: This study established the health literacy level of health science students in Singapore. Gender and years of study influenced health literacy levels, supporting the hypothesis.","PeriodicalId":75087,"journal":{"name":"The journal of medicine access","volume":"24 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139595614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Undiagnosed hypertension and type 2 diabetes mellitus among Marshallese adults in the Republic of the Marshall Islands.","authors":"Jennifer A Andersen, Brett Rowland, Erin Gloster, Gail O'Connor, Williamina Ioanna Bing, Jack Niedenthal, Sheldon Riklon, Pearl A McElfish","doi":"10.1177/27550834231225159","DOIUrl":"10.1177/27550834231225159","url":null,"abstract":"<p><strong>Background: </strong>Given the lack of healthcare access in the Republic of the Marshall Island (RMI) and the potential for complications related to type 2 diabetes mellitus (T2DM) and hypertension, it is crucial to examine these conditions among Marshallese in the RMI.</p><p><strong>Objectives: </strong>This study aims to identify the proportion of Marshallese adults in the RMI with undiagnosed T2DM and hypertension.</p><p><strong>Design: </strong>Using a community-based participatory research approach, screening events were conducted at 20 churches in Majuro Atoll.</p><p><strong>Methods: </strong>Participants completed a questionnaire and biometric data measures, including hemoglobin A1c and blood pressure.</p><p><strong>Results: </strong>Among participants with blood pressure data (<i>N</i> = 528), 11.9% had readings indicative of hypertension, and 38.1% were undiagnosed. Among participants with hemoglobin A1c (HbA1c) data (<i>N</i> = 450), 45.3% had readings indicative of T2DM, and 39.2% were undiagnosed.</p><p><strong>Conclusion: </strong>This study utilized a community-based participatory research approach that promotes equitable and ethical research. Results reaffirm the need to identify strategies for increasing healthcare access and for research to address health disparities in the RMI.</p>","PeriodicalId":75087,"journal":{"name":"The journal of medicine access","volume":"8 ","pages":"27550834231225159"},"PeriodicalIF":0.0,"publicationDate":"2024-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10812094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139572302","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 Los Angeles County Department of Health Services <i>Health Technology Navigators</i>: A novel health workforce to digitally empower patient communities in safety net systems.","authors":"Alejandra Casillas, Anshu Abhat","doi":"10.1177/27550834231223024","DOIUrl":"10.1177/27550834231223024","url":null,"abstract":"<p><p>Significant disparities in the uptake of digital health tools have been previously described. Studies have found that low perceived confidence to engage with digital health resources among medically underserved patients partially account for this. To address barriers to digital health engagement (specifically around patient portal enrollment and use), the Los Angeles County Department of Health Services (LAC DHS) introduced the Health Technology Navigators program. To our knowledge, this is the first formal digital health workforce implemented in a safety net system. The objectives of the editorial are to describe the evolution and roles of the health technology navigators and their early effects within LAC DHS, the second largest safety net health system in the United States.</p>","PeriodicalId":75087,"journal":{"name":"The journal of medicine access","volume":"8 ","pages":"27550834231223024"},"PeriodicalIF":0.0,"publicationDate":"2024-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10788075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139473175","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 narrative review of illegal online pharmacies and contemporary issues with restricting FDA-approved medication access.","authors":"Zarnab Jillani, Lauren Reinhard, John Hertig","doi":"10.1177/27550834231220512","DOIUrl":"10.1177/27550834231220512","url":null,"abstract":"<p><p>The rapid growth of technology has transformed the way the public purchases many products, including medications. Online medication purchasing has become a convenient and confidential route for patients to access healthcare without leaving their homes. Online pharmacies have many benefits but also present an increased risk for patient harm caused by unintentionally purchasing from illegal online pharmacies. Illegal online pharmacies are those that operate online without the requisite valid licenses or supply drugs not approved by the Food and Drug Administration (FDA). As obtaining certain medications has become restricted, either due to policy or drug shortages, more patients are relying on services provided by Internet pharmacies. The overturning of Roe versus Wade has caused an emerging drug restriction that may coerce the public to turn to Internet pharmacies for purchasing medications. A narrative review was conducted to analyze both the past and present effects of medications sold by illegal online pharmacies to help recognize the implications of restricting access to FDA-approved medications. Several large science and health literature databases were searched to find relevant references. Resulting resources, which referenced the connection between restricting access to FDA-approved medications and the increase in illegal online sales, were included in this review. The information evaluated in this article will help inform healthcare providers and policymakers of the inadvertent effects of restricting access to FDA-approved medications.