Mayo Clinic proceedings. Innovations, quality & outcomes最新文献

{"title":"Presenting Symptoms and Delayed Diagnosis of Ehrlichiosis","authors":"Aleksandra Murawska Baptista MD ,&nbsp;Alicja Kaminska MD ,&nbsp;Marko Gorasevic MD ,&nbsp;Salvador Alvarez MD ,&nbsp;Karthik Gnanapandithan MBBS, MD ,&nbsp;Tatjana Gavrancic MD ,&nbsp;Michael Smerina MD ,&nbsp;Adrian G. Dumitrascu MD ,&nbsp;Melissa P. Cortes MD ,&nbsp;Ricardo J. Pagan MD ,&nbsp;Abhinav Singla MD","doi":"10.1016/j.mayocpiqo.2025.100608","DOIUrl":"10.1016/j.mayocpiqo.2025.100608","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the presenting symptoms, outcomes, and time to diagnosis of ehrlichiosis cases treated at Mayo Clinic, Jacksonville, Florida.</div></div><div><h3>Patients and Methods</h3><div>We conducted a retrospective analysis of all patients with ehrlichiosis who were treated at Mayo Clinic in Florida from January 1, 2018, to November 1, 2021. Ehrlichiosis was diagnosed via positive serologic or polymerase chain reaction tests. Abstracted variables included patient demographic characteristics, presenting symptoms, outcomes, and time to diagnosis.</div></div><div><h3>Results</h3><div>Out of 67 patients with ehrlichiosis who were treated at our institution during the study period, 22 were included in our analysis. These patients had diverse presenting symptoms; fever and malaise were common, and severe cases included altered mental status and septic shock. Laboratory test findings included thrombocytopenia, as well as elevated liver enzyme levels and abnormal kidney function. The time to diagnosis varied among the cases studied, with a median time from admission to diagnosis of 4 days.</div></div><div><h3>Conclusion</h3><div>Prompt treatment with doxycycline was effective, but delayed diagnosis remains a challenge. Our findings underscore the importance of considering ehrlichiosis in differential diagnoses, especially in endemic areas, and emphasize the need for early intervention to prevent severe outcomes.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 3","pages":"Article 100608"},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768289","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":"From Waiting Rooms to Recliners: Smart Heart Rhythm Monitoring in the Home","authors":"Samual Turnbull BSc,&nbsp;Saurabh Kumar BSc(Med)/MBBS, PhD","doi":"10.1016/j.mayocpiqo.2025.100606","DOIUrl":"10.1016/j.mayocpiqo.2025.100606","url":null,"abstract":"","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 2","pages":"Article 100606"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143760081","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":"Differential Sources of Distress in Clinical and Research Trainees: A Focus on Work and Role Relationships","authors":"Laurence M. Boitet PhD ,&nbsp;David A. Rogers MD, MHPE ,&nbsp;Katherine L. Sweeney MA ,&nbsp;Mark C. Schall Jr. PhD ,&nbsp;C. Allen Gorman PhD ,&nbsp;Bobby Jones PhD","doi":"10.1016/j.mayocpiqo.2025.100601","DOIUrl":"10.1016/j.mayocpiqo.2025.100601","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the experience of clinical and research trainees within an academic medical center setting to identify and compare factors influencing their wellbeing.</div></div><div><h3>Participants and Methods</h3><div>A cross-sectional, anonymous survey was conducted from June to July 2022 at a large academic medical center. Responses from clinical and research trainees were analyzed for this study. The survey assessed participant wellbeing using the Well-Being Index (WBI), in addition to perceptions of individual and organizational factors. Data were analyzed to identify correlates of elevated WBI scores and differences in clinical and research experience.</div></div><div><h3>Results</h3><div>Ordinal logistic regression analysis identified low sense of recognition (odds ratio [OR], 0.59; 95% CI, 0.44-0.79), low role clarity (OR, 0.58; 95% CI, 0.42-0.80), moral distress (OR, 1.61; 95% CI, 1.24-2.10), and social isolation or loneliness (OR, 2.79; 95% CI 1.69-4.61) as significantly associated with high WBI scores, accounting for 48.8% of predicted variance. Additionally, distressed clinical trainees (WBI≥2) reported lower control over their work (<em>P</em>&lt;.001) and significantly higher perceived stress from heavy workload (<em>P&lt;</em>.05) and long hours (<em>P</em>&lt;.01), compared with distressed research trainees. Distressed research trainees reported lower levels of trust in their supervisor (<em>P</em>&lt;0.01), lower perceived organizational support (<em>P</em>&lt;.05), and lower role clarity (<em>P</em>&lt;.05), compared with distressed medical trainees. Low recognition, moral distress, and perceived stress from social isolation and loneliness were experienced similarly between groups.