The Canadian journal of hospital pharmacy最新文献

{"title":"Evaluation of β-Lactam Allergy Delabelling and Antimicrobial Stewardship in Island Health.","authors":"Ingrid R Frank, Kimberly Scott, Torrance Oravec, Lyle Powell","doi":"10.4212/cjhp.3914","DOIUrl":"10.4212/cjhp.3914","url":null,"abstract":"<p><strong>Background: </strong>Penicillin allergies are commonly reported in hospital settings, yet most are inaccurate and lead to unnecessary use of broad-spectrum antibiotics, which in turn contributes to antimicrobial resistance, adverse effects, and increased health care costs. In 2023, a provincial initiative was launched in British Columbia to promote standardized delabelling of penicillin allergies across health authorities. Island Health participated by implementing a structured process led by antimicrobial stewardship (AMS) pharmacists.</p><p><strong>Objectives: </strong>To compare β-lactam allergy delabelling at AMS-supported and non-AMS-supported sites within Island Health and to describe trends by allergy type, year, and individual hospital site.</p><p><strong>Methods: </strong>This retrospective multicentre observational study involved patients at least 18 years of age who underwent delabelling of a documented β-lactam allergy between January 1, 2017, and September 30, 2024. The primary outcome was the number of allergy delabellings at AMS-supported and non-AMS-supported sites. Secondary outcomes were delabelling counts by reported allergy type, year of delabelling, and individual hospital site. Data were extracted from electronic health records and analyzed using descriptive statistics. Counts were stratified by AMS status, allergy type, year, and site, and were standardized per 100 acute care beds.</p><p><strong>Results: </strong>A total of 1039 β-lactam allergy delabellings were identified, with 928 (89.3%) occurring at AMS-supported sites. With standardization, delabelling counts were 62.8 per 100 beds at AMS-supported sites and 40.7 per 100 beds at non-AMS-supported sites.</p><p><strong>Conclusions: </strong>Although causal relationships could not be confirmed, AMS-supported sites had a greater number of β-lactam allergy delabellings. These findings may reflect the impact of structured implementation and institutional support, potentially informing future efforts to integrate penicillin allergy delabelling processes into hospital-based AMS pharmacist programs.</p>","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"79 4","pages":"e3914"},"PeriodicalIF":0.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13649178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139748","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":"Pharmacist Consults in a Canadian Post-Intensive Care Clinic: A 5-Year Quantitative Analysis.","authors":"Meriem Khatem, Béatriz Noé, Cai Qi Xu, Angelica Le, Ghina Moussa, Anthony Rainone, David Hornstein, Jonathan F Mailman, Marc M Perreault","doi":"10.4212/cjhp.3946","DOIUrl":"10.4212/cjhp.3946","url":null,"abstract":"<p><strong>Background: </strong>Intensive care unit (ICU) survivors face significant drug-related challenges. Pharmacists can play a crucial role in addressing these issues in critical care recovery clinics.</p><p><strong>Objectives: </strong>To describe the nature and number of pharmacy interventions per patient within a post-ICU clinic, while also exploring the patient characteristics that might predict those who would benefit from a pharmacist's intervention.</p><p><strong>Methods: </strong>A retrospective cohort study, which included all patients with a pharmacist consult record from a post-ICU clinic between March 2019 and July 2024, was conducted at the McGill University Health Centre, Montréal, Quebec. The pharmacists' interventions were categorized as follows: medication changes, such as medication cessation, medication initiation, medication substitution, or dosage adjustment; review of adverse drug events; review of drug interactions; laboratory monitoring; patient education; coordination of care; vaccination; and others. The relationship between patient characteristics and benefits derived from a pharmacist intervention was analyzed using stepwise logistic regression.</p><p><strong>Results: </strong>Across the 129 patients who met the inclusion criteria, a mean of 3 interventions (range 0-10) were recorded. The most frequent interventions were patient education (provided to 72 patients, 55.8%), coordination of care (68 patients, 52.7%), medication cessation (42 patients, 32.6%), and dosage adjustment (21 patients, 16.3%). The stepwise logistic regression identified the number of medications being taken when the patient was seen at the post-ICU clinic as the only significant factor determining the likelihood of benefit from a pharmacist intervention (odds ratio 1.182, 95% confidence interval 1.085-1.289, <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Pharmacists working in multidisciplinary post-ICU clinics provided a range of patient-centred interventions, with the number of medications at the time of attending the post-ICU clinic identified as the primary factor influencing which patients would benefit from a pharmacist encounter.</p>","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"79 4","pages":"e3946"},"PeriodicalIF":0.