BMJ Open Quality最新文献

{"title":"A one-stop clinic improvement project for postmenopausal bleeding in NHS Forth Valley.","authors":"Andrew Robinson, Donald Wilson, Dawn Mahal","doi":"10.1136/bmjoq-2024-003248","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003248","url":null,"abstract":"<p><strong>Background: </strong>Referrals for postmenopausal bleeding (PMB) were creating a pressure point within a general gynaecology outpatient clinic in NHS Forth Valley (NHSFV) in Scotland. This project originated in concerns around delays in time from referral to diagnosis as a result of this pressure point.</p><p><strong>Aim: </strong>The aim of this project was to test the efficiency of a process change which reduced waiting time from referral to diagnosis for patients with PMB.</p><p><strong>Methods: </strong>Use Active Clinical Referral Triage (ACRT) and a one-stop clinic to reduce waiting lists. Quality improvement methods including data collection and process mapping were used to understand the current system. Cycles of the Plan-Do-Study-Act (PDSA) tool were applied to test the concept of introducing a one-stop clinic for PMB.</p><p><strong>Results: </strong>Qualitative data gathered during the project showed that patients preferred the one-stop clinic. Limited quantitative data indicated the one-stop clinic design reduced PMB referral waiting time for patients.</p><p><strong>Conclusion: </strong>Our aim was to streamline a process to reduce waiting time between referral and diagnosis for patients with PMB. This was achieved by the creation of a one-stop clinic for PMB/unscheduled bleeding on HRT (hormone replacement therapy) patients. The work to date has highlighted the efficiency of the new process and ultimately suggests the potential for a reduction in waiting times in this pathway.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942274","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":"Invisible harm in patient safety: a framework and definition for preventable psychological harm in cancer care.","authors":"Lara Dreismann, Sofia Zambrano, Yvonne Pfeiffer, David Schwappach","doi":"10.1136/bmjoq-2025-003466","DOIUrl":"10.1136/bmjoq-2025-003466","url":null,"abstract":"<p><strong>Background: </strong>While patient safety is receiving increasing attention in healthcare services research and policies, it is mainly centred around prevention of physical harm. Preventable psychological harm (PPH) remains invisible in reports and quality measurements. As patients with cancer are particularly vulnerable due to the severity of their condition and therapies, they are exposed to risks such as non-physical adverse events. Recently, incidents of psychological harm have gained more attention in patient safety research, but a common and accepted definition and classification are missing.</p><p><strong>Aim: </strong>We aimed to develop a common definition of PPH and a corresponding framework to classify events, settled within patient safety concepts and terminology.</p><p><strong>Methods: </strong>Through a literature review, expert interviews from various healthcare backgrounds and workshops with patient representatives, we gathered information on PPH, which was reviewed and structured by an interdisciplinary research team (patient safety, psycho-oncology, palliative care research, nursing, organisational psychology). The final definition and framework were iteratively developed taking into account existing patient safety concepts.</p><p><strong>Results: </strong>The definition broadens the classification of PPH to include a wide range of commissions and omissions by individuals or organizational practices within the health care system. These actions and inactions result in consequences of varying severity for patients and their close ones. The framework complements the definition of PPH, including those impacted by PPH, types of PPH, potential causes and contributing factors, vulnerabilities influencing severity and occurrence, moderating factors for mitigation and negative consequences of PPH.</p><p><strong>Conclusions: </strong>Defining and classifying PPH is the first step to make it accessible for measurement, analysis and prevention. Its integration within patient safety terminology is important to ensure uptake and integration in research and practice.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12414170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942322","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":"Streamlining organ donation: impact of an artificial intelligence-based protocol post-brain death.","authors":"Srikanth Er, Jaisankar P, Shalini Nair","doi":"10.1136/bmjoq-2025-003334","DOIUrl":"10.1136/bmjoq-2025-003334","url":null,"abstract":"<p><strong>Background: </strong>Delays in organ retrieval following brain death (BD) can compromise organ viability, increasing the risk of post-transplant complications. In 2021, the Transplant Authority of Tamil Nadu, India, implemented an artificial intelligence (AI)-based application aimed at expediting data verification to reduce delays and improve transparency in organ procurement. This retrospective observational study evaluated the effect of this intervention and identified key factors contributing to delays.</p><p><strong>Methods: </strong>Data were collected from organ donors declared dead by neurological criteria (DND) between January 2018 and December 2023. Donors were categorised into two groups: pre-AI implementation (P1) and post-AI implementation (P2). Factors leading to delay were classified into four domains: family-related, physician-related, institution-related and government-related domains. A fishbone analysis was used to identify root causes.