Pub Date : 2022-07-01DOI: 10.1097/NUR.0000000000000684
J. Manning
{"title":"Implications of the Future of Nursing Report on Clinical Nurse Specialists.","authors":"J. Manning","doi":"10.1097/NUR.0000000000000684","DOIUrl":"https://doi.org/10.1097/NUR.0000000000000684","url":null,"abstract":"","PeriodicalId":145249,"journal":{"name":"Clinical nurse specialist CNS","volume":"36 4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131157243","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}
Pub Date : 2022-07-01DOI: 10.1097/NUR.0000000000000687
Phyllis B. Whitehead
{"title":"President's Message: Unstoppable Advocacy in Action This Spring.","authors":"Phyllis B. Whitehead","doi":"10.1097/NUR.0000000000000687","DOIUrl":"https://doi.org/10.1097/NUR.0000000000000687","url":null,"abstract":"","PeriodicalId":145249,"journal":{"name":"Clinical nurse specialist CNS","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124644522","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}
Pub Date : 2022-07-01DOI: 10.1097/NUR.0000000000000686
J. Young-Mason
{"title":"Langston Hughes Implores Us \"Hold Fast to Your Dreams\".","authors":"J. Young-Mason","doi":"10.1097/NUR.0000000000000686","DOIUrl":"https://doi.org/10.1097/NUR.0000000000000686","url":null,"abstract":"","PeriodicalId":145249,"journal":{"name":"Clinical nurse specialist CNS","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127496366","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}
Pub Date : 2022-06-03DOI: 10.1097/NUR.0000000000000682
Fotine Mamais, Maninder Jasdhaul, A. Gawlinski, Mary Lawanson-Nichols, Yuhan Kao, Raquel Branom, Lianna Z. Ansryan
Purpose/Objectives This article describes the contributions of the clinical nurse specialist in navigating the challenges of the COVID-19 pandemic to ensure patient and staff safety while providing science-based quality of care. Description The group of clinical nurse specialists using advanced practice knowledge and skills within the 3 spheres of impact (ie, patient, organization, and nurse) developed and implemented strategies that supported frontline clinicians and met emerging organizational needs during the COVID-19 pandemic. Outcomes The clinical nurse specialist's agility was imperative in navigating the challenges of the pandemic to ensure the safety of patients and staff by providing strategies and standardization to workflow processes across the organization. Conclusion The group's combined clinical expertise and support of frontline nurses positioned the clinical nurse specialist to rapidly escalate the bedside nurse's concerns and provide recommendations to improve workflow while maintaining patient and staff safety.
{"title":"The Agile Clinical Nurse Specialist","authors":"Fotine Mamais, Maninder Jasdhaul, A. Gawlinski, Mary Lawanson-Nichols, Yuhan Kao, Raquel Branom, Lianna Z. Ansryan","doi":"10.1097/NUR.0000000000000682","DOIUrl":"https://doi.org/10.1097/NUR.0000000000000682","url":null,"abstract":"Purpose/Objectives This article describes the contributions of the clinical nurse specialist in navigating the challenges of the COVID-19 pandemic to ensure patient and staff safety while providing science-based quality of care. Description The group of clinical nurse specialists using advanced practice knowledge and skills within the 3 spheres of impact (ie, patient, organization, and nurse) developed and implemented strategies that supported frontline clinicians and met emerging organizational needs during the COVID-19 pandemic. Outcomes The clinical nurse specialist's agility was imperative in navigating the challenges of the pandemic to ensure the safety of patients and staff by providing strategies and standardization to workflow processes across the organization. Conclusion The group's combined clinical expertise and support of frontline nurses positioned the clinical nurse specialist to rapidly escalate the bedside nurse's concerns and provide recommendations to improve workflow while maintaining patient and staff safety.","PeriodicalId":145249,"journal":{"name":"Clinical nurse specialist CNS","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115205100","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}
Pub Date : 2022-06-03DOI: 10.1097/NUR.0000000000000679
Holly Kristy S. Tenaglia, P. Bishop
Purpose The purpose of this study was to examine if a relationship exists between the coronavirus 2019 pandemic and posttraumatic stress disorder in clinical nurse specialists. Design The study used a nonexperimental, correlational, cross-sectional design to explore the relationship between exposure to the coronavirus 2019 pandemic and posttraumatic stress disorder signs and symptoms. Methods The National Association of Clinical Nurse Specialists distributed the electronic survey from August to October 2020. State affiliates and accrediting bodies distributed the survey from October to December 2020. The survey consisted of the Impact of Events Scale — Revised, which measures signs and symptoms of posttraumatic stress disorder. The target sample size was at least 100. Results Statistically significant relationships were identified between the participant demographics, coronavirus 2019 exposure, and signs and symptoms of posttraumatic stress disorder in clinical nurse specialists. Of 129 participants, 30% had Impact of Events Scale — Revised scores that are clinically concerning for posttraumatic stress disorder. Conclusions Clinical nurse specialists can guide policy, practice, and education interventions to combat posttraumatic stress disorder due to the coronavirus 2019 pandemic.