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13649176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139753","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":"Exploring Moral Distress among Canadian Acute Care Pharmacists Using the Measure of Moral Distress for Health Care Professionals.","authors":"Cheryl Harten, Zachary Kronbauer, Angela Gee, Tony Nickonchuk, Catherine Biggs, Kimberley Stever","doi":"10.4212/cjhp.3890","DOIUrl":"10.4212/cjhp.3890","url":null,"abstract":"<p><strong>Background: </strong>Moral distress (MD) negatively affects health care professionals (HCPs) and may lead to attrition if it is left unaddressed. Although MD has been well documented in many health care professions, only limited research has focused on pharmacists.</p><p><strong>Objectives: </strong>To assess MD among pharmacists providing direct patient care in acute care settings and to identify associated risk factors or contextual contributors.</p><p><strong>Methods: </strong>A cross-sectional online survey was distributed to Canadian hospital pharmacists through multiple channels. The survey (available from November 2022 to February 2023) included items relevant for calculating the Measure of Moral Distress for Health Care Professionals (MMD-HP) and also collected sociodemographic and workplace data.</p><p><strong>Results: </strong>A total of 160 pharmacists met the eligibility criteria and completed the survey. Most respondents were female (<i>n</i> = 114, 71.2%), were practising in Alberta (<i>n</i> = 85, 53.1%), and worked in cities with populations of 100 000 or more (<i>n</i> = 133, 83.1%). The median MMD-HP score was 94.5 (interquartile range [IQR] 62 to 133.5), and the mean score was 101 (standard deviation 54.7). Pharmacists who were considering leaving their position due to MD (<i>n</i> = 31, 19.4%) had significantly higher scores (median 129, IQR 109.5 to 154.5) than those who were not considering leaving (median 86, IQR 55 to 126) (<i>p</i> < 0.001). Multivariate regression showed that working 40 hours or more per week, working in smaller municipalities (< 100 000 population), and working in internal medicine or mental health were associated with higher MD. The highest individual scenario scores were in the system-level domain, particularly related to unsafe patient loads and lack of resources.</p><p><strong>Conclusions: </strong>This survey study showed that pharmacists in acute care experienced MD, consistent with findings for other HCPs. More representative research is needed to confirm these findings and to inform the development of effective interventions.</p>","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"79 4","pages":"e3890"},"PeriodicalIF":0.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13649177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139800","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":"Cultural Safety Training: Survey of Canadian Pharmacy Residency and Degree Programs.","authors":"Shadi Sadeghipouya, Rumi McGloin, Michelle Hinch, Penny Bring, Ruthdol Ywaya","doi":"10.4212/cjhp.3753","DOIUrl":"10.4212/cjhp.3753","url":null,"abstract":"<p><strong>Background: </strong>Culturally safe health system interventions can support practitioners in providing culturally safe experiences for patients. Pharmacy regulatory bodies have set out standards for providing culturally safe care, but there is a lack of guidance on how to implement training within educational programs.</p><p><strong>Objective: </strong>To characterize cultural safety education and/or training in Canadian pharmacy educational programs.</p><p><strong>Methods: </strong>Bilingual surveys were created and validated for pharmacy residency and degree programs and were administered through Qualtrics survey software. Each program was limited to one response. Closed-ended responses were analyzed with sample frequencies based on counts and percentages. Free-text responses were reviewed and coded to generate thematic categories.</p><p><strong>Results: </strong>The completed survey response rates were 51% (22 of 43) and 50% (5 of 10) for the residency and degree programs, respectively, with additional respondents providing answers for some but not all sections of the survey (included in the analysis). Cultural safety education and/or training was reported to have been implemented in 21 of 32 residency programs and 4 of 6 degree programs. Of the respondent programs that reported implementation of training and continued the survey, 11 of 15 residency programs and all 4 degree programs reported program-specific training. A common perceived barrier in residency programs was lack of familiarity with resources (13 of 21), whereas a common barrier in degree programs was lack of trained educators (4 of 6).</p><p><strong>Conclusions: </strong>Cultural safety differs from conventional academic content because it is a complex topic that requires an understanding of cultural differences, which takes time to develop. To achieve the goal of cultural competence, it may be beneficial to integrate pharmacy-specific training alongside self-reflections and opportunities to engage in cultural safety experiences.</p>","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"79 4","pages":"e3753"},"PeriodicalIF":0.