BMJ Open Quality最新文献

{"title":"Community breast pain clinics can provide safe, quality care for women presenting with breast pain.","authors":"Mark Sibbering, Veronica Rogers, Louise Merriman, Iman Azmy, Denise Stafford, Kevin Clifton, Jennifer Pickard, Thilan Bartholomeuz, John Robertson","doi":"10.1136/bmjoq-2024-002882","DOIUrl":"10.1136/bmjoq-2024-002882","url":null,"abstract":"<p><strong>Introduction: </strong>Breast pain is not typically a symptom of breast cancer, yet nationally 20% of 2-week wait (2WW) breast referrals are breast pain alone. The East Midlands Breast Pain Pathway improves patient experience and frees capacity in secondary care diagnostic breast clinics, managing women with breast pain only in a community setting. We report the results of implementation of community breast pain clinics (CBPCs) at sites in Derbyshire (catchment population ~1 million), with 12 months follow-up data.</p><p><strong>Results: </strong>1036 patients were seen at CBPCs between June 2021 and February 2023. The median patient age was 49 (range 16-88) years. 993 patients (95.8%) were discharged from the clinic with breast pain management advice. 43 (4.2%) patients were referred for further assessment at a 2WW breast diagnostic clinic. Objective family history risk assessment identified 124 patients (12.3%) above population risk of breast cancer, who were offered referral to familial cancer services for ongoing management.</p><p><strong>Discussion: </strong>Seven patients were diagnosed with breast cancer at or within 12 months of CBPC attendance. Five patients were diagnosed through attending the CBPC, one patient was subsequently referred to 2WW clinic with a new symptom and had a mammographically occult tumour and one was diagnosed following a subsequent routine breast screening invitation. Two of the five patients had a personal history of breast cancer which was a stated exclusion criterion for the CBPC. Breast cancer incidence in women with breast pain only and fulfilling CBPC referral criteria was 4.8/1000, confirming that this population is at low risk of developing breast cancer.Patient service satisfaction was high with 99% (n=1022) 'extremely likely or likely' to recommend the service.</p><p><strong>Conclusion: </strong>The results confirm the pathway is the first to demonstrate women can be safely managed with breast pain alone in a community setting with high levels of patient satisfaction.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"13 4","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11529464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543549","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":"Interactive hygiene training using free open source software.","authors":"Michael Eisenmann, Vera Rauschenberger, Jens Maschmann, Sarah König, Manuel Krone","doi":"10.1136/bmjoq-2024-002861","DOIUrl":"10.1136/bmjoq-2024-002861","url":null,"abstract":"<p><strong>Objectives: </strong>Regular hygiene trainings are an important way to refresh and improve knowledge about hygiene measures and the prevention of healthcare-associated infections. We aimed to develop an e-learning course to allow healthcare workers (HCWs) to learn these contents through a self-paced online format.</p><p><strong>Methods: </strong>We developed an interactive hygiene training for HCWs of a tertiary care hospital using different content types of the HTML-5 package (H5P) plugin embedded into a Moodle-based learning management system. We evaluated the course using a short online questionnaire.</p><p><strong>Results: </strong>We present various suitable topics for online hygiene trainings as well as their implementation in an e-learning course. Examples include content on hand hygiene indications and techniques, information on multidrug-resistant organisms and other current topics in infection control. HCWs reported high overall satisfaction, perceived increase in knowledge, practical relevance as well as good usability and comprehensibility.</p><p><strong>Discussion: </strong>Currently available commercial and non-commercial hygiene trainings present a number of specific advantages but also drawbacks. The presented approach combines the advantages of both approaches. The majority of the presented content can be readily adapted to suit various hospitals and care facilities or serve as inspiration for creating similar courses while remaining cost-effective.</p><p><strong>Conclusion: </strong>H5P course presentations are a low-threshold, cost-effective way to implement digital hygiene trainings in a wide variety of clinical settings.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"13 4","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11529684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543551","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":"Implementing a multisite shared haemodialysis care programme.","authors":"David Green, Angela Pietrafesa, Marianne Reyes, Giada Donnini, Evelyn Gicana, Evelyn Nadurata, Juniya John, Jessica Ponting, Raji Srinivasan, Udaya Prabhakar Udayaraj","doi":"10.1136/bmjoq-2024-003044","DOIUrl":"10.1136/bmjoq-2024-003044","url":null,"abstract":"<p><p>Adults receiving centre-based haemodialysis (HD) have low levels of patient activation which are associated with poorer outcomes. Shared haemodialysis care (SHC) describes an intervention whereby individuals are supported to undertake elements of their treatment to improve their activation levels and promote better self-care. This project aimed to increase the proportion of those performing SHC in seven HD centres within the Oxford Kidney Unit's catchment area. Sequential