{"title":"COVID-19 Posttraumatic Stress Disorder in Clinical Nurse Specialists","authors":"Holly Kristy S. Tenaglia, P. Bishop","doi":"10.1097/NUR.0000000000000679","DOIUrl":"https://doi.org/10.1097/NUR.0000000000000679","url":null,"abstract":"Purpose The purpose of this study was to examine if a relationship exists between the coronavirus 2019 pandemic and posttraumatic stress disorder in clinical nurse specialists. Design The study used a nonexperimental, correlational, cross-sectional design to explore the relationship between exposure to the coronavirus 2019 pandemic and posttraumatic stress disorder signs and symptoms. Methods The National Association of Clinical Nurse Specialists distributed the electronic survey from August to October 2020. State affiliates and accrediting bodies distributed the survey from October to December 2020. The survey consisted of the Impact of Events Scale — Revised, which measures signs and symptoms of posttraumatic stress disorder. The target sample size was at least 100. Results Statistically significant relationships were identified between the participant demographics, coronavirus 2019 exposure, and signs and symptoms of posttraumatic stress disorder in clinical nurse specialists. Of 129 participants, 30% had Impact of Events Scale — Revised scores that are clinically concerning for posttraumatic stress disorder. Conclusions Clinical nurse specialists can guide policy, practice, and education interventions to combat posttraumatic stress disorder due to the coronavirus 2019 pandemic.","PeriodicalId":145249,"journal":{"name":"Clinical nurse specialist CNS","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129791783","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}
Pub Date : 2022-04-15DOI: 10.1097/NUR.0000000000000671
K. Girardot, LeAnn Pancake
The detrimental effects of immobility are well documented in the literature, yet immobility still plagues the hospitalized adult. As the influx of COVID-19 patients began, patient mobility was further compromised. The purpose of this quality improvement project was to assess the impact of COVID mobility teams, composed of deployed coworkers, on COVID-19–positive and person under investigation patient outcomes. Using mobility teams improved mobility in COVID-positive and person under investigation patients. Increasing patient mobility results in improved patient outcomes by preventing hospital-acquired functional decline, preventing intensive care unit transfers, and decreasing length of stay.
