Enfermeria intensiva最新文献

{"title":"Reflections on the perspective of gender in research","authors":"Maria Gema Cid-Exposito","doi":"10.1016/j.enfie.2025.500509","DOIUrl":"10.1016/j.enfie.2025.500509","url":null,"abstract":"","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 1","pages":"Article 500509"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445490","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":"Safe use of inhaled sedation in critically ill patients with invasive mechanical ventilation","authors":"Diana Gil-Castillejos RN, MSN, PhD ,&nbsp;María Luisa Palomanes-Espadalé RN, MSN ,&nbsp;Sara Rosich-Andreu MD ,&nbsp;Olga Vallés-Fructuoso RN, MSN ,&nbsp;Oriol Plans-Galvan MD","doi":"10.1016/j.enfie.2025.100490","DOIUrl":"10.1016/j.enfie.2025.100490","url":null,"abstract":"<div><div>Inhaled sedation uses halogenated drugs (isoflurane and sevoflurane) in a liquid state that, through a vaporizer, change to a gaseous state and reach the patient by the respiratory route. These drugs have a rapid onset of action, with minimal metabolism and elimination takes place almost exclusively through the airways. They do not cause significant tolerance, tachyphylaxis or significant abstinence. Inhaled sedation enables a rapid and more predictable awakening and reduced the need for opioids and neuromuscular relaxants (than intravenous sedation). In addition, have bronchodilatory, anticonvulsing and potential antiinflammatory and cardioprotective effects.</div><div>To date, inhaled sedation has been practically exclusive to the areas of anesthesia and surgery. For its therapeutic application in the environment of the Intensive Care Units (ICU) there are two devices, Sedaconda ACD® and Mirus®. Its design, adaptable to different respirators and with a safe scavenging gas system, has facilitated its introduction in the ICUs. Scientific evidence supports the use of isoflurano and Sevoflurano (with limitations), especially in cases of moderate-deep sedation, and for people with acute respiratory distress syndrome, acute bronchospasm, status epilepticus, people who are difficult to sedate, prolonged sedation (only isoflurano) and patients post cardiac arrest or who need daily neurological assessment.</div><div>Halogenated sedation is safe and effective for the critical patient undergoing mechanical ventilation. However, it is not exempt from risks and requires learning by professionals who will prescribe and/or apply. Nurses must know the characteristics of the drug, its handling, and be an expert in the route of administration so that the therapy is safe for the patient and health professionals.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 1","pages":"Article 100490"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143402799","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 collaboration in the clinical sessions of an intensive care unit: perception of nurses and doctors. A systematic review of the literature","authors":"Marina Alzate-Moreno RN ,&nbsp;Belén Calderón-Breñosa RN ,&nbsp;Kenia Rodríguez-San Miguel RN ,&nbsp;María del Mar Sarasa-Monreal RN, MSc","doi":"10.1016/j.enfie.2025.100488","DOIUrl":"10.1016/j.enfie.2025.100488","url":null,"abstract":"<div><h3>Introduction</h3><div>Intensive Care Units are dynamic and complex units that require several professionals to work together. This is achieved through Interprofessional Collaborative Practice, which is the process in which different professionals interact with common goals and objectives in decision making, providing safe and quality care. Joint clinical sessions provide professionals with the opportunity to interact, improving communication and outcomes in clinical practice.</div></div><div><h3>Objectives</h3><div>To explore nurses' and physicians' perceptions of collaborative practice in joint clinical sessions in an Intensive Care Unit.</div></div><div><h3>Methodology</h3><div>A systematic literature review was conducted in the databases Medline, Pubmed, Cinahl, Web of Science and Psycinfo, including articles published in the last ten years.</div></div><div><h3>Results</h3><div>The analysis of the publications detected five main categories: (1) Concept: definition of interprofessional collaboration according to nurses and doctors, (2) Impact on clinical practice: value given to clinical sessions by nurses and doctors, (3) Barriers: relevant aspects in clinical sessions according to the perception of nurses and doctors, (4) Role: role perceived by each professional and (5) Improvement strategies: proposals put forward by nursing and medical professionals.</div></div><div><h3>Conclusions</h3><div>Although doctors and nurses are aware of the importance and impact of Interprofessional Collaborative Practice in the care of the critically ill patient, it is not a common practice in care.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 1","pages":"Article 100488"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143395708","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":"Quality of work life and intention to rotate in intensive care nurses. Cross-sectional study","authors":"L.P. Quiñones-Rozo RN, MSN, PhD,&nbsp;P.A. Largacha-Medina RN,&nbsp;I.Y. Bravo-Bolaños RN,&nbsp;G.E. Canaval-Erazo RN, MSc, PhD","doi":"10.1016/j.enfie.2025.100484","DOIUrl":"10.1016/j.enfie.2025.100484","url":null,"abstract":"<div><h3>Introduction</h3><div>The high demands and current working conditions of nursing professionals who work in intensive care units’ impact both their quality of life and their intention to rotate, and these in turn impact the quality of care.