BMJ Open Quality最新文献

{"title":"Closed loop full process management and application of body fluid specimens in hospitalised patients.","authors":"Dan Zhao, Yingxin Peng, Jie Wang","doi":"10.1136/bmjoq-2025-003740","DOIUrl":"https://doi.org/10.1136/bmjoq-2025-003740","url":null,"abstract":"<p><strong>Objective: </strong>To develop and implement a closed-loop full-process management system for body fluid specimens in hospitalised patients, with the aim of improving submission timeliness and specimen quality.</p><p><strong>Methods: </strong>A multidisciplinary inpatient specimen management team was established to analyse the causes of inefficiencies in the collection-to-submission process of body fluid specimens. Based on these findings, targeted interventions were formulated and implemented in February 2025. The preanalytical turnaround times and unqualified specimen rate before and after implementation were compared.</p><p><strong>Results: </strong>After implementing the closed-loop management system, the delayed submission rate of body fluid specimens decreased from 15.62% to 5.8% and the unqualified specimen rate decreased from 0.70% to 0.39%. The improvement in submission timeliness and specimen quality was statistically significant (p<0.05). All indicators showed significant differences at 3 and 6 months after intervention compared with before intervention (p<0.05).</p><p><strong>Conclusion: </strong>The implementation of a closed-loop full-process management system for body fluid specimens effectively improved the timeliness of specimen submission, reduced delays and decreased the occurrence of unqualified specimens, thereby enhancing patient safety.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 2","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855550","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":"Study on the effectiveness and accessibility of a CDR-based VTE quality control platform in county-level hospitals.","authors":"Zhenhua Zang, Bing Shuo Liu, Junping Li, Lin Li, Zhaodong Li, Jia Liu, Jianliang Zhang, Wendong Bian, Chunting Yuan, Mei Wang","doi":"10.1136/bmjoq-2025-003626","DOIUrl":"https://doi.org/10.1136/bmjoq-2025-003626","url":null,"abstract":"<p><p>To enhance venous thromboembolism (VTE) prevention and management in county-level hospitals, we developed a VTE quality control platform leveraging clinical databases and Clinician Workstations. The platform is characterised by simplified construction, cost-effectiveness and a user-friendly interface enabling precise real-time monitoring of VTE prevention measures in hospitalised patients. Comparative analysis of pre-implementation and post implementation data revealed significant improvements in key metrics: VTE bleeding risk assessment rate (1.33% vs 7.43%, p<0.001), basic prevention compliance (20.87% vs 50.38%, p<0.001), mechanical prevention utilisation (24.60% vs 27.37%, p=0.002) and appropriate prevention rate (11.67% vs 53.11%, p<0.001). The platform effectively optimised VTE prevention practices, demonstrating ease of deployment, affordability and operational efficiency-making it a scalable and practical solution for county-level hospitals in China.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 2","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855618","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":"Participatory system dynamics in implementation science practice: a scoping review of methods, contexts and outcomes.","authors":"Lauren Caton, Lindsey Zimmerman, Anna Kahkoska, Benjamin A Goldstein, Nina Sperber","doi":"10.1136/bmjoq-2025-003919","DOIUrl":"10.1136/bmjoq-2025-003919","url":null,"abstract":"<p><strong>Background: </strong>This scoping review documents participatory system dynamics (PSD) applications in implementation science (IS) studies following a recent, increased integration of the two fields in the USA. It aims to illustrate 'how' and 'why' PSD modelling improves understanding of determinants of implementation outcomes for quality improvement.</p><p><strong>Methods: </strong>We queried PubMed and PsycInfo for PSD, IS and their synonyms (community-based system dynamics or group model building, dissemination, quality improvement, translational research or knowledge translation). USA-based empirical studies were included when they described synchronous participatory activities to define a modelling problem over time. Studies were included when PSD was used as an implementation research method or implementation practice strategy. Fifty-eight studies on concept mapping were excluded, as were 65 intervention mapping studies. Nine articles remained after full-text review.</p><p><strong>Results: </strong>Most studies (n=7) investigated PSD itself as the intervention for understanding an implementation problem or use it as a tool to understand how to implement an evidence-based practice (n=4) or select an IS strategy (n=3). Most articles were case studies, investigating feasibility and knowledge translation during the preparation phase.</p><p><strong>Conclusions: </strong>We recommend that implementation research and practice clarify whether PSD is used as a method to uncover contextual determinants or strategy to do so. PSD has strong potential to use enhanced participant buy-in and problem definition to understand 'how' implementation strategies account for cyclical and temporal determinants. Greater alignment between PSD activities, participatory theory, implementation phases and outcomes is needed to strengthen evaluation of PSD's applications in IS.