BMJ Quality & Safety最新文献

{"title":"Widespread inappropriate prescribing for older people with reduced kidney function: what are the harms and how do we tackle them? A scoping review for primary care.","authors":"Owen Thomas, Liz Glidewell, Sarah Alderson, David K Raynor, Su Wood","doi":"10.1136/bmjqs-2025-018736","DOIUrl":"10.1136/bmjqs-2025-018736","url":null,"abstract":"<p><strong>Background: </strong>Increasing age is associated with reductions in kidney function and increasing polypharmacy. Most medicines are eliminated through the kidney, meaning older patients are at risk of medication accumulation and toxicity. This scoping review synthesised: (1) the prevalence at which older patients with reduced kidney function in primary care are exposed to inappropriate prescribing; (2) its associated harms; (3) the reasons for this occurring; and (4) the interventions used to improve prescribing practices.</p><p><strong>Methods: </strong>This scoping review searched 'Medline', 'Embase', 'PsycINFO', 'CINAHL' and 'Web of Science' for publications before October 2024. References were managed on EndNote V.X5 and thematic data analysis was undertaken on Microsoft Excel. Common themes were identified, summary statistics were calculated and insights were summarised through a narrative technique.</p><p><strong>Results: </strong>43 relevant studies explored the scale of inappropriate prescribing, estimating prevalences of patient exposure ranging from 0.6% to 49.1% (median 24.9%). Five studies explored the associated harm from inappropriate prescribing, but only one study assessed harm as a primary outcome. Eight studies that assessed difficulties in following prescribing guidelines in reduced kidney function suggested that a lack of awareness and trusted guidelines are fundamental problems. While 13 studies evaluated interventions for improving prescribing in reduced kidney function, only two demonstrated evidence of effectiveness and only one intervention was theoretically informed.</p><p><strong>Conclusions: </strong>Despite significant heterogeneity in study characteristics, it is clear that the prevalence of inappropriate prescribing for older people is uncomfortably high. There is a lack of evidence linking this to associated adverse outcomes, as well as identifying the causative issues driving this behaviour and the preventative interventions that could prevent harm.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"346-357"},"PeriodicalIF":6.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of medical safety huddles on patient safety: a stepped-wedge cluster randomised study.","authors":"Meiqi Guo, Mark Bayley, Xiang Y Ye, Richard Dunbar-Yaffe, Chris Fortin, Katharyn Go, Alyssa Macedo, John Matelski, Amanda Mayo, Jordan Pelc, Lawrence R Robinson, Leahora Rotteau, Jesse Wolfstadt, Peter Cram, Lauren Linett, Christine Soong","doi":"10.1136/bmjqs-2025-019170","DOIUrl":"10.1136/bmjqs-2025-019170","url":null,"abstract":"<p><strong>Background: </strong>Medical safety huddles are short, structured meetings for physicians to proactively discuss and respond to profession-specific patient safety concerns, with the goal of decreasing future adverse events. Prior observational studies found associations with improved patient safety outcomes, but no randomised controlled studies have been conducted.</p><p><strong>Objective: </strong>The primary objective was to determine the impact of medical safety huddles on adverse events. Secondary objectives included the fidelity of huddle implementation and the impact on patient safety culture among physicians.</p><p><strong>Design: </strong>Stepped-wedge cluster randomised trial with four sequences, and each hospital site was a cluster.</p><p><strong>Setting: </strong>Inpatient oncology, surgery and rehabilitation programmes in four academic hospitals.</p><p><strong>Participants: </strong>Physicians in participating programmes.</p><p><strong>Intervention: </strong>Medical safety huddles were adapted for local context and implemented sequentially based on a computer-generated random sequence every 2 months after a 4-month control period. All sites remained in the intervention phase for at least 9 months.</p><p><strong>Main outcome and measures: </strong>The primary outcome was the rate of adverse events, as determined through blinded chart audits of 912 randomly selected patients. The fidelity of implementation was assessed through the huddle attendance rate, number of safety issues raised in the huddles and number of actions taken in response. Patient safety culture was assessed using the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety.</p><p><strong>Results: </strong>The adjusted rate of adverse events (per 1000 patient days) in the postintervention phase was 12% lower compared with preintervention (RR: 0.88; 95% CI: 0.80 to 0.98; p=0.016). The odds of having adverse events posthuddle implementation were 17% lower in the postintervention period compared with preintervention (OR intervention vs control: 0.83; 95% CI: 0.80 to 0.87; p<0.001). The mean huddle attendance rate at each site ranged from 30% to 85%, and the mean number of issues raised per huddle and the mean number of actions taken per huddle ranged from 1.6 to 3.1. The mean (SD) overall patient safety rating increased from 2.3 (0.53) to 2.8 (0.88), p=0.010. The mean per cent (SD) positive score for the composite measures of 'Organisational learning' increased significantly from 35% (26%) to 54% (23%), p=0.00, 'Response to error' 37% (24%) to 52% (22%), p=0.025 and 'Communication about error' 36% (28%) to 64% (42%), p=0.016 after implementation.