Enfermeria intensiva最新文献

{"title":"Association between family caregiver competence and dependency in patients discharged from the Intensive Care Unit","authors":"Natalia Esquivel Garzón,&nbsp;Dora Inés Parra","doi":"10.1016/j.enfie.2025.500540","DOIUrl":"10.1016/j.enfie.2025.500540","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the association between the competence (knowledge, skill and preparation) of the family caregiver and the degree of dependency of patients discharged from Intensive Care Unit.</div></div><div><h3>Method</h3><div>A descriptive, cross-sectional study was carried out to characterize family caregivers and patients discharged from the ICU with moderate, severe or total dependence according to Barthel score. Competence was measured with the application of the CUIDAR instrument and caregiver performance (execution of activities in a specific situation) with an instrument that evaluated the performance of actions aimed at supplying basic needs of feeding, elimination, body hygiene, skin care, oxygen therapy and medication administration in a sample of 140 caregivers.</div></div><div><h3>Results</h3><div>A positive association was found between patient functionality and caregiver performance (Spearman rho: 0.38; <em>p</em> &lt; .001). In contrast, no significant correlation was observed between the self-perception of caregiver competence assessed with the CUIDAR instrument and the patient’s functionality, measured by the Barthel scale (Spearman rho: 0.12; <em>p</em> = .16). The 69.3% of the participants had a medium or low competence, only (30.7%) were classified at a high level. The lowest scores were obtained in knowledge (62.9%), followed by uniqueness (32.9%).</div></div><div><h3>Conclusion</h3><div>There is a significant association between patient functionality and objectively assessed caregiver performance; thus, caregivers of more dependent patients have significant challenges to achieve adequate performance in their role.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 2","pages":"Article 500540"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906360","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":"Ethical and legal considerations and recommendations for action in the physical restraint use in critically ill patients","authors":"Maria Acevedo-Nuevo RN, MsC, PhD ,&nbsp;Tayra Velasco-Sanz RN, MsC, PhD ,&nbsp;Belen Del Olmo-Somolinos RN, MsC ,&nbsp;Gemma Vía-Clavero RN, MsC, PhD","doi":"10.1016/j.enfie.2025.100497","DOIUrl":"10.1016/j.enfie.2025.100497","url":null,"abstract":"<div><div>Physical restraint use is a common practice in Intensive Care Units. However, despite this high prevalence, it is a practice full of adverse effects, with uncertain effectiveness in preventing self-removal devices and that raises numerous ethical conflicts. Current recommendations suggest restraints should be a last resort measure, they should not be prolonged beyond what is strictly necessary and that they should only be used if, in the interprofessional assessment of benefits-risks for the patient, benefits greatly outweigh harms. This manuscript aims to serve as a guide for decision-making from an ethical perspective on the use or non-use of physical restraints in critically ill patients. Likewise, a review of the legal and deontological framework that governs restraint use in our country is proposed. Finally, recommendations for practice are offered, both for healthcare professionals and healthcare managers, upon the construction of restraints-free Intensive Care Units and good practices in the exceptional cases they are necessary.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 2","pages":"Article 100497"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143776557","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":"TeamSTEPPS®-based teamwork training through an escape room experience: A mixed research study","authors":"Oscar Arrogante RN, Psy, MSc, PhD ,&nbsp;Marta Raurell-Torredà RN, MSN, PhD ,&nbsp;Elena Maestre-González RN, MsC ,&nbsp;Francisco Javier Sánchez-Chillón RN, MSN ,&nbsp;Martín Torralba-Melero RN, MSN ,&nbsp;Anna Maria Aliberch-Raurell RN, MSN ,&nbsp;Andrés Rojo-Rojo RN, PhD ,&nbsp;Ignacio Zaragoza-García RN, PhD","doi":"10.1016/j.enfie.2025.500536","DOIUrl":"10.1016/j.enfie.2025.500536","url":null,"abstract":"<div><h3>Introduction</h3><div>The Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) programme has been shown to improve teamwork among critical care professionals. The <em>escape</em> room as an educational strategy is effective for the learning process of professionals according to recent evidence.</div></div><div><h3>Objectives</h3><div>To analyse the degree of satisfaction and explore the perceptions of intensive care nurses after an <em>escape</em> room experience based on the TeamSTEPPS® programme.</div></div><div><h3>Methods</h3><div>Cross-sectional descriptive and phenomenological study using a mixed methodology. A specific and adapted satisfaction survey was applied to the participants of the <em>escape</em> room, including at the end an open-ended question for them to make comments and thus analyse their perceptions of the experience. A thematic content analysis of the comments was carried out using the interpretative paradigm. Quantitative and qualitative data were analysed using IBM SPSS Statistics™ 29.0 and ATLAS.ti 24™ respectively.