BMJ Open Quality最新文献

{"title":"Confidence in consent: the use of a patient information leaflet as a tool for consent for regional anaesthesia - a service improvement project.","authors":"Emma Lennon, Abigail Walsh, Shanika Wijayaratne, Sherife El Mahgoub","doi":"10.1136/bmjoq-2024-003241","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003241","url":null,"abstract":"<p><p>Regional anaesthesia is increasingly used for perioperative pain management, offering benefits such as improved pain scores, reduced opioid use and early mobilisation. However, informed consent remains a critical issue, particularly given the rising litigation claims related to peripheral nerve blockade. This service improvement project evaluates the impact of introducing a patient information leaflet (PIL) on patient understanding and experience of the consent process. A structured in-person survey was administered pre and post intervention to two cohorts of 30 patients each. The results demonstrate improvements in patient recall of risks and benefits, understanding of voluntary consent and overall satisfaction with the consent process. The findings are suggestive that PILs enhance shared decision-making and should be integrated into standard consent procedures.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315870","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":"Improving venous access by using a near-infrared vein-finder device and ultrasound skill building: a quality improvement project.","authors":"Hassan Bennakhi, Mohammad Alajmi, Mahmoud Baqer, Naser Qasem, Zafeer Ul Hassan Iqbal, Nihal Abosaif, Clare Philliskirk","doi":"10.1136/bmjoq-2024-003232","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003232","url":null,"abstract":"<p><strong>Introduction: </strong>Venous access by venipuncture and cannulation is a crucial procedure in day-to-day patient care in clinical settings. Performing this procedure on difficult veins can be time-consuming and burdensome for healthcare providers and painful and uncomfortable for patients. This quality improvement project aimed to optimise venous access by using a near-infrared (NIR) vein-finder device and provide ultrasound practical skills training to facilitate venous access.</p><p><strong>Methods: </strong>The first plan-do-study-act (PDSA) cycle introduced an NIR device to hospital wards after collecting baseline data on success rate, number of attempts, procedure duration and need for help or escalation. These data were submitted by ward staff voluntarily for any venipuncture or cannulation procedure, followed by data analyses and plans for a second cycle. The second PDSA cycle involved organising a practical training session for the use of an ultrasound device for venous access. Participants voluntarily used their newly acquired ultrasound skills for difficult veins after multiple failed attempts without a device and submitted a Google form with questions about the above-mentioned success indicators.</p><p><strong>Results: </strong>In the first cycle, improvements were observed in all chosen quality indicators but were only statistically significant for the overall success rate (venipuncture and cannulations combined), the overall number of attempts and the overall duration of venous access procedures as well as for number of attempts and procedure duration for venipuncture individually. For the second PDSA cycle, after attending the ultrasound training session, participants reported an 80.95% overall success rate of venous access for difficult veins that were inaccessible before the ultrasound device was used. It also significantly reduced the number of attempts needed to get venous access when compared with attempts before using the ultrasound device.</p><p><strong>Conclusions: </strong>Based on our findings, we recommend providing an NIR vein-finder device and ultrasound training to improve venous access in hospital settings and encourage further research to evaluate their effectiveness.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301080","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":"Evaluation of a data-driven recall system in general practice.","authors":"Tim Benson, Alex Benson","doi":"10.1136/bmjoq-2024-003137","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003137","url":null,"abstract":"<p><strong>Introduction: </strong>This paper presents a mixed-methods evaluation of the spread of the Target Health Solutions data-driven recall system to seven general practices (GPs). The aim was to assess implementation success, changes in staff perceptions and impact on patient recall.</p><p><strong>Method: </strong>Data was collected about recall rates at each practice. Staff (n=128) answered surveys before (32 questions) and after (51 questions) implementation of the system.</p><p><strong>Results: </strong>Overall, there were substantial quantitative improvements in recall. Performance was lower in some practices, which continued to run their existing recall systems alongside the new system.Staff perceived significant improvement in their recall systems, although other areas were not affected. Challenges to implementation included running parallel systems, workload pressures and training.</p><p><strong>Discussion: </strong>The results suggest that strong leadership and focused implementation planning are needed for successful adoption of this type of innovation in GP.