</div></div><div><h3>Conclusion</h3><div>Our study indicates that trainees experience high levels of distress, although the sources differ. To effectively address these challenges, organizations should implement interventions targeted to address specific stressors of each group.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 2","pages":"Article 100601"},"PeriodicalIF":0.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143643350","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":"A Prospective Randomized Dose-Finding Study of Intrathecal Opioids for Postoperative Analgesia After Minimally Invasive Colorectal Operation","authors":"Patrice A. Vinsard MD ,&nbsp;Josef Pleticha MD ,&nbsp;Emily E. Sharpe MD ,&nbsp;Jason K. Panchamia DO ,&nbsp;David A. Olsen MD ,&nbsp;Hans P. Sviggum MD ,&nbsp;Sherief F. Shawki MB, MD ,&nbsp;Kevin T. Behm MD ,&nbsp;David W. Larson MD, MBA ,&nbsp;Allison M. LeMahieu MS ,&nbsp;Adam D. Niesen MD ,&nbsp;Adam W. Amundson MD","doi":"10.1016/j.mayocpiqo.2025.100600","DOIUrl":"10.1016/j.mayocpiqo.2025.100600","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the optimal dose of intrathecal morphine and hydromorphone in patients undergoing minimally invasive colorectal operation for postoperative analgesia.</div></div><div><h3>Patients and Methods</h3><div>The study was a double-blinded clinical dosing trial that randomized patients to intrathecal morphine or hydromorphone from March 12, 2021, to February 17, 2023. Intrathecal dosing was determined by a sequential up-down method using a biased-coin design. Doses of the subsequent patients were stepped up or down based on the success or failure of the previous dose. The primary outcome was the dose effective in 90% of patients (ED₉₀) to achieve numeric rating pain scores ≤4 with postoperative opioid requirements ≤15 oral morphine equivalent at 12 hours.</div></div><div><h3>Results</h3><div>Eighty patients completed the study with 40 patients in each group. The ED₉₀ for intrathecal morphine and hydromorphone could not be determined for the examined dose ranges. The ED₅₀ for morphine was 100 mcg and for hydromorphone was 75 mcg. Morphine median (interquartile range [IQR]) numeric rating scale scores was 3.0 (1.5-4.5) at 12 hours and 3.0 (2.0-4.0) at 24 hours, whereas hydromorphone median (IQR) numeric rating scale were 3.0 (1.5-5.0) at 12 hours and 3.0 (2.0-5.0) at 24 hours. As the dosage of hydromorphone increased, moderate to severe pruritus increased (<em>P</em>=.009).</div></div><div><h3>Conclusion</h3><div>The study could not establish an ED₉₀ for IT dosing for minimally invasive colorectal surgical patients. However, we did determine the ED₅₀ for both agents. No serious adverse events were observed throughout the study duration.</div></div><div><h3>Trial Registration</h3><div><span><span>clinicaltrials.gov</span><svg><path></path></svg></span> Identifier: NCT04752033</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 2","pages":"Article 100600"},"PeriodicalIF":0.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143528623","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":"A Pilot Study of the Home-Based 12-Lead Electrocardiogram in Clinical Practice","authors":"Levi W. Disrud CCRC, CRAT, CCT ,&nbsp;William H. Swain MD ,&nbsp;Halley Davison MBA/HCM ,&nbsp;Tara Gosse MS, FACHE ,&nbsp;Manfred M. Kubler MD ,&nbsp;David M. Harmon MD ,&nbsp;Paul A. Friedman MD ,&nbsp;Peter A. Noseworthy MD ,&nbsp;Anthony H. Kashou MD","doi":"10.1016/j.mayocpiqo.2025.100598","DOIUrl":"10.1016/j.mayocpiqo.2025.100598","url":null,"abstract":"<div><div>Telehealth consultation with a physician can be an attractive option for eligible patients. In this pilot study, we evaluate the feasibility and efficiency of an FDA approved 12-lead electrocardiogram (ECG) device, Smeartheart, that can be used remotely in the patients’ home before telehealth appointments with a cardiac electrophysiologist. We scheduled a phone call with 10 patients who used this device as part of their care. Eight patients were able to obtain a diagnostic quality ECG. Telephone call appointments with ECG technicians took a median of 51 minutes, and it took patients an average of 2.2 attempts to record a usable ECG. We also identified barriers to the use of the Smartheart device, including internet accessibility, training material, patient functional status, and motion artifact that may inform more widespread study and utilization of remote-recorded 12-lead ECGs. We conclude that the Smartheart device may have clinical use with remote use in routine clinical care, although the best use of this technology requires further study.