</div></div><div><h3>Results</h3><div>Fifty-five nursing professionals from different intensive care units in Spain participated, with a median age of 34 years (RIC = 12) and 9 years of experience in intensive care (RIC = 11), most of them being women (89.1%). The participants expressed high overall satisfaction with the activity, with a median of 47 points out of 50 (RIC = 4). Three main categories with their respective subcategories emerged from their comments: learning through the <em>escape</em> room (learning new tools; fun way to learn); usefulness of TeamSTEPPS® strategies (communication skills, patient safety and teamwork); implementation in clinical practice (applicable strategies and ease of implementation).</div></div><div><h3>Conclusions</h3><div>The <em>escape</em> room can be a dynamic, interactive, engaging, and fun way to promote teamwork training and education in intensive care nurses through the TeamSTEPPS® training programme.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 2","pages":"Article 500536"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144084194","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":"Analysis of the nurse workload and impact of patient volume and flow in a Surgical ICU","authors":"Amaia Gutiérrez-Abarca MSN,&nbsp;Alberto Casado-Álvarez MSN,&nbsp;Sare Espinosa-Carcabilla MSN","doi":"10.1016/j.enfie.2025.500535","DOIUrl":"10.1016/j.enfie.2025.500535","url":null,"abstract":"<div><h3>Introduction</h3><div>A poor Nurse-to-Patient (N:P) ratio has a negative impact on the health of both patients and professionals. There are several tools to quantify the Nurse Workload (NW) and adjust nurse staffing. The use of such tools in the Intensive Care Units (ICU) can facilitate the adaptation of Nursing resources to patients’ real needs and improve working conditions.</div></div><div><h3>Objective</h3><div>To determine the NW in a Surgical ICU.</div></div><div><h3>Methodology</h3><div>Descriptive, transversal and unicentric study during March and April 2023. Determination of the operative N:P ratio adequated to the NW using the “Nursing Activities Score” (NAS). Measurement of the NW using NAS and “Valoración de Cargas de Trabajo y Tiempos de Enfermería” (VACTE) scales, together with the proposed NW indicators. Management and efficiency analysis of the Nursing Resources using the “Work Utilization Ratio” Index (WUR). Identification of work days and shifts with greater workload. Bivariate analysis relating NAS and VACTE to reason for admission. Calculation of the NW of each reason for admission relating the stay average and its NAS and VACTE average. Correlation analysis between scales.</div></div><div><h3>Results</h3><div>1705 records per scale were collected. NAS per patient median: 55.70 (IR: 51.30−60.38), (95%CI: 54.74−56.66). NAS per patient mean: 56,67 (SD: ±8,28), (95%CI: 55.72–57.63). NW per bed NAS: 63.39, VACTE: 652.93. NAS per nurse: 135.23%. B:P Ratio: 1:1.09. Operative N:P Ratio: 1:1.76. WUR &gt; 1. Correlation coefficient between scales: 0.45.</div></div><div><h3>Conclusions</h3><div>There is a shortage of nurses in relation to the work generated. An update in the scales is required. The NAS per nurse is more effective than the NAS per patient for the adequacy of the Nursing workforce. The new proposed indicators might be suitable to determine the NW and to optimize the calculation of Nursing resources.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 2","pages":"Article 500535"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906362","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":"Catamenial pneumothorax: A case report","authors":"Jorge Álvarez-López RN, MSN ,&nbsp;Cristina Pérez-Talavera RN, MSc","doi":"10.1016/j.enfie.2025.500530","DOIUrl":"10.1016/j.enfie.2025.500530","url":null,"abstract":"<div><h3>Introduction</h3><div>Catamenial pneumothorax (CN) is a rare type of pneumothorax that affects women of childbearing age. Its etiopathogenesis is controversial and several theories have been proposed, although there is a frequent relationship with intrathoracic endometriosis. The diagnosis can be a challenge, so recurrences can appear until it is found and it can be treated correctly. This document describes a case of catamenial pneumothorax and develops a care plan tailored at a patient suffering from this type of pathology.</div></div><div><h3>Case description</h3><div>A 41-year-old woman, with no personal or family history who attended the emergency department reporting pain in the right hemithorax and dyspnea. The chest X-ray revealed a complete pneumothorax that required placement of a chest drain. During the surgical intervention, cicatricial lesions with gray and black diaphragmatic pores are observed, which suggests a pneumothorax of catamenial origin.</div></div><div><h3>Assessment</h3><div>The nursing assessment was designed using the conceptual model of Marjory Gordon, where the patterns of activity-exercise, rest, perception and sexuality-related patterns were identified as altered.</div></div><div><h3>Diagnosis</h3><div>Using the taxonomy created by NANDA, nursing diagnoses related to impaired gas exchange, pain, rest, skin integrity, and problems related to gynecologic-obstetric aspects were established.