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301079","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":"Collaboration in nursing-home care: perspectives of care professionals - a qualitative study.","authors":"Roeyel J F Koldeweij, Marleen H Lovink, Anke Persoon","doi":"10.1136/bmjoq-2024-003147","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003147","url":null,"abstract":"<p><p>Interprofessional collaboration became more firmly positioned after the WHO highlighted its importance for better healthcare outcomes. In nursing homes, interprofessional collaboration refers to collaboration between teams of physicians/allied health professionals and care teams. Collaboration within care teams is known as intraprofessional collaboration. Determinants of interprofessional and intraprofessional collaboration have yet to be explored within the nursing-home context. Our exploratory qualitative study focused on the determinants considered important by professionals in seven nursing homes. We conducted 14 one-on-one, semistructured interviews with nurses and collaborating physicians/allied health professionals from seven teams of one care organisation. Data were analysed on thematic analysis, proceeding from an inductive approach. Five interacting determinants were identified. The core determinant was 'investing in each other', followed by 'roles, functions and responsibilities within care teams'; 'written policies for individual residents'; 'verbal coordination meetings'; and 'organisational influences'. One notable finding is the influence of intraprofessional collaboration within the care team on all determinants of interprofessional collaboration, including the role of the coordinating nurse. Future ethnographic and action research on intraprofessional collaboration is needed, including the perspective of nurse assistants, as well as on interventions aimed at improving interprofessional collaboration. We recommend training professionals to invest in each other as a skill that encourages relationships.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301078","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":"Return to care of children and adolescents living with HIV who missed their clinic visits or were lost to follow-up: a continuous quality improvement study in Uganda.","authors":"Ssentongo Mugerwa Saadick, Jonathan Izudi, Boniface Oryokot, Ronald Opito, Baker Bakashaba, Abel Munina, Kokas Opolot, Daniel Ogwal, Julius Ssendiwala, Kenneth Mugisha","doi":"10.1136/bmjoq-2024-003157","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003157","url":null,"abstract":"<p><strong>Background: </strong>While the UNAIDS 95-95-95 targets have been met among adults, those for children and adolescents remain suboptimal. This study aimed to improve the return-to-care rates among children and adolescents living with HIV (CALHIV) who missed clinic appointments at a county-level rural health facility in eastern Uganda.</p><p><strong>Methods: </strong>Between January 2023 and January 2024, we conducted a continuous quality improvement (CQI) study. A CQI committee was established through entry meetings and training, and quality of care gaps were identified through data reviews. We prioritised one gap for CQI through ranking, performed a root-cause analysis using a fishbone diagram, and developed and ranked improvement changes using the impact-effort matrix. The improvement changes were implemented using Plan-Do-Study-Act cycles. The changes included (1) line listing CALHIV with missed appointments and following up via phone calls; (2) weekly data reviews to harmonise missed appointments and (3) assigning community health workers (CHWs) to trace and return CALHIV to care. We tracked and plotted the proportion of CALHIV returning to care over time to assess improvements.</p><p><strong>Results: </strong>Before the implementation of CQI initiatives (August 2022-January 2023), the average return-to-care rate was 35% (baseline). Following the initiation of CQI in February 2023, the average return-to-care rate increased to 59% from February to May 2023 with the introduction of line listing (phase 1), to 69% from June to September 2023 with the implementation of weekly data reviews (phase 2), and to 88% from October 2023 to January 2024 with the involvement of CHWs (phase 3), ultimately reaching a peak of 100% in January 2024.</p><p><strong>Conclusion: </strong>The CQI approach improved the return to care of CALHIV who missed clinic appointments, allowing access to optimal care and better health outcomes. These findings should serve as preliminary data for larger randomised studies.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12164632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293282","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":"Increasing credibility in government assignments: an example from Sweden of stakeholder involvement by using Concept Mapping.","authors":"Frida Smith, Katarina Fredriksson, Katrín Ásta Gunnarsdóttir, Mikael Holtenman, Christina Carlsson","doi":"10.1136/bmjoq-2024-003021","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003021","url":null,"abstract":"<p><strong>Background: </strong>The incidence of people diagnosed with cancer is increasing worldwide, in Sweden with approximately 65 000 new cases yearly. To enhance conditions for a continued good life, high-quality, accessible and equal cancer rehabilitation is required. In 2020 the National Board of Health and Welfare (NBHW) received a government assignment to investigate the conditions for the offer of cancer rehabilitation. This paper aims to highlight how the Concept Mapping (CM) methodology was strategically used by the NBHW for mutual learning to raise different perspectives and 'voices' of cancer rehabilitation.