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 2","pages":"Article 100598"},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143487645","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":"Follow-up Colorectal Cancer Screening After Negative-Result and Positive-Result Multitarget Stool DNA Tests: A Population-Based Study in Southeast Minnesota","authors":"Alanna M. Chamberlain PhD, MPH ,&nbsp;Derek W. Ebner MD ,&nbsp;Gregory D. Jenkins MS ,&nbsp;Mallik Greene PhD ,&nbsp;Lila J. Finney Rutten PhD, MPH","doi":"10.1016/j.mayocpiqo.2025.100599","DOIUrl":"10.1016/j.mayocpiqo.2025.100599","url":null,"abstract":"<div><h3>Objective</h3><div>To provide contemporary data on subsequent screening after negative-result multitarget stool DNA (mt-sDNA) tests and follow-up colonoscopy after positive-result mt-sDNA tests.</div></div><div><h3>Patients and Methods</h3><div>Negative-result mt-sDNA tests (for patients aged 50-72 years) and positive-result mt-sDNA tests (for patients aged 50-75 years) were identified among average risk patients from a 9-county region in Southeast Minnesota from January 1, 2016 to December 31, 2022. Competing risks models of time to subsequent colorectal cancer (CRC) screening were modeled separately for the negative mt-sDNA and positive mt-sDNA cohorts. Multistate Cox proportional hazards models compared rates of CRC screening modality by patient demographic characteristics.</div></div><div><h3>Results</h3><div>At 3.5 years after a negative-result mt-sDNA test (n=18,739 tests), 55.0% (95% CI, 53.9%-56.3%) of patients were rescreened, which increased to 81.0% (95% CI, 80.0%-82.1%) at 5 years. Most tests were repeat mt-sDNA tests (48.3% at 3.5 years; 95% CI, 47.2%-49.5%). Rescreening with any modality was more likely with older age and among females and less likely among Black persons, Asian persons, and those with other or mixed race. After a positive-result mt-sDNA test (n=2863 tests), 80.9% (95% CI, 79.6%-82.6%) and 84.4% (95% CI, 83.2%-86.0%) of patients completed follow-up colonoscopy by 6 months and 1 year, respectively. Those of other or mixed race had lower rates of follow-up colonoscopy compared with White persons.</div></div><div><h3>Conclusion</h3><div>Although rates of overall rescreening after a negative-result mt-sDNA test and follow-up colonoscopy after positive-result mt-sDNA tests were high, racial disparities were apparent. Targeted interventions are needed to improve equity in CRC screening adherence and follow-up care across diverse patient populations.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 2","pages":"Article 100599"},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143487644","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":"","authors":"","doi":"10.1016/j.mayocpiqo.2025.100596","DOIUrl":"10.1016/j.mayocpiqo.2025.100596","url":null,"abstract":"","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 2","pages":"Article 100596"},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444416","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":"Medical Cannabis in the United States: Comparing 2017 and 2024 State Qualifying Conditions to the 2017 National Academies of Sciences Report","authors":"Elena L. Stains BS ,&nbsp;Amy L. Kennalley MBS ,&nbsp;Maria Tian MBS ,&nbsp;Kevin F. Boehnke PhD ,&nbsp;Chadd K. Kraus DO, MPH ,&nbsp;Brian J. Piper PhD","doi":"10.1016/j.mayocpiqo.2025.100590","DOIUrl":"10.1016/j.mayocpiqo.2025.100590","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the 2017 National Academies of Sciences, Engineering, and Medicine cannabis report to state medical cannabis (MC) laws defining approved qualifying conditions (QC) from 2017 and 2024 and to determine the evidence level of the QCs approved in each state.</div></div><div><h3>Patients and Methods</h3><div>The 2017 National Academies of Sciences (NAS) report assessed therapeutic evidence for over 20 medical conditions treated with MC. We identified the QCs of 38 states (including Washington DC) where MC was legal in 2024 and compared them to the QCs listed by these states in 2017. The QCs were then categorized on the basis of NAS-established levels of evidence: limited, moderate, or substantial/conclusive evidence of effectiveness, limited evidence of ineffectiveness, or no/insufficient evidence to support or refute effectiveness. This study was completed from January 31, 2023 to June 20, 2024.</div></div><div><h3>Results</h3><div>Most states listed at least one QC with substantial evidence—80.0% in 2017 and 97.0% in 2024. However, in 2024 only 8.3% of the QCs on states’ QC lists met the standard of substantial/conclusive evidence. Of the 20 most popular QCs in the country in 2017 and 2024, one only (long-term pain) was categorized by the NAS as having substantial evidence for effectiveness. However, 7 were rated as either ineffective (eg, glaucoma) or insufficient evidence.</div></div><div><h3>Conclusion</h3><div>Most QCs lack evidence for use on the basis of the 2017 NAS report. Many states recommend QCs with little evidence (amyotrophic lateral sclerosis) or even those for which MC is ineffective (depression). These findings highlight a disparity between state-level MC recommendations and the evidence to support them.