</div></div><div><h3>Planning</h3><div>The objectives and interventions were established based on the previously marked diagnoses, using the NOC and NIC taxonomy. Those related to gas exchange, skin care at the level of the chest tube area, pain, rest and those with gynaecological links stand out.</div></div><div><h3>Discussion</h3><div>CN is a rare entity and it is necessary to know its etiopathogenesis for early detection of the problem and apply care aimed at meeting the needs of the patient and avoiding complications derived from it.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 2","pages":"Article 500530"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144107811","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":"Interprofessional intervention in the prevention of PICS and PICS-F","authors":"Beatriz Lobo-Valbuena MD, PhD, MBE ,&nbsp;María Dolores Sánchez-Roca RN ,&nbsp;María Pilar Regalón-Martín RN ,&nbsp;Julia Torres-Morales RN ,&nbsp;Victoria Enciso-Calderón MD","doi":"10.1016/j.enfie.2025.500528","DOIUrl":"10.1016/j.enfie.2025.500528","url":null,"abstract":"<div><div>The follow-up of the critically ill patient at discharge is an essential process to ensure continuity of care and prevent complications after the stay in an intensive care unit (ICU). The nurse's role as coordinator of this follow-up is crucial because of her experience in managing complex care and her ability to act as a liaison between the patient, her family and the interprofessional health care team. The article highlights that the transition of the critically ill patient from the ICU to other inpatient units or home represents a vulnerable period, where the risk of readmission and complications is high. The nurse plays a central role in planning and executing a comprehensive discharge plan, which includes educating the patient and family about continuing care, communicating with other healthcare professionals, and recognising warning signs that require immediate medical attention. In addition, she addresses the emotional and psychological needs of the patient and family, providing support and resources to adjust to life post-ICU. The nurse acts as an advocate for the patient, ensuring that person-centred care is maintained, respecting the patient's preferences and values.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 2","pages":"Article 500528"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143769151","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":"Nursing specialization in intensive care: A scoping review","authors":"Cristina Pérez-Talavera RN, MSc","doi":"10.1016/j.enfie.2025.500529","DOIUrl":"10.1016/j.enfie.2025.500529","url":null,"abstract":"<div><h3>Introduction</h3><div>Nursing in Intensive Care Units (ICU) presents an additional difficulty due to the highly complex nature of the patients. This implies a demand for training, skills, and management from the nurses attending to this type of patient, which is not currently guaranteed due to the lack of mandatory prior training. Despite the importance of such education and training, there is currently no existing regulation or national or international consensus regarding its mandatory requirement for performing professional activities in ICUs.</div></div><div><h3>Objectives</h3><div>The main research question posed is to identify the existing recommendations on specialised nursing care in adult intensive care.</div></div><div><h3>Methodology</h3><div>A scoping review was conducted using the databases PubMed, CINAHL, MEDLINE, COCHRANE, CUIDEN, and SciELO. The review included studies in both Spanish and English with varied designs on the topic of study. The quality of the articles was analyzed, achieving moderate to high levels of compliance with quality guidelines.</div></div><div><h3>Results</h3><div>A sample of N = 25 was selected, divided according to the primary theme of the articles: 40% (n = 10) on the implementation of training programmes in ICUs, 24% (n = 6) on nursing competencies, 16% (n = 4) on the needs identified by ICU staff themselves, and 20% (n = 5) on the clinical specialty of ICU nursing.</div></div><div><h3>Conclusions</h3><div>The findings indicate an improvement in both patient outcomes and the functioning of ICUs following appropriate training of nursing staff. A model for an Intensive Care Nursing Specialty in Spain is proposed as a viable option to develop the necessary specific training.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 2","pages":"Article 500529"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143714271","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":"Incidence of unscheduled removal of invasive devices in patients with COVID-19 in intensive care","authors":"Susana Arias-Rivera PhDc, MsN, RN ,&nbsp;Raquel Jareño-Collado RN ,&nbsp;María del Mar Sánchez-Sánchez MsN, RN ,&nbsp;Fernando Frutos-Vivar MD","doi":"10.1016/j.enfie.2025.100507","DOIUrl":"10.1016/j.enfie.2025.100507","url":null,"abstract":"<div><h3>Introduction</h3><div>The rate of unscheduled removal of invasive devices (ID) is an indicator of quality programmes in the critically ill. Our research group performed prevalence analyses since 2010 and another during the pandemic. The aim was to analyse the rates of use and non-planed removal of endotracheal tubes, catheters (central venous and arterial) and enteral catheters in the first wave of the COVID-19 pandemic comparing them with previous rates.