</div></div><div><h3>Objective</h3><div>Identify the relationship between quality of Work Life (QWL) and the intention to rotate and/or leave the organization of nursing profession in intensive care units.</div></div><div><h3>Method</h3><div>Analytical cross-sectional observational study with 101 nursing professionals (NP) working in adult intensive care with more than one year of experience in the area. Simple random probabilistic sampling – 51NP and non-probabilistic convenience sampling – 50NP. The Quality of Life at Work – CVT GOHISALO instrument is applied plus five questions on turnover intention and other sociodemographic questions. The exploratory statistical analysis considered frequency tables and Chi square measures of association to develop the Logit model with the CVT variable as the exposure and the intention to rotate as the outcome.</div></div><div><h3>Results</h3><div>The dimensions of Quality of Life at Work that show the greatest dissatisfaction are integration with work – D3 (61%), job satisfaction – D4 (72%), personal development – D6 (67%) and free time management – D7 (75%). There is a high intention to change to another institution (57%) and to migrate to another country (63%). The intention to change to another institution can be explained by job satisfaction and institutional support (p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>There is an inverse relationship between satisfaction with the dimensions of quality of life at work and the intention to change to another service, institution, or independent work, which would imply developing strategies that improve CVT to reduce the intention to rotate.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 1","pages":"Article 100484"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061785","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":"Modification of an eye injury risk scale for critically ill children","authors":"Beatriz Vilchez-Rodriguez RN ,&nbsp;Marta Marcos-López RN ,&nbsp;Isabel Manzanal-Martín RN ,&nbsp;Pablo González-Navarro MSc ,&nbsp;Jesús López-Herce MD, PhD","doi":"10.1016/j.enfie.2025.100495","DOIUrl":"10.1016/j.enfie.2025.100495","url":null,"abstract":"<div><h3>Introduction</h3><div>There is no validated tool that assesses the risk of eye injury in intensive care units. The aim of this study was to analyse the ability to detect keratopathies after modification of an eye injury risk assessment scale in critically ill children.</div></div><div><h3>Methods</h3><div>Observational, retrospective study. We modified a designed scale of risk of ocular damage tested in 194 children without previous ocular pathology admitted to paediatric intensive care for more than 48 h. The original scale classified patients as high/medium/low risk according to a sum of 10 risk factors. The scale was simplified by eliminating the face mask and slow blinking. Intubation was replaced by mechanical ventilation. All patients were re-classified with the new scale and the early detection ability of the modified scale for eye damage was compared.</div></div><div><h3>Results</h3><div>There was no statistically significant difference between the two scales for the ability to detect patients at risk of eye injury (p = 0.4361). The new scale classified patients' risk of eye injury with the same reliability, with the exception of one patient whose eye injury with the new scale would have been detected one day later.</div></div><div><h3>Conclusions</h3><div>The new scale had a similar ability to detect eye injury risk as the original scale in critically ill children.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 1","pages":"Article 100495"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143377598","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":"Advanced practice nursing, critical care, and Spain: A point of view","authors":"R. Galao-Malo DNP","doi":"10.1016/j.enfie.2024.100491","DOIUrl":"10.1016/j.enfie.2024.100491","url":null,"abstract":"<div><div>Advanced Practice Nursing (APN) continues to gain recognition. Despite the guidelines published by the International Council of Nurses in 2020, there is still some confusion about this concept. In general, APN is used in three different and not necessarily compatible ways: as an umbrella term that regulates four different roles, as a level of practice, or as a role itself. Specialization in nursing does not always imply advanced practice, although both concepts are not mutually exclusive. The “Acute Care Nurse Practitioners” in the United States can conduct physical examinations and medical histories, diagnose, prescribe medications, or request and interpret complementary tests. They pose no risk to patients and have shown positive clinical outcomes in Critical Care Units. They also add \"value\" by improving communication, interprofessional coordination, or adherence to protocols. The “Clinical Nurse Specialists” in Critical Care help improve quality, staff education, and provide care to complex patients. They have a beneficial impact on reducing nosocomial infections, adverse events, hospital stay, or costs. The implementation of APN roles in Spain faces challenges due to its circumstances, such as the high number of physicians or the lack of systematic and transparent measurement of outcomes. Historically, the nursing corporation has promoted a disproportionately positive view of the Spanish healthcare system and nursing. The corporation has followed the model of medical specialization without supporting studies and a framework that hinders its integration into APN. The orthodox vision of Spanish nursing still holds significant weight, where experience is valued more than education, complicating the expansion of competencies. Numerous regional projects have been developed without a unified voice or approach. APN should not be a distraction from continuing to advocate for improvements in nurses' working conditions.