</p><p><strong>Methods: </strong>The stepwise, mixed-method CM was used. A broad selection of relevant stakeholders was invited to complete the prompt: a good and equal cancer rehabilitation requires… the stakeholders were involved in brainstorming, sorting and grading data. The research group performed multi-dimensional scaling and hierarchical cluster analysis to provide a visual presentation of the results. Two digital seminars were held: one where stakeholders did online sorting and grading of data and one where results were presented and discussed.</p><p><strong>Results: </strong>118 respondents from four stakeholder groups provided 489 original ideas. Six clusters from 67 unique ideas constituted the concept map, and a go-zone showing the 12 ideas rated as most important and feasible was obtained.</p><p><strong>Conclusion: </strong>For the first time, the NBHW has used CM in investigative work to produce development proposals and improvements that the government can use as a basis for political decisions. The method showed great potential, by allowing for stakeholder involvement as co-creators in all steps, high participation and possible direct utilisation of results. A clear learning perspective was obtained, both from the NBHW and the involved stakeholders; hence, the method can be used in further assignments where improvement perspectives are requested.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12164613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293281","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":"Zeroing in: achieving zero complications in lumbar puncture - a quality improvement initiative to reduce complications at the University Hospital of North Norway.","authors":"Susanne Gaarden Ingebrigtsen, Agnethe Eltoft, Thomas Karsten Kilvaer","doi":"10.1136/bmjoq-2025-003327","DOIUrl":"https://doi.org/10.1136/bmjoq-2025-003327","url":null,"abstract":"<p><strong>Background: </strong>Lumbar puncture (LP) is an essential diagnostic procedure in neurology, but carries risk, with post-lumbar puncture headache being the most frequent complication. In 2017, a severe complication with intracranial haemorrhage following LP in Northern Norway led to an evaluation of LP procedures and resulted in the development of a new unified regional procedure.</p><p><strong>Local problem: </strong>At the University Hospital of North Norway (UNN), 10% of LPs performed in 2017 resulted in a complication. A survey identified gaps in protocol adherence, physician training, and patient education.</p><p><strong>Intervention: </strong>Aiming to reduce LP complication rates from 10% to 1% by January 2019, we implemented standardised protocols, introduced smaller gauge needles, enhanced physician training and improved patient education.</p><p><strong>Results: </strong>Complication rates dropped to 1%, achieving 107 consecutive complication-free procedures by January 2019, with sustained improvement over subsequent years.</p><p><strong>Conclusion: </strong>Standardised protocols, physician training, introduction of smaller gauge needles and patient education significantly reduced LP complications. Educating patients on expectations and post-procedure care was critical in preventing unnecessary admissions and outpatient visits.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12164642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293283","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":"Beyond the individual: a qualitative case study into the systemic determinants of speaking-up behaviour in multidisciplinary team meetings.","authors":"Dimmy van Dongen, Jaco Tresfon, Frank Guldenmund, Irene Grossmann, Daphne Roos, Jop Groeneweg","doi":"10.1136/bmjoq-2025-003335","DOIUrl":"10.1136/bmjoq-2025-003335","url":null,"abstract":"<p><strong>Background: </strong>Healthcare workers (HCWs) voicing their views (speaking up) is crucial for patient safety and care quality. Yet, this is underused, especially during multidisciplinary team meetings (MDTMs), where diverse professionals collaborate to optimise patient treatment plans. Despite the benefits of open communication, HCWs face barriers such as hierarchical dynamics, time constraints and psychological risks.</p><p><strong>Aim: </strong>This study examines factors influencing HCWs' speaking-up behaviours in MDTMs, focusing on motivators, barriers and dynamics across disciplines.</p><p><strong>Method: </strong>We conducted 21 semistructured interviews with MDTM participants of a gastrointestinal surgery ward, including surgeons, residents, nurses, nursing students, dieticians, ostomy nurses and physical therapists. Data were analysed collaboratively using thematic analysis.</p><p><strong>Results: </strong>Participants are highly motivated to advocate for patients and provide optimal care. However, barriers impact speaking up during MDTMs. Three major themes were identified: (1) time pressure, (2) perception of goals and roles and (3) familiarity among team members. Structural, relational and contextual factors affect HCWs' ability to speak up, with nurses and paramedics experiencing more hesitancy than physicians. Lack of preparation time, ambiguous objectives, no formal agenda and unfamiliarity among team members hinder contributions, leading to unbalanced input.</p><p><strong>Conclusion: </strong>Findings support a systems-based approach to addressing barriers. Interventions should focus on clear goals, reduced time pressures and enhanced team cohesion, rather than placing the responsibility solely on individuals. For instance, adjusting meeting schedules to accommodate diverse availability improves participation across disciplines. Strengthening familiarity among team members fosters trust and lowers the perceived risks of speaking up, ensuring more balanced contributions during MDTMs.