</p><p><strong>Registration: </strong>The protocol for this paper is listed in the UNC Libraries repository (https://cdr.lib.unc.edu/concern/scholarly_works/6682xg09r).</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 2","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833284","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":"Performance and challenges of success in quality improvement projects of selected public hospitals in Addis Ababa, Ethiopia: A MUSIQ analysis of a perinatal quality improvement collaborative in Ethiopian public hospitals.","authors":"Bisrat Tamene Bekele, Wubet Mihretu Workneh, Getinet Tilahun Simeneh, Biniam Yohannes Wotango","doi":"10.1136/bmjoq-2025-003893","DOIUrl":"10.1136/bmjoq-2025-003893","url":null,"abstract":"<p><strong>Background: </strong>Quality improvement collaboratives (QICs) are a common strategy to improve healthcare in low-resource settings. However, their success is highly variable. The Model for Understanding Success in Quality (MUSIQ) posits that contextual factors at multiple levels determine outcomes. We used MUSIQ to investigate why a well-supported perinatal QIC in Ethiopia had mixed results, testing the hypothesis that internal organisational factors rather than external support would be the primary differentiator of success.</p><p><strong>Methods: </strong>A cross-sectional study was conducted with all quality improvement (QI) team members across six public hospitals in Addis Ababa participating in a perinatal QIC. Contextual factors were assessed using the validated MUSIQ tool. The primary outcome was binary QI success (met/not met a predefined target for reducing perinatal mortality/morbidity). MUSIQ scores were compared between successful and non-successful hospitals using Mann-Whitney U tests. A multivariable logistic regression model was built to identify factors independently associated with success.</p><p><strong>Results: </strong>Sixty-seven QI team members participated (95.7% response rate). The overall mean MUSIQ score was 121.2±15.6, indicating a 'reasonable chance of success'. However, scores were significantly higher in successful hospitals (median 129.9 vs 118.8, p=0.002). While external support scores were uniformly high, successful hospitals demonstrated significantly stronger scores in the organisation (p=0.045) and QI team (p=0.005) domains. Regression analysis confirmed that factors within the QI team (leadership, physician involvement) and organisation (senior leadership engagement) domains were independently associated with success, after accounting for other variables.</p><p><strong>Conclusion: </strong>The success of this QIC was predominantly determined by internal organisational and team factors, not by the strong external support common to many global health initiatives. This highlights a critical implementation gap: top-down QICs often fail to catalyse the necessary internal leadership and team dynamics for success. Future initiatives must invest in building internal organisational context alongside providing external technical support.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 2","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833271","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 patient well-being in subacute care: a quality improvement initiative.","authors":"Petra Bierer, Marina Brown, Madison Chapman, Kate Laver","doi":"10.1136/bmjoq-2025-003977","DOIUrl":"10.1136/bmjoq-2025-003977","url":null,"abstract":"<p><p>Individuals experience lower levels of well-being when admitted to hospital. Maximising well-being may lead to improved outcomes for patients and the health service. We aimed to (1) implement co-designed strategies to improve patient well-being on subacute wards, (2) evaluate the well-being levels of the patient cohort before and after implementation and (3) identify barriers and enablers to implementation of strategies. We conducted a quality improvement study with pre-post evaluation across six subacute wards in a tertiary hospital. Data from interviews with patients and meetings between ward staff and management enabled the co-design of strategies to enhance patient well-being. Strategies were prioritised and implemented using plan, do, study, act cycles. Well-being levels were assessed in the cohort using a scale before (n=153) and after (n=145) implementation. A total of 17 strategies to optimise patient well-being were generated; each ward prioritised implementing key strategies relevant to their setting. While intentions to implement the strategies were high, implementation fidelity of strategies varied due to several barriers identified by staff. Well-being levels reported by patients after implementation were not significantly different from those reported by patients before. Despite extensive consultation and co-design of strategies with patients and staff, well-being levels were not improved at the conclusion of the improvement project. Confounders (such as high hospital demand at the follow-up evaluation time) may have impacted results. Suboptimal implementation fidelity may have also reduced the impact of the initiative.