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 1","pages":"Article 100491"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143292746","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":"Bowel rhythm in the lung transplant patient","authors":"Cristina González-Blasco RN ,&nbsp;Blanca Isabel Fernández-Alonso RN ,&nbsp;Beatriz Hernández-Iglesias RN ,&nbsp;Ignacio Zaragoza-García RN, PhD ,&nbsp;Marta María Torres-Romero RN ,&nbsp;Patricia Sotillo-Nieto RN ,&nbsp;Laura Alonso-Pérez RN","doi":"10.1016/j.enfie.2025.100503","DOIUrl":"10.1016/j.enfie.2025.100503","url":null,"abstract":"<div><h3>Introduction</h3><div>Lung transplantation is the option for patients with end-stage respiratory pathology. Among the acute post-surgical complications, constipation is novel and relevant, as it has been little studied. Knowing the incidence of patients with constipation during post-implantation allows the creation of an adequate care plan. Several authors relate it to poor postoperative prognosis.</div></div><div><h3>Methodology</h3><div>Descriptive, longitudinal and retrospective study. Target population: lung transplanted patients in a tertiary hospital with an ICU stay ≥3 days.</div></div><div><h3>Main variable</h3><div>Presence of constipation. Sociodemographic, clinical and pharmacological variables related to the patient’s bowel rhythm were collected. Prior authorization was obtained from the hospital research committee.</div></div><div><h3>Results</h3><div>44 transplanted patients were analyzed. The mean age was 52.75 ± 13.05 years, 59,1% were male. The 45,4% were overweight-obese. The main diagnosis is COPD. The majority were bipulmonary (88,6%). Constipation was between 97,7% and 67,9%. The median stool onset is 7,40 days. Prokinetics were introduced prophylactically in a median of 4 days and laxatives in 3 days. Enteral nutrition was introduced early in only 6,8% of patients.</div></div><div><h3>Conclusions</h3><div>A high percentage of lung transplanted patients present constipation; prophylaxis by means of prokinetics and laxatives is early, although enteral nutrition is not introduced early; it is necessary to review the nutritional protocol to avoid constipation.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"36 1","pages":"Article 100503"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141093","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":"The comfort perception in the critically ill patient from the Kolcaba theoretical model","authors":"M.D. Gonzalez-Baz RN, MSN, PhD ,&nbsp;E. Pacheco-del Cerro RN, MSN, PhD ,&nbsp;M.I. Durango-Limárquez RN, MSN ,&nbsp;A. Alcantarilla-Martín RN ,&nbsp;R. Romero-Arribas RN ,&nbsp;J. Ledesma-Fajardo RN ,&nbsp;M.N. Moro-Tejedor RN, MSN, PhD","doi":"10.1016/j.enfie.2024.03.001","DOIUrl":"10.1016/j.enfie.2024.03.001","url":null,"abstract":"<div><h3>Background</h3><div><span>The stay in a critical care unit (CCU) has a serious impact on physical condition causing numerous discomfort factors such as pain or difficulty in communicating. All of these are associated with possible </span>sequelae following discharge from the Intensive Care Unit (ICU) named post-ICU syndrome. The Kolcaba Comfort Theory allows, from a holistic approach, to identify care needs from the patient's perspective using instruments such as the General Comfort Questionnaire (GCQ).</div></div><div><h3>Objectives</h3><div>To determine the comfort level of patients admitted to the CCU using the GCQ of Kolcaba and to identify the discomfort factors.</div></div><div><h3>Methods</h3><div>Cross-sectional descriptive observational prospective study. Population: 580 patients admitted to adult CCU<span> of two high complexity hospitals from June 2015 to March 2020 with stay ≥24 h were interviewed. Descriptive analysis, Student's t-test and ANOVA and multivariate analysis were performed using SPSS v26 and STATA v16.</span></div></div><div><h3>Results</h3><div>The mean age was 52,62 (16,21), 357 (61,6%) were male and 434 (74,8%) were believers. The type of admission was planned in 322 (55,5%) and the most prevalent reason for admission was surgical 486 (83,8%). The median pain score (NRS) was 3,00 [0–4] and severity score (APACHE II) was 13,26 (5,89), the median length of stay was 4,00 [2–7] days. The mean comfort level was 3,02 (0,31) showing the highest value Reanimation 3.02 (0.30) and the lowest Trauma and Emergency Unit 2.95 (0.38). Statistically significant differences were found between the units in the comfort level of patients &gt;65 years of age (p = 0.029). The Relief comfort type obtained the lowest mean 2.81 (0.33) and the physical context 2.75 (0.41) in the three units. In the multivariate analysis, statistically significant differences were found between the comfort level and the pain level: no pain (p = 0,000) OR 4,361 CI [2,184−8,707], mild pain (p = 0,000) OR 4,007 CI [2,068−7,763], moderate pain (p = 0,007) OR 2,803 CI [1,328−5,913], and the APACHE II score equal to or greater than 10 (p = 0,000) OR 0,472 CI [0,316−0,705].