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12161376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274154","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":"Assessment of a simulation-based implementation method to support the introduction of a new invasive device: a prospective cross-over study.","authors":"Cordélia Salomez-Ihl, Claire Chapuis, Pierrick Bedouch, Pierre Albaladejo, Julien Picard","doi":"10.1136/bmjoq-2024-003029","DOIUrl":"10.1136/bmjoq-2024-003029","url":null,"abstract":"<p><strong>Study objective: </strong>The introduction of new medical devices into care units, or their replacement by new devices, is not always accompanied by implementation strategies that enable healthcare professionals to use them safely. Simulation is a relevant tool for reproducing critical care clinical situations without danger for the patients and providing training support. The aim of the study was to assess a simulation-based implementation method to accompany and reduce the risks associated with the deployment of a new invasive medical device in critical care units.</p><p><strong>Design: </strong>Prospective mono-centric cross-over study.</p><p><strong>Setting: </strong>In our hospital, the type of Invasive Arterial Blood Pressure Sensors (IABPS) for blood pressure (BP) monitoring and arterial sampling has been completely replaced by a new one with numerous differences. No specific training had been planned.</p><p><strong>Participants: </strong>66 intensive care unit (ICU) nurses from three ICUs with a total number of 39 beds were involved.</p><p><strong>Interventions: </strong>The scenario and evaluation grid were designed by multi-disciplinary teams who received in-depth training on the new IABPS from the laboratory and the institution's equipment specialists. Nurses in group A (GA) (n=33) started by using the IABPS on a simulation scenario and then received explanations on differences. Nurses in group B (GB) (n=33) received explanations and then used the IABPS on the simulation scenario. Nurses in GA and GB all had individual feedback on their errors at the end. Next, they listed the most important information they would give to a colleague if they had a few minutes to train him or her. They also completed an anonymous self-questionnaire to assess their satisfaction with the training and with the new IABPS.</p><p><strong>Main results: </strong>The mean number of errors in the act of measuring BP and taking biological samples was statistically higher for GA, demonstrating the relevance of offering a training programme to support the deployment of a new device. The mean times to BP measurement and to collection were similar. Recommendations for asepsis of the sampling site were not followed. Recurrent errors were related to the ergonomics of the IABPS. Caregivers (n=55 questionnaires) appreciated the training and the new IABPS.</p><p><strong>Conclusions: </strong>Simulation can be useful for both providing a training model and identifying the situations that would require dedicated training support. The simulation tool provided training and context to nurses before they use the new IAPBS in clinical practice. Simulation training has also led to a better understanding of the most common errors. Because of new IABPS widespread use, it was all the more important to prevent usage errors.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12161344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246357","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":"Strategies for implementing Sustainability in Quality Improvement (SusQI) education: educator perspectives.","authors":"Victoria Stanford, Kathleen Leedham-Green, Alice Clack, Siobhan Parslow-Williams, Ayoma Ratnappuli, Frances Mortimer","doi":"10.1136/bmjoq-2024-003055","DOIUrl":"10.1136/bmjoq-2024-003055","url":null,"abstract":"<p><p>The climate and ecological emergencies represent a significant threat to health, and yet healthcare is a major contributor to environmental degradation. Sustainability in Quality Improvement (SusQI) is a framework that enables healthcare professionals to improve how good health is achieved and healthcare delivered in line with social, economic and environmental sustainability goals. SusQI education provides healthcare learners with the knowledge and practical skills for sustainable clinical transformation.We interviewed 11 SusQI course leads at 10 educational sites in the UK and Ireland, exploring educator perspectives on how SusQI can be successfully implemented in diverse health educational contexts. Our aim was to identify what works, in which contexts and why. We thematically analysed the interviews and tabulated case study details.We identified four interlinked themes: choosing SusQI, getting it into the curriculum, making it work and embedding it. Each of these stages was influenced by factors related to the educators themselves, their students and their institution, as well as specific educational or curricular factors. The most successful implementations demonstrated synergistic benefits for both learners and institutions, engendering self-sustaining communities of practice.Strong institutional commitment, distributed expertise and opportunities for supported project work emerge as key success factors. Together, these fostered self-sustaining virtuous cycles of stakeholder engagement, transformative educational impacts and progress towards sustainable clinical practice.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12161363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246359","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}