</p><p><strong>Results: </strong>A total of 45 DND cases were analysed. The median time from the first apnoea test to organ procurement was 1657 (IQR, 1499-1899) min. A statistically significant increase in the retrieval time was observed at P2: 1587 (IQR, 1328-1779) min at P1 vs 1660 min (IQR, 1556-1959) at P2 (p=0.04). This increase was primarily driven by longer delays in transferring patients to the operating room after legal verification, which rose from 125 (IQR, 96-231) to 384 (IQR, 186-457) min (p=0.002).</p><p><strong>Conclusion: </strong>This study underscores critical factors affecting organ retrieval timelines in a low-income to middle-income setting. While the AI-based protocol enhanced data verification and transparency, it also introduced unanticipated procedural delays. Ongoing evaluation and iterative refinement of AI tools are essential to optimise organ procurement efficiency and clinical outcomes.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144941834","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":"Evaluation of patient satisfaction after primary care system interventions: a follow-up study.","authors":"Noleen Marie Fabian, Carol Stephanie Chua Tan-Lim, Leonila F Dans, Mark Anthony U Javelosa, Antonio L Dans","doi":"10.1136/bmjoq-2024-003271","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003271","url":null,"abstract":"<p><strong>Background: </strong>The Philippine Primary Care Studies implemented interventions that aimed to improve primary care services in selected urban, rural and remote communities. This study aims to describe trends in patient satisfaction in years 2 and 3 after implementation of primary care interventions.</p><p><strong>Methods: </strong>This study is a serial cross-sectional study that assessed patient satisfaction under the domains of healthcare availability, service efficiency, technical competency, environment, location, health communication, handling and general perception in three primary care sites. Patient satisfaction was obtained via a 16-item questionnaire at baseline, and at 2 and 3 years after implementation. Pairwise testing was conducted to compare significant changes across sites over the time points.</p><p><strong>Results: </strong>There were 200 respondents per time point for each of the three sites. Despite the cessation of funding, system changes allowed significant improvements in patient satisfaction at the urban site. The improvements were noted in 12 out of 16 items in year 3 compared with baseline. These items belonged to the domains of healthcare availability, service efficiency, technical competency, health communication, handling and general perception. At the rural site, patient satisfaction decreased in 4 out of 16 items by year 3. These items belonged to the domains of handling and general perception. At the remote site, a significant decline in patient satisfaction was noted in 8 out of 16 items by year 3. These items belonged to the domains of healthcare availability, service efficiency, environment, location and health communication.</p><p><strong>Discussion: </strong>Patient satisfaction increased in the urban site and declined in the rural and remote site 3 years after implementation of a primary care system, when funding ended. This suggests that patient satisfaction in the urban centre was related more to the system improvements rather than fund augmentation.In contrast, it was more difficult to improve patient satisfaction in the rural and remote sites for two reasons. First, baseline satisfaction was much higher in these areas. This was probably because patients did not have alternative options for care and were therefore more appreciative. Second, cessation of financial aid led to an inability to sustain the system changes that were implemented on initiation. Their brief experience with primary care enhancements may have added perspective on pre-existing deficiencies they previously did not notice.</p><p><strong>Conclusions: </strong>Modest financing and systemic improvements in primary care can lead to a significant increase in patient satisfaction. If funding is not sustained, however, patient satisfaction may decline significantly, especially in remote and underserved areas.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942337","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":"Enhancing patient flow through standardised discharge pathways for neurology and medicine services.","authors":"Colin M McCrimmon, Molly R Fensterwald, Linda K Czypinski, Marc R Nuwer, Sherrille E Abelon, Melissa Reider-Demer","doi":"10.1136/bmjoq-2024-003303","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003303","url":null,"abstract":"<p><strong>Background and objectives: </strong>Poor discharge planning impairs hospital throughput, adds to the financial strain on health systems and diminishes patient and provider satisfaction. We developed consensus-based discharge criteria coupled with a standardised discharge pathway for four presenting diagnoses and tracked their effect on discharge timing and length of stay (LOS).