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 2","pages":"Article 100590"},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143453515","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":"Medication and Therapy Profiles for Pain and Symptom Management Among Adults With Cerebral Palsy","authors":"Mark D. Peterson PhD, MS ,&nbsp;Michael O’Leary BS ,&nbsp;Kathryn Ashbaugh BS ,&nbsp;Heidi Haapala MD ,&nbsp;Mary Schmidt DO ,&nbsp;Neil Kamdar MA ,&nbsp;Edward A. Hurvitz MD","doi":"10.1016/j.mayocpiqo.2025.100597","DOIUrl":"10.1016/j.mayocpiqo.2025.100597","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the most common patterns of pain and symptom management strategies among adults living with cerebral palsy (CP), and to determine if there are differences by pain phenotype or co-occurring neurodevelopmental disorders.</div></div><div><h3>Patients and Methods</h3><div>Federally insured beneficiaries were included if they had an ICD-9-CM/ICD-10-CM diagnosis code for CP (N=41,595). The study took place from January 10, 2024, to December 15, 2024. Medication and therapy prescription estimates for pain and CP symptom management were examined for the entire cohort, and between individuals with and without neurodevelopmental disorders and across pain phenotypes.</div></div><div><h3>Results</h3><div>The most common pharmaceutical/nontherapy-based pain and symptom management interventions included high frequency prescriptions for antiepileptics (58%), antidepressants (49%), benzodiazepines (43%), nonsteroidal anti-inflammatories (43%), nonperioperative opioids (42%), antipsychotics (33%), muscle relaxants (31%), irritable bowel syndrome-specific drugs (20%), clonidine (12%), anticholinergics (11%), and botulinum toxin A injections (6%). Physical and occupational therapy were prescribed for 41% of the study cohort. Significant differences in treatment patterns were found for individuals with co-occurring neurodevelopmental disorders, and across pain phenotypes. Notably, for individuals with a mixed pain phenotype, nearly 80% were prescribed nonperioperative opioids.</div></div><div><h3>Conclusion</h3><div>Adults with CP have a high prescription prevalence of nonperioperative opioids and common nonopioid pain and symptom management.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 2","pages":"Article 100597"},"PeriodicalIF":0.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444415","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":"The Financial Impact of Ehlers-Danlos Syndromes on Patients in the United States in 2022","authors":"Jane R. Schubart PhD ,&nbsp;Eric W. Schaefer MS ,&nbsp;Susan E. Mills MPH ,&nbsp;Dacre R.T. Knight MD ,&nbsp;Chan Shen PhD ,&nbsp;Clair A. Francomano MD","doi":"10.1016/j.mayocpiqo.2024.11.003","DOIUrl":"10.1016/j.mayocpiqo.2024.11.003","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the financial impact of Ehlers-Danlos syndromes (EDS) on patients in the United States by examining the medical expenses incurred by patients.</div></div><div><h3>Patients and Methods</h3><div>We used a convenience sample approach and disseminated a self-reported survey questionnaire to individuals with EDS via patient advocacy organizations and support groups across the country, social media, and health professionals from April 1, 2023, to December 31, 2023. The survey focused on the out-of-pocket medical expenses incurred by patients.</div></div><div><h3>Results</h3><div>The final analytic data set included 884 responses. Responses were received from individuals in all 50 states and the District of Columbia. More than 50% reported individual income less than $25,000, and more than 30% reported household income less than $50,000. More than 80% of respondents had some type of commercial insurance and 29% reported receiving Medicaid. Respondents received more financial assistance from their family and friends than from government sources. The total median out-of-pocket financial cost by our analysis was $13,450 (IQR: $6500-$25,800). Of the 838 who responded to the question, “Did the affected person receive the health care they needed?”, 19% answered “no”, 51% answered “yes, sometimes”, and 30% answered “yes, most of the time”.</div></div><div><h3>Conclusion</h3><div>The factors contributing to financial impact include both direct and indirect costs of accessing and receiving medical care. Our study findings highlight the magnitude of the burden of health care spending on patients with EDS.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 1","pages":"Article 100586"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11713486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960745","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}