</div></div><div><h3>Conclusions</h3><div>The comfort level showed high scores in all three units. The physical and environmental contexts and the relief comfort type negatively affected the perception of comfort. The variables that explained comfort were pain and severity of illness. The evaluation of comfort from the patient's perspective through the GCQ could be considered an indicator of quality of nursing interventions.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"35 4","pages":"Pages 264-277"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140320186","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":"Perception of novice nurses in an emergency box: A qualitative approach to their experiences and needs","authors":"A. Monterde-Estrada RN, MSN ,&nbsp;L. Ventura-Garcia PhD ,&nbsp;F. Valls-Fonayet PhD","doi":"10.1016/j.enfie.2024.06.003","DOIUrl":"10.1016/j.enfie.2024.06.003","url":null,"abstract":"<div><h3>Background</h3><div>Nurses play an essential role in the care of emergency hospital patients, being the ones who have the most contact with the patient and the first to be able to detect their imminent deterioration. However, the literature shows the impact that this can have in terms of stress and insecurity among new nurses, with the consequent risk of resignation in the institution and in their learning process.</div></div><div><h3>Aims</h3><div>To explore the process of incorporation of new nurses in the emergency room, as well as to identify and understand their emotions, difficulties, needs and proposals for improvement.</div></div><div><h3>Methods</h3><div>Qualitative research aimed at emergency room nurses in a tertiary level university hospital in Catalonia, between April 2022 and March 2023. Twelve semi-structured interviews were conducted with content analysis.</div></div><div><h3>Results</h3><div>Four categories emerged: identification of deficiencies, emotional dimension, competencies of the expert nursing professional, and needs and proposals for improvement, as main themes.</div></div><div><h3>Conclusions</h3><div>Insufficient training and deficit of interdisciplinary communication skills appear as main stressors. The analysis of the results suggests the need to create an intervention program that protects the mental and emotional health of new nurses and ensures the integrity of their patients. Innovative and multimodal training adapted to generational change is called for, with virtual, immersive, and contextualized simulation scenarios, together with the implementation of tools such as debriefing and nursing clinical sessions.</div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"35 4","pages":"Pages 319-328"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141581861","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":"Adverse events with arterial catheters in intensive care units: a scoping review","authors":"P.M. Mariano-Gomes,&nbsp;A. Ouverney-Braz,&nbsp;G. Oroski-Paes","doi":"10.1016/j.enfie.2024.06.001","DOIUrl":"10.1016/j.enfie.2024.06.001","url":null,"abstract":"<div><h3>Introduction</h3><div><span><span>The installation of an arterial line is one of the </span>invasive procedures performed for </span>hemodynamic monitoring<span> and, even with its clear importance in intensive care, it is still an invasive procedure and liable to cause harms to the patients.</span></div></div><div><h3>Objective</h3><div>To identify the adverse events<span> associated with the use of arterial catheters in critically-ill patients in the world scientific production.</span></div></div><div><h3>Methodology</h3><div>The present scoping review was conducted according to the JBI methodology for scoping reviews. The Preferred Reporting Items for Systematic Reviews<span><span><span> and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist was used for reporting. The research question was “Which adverse events related to the use of </span>arterial catheters in patients admitted to intensive care are more evident in the literature?”. Data collection took place in the following databases: LILACS; MEDLINE; </span>EMBASE<span>; CINAHL, EBSCOhost; and WEB OF SCIENCE.</span></span></div></div><div><h3>Results</h3><div><span><span>Through the search strategies, 491 articles were found in the databases. After exclusion of duplicates, peer analysis of titles and abstracts, full reading and screening of lists of references, the final sample of studies included was 38 articles. The main harms cited by the publications were as follows: limb ischemia, thrombosis, </span>hemorrhage<span>, accidental removal, inadvertent connection of inadequate infusion solution, pseudoaneurysm and </span></span>bloodstream infection.</div></div><div><h3>Conclusions</h3><div>It was evidenced that patients are subjected to risks of adverse events from the insertion moment to removal of the arterial catheter, focusing on the infusion solution used to fill the circuit, the type of securement and dressings chosen, as well as the Nursing care<span> measures for the prevention of bloodstream infection.</span></div></div>","PeriodicalId":93991,"journal":{"name":"Enfermeria intensiva","volume":"35 4","pages":"Pages 410-427"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617866","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}