Plan-Do-Study-Act (PDSA) cycles effected change first in two central HD centres, in cycles 1 and 2, before rolling out to five satellite HD centres, in cycles 3 and 4. Cycle 1 explored and transformed staff perceptions regarding SHC using a questionnaire and teaching sessions while in cycle 2, staff partnered with patients to develop leaflets and noticeboards to improve awareness and participation. These interventions were then rolled out to the remaining HD centres in PDSA cycles 3 and 4. Other interventions included: Enrolling staff and patients in virtual training courses; designating SHC 'Champions'; engagement with a national SHC forum; and changes to the electronic patient record to enable the monitoring of patient SHC opportunity and to promote sustainable change. Outcome measurement data on the number of patients performing SHC and the number at different defined stages of SHC competency were captured monthly. In April 2022, only 4% (19/483) of those receiving centre-based HD performed any aspect of SHC. By the end of the project in December 2023, this had increased to 43% (220/511). There was a significant and sustained growth in the stage of patient SHC competency as well as the number of patients performing SHC in each HD centre. The project demonstrated that it is possible to implement, scale-up and maintain a multisite SHC programme even with little baseline staff and patient SHC experience.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"13 4","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11529755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing healthcare waste by eliminating exam table paper in a primary care practice: a sustainable quality improvement initiative.","authors":"Ilona Hale, Amanda McKenzie","doi":"10.1136/bmjoq-2024-002838","DOIUrl":"10.1136/bmjoq-2024-002838","url":null,"abstract":"<p><strong>Purpose: </strong>Climate change is now the greatest threat to human survival. The healthcare system contributes significantly to global pollution and greenhouse gas emissions. Individual practitioners play an important role in helping to reduce these impacts in day-to-day practice. Deimplementation of unnecessary processes and products, such as exam table paper, in medical offices is one simple approach to incorporating principles of planetary health into practice. All quality improvement (QI) projects must start to consider environmental impacts to fully evaluate change ideas.</p><p><strong>Methods: </strong>We designed a single Plan-Do-Study-Act cycle using the Institute for Health Improvement Model for Improvement. We removed the exam table paper from our primary care office and measured changes in staff time, laundry, financial costs, paper use and carbon dioxide (CO₂) emissions.</p><p><strong>Results: </strong>Eliminating exam table paper in our clinic resulted in modest annual cost savings of $C718 and improved staff efficiency and motivation to introduce other green office practices. In our clinic alone, this change will save 8.2 km of exam table paper, 10 trees and 148 kg of CO2e (equivalent to driving 1233 km) every year. There were no negative consequences or feedback.</p><p><strong>Conclusions: </strong>This simple QI project demonstrates the feasibility of implementing a small change in a primary care clinic that can improve environmental sustainability with multiple co-benefits. If all family physicians in Canada eliminated exam table paper in their offices, it would result in savings of approximately 95 940 km of paper, 121 680 trees, $C8 400 600 and 3054 T CO₂ emissions, equivalent to driving around the world 360 times.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"13 4","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11529457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520974","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":"Resilience in nursing medication administration practice: a systematic review with narrative synthesis.","authors":"Pollyanna Lr Kellett, Bryony Dean Franklin, Susie Pearce, Jonathan Benn","doi":"10.1136/bmjoq-2023-002711","DOIUrl":"10.1136/bmjoq-2023-002711","url":null,"abstract":"<p><p>Resilience in nursing medication administration practice: a systematic review with narrative synthesis.</p><p><strong>Objective: </strong>Little is known about how nurses adapt medication administration practices to preserve safety. The capacity to adapt and respond before harm occurs has been labelled 'resilience'. Current evidence examining medication safety largely focuses on errors and what goes wrong. This review aimed to synthesise evidence for the application of resilience principles and practices in nursing medication administration.</p><p><strong>Design: </strong>The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided the review, which was registered with PROSPERO.</p><p><strong>Data sources: </strong>MEDLINE, EMBASE, PsychINFO and CINAHL databases were searched from 14 August 2020 to 1 January 2021 for English-language studies.</p><p><strong>Methods: </strong>A systematic review of empirical studies of any design relating to resilience and safety in nursing medication administration in the inpatient setting was conducted. Methodological quality was appraised using the Mixed Methods Appraisal Tool. Data were synthesised thematically.</p><p><strong>Results: </strong>Thirty-two studies with a range of methodologies of mostly good quality met the inclusion criteria. Eleven interventional studies included two that evaluated the effectiveness of education interventions and nine exploratory studies with outcomes showing the impact of an intervention designed or examined to build resilience. Twenty-one non-interventional studies showed how resilience principles are put into practice. Only three studies explicitly named the concept of resilience. Resilient medication administration strategies result from five triggers.