</p><p><strong>Conclusions and relevance: </strong>Medical safety huddles decreased adverse events and may improve patient safety culture through engaging physicians.</p><p><strong>Trial registration number: </strong>NCT05365516.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"326-333"},"PeriodicalIF":6.5,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145197851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustainability of the de-implementation of low-value care in infants with bronchiolitis: 2-year follow-up of a cluster randomised controlled trial.","authors":"Victoria Ramsden, Franz E Babl, Libby Haskell, Catherine Wilson, Sandy Middleton, Rachel Schembri, Alex King, Alexandra Wallace, Alison Partyka, Casey Baldock, Julian Wong, Kai Steinmann, Louise Mills, Natalie Phillips, Nola Poulter, Shefali Jani, Suzanne Kenny, Ed Oakley, Anna Lithgow, Peter Wilson, Elizabeth McInnes, Stuart Dalziel, Emma Tavender","doi":"10.1136/bmjqs-2024-018135","DOIUrl":"10.1136/bmjqs-2024-018135","url":null,"abstract":"<p><strong>Background: </strong>In 2017, the PREDICT (Paediatric Research in Emergency Departments International Collaborative) network conducted a cluster randomised controlled trial (cRCT) at 26 Australian and New Zealand hospitals to improve bronchiolitis care. Findings demonstrated that targeted interventions significantly improved adherence with five evidence-based low-value bronchiolitis practices (no chest radiography, salbutamol, glucocorticoids, antibiotics and epinephrine) in the first 24 hours of hospitalisation (adjusted risk difference, 14.1%; 95% CI: 6.5% to 21.7%; p<0.001). During the intervention year (2017), intervention hospital (n=13) compliance was 85.1% (95% CI: 82.6% to 89.7%). This study aimed to determine if improvements in bronchiolitis management were sustained at intervention hospitals 2 years post-trial completion.</p><p><strong>Methods: </strong>International, multicentre follow-up study of hospitals in Australia and New Zealand that participated in a cRCT of de-implementation of low-value bronchiolitis practices, 1 year (2018) and 2 years (2019) post-trial completion, obtained retrospectively from medical audits. Sustainability was defined a priori as no more than a <7% decrease to any level of improvement in adherence for all five low-value practices (composite outcome) from the cRCT intervention year.</p><p><strong>Results: </strong>Of the 26 hospitals, 11 intervention and 10 control hospitals agreed to participate in the follow-up study. Data were collected on 3299 infants with bronchiolitis 1 year (intervention and control hospitals) and 1689 infants 2 years post-trial (intervention hospitals). Adherence with no use of the five low-value practices 2 years post-trial completion was 80.9% (adjusted predicted adherence, 80.8%, 95% CI: 77.4% to 84.2%; estimated risk difference from cRCT outcome -3.9%, 95% CI: -8.6% to 0.8%) at intervention hospitals, fulfilling the a priori definition of sustainability.</p><p><strong>Discussion: </strong>Targeted interventions, delivered over one bronchiolitis season, resulted in sustained improvements in bronchiolitis management in infants 2 years later. This follow-up study provides evidence for sustainability in de-implementing low-value care in bronchiolitis management.</p><p><strong>Trial registration details: </strong>Australian and New Zealand Clinical Trials Registry No: ACTRN12621001287820.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"304-315"},"PeriodicalIF":6.5,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inappropriate prescribing for older people with reduced kidney function: can we do better at the primary care level?","authors":"Laetitia Hattingh, Matt Percival","doi":"10.1136/bmjqs-2025-019580","DOIUrl":"10.1136/bmjqs-2025-019580","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"300-302"},"PeriodicalIF":6.5,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145480824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning to forget: deimplementation and the science of sustainability in healthcare.","authors":"Rachel Flynn, Christine Cassidy, Shannon D Scott","doi":"10.1136/bmjqs-2025-019666","DOIUrl":"10.1136/bmjqs-2025-019666","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"293-296"},"PeriodicalIF":6.5,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of financial incentive for team-based dementia care on patient outcomes in acute-care hospitals in Japan: a difference-in-differences analysis.","authors":"Jinyan Wu, Kojiro Morita, Ayumi Igarashi, Hideo Yasunaga, Taisuke Yasaka, Yuya Kimura, Taro Kojima, Hiroki Matsui, Kiyohide Fushimi, Noriko Yamamoto-Mitani","doi":"10.1136/bmjqs-2025-019634","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-019634","url":null,"abstract":"<p><strong>Background: </strong>Dementia increases the risk of adverse outcomes during hospitalisation, underscoring the need for system-level strategies. In 2016, Japan introduced Dementia Care Add-on 1 (DCA1), a financial incentive requiring hospitals to establish multidisciplinary dementia care teams. The short-term impact of DCA1 has been elucidated; however, its potential for medium-term to long-term benefits remains uncertain. In this study, we aimed to evaluate the medium-term to long-term impact of DCA1 on care processes and patient outcomes in older adults with dementia in acute-care hospitals.