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13649179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139423","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":"Nurses' Perceptions, Attitudes, and Recommendations Concerning Medication Waste in Health Care Facilities: A Survey of Lower Mainland Nurses.","authors":"Armita Shadgan, Elissa Sy Aeng, Sunny Gidda, Alfie Chung, Aaron M Tejani","doi":"10.4212/cjhp.3938","DOIUrl":"10.4212/cjhp.3938","url":null,"abstract":"<p><strong>Background: </strong>Medication waste in health care settings contributes to environmental harm and health care costs. As key players in medication administration and disposal, nurses are well positioned to identify and mitigate waste, yet limited research has explored the perspectives of nurses working in health care facilities.</p><p><strong>Objectives: </strong>To characterize the beliefs, attitudes, experiences, and recommendations of nurses in the Lower Mainland of British Columbia concerning medication waste in health care facilities and to identify opportunities for effective reduction of medication waste.</p><p><strong>Methods: </strong>A cross-sectional online survey was conducted between November 2024 and January 2025 among registered/licensed nurses working at Fraser Health, Vancouver Coastal Health, and Providence Health Care facilities. The 17-item questionnaire explored attitudes toward medication waste, perceived barriers to and facilitators of waste reduction, and suggestions for reduction strategies. Responses were analyzed using descriptive statistics and thematic analysis.</p><p><strong>Results: </strong>A total of 1001 eligible responses were analyzed. Although 91% (908/997) of respondents acknowledged medication waste in their workplace, only 27% (244/889) felt empowered to reduce it. Key barriers included lack of clear policies, limited training, and time constraints. Wastage of partial doses-particularly narcotics, insulin, and parenteral medications-was perceived as a major contributor. Respondents recommended optimizing dosage forms, enabling safe take-home of remaining medications, and revising return and reuse protocols.</p><p><strong>Conclusions: </strong>Despite high awareness, many respondents felt unsupported in reducing medication waste. Revised policies, targeted education, and systems-level interventions are needed to enable sustainable medication practices. Future research should quantify waste associated with narcotics, insulin, and parenteral medications.</p>","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"79 4","pages":"e3938"},"PeriodicalIF":0.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13649180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139786","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":"Pharmacists' Prioritization of Patients for Discharge Medication Reconciliation at a Tertiary Academic Centre.","authors":"Alexandra Sasha Goldstein, Amanda Shea, Olavo Fernandes, Paula Newman, Sarah Spec, Erika MacDonald","doi":"10.4212/cjhp.3936","DOIUrl":"10.4212/cjhp.3936","url":null,"abstract":"<p><strong>Background: </strong>Involvement of pharmacists in discharge medication reconciliation (DMR) reduces readmissions when DMR is delivered as part of a medication management bundle. With current staffing and workload, pharmacists are unable to complete DMR for every inpatient. Consequently, it is necessary to prioritize patients for DMR interventions according to clinical need and risk.</p><p><strong>Objectives: </strong>To describe how pharmacists prioritize patients for DMR at a tertiary hospital; to identify facilitators of and barriers to pharmacist involvement in DMR; and to compare pharmacists' patient-priority assessment with scores derived using the Epic risk-of-unplanned-readmission, PRIME, and PADR-EC risk assessment tools.</p><p><strong>Methods: </strong>Pharmacists involved in DMR participated in focus groups to explore their DMR practices, including factors considered in patient prioritization, as well as facilitators of and barriers to their involvement in DMR. For patients on their service with an expectation of discharge within 48 hours, pharmacists used a questionnaire to rank DMR priority and indicate their intent to complete DMR. For each patient, the Epic, PRIME, and PADR-EC scores were collected and compared with the pharmacist's assessment.</p><p><strong>Results: </strong>A total of 13 pharmacists participated in 2 focus groups, and 11 of these pharmacists completed the questionnaire (for a total of 110 patients). Twenty-two unique factors and 27 subfactors for patient prioritization were identified. The top 5 factors were complex medication regimen, high-risk medications, medication changes, medication access, and length of stay. Facilitators and barriers were categorized into 6 themes: team dynamics, pharmacist workload, prior pharmacist involvement, process for DMR, discharge planning, and technology. Pharmacists' assessments appeared to differ from scores obtained with the 3 risk assessment tools.</p><p><strong>Conclusions: </strong>Pharmacists at the study institution lacked a consistent approach to prioritizing patients for DMR. Next steps will include developing and piloting a standardized process for prioritization.