</p>","PeriodicalId":75087,"journal":{"name":"The journal of medicine access","volume":"7 ","pages":"27550834231220512"},"PeriodicalIF":0.0,"publicationDate":"2023-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10750516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139041167","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":"Challenges of treating catatonia in the community setting without access to electroconvulsive therapy.","authors":"Tyler Torrico, Shahzeb Shaheen, David Weinstein, Ranjit Padhy, Md Towhid Salam","doi":"10.1177/27550834231220504","DOIUrl":"10.1177/27550834231220504","url":null,"abstract":"<p><p>Catatonia is a psychomotor syndrome resulting from an underlying psychiatric or medical disorder commonly observed in inpatient psychiatric units. While benzodiazepines and electroconvulsive therapy (ECT) are effective treatment options, the unavailability of ECT in many community psychiatric hospitals in the United States negatively affects patient outcomes. We present a 25-year-old African American male with a psychiatric diagnosis of schizophrenia complicated by malignant catatonia who was admitted to a community psychiatric hospital. He required intensive medical stabilization with supportive management, and transfer requests to ECT-equipped hospitals were initiated. While awaiting transfer for 148 days, the patient's symptoms did not fully remit with lorazepam (even with 36 mg daily in divided doses) and other psychotropic medication trials, including antipsychotics and mood stabilizers. After nearly 5 months of inpatient stay, he was successfully transferred, received ECT treatment, and experienced rapid resolution of catatonia. After discharge, to obtain three monthly sessions of maintenance ECT, he had 5-h one-way ground transportation arranged to an out-of-county ECT-equipped facility. There was no relapse in catatonia by the 2-year follow-up. This report highlights a significant healthcare disparity when attempting to manage severe catatonia within community hospital settings without access to ECT in the United States. Alternative treatments, including antipsychotics, had minimal impact on symptoms and possibly increased morbidity in this case while awaiting ECT. Treatment at our designated safety net hospital still required referral to 14 ECT-equipped hospitals before successful transfer. This case highlights the urgent need for ECT availability in more community hospitals to treat patients with refractory psychiatric conditions, including catatonia. ECT is an essential psychiatric treatment that, for certain conditions, has no appropriate alternatives. We propose that access to ECT be considered in the determination of safety net hospital systems, with improved ability to transfer patients who are suffering from treatable life-threatening mental health conditions.</p>","PeriodicalId":75087,"journal":{"name":"The journal of medicine access","volume":"7 ","pages":"27550834231220504"},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10748610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139032945","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":"Overcoming structural barriers to diffusion of HIV pre-exposure prophylaxis.","authors":"Manya Magnus, Hannah Yellin, Kayley Langlands, Madhu Balachandran, Melissa Turner, Jeanne Jordan, Daniel Ramin, Irene Kuo, Marc Siegel","doi":"10.1177/27550834231214958","DOIUrl":"10.1177/27550834231214958","url":null,"abstract":"<p><p>HIV prevention with antiretroviral medication in the form of pre-exposure prophylaxis (PrEP) offers a critical tool to halt the HIV pandemic. Barriers to PrEP access across drug types, formulations, and delivery systems share remarkable commonalities and are likely to be generalizable to future novel PrEP strategies. Appreciation of these barriers allows for planning earlier in the drug-development pathway rather than waiting for the demonstration of efficacy. The purpose of this article is to propose a core set of considerations that should be included in the drug-development process for future PrEP interventions. A literature synthesis of key barriers to PrEP uptake in the United States was conducted to elucidate commonalities across PrEP agents and delivery methods. Based on the published literature, we divided challenges into three main categories of structural barriers: (1) provider and clinic characteristics; (2) cost considerations; and (3) disparities and social constructs, with potential solutions provided for each. Pragmatic strategies for examining and overcoming these barriers before future PrEP regulatory approval are recommended. If these strategies are considered well before the time of commercial availability, the potential for PrEP to interrupt the HIV pandemic will be greatly enhanced.</p>","PeriodicalId":75087,"journal":{"name":"The journal of medicine access","volume":"7 ","pages":"27550834231214958"},"PeriodicalIF":0.0,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10702399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138815169","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":"Out-of-pocket expenditures and catastrophic expenditures on inpatient care among households of an urban village in Delhi.","authors":"Suraj Prakash Singh, Anita Khokhar","doi":"10.1177/27550834231213704","DOIUrl":"10.1177/27550834231213704","url":null,"abstract":"<p><strong>Background: </strong>Out-of-pocket expenditure (OOPE) for inpatient care has been known to cause maximum impoverishment. It can have debilitating consequences for urban poor households. It is necessary to study inpatient care costs and the related factors among the households of an urban village to determine their vulnerability to catastrophic expenditure and to protect them from it.</p><p><strong>Objective: </strong>The study aimed to calculate the mean OOPE on inpatient care, and catastrophic health expenditure among households of an urban village in Delhi.</p><p><strong>Design: </strong>This was a cross-sectional study conducted over 18 months among urban village households of Delhi who have been residing for the last 1 year.</p><p><strong>Methods: </strong>A sample size of 188 was calculated based on another study, and households were selected using systematic random sampling. A pre-designed, pre-tested, semi-structured, and interviewer-administered questionnaire in Hindi was used to elicit and record relevant information. Data were recorded and coded, and analysis was done using licensed SPSS v.26 software. Tables were generated for relevant data, and cross-tables were used to assess statistical association with chi-square or Fisher exact tests, as required. A <i>p</i>-value of 0.05 was considered statistically significant.</p><p><strong>Results: </strong>The mean annual OOPE borne by a household on inpatient care was INR 6870.3 (SD ± 30,580.6), where 93.3% of OOPE was incurred while seeking treatment from public facilities. The OOPE on inpatient care had a statistically significant association with households having joint family, members from vulnerable population, and belonging to Delhi.</p><p><strong>Conclusion: </strong>The households of an urban village of Aliganj, Delhi, have high OOPE on inpatient care (60.6%) and catastrophic health expenditure (75.6%).</p>","PeriodicalId":75087,"journal":{"name":"The journal of medicine access","volume":"7 ","pages":"27550834231213704"},"PeriodicalIF":0.0,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10697042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138500450","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}