</p><p><strong>Methods: </strong>Medical readiness for discharge criteria for patients diagnosed with transient ischaemic attack, seizure, demyelinating disease or syncope were generated by expert consensus at our institution. A standardised discharge pathway was developed for eligible patients based on discussions with stakeholders and staff. Discharge timing and readmissions were tracked for 6 months pre-intervention and 12 months post-intervention (divided into 6 months of implementation and post-implementation periods). The primary outcome was a discharge time of ≤2 hours for 60% of patients during the implementation period. Secondary outcomes included reduced time to discharge (TTD) and LOS compared with the pre-intervention period.</p><p><strong>Results: </strong>318 total patient visits were included across the baseline, implementation and post-implementation periods. Median TTD improved from 171 min at baseline to 88 and 92 min, respectively, during the implementation and post-implementation periods. Median LOS similarly decreased from 94 hours to 35 and 30 hours, respectively. All primary and secondary outcomes were achieved during the implementation period and sustained post-implementation. The rate of emergency department visits and hospital readmissions within 30 days remained low (~1.5%) post-intervention. Additionally, most providers reported that the intervention improved clinical workflow.</p><p><strong>Conclusions: </strong>This standardised discharge framework improved discharge efficiency for patients with four common diagnoses during an 18-month quality improvement study. The framework and its implementation are highly scalable, and similar systems-level approaches should be considered by hospitals to improve throughput.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942271","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":"Low-touch approach empowering clinical teams to improve the medical on-call communication experience.","authors":"Adele Marie Harrison, Julia Porter","doi":"10.1136/bmjoq-2024-003197","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003197","url":null,"abstract":"<p><strong>Background/purpose: </strong>Team functioning is integral to providing high quality patient care. Improving communication during on-call medical coverage requires a level of individual engagement that can be challenging to achieve in large organisations, particularly in a climate of high population healthcare needs and health human resource limitations. This project represents a novel approach through engaging care providers in addressing on-call communication culture using a systems approach and quality improvement methodology.</p><p><strong>Methods: </strong>Factors that influence the interdisciplinary experience of making, receiving and responding to calls about patient care were identified. An asynchronous action series addressed the key drivers of a good call experience.</p><p><strong>Results: </strong>The Good Call Action Series was developed collaboratively by interdisciplinary teams. Six multidisciplinary teams across seven specialties participated over 5 months. A modified team effectiveness score demonstrated a 13% improvement on completion of the action series.</p><p><strong>Conclusion: </strong>System thinking can be effectively applied to the complexity of the on-call experience for all members of the healthcare team. Clinical teams can develop team functioning skills and solve complex on-call communication issues with minimal support and without structured quality improvement training. Low-touch, time-efficient activities designed and delivered using quality improvement methodology can effectively address team-based care delivery challenges.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942371","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":"Task shifting: a key aspect to improving care for women at risk of preterm birth.","authors":"Laurence Nathalie Irene Frei, Naomi Carlisle, Zoe Manton, Mareike Bolten, Helena A Watson","doi":"10.1136/bmjoq-2024-003104","DOIUrl":"10.1136/bmjoq-2024-003104","url":null,"abstract":"<p><strong>Local problem: </strong>Until April 2021, women presenting to maternity triage with symptoms of threatened preterm labour (TPTL) and/or preterm premature rupture of the membranes (PPROM) were triaged by a doctor. Depending on the acuity on the labour ward, women in triage often had a long wait for a doctor's review. These delays create anxiety for women and impair the capacity of triage midwives to care for other women.</p><p><strong>Methods: </strong>The Plan-Do-Study-Act method of quality improvement was used for this project. 3 months prior to the intervention, the baseline assessment was women's wait time for medical review when presenting with TPTL and/or PPROM.</p><p><strong>Intervention: </strong>Triage midwives were trained in performing speculum examination on preterm (<37 weeks' gestation) women to allow quicker review. Waiting time for review by a midwife vs doctor was compared using data collected between January and December 2021.</p><p><strong>Results: </strong>88 eligible women were identified. 44 cases (intervention group) had their initial assessment by the triage midwife, while 44 cases (control group) had their initial assessment by a doctor. The mean waiting time between arrival and performance of quantitative fetal fibronectin (qfFN) in the intervention group was 67 min (SD=42.7), compared with 127 min (SD=61.2) in the control group (p<0.001). However, there was no significant difference in the waiting time between arrival and discharge/admission.