</div></div><div><h3>Methodology</h3><div>Prevalence study in a polyvalente ICU. After 4 prospective observational analyses (2010, 2011, 2018, 2019) a retrospective analysis was performed (8 March–8 May 2020). Variables: diagnosis, stay and reason for removal of ID (endotracheal tubes (ET), central venous catheters, arterial catheters and enteral catheters) and rate of reintubation after self-removal of ET. Variables analysed and described as accidental removal rates per 1000 device-days and rates of ID use.</div></div><div><h3>Results</h3><div>2026 patients were included (631 in 2010, 724 in 2011, 210 in 2018, 361 in 2019 and 100 in 2020). Significant differences, between all periods, in diagnoses (<em>p</em> &lt; 0.001), ICU stay (<em>p</em> &lt; 0.001) and mortality (<em>p</em> = 0.016) and, between 2020 and all other periods, in rates of use per 100 days-stay (<em>p</em> &lt; 0.010) and per 100 admissions (<em>p</em> &lt; 0.001) in all devices except arterial catheter. In 2020, there was an increase in ET obstruction (36.0%; rate 20.27 per 1000 intubation-days, <em>p</em> &lt; 0.010), decrease in ET self-removals (2020 rate: 0.00 per 1000 intubation-days; <em>p</em> &lt; 0.050) and enteral catheters (14.33 per 1000 catheter-days). Overall reintubation (all periods) after self-extubation: 12.5%.</div></div><div><h3>Conclusions</h3><div>The rate of devices self-removal in COVID-19 patients in the first wave of the pandemic was lower than that observed in the previous four periods. The high incidence rate of ET obstruction in these patients was significant and relevant.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 2","pages":"Article 100507"},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143684590","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":"Efficacy of locally infiltrated amides as local anesthesia in arterial puncture for blood gas analysis: A systematic review","authors":"Itxaso Nieves-Cámara RN ,&nbsp;Sendoa Ballesteros-Peña RN, MPH, PhD","doi":"10.1016/j.enfie.2025.100506","DOIUrl":"10.1016/j.enfie.2025.100506","url":null,"abstract":"<div><h3>Aim</h3><div>To assess the efficacy of infiltrated amides in reducing pain caused by arterial puncture for blood gas analysis.</div></div><div><h3>Method</h3><div>A search protocol was developed and applied across four databases (Medline, SCOPUS, Embase, and TRIP Database). Clinical trials published between January 2000 and May 2024, in either Spanish or English, were considered. Clinical trials comparing the analgesic efficacy of infiltrated amides in adult patients undergoing arterial puncture were selected.</div></div><div><h3>Results</h3><div>Five randomised clinical trials were selected, with sample sizes ranging from 10 to 133 adult patients per randomization group. The studies showed mixed results regarding the efficacy of infiltrated amides in reducing pain associated with arterial puncture. Two studies highlighted mepivacaine for its pain reduction efficacy, while the other three demonstrated variable efficacy of lidocaine.</div></div><div><h3>Conclusions</h3><div>The efficacy of infiltrated amides as local anaesthetics in arterial puncture for blood gas analysis varies. Mepivacaine appears promising; however, further studies are needed to establish clear recommendations. It is crucial to consider patient preferences and professional experience when deciding on the use of these anaesthetics.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 2","pages":"Article 100506"},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143547981","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":"Management of critically ill patients difficult to sedate: Update and clinical strategies","authors":"Diana Gil-Castillejos RN, MSN, PhD ,&nbsp;Aaron Castanera-Duro RN, MSN, PhD ,&nbsp;Gemma Via-Clavero RN, MSN, PhD ,&nbsp;Alberto Sandiumenge-Camps MD, PhD","doi":"10.1016/j.enfie.2025.100500","DOIUrl":"10.1016/j.enfie.2025.100500","url":null,"abstract":"<div><div>One in every three critically ill patients who receive prolonged analgosedation may experience difficult sedation, negatively influencing their evolution and prognosis. Difficult sedation includes situations of therapeutic failure, tolerance or deprivation of analgesic and sedative drugs. Its origin is multifactorial and depends on the patient’s characteristics, history of drug consumption, critical condition and the administration of drugs that alter the pharmacokinetics of the sedatives used. This update aims to describe the definition of difficult sedation, identify the group of critically ill sedated patients who can develop it, its etiology, and how it should be treated and managed. The difficulty in achieving an adequate level of sedation, increasing the dose of sedatives or adding new agents represents a challenge in daily practice in critical care units since it can increase the risks of toxicity and related complications. Prevention and early identification of difficult sedation situations are essential strategies to minimize their impact; hence nurses’ autonomy in the management of analgosedation represents a primary intervention.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 2","pages":"Article 100500"},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143547982","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}