{"title":"Outcomes of a COVID Mobility Team","authors":"K. Girardot, LeAnn Pancake","doi":"10.1097/NUR.0000000000000671","DOIUrl":"https://doi.org/10.1097/NUR.0000000000000671","url":null,"abstract":"The detrimental effects of immobility are well documented in the literature, yet immobility still plagues the hospitalized adult. As the influx of COVID-19 patients began, patient mobility was further compromised. The purpose of this quality improvement project was to assess the impact of COVID mobility teams, composed of deployed coworkers, on COVID-19–positive and person under investigation patient outcomes. Using mobility teams improved mobility in COVID-positive and person under investigation patients. Increasing patient mobility results in improved patient outcomes by preventing hospital-acquired functional decline, preventing intensive care unit transfers, and decreasing length of stay.","PeriodicalId":145249,"journal":{"name":"Clinical nurse specialist CNS","volume":"118 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121532573","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}
Pub Date : 2022-04-15DOI: 10.1097/NUR.0000000000000670
Mariah Foster, Jackeline I. Iseler
Purpose/Objectives The purpose of this article is to share observations one clinical nurse specialist noted after applying the concept of proning to treat acute respiratory distress syndrome in nonintubated patients with a confirmed or suspected diagnosis of coronavirus disease 2019 (COVID-19). Description of the Project/Problem Respiratory distress was a main symptom of many patients. However, hospitals were unable to meet the demand for automatic proning beds at the beginning of the pandemic, and no literature on prone positioning for nonintubated patients was published. One clinical nurse specialist identified self-proning as a means to improve respiratory distress, subsequently disseminating education and applying the practice with nonintubated patients with respiratory distress in the emergency department and throughout the COVID units in 1 hospital. Outcome Improved oxygenation saturation was observed by bedside staff after self-proning was implemented. Patients verbalized breathing easier while in the prone position. Patients were reminded to self-prone if their oxygenation saturations decreased. Self-proning afforded some patients enough stamina to call their loved ones before requiring intubation. Conclusion Through this observational experience, it was apparent that this low-risk intervention of nonintubated self-prone positioning improved oxygenation in patients with respiratory distress with a confirmed or suspected diagnosis of COVID-19.
{"title":"Self-proning in Nonintubated Patients with Coronavirus Disease 2019","authors":"Mariah Foster, Jackeline I. Iseler","doi":"10.1097/NUR.0000000000000670","DOIUrl":"https://doi.org/10.1097/NUR.0000000000000670","url":null,"abstract":"Purpose/Objectives The purpose of this article is to share observations one clinical nurse specialist noted after applying the concept of proning to treat acute respiratory distress syndrome in nonintubated patients with a confirmed or suspected diagnosis of coronavirus disease 2019 (COVID-19). Description of the Project/Problem Respiratory distress was a main symptom of many patients. However, hospitals were unable to meet the demand for automatic proning beds at the beginning of the pandemic, and no literature on prone positioning for nonintubated patients was published. One clinical nurse specialist identified self-proning as a means to improve respiratory distress, subsequently disseminating education and applying the practice with nonintubated patients with respiratory distress in the emergency department and throughout the COVID units in 1 hospital. Outcome Improved oxygenation saturation was observed by bedside staff after self-proning was implemented. Patients verbalized breathing easier while in the prone position. Patients were reminded to self-prone if their oxygenation saturations decreased. Self-proning afforded some patients enough stamina to call their loved ones before requiring intubation. Conclusion Through this observational experience, it was apparent that this low-risk intervention of nonintubated self-prone positioning improved oxygenation in patients with respiratory distress with a confirmed or suspected diagnosis of COVID-19.","PeriodicalId":145249,"journal":{"name":"Clinical nurse specialist CNS","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114333341","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}
Pub Date : 2022-02-04DOI: 10.1097/NUR.0000000000000655
L. Steere
Problem/Purpose Intraluminal thrombotic catheter occlusions are associated with a greater risk of delayed treatment, morbidity, and mortality and higher healthcare costs. Methods The Vascular Access Specialist Team at Hartford Hospital used Lean Six Sigma methodology to identify and address waste, variability, and defects associated with occlusion management. Interventions Beginning in 2015, all central venous catheter occlusions in acute inpatient care were assessed by a vascular access nurse specialist. First, the decisions to treat with tissue plasminogen activator were determined using a catheter patency algorithm. Second, negative displacement needleless connectors were replaced by antireflux needleless connectors to reduce unintentional blood reflux and other complications associated with intraluminal thrombotic catheter occlusion. Results A total of 159 934 central line days were reported between 2014 and 2020. The hospital achieved a 71.3% reduction in annual tissue plasminogen activator used for occlusions over the study period. There was a sustained decrease in annual average needleless connector consumption of 41% after switching to antireflux needleless connectors in 2015. The 5-year cost savings for these 2 interventions were estimated to be $356 005. Conclusions Lean occlusion management interventions were associated with reduced pharmacy use, medical supply waste, and spending, which have been sustained for over a 5-year period.