</p>","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"79 3","pages":"e3936"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898741","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":"Should Mannequin-Based Simulations Be Adopted into Hospital Pharmacy Practice? The Con Side.","authors":"Harleen Chohan, Nilu Partovi, Trana Hussaini","doi":"10.4212/cjhp.3943","DOIUrl":"10.4212/cjhp.3943","url":null,"abstract":"","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"79 3","pages":"e3943"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898764","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":"Costs Associated with Failure of Vancomycin Treatment for Pneumonia and Bacteremia Due to Methicillin-Resistant <i>Staphylococcus aureus</i>.","authors":"Maria Josey, Ryan Marko, Jérémie Gauthier, Letissia Fadel, Kednapa Thavorn, Salmaan Kanji","doi":"10.4212/cjhp.3860","DOIUrl":"10.4212/cjhp.3860","url":null,"abstract":"<p><strong>Background: </strong>Methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) infections are associated with high rates of mortality and morbidity. Vancomycin is widely used for the treatment of pneumonia and bacteremia due to MRSA, despite treatment failure rates between 21% and 50%. Given the high rates of treatment failure with vancomycin, it is hypothesized that such failure may add a substantial burden to the health care system.</p><p><strong>Objectives: </strong>To estimate the hospital costs for patients treated with vancomycin for MRSA pneumonia and/or bacteremia, comparing costs between those who experienced treatment failure and those who experienced treatment success.</p><p><strong>Methods: </strong>This retrospective cohort study involved patients admitted to a Canadian hospital between 2014 and 2018 with MRSA pneumonia and/or bacteremia who were treated with vancomycin. Direct and indirect hospital costs and additional clinical data were obtained from the hospital database. All costs were inflated to 2024 Canadian dollars using the Consumer Price Index. A generalized linear model was used to estimate the adjusted difference in hospital costs between patients with and without treatment failure.</p><p><strong>Results: </strong>A total of 128 patients were included in the cohort, of whom 43 (34%) were identified as having treatment failure. Treatment failure was associated with significantly higher costs than treatment success, with an adjusted mean difference in total cost of $43 082 (95% confidence interval $2065 to $84 098). Those with treatment failure had higher rates of vasopressor use, greater need for intensive care, higher sequential organ failure assessment scores, greater need for mechanical ventilation, and higher rates of nephrotoxicity.</p><p><strong>Conclusions: </strong>Failure of vancomycin treatment for MRSA pneumonia and/or bacteremia significantly increased hospital costs.</p>","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"79 3","pages":"e3860"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898756","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":"Should Mannequin-Based Simulations Be Adopted into Hospital Pharmacy Practice? The Pro Side.","authors":"Danielle G Co, Vincent H Mabasa, Michelle Hinch","doi":"10.4212/cjhp.3948","DOIUrl":"10.4212/cjhp.3948","url":null,"abstract":"","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"79 3","pages":"e3948"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898787","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":"Effect of IV Hydrocortisone on Mortality among Neonates with Hypotension: A Systematic Review and Meta-analysis of Randomized, Placebo-Controlled Trials.","authors":"Chia Siang Kow, Kaeshaelya Thiruchelvam","doi":"10.4212/cjhp.3953","DOIUrl":"10.4212/cjhp.3953","url":null,"abstract":"<p><strong>Background: </strong>Hypotension is common among preterm and term neonates in the neonatal intensive care unit, particularly those with very low birth weight, sepsis, or hypoxic-ischemic encephalopathy. Some remain hypotensive despite volume expansion and vasopressors, possibly due to relative adrenal insufficiency. Hydrocortisone is proposed as adjunct therapy, but its effect on mortality is uncertain.</p><p><strong>Objective: </strong>To evaluate whether IV hydrocortisone reduces all-cause mortality in neonates with hypotension.</p><p><strong>Methods: </strong>The MEDLINE, Embase, CENTRAL, and Scopus databases were searched up to March 30, 2025, for randomized controlled trials (RCTs) that compared IV hydrocortisone with placebo and reported mortality. Two reviewers independently screened the studies, extracted data, and assessed bias. A fixed-effects Mantel-Haenszel meta-analysis was used, based on the degree of heterogeneity.</p><p><strong>Results: </strong>Five RCTs (with a total of 239 neonates) were included. Heterogeneity was low (<i>I</i> ² = 0%). Hydrocortisone significantly reduced mortality (odds ratio 0.48, 95% confidence interval 0.24-0.96).</p><p><strong>Conclusions: </strong>IV hydrocortisone may reduce mortality in refractory neonatal hypotension. However, larger trials are needed to confirm this finding.</p>","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"79 3","pages":"e3953"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898751","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}