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 2","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833266","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":"Assessing stakeholder readiness for implementation of a diabetes prevention programme for patients with recent gestational diabetes: a short report.","authors":"Katelyn Sushko, Apishanthi Sriskandarajah, Sameen Ali, Megan Racey, Ishraq Rahman, Sandhya Sahye-Pudaruth, Diana Sherifali, Kelly Smith, Aimen Zehra, Lorraine Lipscombe","doi":"10.1136/bmjoq-2025-004026","DOIUrl":"10.1136/bmjoq-2025-004026","url":null,"abstract":"<p><strong>Background: </strong>Implementing guideline-based diabetes prevention programs (DPPs) for women with recent gestational diabetes mellitus (GDM) is critical, given the global rise in type 2 diabetes (T2D) and the established association between GDM and subsequent diabetes risk. Implementing new healthcare programs, however, is inherently challenging, as success depends on the engagement and commitment of frontline providers. Determining stakeholders' readiness for change was therefore critical before implementing a postpartum DPP for patients with recent GDM.</p><p><strong>Method: </strong>We conducted a cross-sectional survey of healthcare providers across three DPP implementation settings in Ontario, Canada. Survey measures included the Organizational Readiness for Implementing Change (ORIC) scale and a measure assessing constructs from the inner setting domain of the Consolidated Framework for Implementation Research (CFIR). Due to our low sample size, we analyzed results descriptively.</p><p><strong>Results: </strong>We surveyed 36 stakeholders across three implementation settings. The ORIC scale and CFIR-based measurement tool scores were relatively high (greater than 4.00 out of 5.00) across most participants. Scores were similar across service types and professional roles.</p><p><strong>Conclusions: </strong>Stakeholders across three settings appear ready to implement a postpartum DPP for patients with GDM. Although those from an integrated care setting tended toward higher readiness based on change efficacy and commitment, the results of the CFIR-based measurement tool underscore the importance of using tailored approaches when implementing programs in community-based settings with lower resources.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 2","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833255","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 loop on tourniquet safety in distal radius fracture fixation surgery: a two-cycle quality improvement project.","authors":"Mahmoud Mersal, Samer Sarofeen, Osama Embaby, Sara Shammout, Ciara O'Sullivan, Chloe Lawrence, Sitaram Giri","doi":"10.1136/bmjoq-2025-003956","DOIUrl":"https://doi.org/10.1136/bmjoq-2025-003956","url":null,"abstract":"<p><strong>Background: </strong>The application of intraoperative tourniquets is a fundamental component of distal radius fracture surgery, yet it carries a risk of significant complications. The British Orthopaedic Association (BOA) has published safety guidelines (BOA Standards for Trauma (BOAST)) to standardise practice, but adherence is often suboptimal. This quality improvement project aimed to evaluate and improve compliance with these guidelines in a real-world clinical setting.</p><p><strong>Methods: </strong>A two-cycle retrospective audit was conducted at a major trauma centre in the UK. The first cycle (January to April 2023, n=34) established baseline compliance with seven key BOAST documentation standards. Following this, a multifaceted intervention was implemented, including staff education, the introduction of a standardised checklist and the placement of visual reminders in operating theatres. A re-audit was then conducted (May to June 2024, n=63) to measure the impact of these interventions.</p><p><strong>Results: </strong>Baseline documentation compliance was extremely low, with only tourniquet pressure recorded in 20.5% (7/34) and tourniquet time documented in 55.9% (19/34). Following the interventions, documentation of tourniquet pressure increased to 59.0% (37/63) and tourniquet site, padding, compressive exsanguination, skin condition, tourniquet size and tourniquet time showed modest improvements. Overall compliance, however, remained below optimal levels.</p><p><strong>Conclusions: </strong>A targeted quality improvement initiative combining education and practical tools can lead to meaningful improvements in adherence to tourniquet safety guidelines. Despite these gains, persistent documentation gaps highlight the need for more robust, system-level solutions, such as integration into electronic health records, to ensure sustained compliance and enhance patient safety.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 2","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833340","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":"Addressing low-value care (LVC) in Asia: a narrative review of Choosing Wisely and other initiatives across Asia.","authors":"Jia Xuan Yeo, Yasuharu Tokuda, Shu Sasaki, Jay Pan, Hanin Kamaruzaman, Priya Ranganathan, Liyong Lu, Aliza Mohamad Yusof, Azarinah Izaham, C S Pramesh, Hairil Rizal Abdullah","doi":"10.1136/bmjoq-2025-003806","DOIUrl":"https://doi.org/10.1136/bmjoq-2025-003806","url":null,"abstract":"<p><strong>Background: </strong>Low-value care (LVC) research originates predominantly from Western healthcare systems. This narrative review offers the first synthesis of LVC patterns, determinants and reduction initiatives across six diverse Asian countries (Japan, Singapore, South Korea, China, Malaysia and India), comparing them with Western models to inform context-specific de-implementation strategies and identify key priorities for further research.</p><p><strong>Methods: </strong>This is a narrative review of 132 English and non-English literature (2000-2025) from academic databases, grey literature, and policy documents across the six countries that was analysed using a novel framework examining LVC landscapes (healthcare challenges and measurement), determinants (structural, organisational, clinician, patient) and reduction initiatives.