</p><p><strong>Methods: </strong>Patients aged ≥65 years with moderate-to-severe dementia who were admitted to acute-care hospitals between April 2014 and March 2020 were identified using a nationwide inpatient database. Hospital-level propensity score matching was conducted, followed by a difference-in-differences analysis comparing identified inpatients of DCA1-certified and non-certified hospitals. Outcome measures were length of stay (LOS), activities of daily living maintenance, potentially inappropriate medication prescriptions, in-hospital fractures and home discharge. A sensitivity analysis excluding hospitals certified only for the less stringent DCA2 scheme was conducted.</p><p><strong>Results: </strong>Overall, 309 791 patients from 235 matched hospital pairs were analysed. DCA1 certification was not associated with improvements in the measured outcomes. Notably, >60% of DCA1 hospitals billed for <20% of eligible patients, indicating limited and inconsistent implementation. In a restricted analysis excluding DCA2-certified hospitals, DCA1 certification showed a statistically significant reduction in LOS (change: -11.3%; 95% CI -19.8% to -3.0%). No significant associations were observed for the other outcomes.</p><p><strong>Conclusions: </strong>DCA1 was not associated with measurable improvements in patient outcomes at the certification level. However, under more homogeneous comparison conditions, an association was observed with shorter LOS. These findings show that structural certification alone may be insufficient to achieve consistent improvements in dementia care outcomes in acute hospital settings.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How do community advocates address racial inequities in maternity care for Black, African, Caribbean and mixed-Black families? A realist review.","authors":"Sarindi Aryasinghe, Ruchi Wadhwa, Phoebe Averill, Gabriella Sarpong, Susan Ibuanokpe, Phayza Fudlalla, Carole Waithe, Rhianna Newby-Mayers, Abimbola Ayorinde, Sabrina Das, Helen Ward","doi":"10.1136/bmjqs-2025-019646","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-019646","url":null,"abstract":"<p><strong>Background: </strong>Black, African, Caribbean and mixed-Black women face higher maternal mortality and poorer maternity outcomes than white women due to structural, institutional and interpersonal racism. Experiences of coercion, neglect and biased decision-making foster mistrust and disengagement from care. In response, families adopt protective strategies, including using community advocates. Advocates, such as doulas and perinatal support professionals, can provide continuous, culturally tailored support that complements clinical care, improving maternal health outcomes and care satisfaction.</p><p><strong>Aim: </strong>To explore how, for whom and in what contexts community advocates address racial inequities in maternity care for Black, African, Caribbean and mixed-Black families.</p><p><strong>Methods: </strong>We conducted a realist review, developing initial programme theories and searching MEDLINE, Embase, CINAHL, Maternity and Infant Care, PsycINFO, Global Health, HMIC, Web of Science and grey literature. Sources were included if they examined use of community advocates in maternity care for Black, African, Caribbean and mixed-Black families. Data were analysed to generate and refine context-mechanism-outcome configurations with input from lived experience, policy, practitioner and academic experts.</p><p><strong>Results: </strong>Of 1168 records screened, 46 met inclusion criteria, from the USA, UK, and Canada. Three components emerged: how advocates co-create personalised care, how they are supported and how they are embedded in health systems to influence service improvements. Advocates address racial inequities by building trust, fostering family empowerment and autonomy. Effectiveness depends on formal recognition, fair remuneration, training, mentorship and institutional anti-racism support ensuring independence and accountability.</p><p><strong>Conclusion: </strong>Community advocates can reduce racial inequities in maternity care by co-creating culturally responsive, individualised, non-judgemental and empathetic care with families. Sustained impact depends on adequate support and systemic anti-racism reforms that embed advocates while preserving their independence.</p><p><strong>Prospero registration number: </strong>CRD42024596506.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147643788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring guideline concordance via electronic health records: a new model for estimating concordance scores.","authors":"Stephanie C C van der Lubbe, Lay Hoon Goh, Evangelos Kontopantelis, Wilson Ws Tam, Jose M Valderas","doi":"10.1136/bmjqs-2025-018494","DOIUrl":"10.1136/bmjqs-2025-018494","url":null,"abstract":"<p><strong>Background: </strong>Guideline concordance is associated with improved patient outcomes. Accurately quantifying the concordance between provided care and guideline recommendations offers valuable insights into the alignment of care with established guidelines and supports proactive approaches for improving the quality of care. Traditional models for calculating guideline concordance are effective in assessing clinical performance via cohort averages. However, these models fail at the individual patient level by not accounting for past clinical activities and their timing, which may give a distorted impression of the actual alignment between guideline recommendations and received care.