{"title":"CLE3AR Study","authors":"L. Steere","doi":"10.1097/NUR.0000000000000655","DOIUrl":"https://doi.org/10.1097/NUR.0000000000000655","url":null,"abstract":"Problem/Purpose Intraluminal thrombotic catheter occlusions are associated with a greater risk of delayed treatment, morbidity, and mortality and higher healthcare costs. Methods The Vascular Access Specialist Team at Hartford Hospital used Lean Six Sigma methodology to identify and address waste, variability, and defects associated with occlusion management. Interventions Beginning in 2015, all central venous catheter occlusions in acute inpatient care were assessed by a vascular access nurse specialist. First, the decisions to treat with tissue plasminogen activator were determined using a catheter patency algorithm. Second, negative displacement needleless connectors were replaced by antireflux needleless connectors to reduce unintentional blood reflux and other complications associated with intraluminal thrombotic catheter occlusion. Results A total of 159 934 central line days were reported between 2014 and 2020. The hospital achieved a 71.3% reduction in annual tissue plasminogen activator used for occlusions over the study period. There was a sustained decrease in annual average needleless connector consumption of 41% after switching to antireflux needleless connectors in 2015. The 5-year cost savings for these 2 interventions were estimated to be $356 005. Conclusions Lean occlusion management interventions were associated with reduced pharmacy use, medical supply waste, and spending, which have been sustained for over a 5-year period.","PeriodicalId":145249,"journal":{"name":"Clinical nurse specialist CNS","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127382539","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}
Pub Date : 2022-02-04DOI: 10.1097/NUR.0000000000000657
M. Harlan, Jamilyn S. Kennell, Wendy Lucas, D. Ren, P. Tuite
Purpose This clinical nurse specialist–led quality improvement project identified barriers to adherence to a bundle for central line maintenance and examined the relationship between increased bundle adherence and central line–associated bloodstream infections. Project Description Oncology and critical care nurses were surveyed to identify barriers to adherence to a bundle for central line maintenance. Targeted initiatives based on survey responses were implemented focusing on antimicrobial bathing, increasing confidence in an evidence-based bundle, and its ability to reduce infections. Adherence and central line–associated bloodstream infection rates were monitored at baseline and at 3, 9, and 15 months post intervention. Outcomes Adherence to bundle elements improved post intervention in 4 areas in critical care units: correctly labeling catheter dressings, maintaining an occlusive dressing, clamping unused catheter lumens, and daily antimicrobial bathing. In oncology units, adherence improved in clamping unused lumens and daily antimicrobial bathing. At 9 months post intervention, infection rates decreased from 6.08 to 1.48 in critical care units and 3.13 to 0.30 in oncology units. Conclusions Identifying unit-specific barriers to adherence to bundles for central line maintenance and implementing targeted initiatives to reduce barriers increase adherence and prevent central line infections.