</p><p><strong>Conclusion: </strong>Women presenting with symptoms of TPTL are reviewed on average twice as quickly by the triage midwife compared with a doctor, allowing a quick reassurance for those where TPTL/PPROM has been excluded. However, the overall waiting time in triage was similar, as women in our unit currently need a doctor's review before discharge.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942067","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":"What should a learning health system look like?","authors":"Robbie Foy, Paul Carder, Stella Johnson, Bethan Copsey, Sarah Alderson","doi":"10.1136/bmjoq-2025-003455","DOIUrl":"https://doi.org/10.1136/bmjoq-2025-003455","url":null,"abstract":"","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144941994","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 an acute abdominal pain diagnostic pathway in the emergency department.","authors":"Samari Blomerus, Tracy-Lee Splinter, Amy Gillis, Orla Buckley, Hannah Turner, Aileen McCabe","doi":"10.1136/bmjoq-2025-003505","DOIUrl":"https://doi.org/10.1136/bmjoq-2025-003505","url":null,"abstract":"<p><p>Acute abdominal pain is a common acute presentation to the emergency department (ED). Contrast-enhanced abdominopelvic CT (AP CT) is typically the most appropriate imaging test. Previously in our ED, it was noted that the process to access AP CT was complicated and associated with delays. We implemented a quality intervention project to develop and implement a diagnostic pathway of ED patients with acute abdominal pain requiring AP CT imaging. Our overall aim was to improve ED length of stay and ED process times for patients presenting with acute abdominal pathology to our ED.After baseline data collection, we conducted a phased improvement project with pre-measurement and post-measurement. A rationalised multidisciplinary diagnostic pathway was agreed by the radiology, general surgery and emergency medicine teams. The imaging protocol for AP CT abdomens was revised using intravenous contrast only for the majority of patients. The ED length of stay statistically significantly improved from the pre-implementation period (1532 min), the first evaluation (1312 min) and the second evaluation period (1216 min) (p value<0.01). There was a non-statistically significant improvement in the mean-time from ED arrival to AP CT scan in the pre-implementation and post implementation phases (855 min in pre-implementation phase and 670 min and 621 min in the first and second phases, respectively, p=0.06). The overall positivity for significant acute pathology on CT abdomen in the implementation loop was 79.6%.The introduction of an acute abdominal pain diagnostic pathway improved ED throughput times and reduced admission rates in patients presenting to the ED with acute abdominal pain. The high diagnostic yield from AP CT scans indicates that our pathway was appropriate for ED patients with undifferentiated acute abdominal pain requiring urgent advanced imaging.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942306","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":"Transforming care with community breast pain clinics: a validated innovative solution benefitting patients and the healthcare system.","authors":"John Robertson, Thilan Bartholomeuz, Veronica Rogers, Kevin Clifton, Izaak Gilchrist, Emily Griffiths, Mark Sibbering","doi":"10.1136/bmjoq-2025-003363","DOIUrl":"https://doi.org/10.1136/bmjoq-2025-003363","url":null,"abstract":"<p><strong>Rationale: </strong>Literature shows that breast pain alone has no significant association with breast cancer. Currently, patients experiencing these symptoms are often referred to breast cancer diagnostic clinics (BCDCs), leading to an increase in unnecessary anxiety and overutilisation of already strained secondary care resources. The East Midlands Breast Pain Pathway (EMBPP) aims to establish a new pathway that improves patient care and eases pressure on BCDCs, as well as being cost-beneficial and providing a positive patient experience.</p><p><strong>Aim and objectives: </strong>This study aims to evaluate the impact of the EMBPP on patient care, including safety, costs incurred by the health system and patient experience.</p><p><strong>Methods: </strong>The EMBPP was analysed quantitatively and qualitatively using data extracted from the community breast pain clinics (CBPCs), BCDCs, patient-reported outcome measures, clinic costs, family history data and staff interviews.</p><p><strong>Results: </strong>Breast cancer incidence within the cohort of patients with a full 12-month follow-up period was shown to be 3.7 per 1000 patients, below the population estimates in the literature. There was no delay to care for those who were diagnosed with breast cancer after attending a CBPC. The clinics were found to be cost-beneficial, with a cost-benefit ratio of 1.26 in year 1, 1.40 in year 2 and 1.56 in year 3. The pathway was positively received by patients, with 98.7% indicating that they would recommend the service.</p><p><strong>Conclusion: </strong>Following on from previous audits and analysis of the EMBPP pathway, this national evaluation has shown that CBPCs are effective across multiple Cancer Alliances, National Health Service (NHS) Trusts and demographics. The CBPC offers a positive patient experience and is cost-beneficial and safe, with no evidence of a delay to care for the patients.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942077","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}