</p><p><strong>Conclusions: </strong>Nurses' resilience practices were found to be responses to identified trigers that threaten safety and productivity. These were often short term, real-time proactive adaptations to preserve safety, compensating for and responding to complexities in the modern healthcare setting.</p><p><strong>Prospero registration number: </strong>CRD42018087928.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"13 4","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11529676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520975","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 the assessment of cultural, religious and spiritual needs for patients at the end-of-life within an acute hospital trust.","authors":"Nipuna Gunawardena, Hannah Britton, Jacqueline Roy, Samantha Harding, Stephanie Eckoldt, Natasha Lovell","doi":"10.1136/bmjoq-2024-002821","DOIUrl":"10.1136/bmjoq-2024-002821","url":null,"abstract":"<p><strong>Background: </strong>Cultural, religious and spiritual (CRS) needs become increasingly important to individuals as they approach the end of life. CRS needs often remain unmet for patients dying in an acute hospital setting. The 'Just Ask' quality improvement project was designed to explore barriers to routine assessment of CRS needs, and to design resources and intervention to support staff to increase assessment of these needs.</p><p><strong>Aims: </strong>The primary aim of the project was to increase the number of patients receiving end-of-life care in hospital with a documented CRS needs assessment from 43% (based on audit data) to greater than 50% over the 9-month project.</p><p><strong>Design: </strong>The study occurred in two phases.The scoping phase evaluated the current service, enablers, barriers and confidence in assessing CRS needs using an online staff survey and four staff focus groups. Results were analysed using qualitative content analysis, descriptive statistics and thematic analysis and informed the intervention phase.The intervention phase consisted of two Plan-Do-Study-Act (PDSA) cycles focusing on resource visibility/accessibility, organisational value placed on CRS needs assessment and staff education.Outcomes (documented CRS needs assessment) were measured by case notes review over 3 month periods - 1 year prior to and after the PDSA cycles. The impact of education interventions on staff confidence relating to CRS needs assessment were measured via an anonymous questionnaire.</p><p><strong>Outcome: </strong>Documented assessment of CRS needs increased from 43% to 57% in patients receiving end-of-life care in our hospital. Staff confidence scores in CRS needs assessment increased by 46-87%.</p><p><strong>Conclusions: </strong>The factors that influence the addressing of CRS needs in a busy hospital are multifactorial. Organisational culture, appropriate resource provision and visibility, and education are essential factors in supporting staff to recognise, understand and engage with CRS needs assessment in patients receiving end-of-life care in hospital.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"13 4","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11529749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142494845","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 the efficiency and person-centredness of occupational therapy input into care-plans in a forensic mental health and rehabilitation service.","authors":"Joshua Jesudunsin Ige Ige, Amanda Alston, Velmer Boreland, Megan Caudwell, Rhiannon Ashbourne, Bronwen Ford, Fortunate Katsere, Georgia Banham","doi":"10.1136/bmjoq-2024-002883","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-002883","url":null,"abstract":"<p><p>Care-planning is vital to the delivery of timely, person-centred, safe and effective care. Despite the understanding of the benefits of person-centred care-plan in both services, occupational therapists (OTs) within our forensic and rehabilitation services had difficulties in inputting into patient care-plan an efficient and person-centred manner.The OT team developed a Quality Improvement (QI) project to improve the efficiency of the OT process to create more time for care-planning and improve person-centredness of OT input into care-plans to 82% in the forensic services and rehabilitation services by December 2023.The results indicated an increase in the person-centredness of care-plans from 63.64% to 84.34% within the rehabilitation service and an increase from 65.15% to 95.45% in the forensic service. This project used feedback from patients to develop our input into care-plans. The project also increased the efficiency of the admission process and released time to be spent on care-planning and treatment.We improved the quality of our input to care-plans in a sustainable way by using the Royal Academy of Improvement sustainability measure and taking actions which included training our band 6 and 7 OTs to complete their monthly audit and reporting this as part of the head of nursing report for assurance in our monthly Clinical and Operational Assurance Team meetings. These actions ensured that our project fitted with the organisation's strategic aims and values. We also used low carbon alternatives by holding most of our improvement meetings online and eliminating the use of paper.Lastly, we improved the generalisability of this project by using the Goal Directed Care Plan audit tool, which is a well-researched, evidence-based tool created by service-users, carers and members of staff. This was used to train members of staff and develop an example of a person-centred input into care-plans to improve their practice.