{"title":"A Clinical Nurse Specialist–Led Quality Improvement Initiative to Identify Barriers to Adherence to a Bundle for Central Line Maintenance","authors":"M. Harlan, Jamilyn S. Kennell, Wendy Lucas, D. Ren, P. Tuite","doi":"10.1097/NUR.0000000000000657","DOIUrl":"https://doi.org/10.1097/NUR.0000000000000657","url":null,"abstract":"Purpose This clinical nurse specialist–led quality improvement project identified barriers to adherence to a bundle for central line maintenance and examined the relationship between increased bundle adherence and central line–associated bloodstream infections. Project Description Oncology and critical care nurses were surveyed to identify barriers to adherence to a bundle for central line maintenance. Targeted initiatives based on survey responses were implemented focusing on antimicrobial bathing, increasing confidence in an evidence-based bundle, and its ability to reduce infections. Adherence and central line–associated bloodstream infection rates were monitored at baseline and at 3, 9, and 15 months post intervention. Outcomes Adherence to bundle elements improved post intervention in 4 areas in critical care units: correctly labeling catheter dressings, maintaining an occlusive dressing, clamping unused catheter lumens, and daily antimicrobial bathing. In oncology units, adherence improved in clamping unused lumens and daily antimicrobial bathing. At 9 months post intervention, infection rates decreased from 6.08 to 1.48 in critical care units and 3.13 to 0.30 in oncology units. Conclusions Identifying unit-specific barriers to adherence to bundles for central line maintenance and implementing targeted initiatives to reduce barriers increase adherence and prevent central line infections.","PeriodicalId":145249,"journal":{"name":"Clinical nurse specialist CNS","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124789886","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}
Pub Date : 2022-02-04DOI: 10.1097/NUR.0000000000000654
R. Kapoor, Tiffany Rader, J. Dillon, Fnu Jaydev, Dawn Horvath, Aubrey Little, J. Vickery, C. DiPerna, L. Brittain, O. Rahman
Purpose/Aims Healthcare workers internationally continue to look for innovative ways to improve patient outcomes and optimize resource utilization during the coronavirus disease 2019 (COVID-19) pandemic. Proning awake, nonintubated patients has been suggested as a potential intervention in critical care. The aim of this study is to provide a multidisciplinary approach to safely perform awake self-prone positioning in the acute care setting. Design This is a prospective, descriptive study. Method Patients with COVID-19 were screened and enrolled within 48 hours of a positive test. After approval from the primary team, patients were provided education materials by a multidisciplinary team on the self-prone intervention. Visual cues were placed in the room. Patients were requested to maintain a diary of hours of prone positioning. Patients' baseline characteristics, admission vitals, daily oxygen requirements, and level of care were collected. Results Of 203 patients screened, 31 were enrolled. No pressure-related injury or catheter (intravenous or urinary) displacement was identified. Eighty-one percent of patients spent less than 8 hours a day in prone positioning. Among patients enrolled, none required invasive ventilation or died. Conclusions Awake self-proning can be performed safely in patients given a diagnosis of COVID-19 in the acute care setting with a multidisciplinary team.
{"title":"A Prospective, Descriptive Study on Awake Self-prone in Hospitalized COVID-19 Patients","authors":"R. Kapoor, Tiffany Rader, J. Dillon, Fnu Jaydev, Dawn Horvath, Aubrey Little, J. Vickery, C. DiPerna, L. Brittain, O. Rahman","doi":"10.1097/NUR.0000000000000654","DOIUrl":"https://doi.org/10.1097/NUR.0000000000000654","url":null,"abstract":"Purpose/Aims Healthcare workers internationally continue to look for innovative ways to improve patient outcomes and optimize resource utilization during the coronavirus disease 2019 (COVID-19) pandemic. Proning awake, nonintubated patients has been suggested as a potential intervention in critical care. The aim of this study is to provide a multidisciplinary approach to safely perform awake self-prone positioning in the acute care setting. Design This is a prospective, descriptive study. Method Patients with COVID-19 were screened and enrolled within 48 hours of a positive test. After approval from the primary team, patients were provided education materials by a multidisciplinary team on the self-prone intervention. Visual cues were placed in the room. Patients were requested to maintain a diary of hours of prone positioning. Patients' baseline characteristics, admission vitals, daily oxygen requirements, and level of care were collected. Results Of 203 patients screened, 31 were enrolled. No pressure-related injury or catheter (intravenous or urinary) displacement was identified. Eighty-one percent of patients spent less than 8 hours a day in prone positioning. Among patients enrolled, none required invasive ventilation or died. Conclusions Awake self-proning can be performed safely in patients given a diagnosis of COVID-19 in the acute care setting with a multidisciplinary team.","PeriodicalId":145249,"journal":{"name":"Clinical nurse specialist CNS","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123746089","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}
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