</p><p><strong>Results: </strong>Asian systems mirror Western pressures from demographic shifts, escalating costs and a growing burden of non-communicable diseases, underscoring the urgency of reducing LVC. Despite this, systematic measurement of LVC in Asia remains limited. Common LVC determinants include fee-for-service incentives, medicolegal concerns and a 'more is better' cultural perception, though further research, particularly on cross-country comparisons and from the patient's perspective, is needed. LVC reduction initiatives are still emerging in Asia, with existing approaches shaped by local cultural norms and resource constraints, suggesting that Western strategies provide valuable insights but require adaptation for successful local de-implementation.</p><p><strong>Conclusions: </strong>This multicountry review establishes a foundation for further collaborative LVC research in Asia via a holistic framework linking country-specific contexts to tailor de-implementation strategies. Key priorities for LVC research in Asia include systematic LVC quantification, development of contextualised evidence-based recommendations and implementation of contextualised multicomponent interventions, supported by further research and regional collaboration.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 2","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833313","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":"Lean management enhances antimicrobial stewardship in a Chinese psychiatric hospital: a quality improvement study on aetiological submission rates.","authors":"Lijiang Zhang, Nailing Wu, Jiyu Zheng, Yong Meng, Kui Ning, Jingjing Wang, Wenjie Ren","doi":"10.1136/bmjoq-2025-003981","DOIUrl":"https://doi.org/10.1136/bmjoq-2025-003981","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial resistance poses a significant threat to global health, exacerbated by the misuse of antibiotics. The aetiology examinations are crucial for rational antibiotic use but often inadequate in clinical practices. This study aimed to improve the aetiological submission rate before therapeutic antibiotic use (aetiological submission; AS rate) in a provincial psychiatric hospital in China using lean management to improve antimicrobial stewardship.</p><p><strong>Methods: </strong>A quality improvement initiative was conducted from June 2021 to April 2022 by employing the Define, Measure, Analyze, Improve, Control (DMAIC) lean model. The effectiveness of the intervention was evaluated by comparing the aetiological submission status of 885 hospitalised patients receiving therapeutic antibiotics during the baseline period (June to October 2021) with that of 904 inpatients during the postintervention period (November 2021 to April 2022) and by evaluating whether there was a significant difference in the AS rates within the five targeting departments before and after the intervention.</p><p><strong>Results: </strong>The hospital-wide AS rate significantly increased from 12.43% (110/885) at baseline to 84.96% (768/904) after intervention (χ²=941.24, p<0.001), exceeding the target of 50%. Significant improvements (all p<0.001) were also observed in all targeting departments.</p><p><strong>Conclusion: </strong>The application of lean management, specifically the DMAIC lean model, proved highly effective in enhancing the AS rate. This systematic approach provides an improvement model for antimicrobial stewardship and offers valuable experience and reference for other healthcare institutions in their antimicrobial stewardship practices.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 2","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833252","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":"Towards resilient and agile health systems: lessons from abrupt donor withdrawal in Jordan.","authors":"Salma Jaouni, Peter Lachman, Samar Hassan","doi":"10.1136/bmjoq-2025-004084","DOIUrl":"10.1136/bmjoq-2025-004084","url":null,"abstract":"<p><strong>Background: </strong>Donor-funded health programmes strengthen national quality systems in low-income and middle-income countries, but abrupt withdrawal of external support can create institutional gaps and threaten service sustainability.</p><p><strong>Aim: </strong>To analyse the impact of sudden donor funding cessation, using the experience of the Health Care Accreditation Council (HCAC) as an illustrative case, and to explore implications for quality infrastructure and health system resilience.</p><p><strong>Methods: </strong>This structured case-based policy analysis draws on institutional documentation, administrative records and publicly available reports to examine the effects of funding withdrawal on quality programmes and organisational capacity.</p><p><strong>Results: </strong>Funding cessation led to contraction of technical workforce capacity, scaling back of quality improvement and professional development activities, and disruption of accreditation-related support. The case exposed vulnerabilities associated with donor dependency and insufficient transition planning.</p><p><strong>Conclusion: </strong>Abrupt donor withdrawal can weaken quality systems and patient safety gains. Strengthening resilience requires diversified financing, structured transition frameworks and institutional strategies that embed quality governance within nationally owned systems.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 2","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147761811","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}