</p><p><strong>Objectives: </strong>To develop a model for evaluating guideline concordance that provides accurate concordance scores at the individual patient level.</p><p><strong>Methods: </strong>The newly developed ratio model incorporates past clinical activities and their timing (ie, past clinical trajectories), resulting in accurate, patient-centred concordance scores. We discuss its advantages and limitations and showcase its performance using clinical indicators for patients with type 2 diabetes mellitus.</p><p><strong>Results: </strong>The ratio model demonstrates enhanced precision in evaluating guideline concordance at the individual level and better reflects the clinical trajectory of individual patients. While primarily designed to produce accurate individual patient scores, the model is also effective for assessing clinical performance through cohort averages. The ratio model is adaptable to diverse clinical contexts requiring regular follow-up, including chronic disease management, vaccination programmes, cancer surveillance and routine health screenings.</p><p><strong>Conclusions: </strong>The ratio model provides accurate and patient-centred guideline concordance scores. The model's enhanced precision at the individual level creates opportunities for research and clinical applications, including integration into clinical decision support systems.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"237-246"},"PeriodicalIF":6.5,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality as a catalyst to achieve environmentally sustainable healthcare.","authors":"Sara Ehsan, Hardeep Singh","doi":"10.1136/bmjqs-2025-019591","DOIUrl":"10.1136/bmjqs-2025-019591","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"219-223"},"PeriodicalIF":6.8,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12934554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146206519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing and evaluating a low-carbon, high-quality perioperative patient warming pathway.","authors":"Karina Spoyalo, Thais Ayres Rebello, Christina Schwarz, Gyan Chhipi Shrestha, Kasun Hewage, Rehan Sadiq, Shawn E Mondoux, Matthew Walker, Kelly Mayson, Andrea J MacNeill","doi":"10.1136/bmjqs-2025-018638","DOIUrl":"10.1136/bmjqs-2025-018638","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative hypothermia can lead to adverse clinical outcomes and avoidable financial and environmental costs. Environmentally preferable warming practices have been identified, including using reusable resistive blankets, extending the life cycle of forced air warming (FAW) garments and minimising flannel blanket use. This study integrates existing environmental data with best practices and quality improvement methodology to develop an optimised patient warming pathway (OPWP). This pathway was adapted to our local context, implemented and evaluated.</p><p><strong>Methods: </strong>The OPWP was developed using a scoping review, prior environmental impact assessment and root cause analysis. It was tailored to the workflows, patient population and warming practices at a tertiary care hospital and implemented using a multifaceted approach encompassing nine PDSA (Plan-Do-Study-Act) cycles. Major interventions included expanding pre-warming criteria to meet best practice guidelines, preserving the FAW Flex Gown, staff education and training, behaviourally informed strategies, gamification and policy development. Pre-intervention and post-intervention audits assessed environmental and financial savings, incidence of hypothermia and patient-reported outcomes (PROs).</p><p><strong>Results: </strong>The OPWP recommends preferential use of the resistive blanket for intraoperative warming, preservation of the Flex Gown for postoperative use when warming with FAW and minimising flannel blanket use. A modified pathway was implemented using FAW with preservation of a single Flex Gown throughout the perioperative journey. From pre-intervention (N=51) to post-intervention (N=64), flannel blanket use decreased from an average of 6 to 3 per patient (p<0.01). Active warming increased from 55% to 80% (p=0.04) preoperatively and from 0% to 55% (p<0.01) postoperatively. There was no significant change in the incidence of hypothermia (18% to 15%, p=0.77) and PROs remained favourable. Implementation of this pathway could lead to annual environmental savings of 940 339 kg of carbon dioxide equivalents and cost savings of $C117 978.</p><p><strong>Conclusions: </strong>This study demonstrates the successful implementation of an evidence-based and environmentally sustainable perioperative warming pathway to achieve low-carbon, high-quality patient care.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"275-287"},"PeriodicalIF":6.8,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146148993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}