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"13 4","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142494846","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":"Costs and benefits of routine labs in hospital patients: iatrogenic anaemia and undiagnosed acute kidney injury.","authors":"Dawson Dean","doi":"10.1136/bmjoq-2024-002884","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-002884","url":null,"abstract":"<p><strong>Importance: </strong>Guidelines recommend avoiding unnecessary laboratory tests to minimise risks of anaemia in hospitalised patients as well as reduce costs, but there are costs to skipping routine labs including missing acute kidney injury.</p><p><strong>Objective: </strong>Quantify the costs and benefits of routine labs in dollar costs as well as mortality.</p><p><strong>Evidence review: </strong>This is a retrospective analysis of 48 204 admissions at University of Kentucky Hospitals and simulates different strategies for skipping labs.</p><p><strong>Findings: </strong>In a simplified estimate of pure dollar costs, the costs of daily labs appear to outweigh the costs of missing acute kidney injury.</p><p><strong>Conclusions and relevance: </strong>In both dollar costs and the number of patients with mortality effects, the benefits of randomly skipping labs appear to significantly outweigh the costs, but the costs are not insignificant.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"13 4","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11499769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142494835","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":"Early ward discharge clinic: facilitating discharges and prompt follow-up for medical inpatients in a district general hospital.","authors":"Georgia Kate Galloway, Tasneem Ahmed, Sarah Nahin Choudhury","doi":"10.1136/bmjoq-2024-002935","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-002935","url":null,"abstract":"<p><p>Early discharge and follow-up for medical admissions could facilitate reduced length of stay and improve patient satisfaction. However, evidence to confirm this is lacking. Peterborough City Hospital (PCH) designed an early ward discharge clinic (EWDC) service embedded within its acute medicine department to provide clinicians with the opportunity for a prompt clinical review following a hospital admission.Across three cycles, several interventions aimed to improve the utilisation of clinic, appropriateness of referrals and reduce the number of missed attendances. Our work has demonstrated that a service such as the EWDC can provide ample opportunity for early review of patients which could reduce the rate of readmissions and improve services. Interventions to date have improved the utilisation of the clinic, reduced the number of patients not being aware of appointments and provided training opportunities for junior clinicians. Data has also suggested a high level of patient satisfaction from using the service.Further research is needed to confirm the use of such services in reducing readmissions and mortality, however, results from clinics at individual units such as PCH provide useful insight until such data is available.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"13 4","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11499832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142494844","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":"Implementation of a standardised questionnaire for documenting preoperative respiratory illness in paediatric patients.","authors":"Abby Victoria Winterberg, Stacie Richmond, Nathaniel T G Tighe, Jennifer Buckley, David Winthrop Buck","doi":"10.1136/bmjoq-2024-002843","DOIUrl":"10.1136/bmjoq-2024-002843","url":null,"abstract":"<p><p>Paediatric patients often present with symptoms of respiratory illnesses in the weeks leading up to surgery. Current or recent illness can increase the risk of experiencing perioperative respiratory complications. Ideally, children with recent illnesses should be identified before coming to the hospital to determine the safest course of action. We recognised that our system lacked a standardised process for documenting preoperative respiratory illness during the preoperative phone call. The global aim of this quality improvement initiative was to decrease paediatric perioperative respiratory adverse events. The SMART Aim (Specific, Measurable, Achievable, Relevant and Time-bound) was to increase the percentage of patients with standardised documentation of preoperative respiratory illness from 0% to 90% by 1 March 2023. Implementation of a standardised preoperative illness questionnaire increased standardised illness documentation from 0% to 95%. Nurses quickly adopted this intervention and easily integrated it into their routine workflow. Clinical leaders elected to implement the intervention electronically across all three operating room (OR) locations (main OR, satellite location and procedure centre). Future implementation of additional standardised preoperative processes will be needed to improve the global aim of decreasing perioperative respiratory complications.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"13 4","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11492934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142457686","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}