Pub Date : 2025-01-01DOI: 10.1016/j.medin.2024.05.012
Johanna Marcela Abril-Victorino, Mirian Ruiz de la Cuesta-López, Sergio Gómez-Camino
{"title":"Neumonía grave adquirida en la comunidad por Streptococcus pyogenes","authors":"Johanna Marcela Abril-Victorino, Mirian Ruiz de la Cuesta-López, Sergio Gómez-Camino","doi":"10.1016/j.medin.2024.05.012","DOIUrl":"10.1016/j.medin.2024.05.012","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 1","pages":"Pages 66-67"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143160861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.medin.2024.07.010
María Cruz Martín-Delgado , María Bodí
Patient safety is a priority for all healthcare systems. Despite this, too many patients still suffer harm as a consequence of healthcare. Furthermore, it has a significant impact on family members, professionals and healthcare institutions, resulting in considerable economic costs. The critically ill patient is particularly vulnerable to adverse events. Numerous safe practices have been implemented, acknowledging the influence of human factors on safety and the significance of the well-being of professionals, as well as the impact of critical episodes at hospital discharge on patients and their families. Training and engagement of professionals, patients and families are of paramount importance. Recently, artificial intelligence has demonstrated its ability to enhance clinical safety. This update on “Patient Safety” reviews all these aspects related to one of the most pivotal dimensions of healthcare quality.
{"title":"Patient safety in the Intensive Care Department","authors":"María Cruz Martín-Delgado , María Bodí","doi":"10.1016/j.medin.2024.07.010","DOIUrl":"10.1016/j.medin.2024.07.010","url":null,"abstract":"<div><div>Patient safety is a priority for all healthcare systems. Despite this, too many patients still suffer harm as a consequence of healthcare. Furthermore, it has a significant impact on family members, professionals and healthcare institutions, resulting in considerable economic costs. The critically ill patient is particularly vulnerable to adverse events. Numerous safe practices have been implemented, acknowledging the influence of human factors on safety and the significance of the well-being of professionals, as well as the impact of critical episodes at hospital discharge on patients and their families. Training and engagement of professionals, patients and families are of paramount importance. Recently, artificial intelligence has demonstrated its ability to enhance clinical safety. This update on “Patient Safety” reviews all these aspects related to one of the most pivotal dimensions of healthcare quality.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 1","pages":"Pages 25-31"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143160863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.medin.2024.01.004
Nicolás Contrera Rolón , Joaquín Cantos , Iván Huespe , Eduardo Prado , Griselda I. Bratti , Carlos Schreck , Sergio Giannasi , Guillermo Rosa Diez , Carlos F. Varela
Objective
To evaluate the diagnostic performance of FENa (Fractional excretion of sodium), FEK (fractional excretion of potassium) and uSID (urinary strong ion difference) in predicting pAKI in sepsis and septic shock.
Design
Retrospective cohort study.
Setting
Two intensive care units in Argentina.
Patients
Adult patients with a confirmed diagnosis of sepsis or septic shock and AKI, and had a urinary biochemistry within 24 h of the AKI diagnosis.
Interventions
None.
Main variables of interest
We evaluated the diagnostic accuracy of FENa, FEK and uSID through a ROC (Receiver Operating Characteristic) curve analysis.
Results
80 patients were included. 40 patients presented pAKI. pAKI group had higher APACHE, SOFA score, and mortality rate. In the ROC curve analysis, uSID had no diagnostic utility (AUC = 0.52, p = 0.69). FENa presented moderate accuracy showing an AUC of 0.71 (95% CI 0.60−0.83; p = 0.001), while FEK presented low accuracy with an AUC of 0.69 (95% CI 0.57−0.80; p = 0.04). The optimal Youden point for identifying pAKI was at a FENa higher than 0.51 % with a specificity of 72.5% and a sensitivity of 65.0%. In the case of FEK, a value higher than 21.9 % presented the best relation, with a specificity of 67.5% and a sensitivity of 65.0%.
Conclusions
urine biochemistry interpretation in septic patients must be revised. FENa and FEK are related to the severity of AKI and could be helpful complementary tools for diagnosing pAKI.
{"title":"Fractional excretion of sodium and potassium and urinary strong ion difference in the evaluation of persistent AKI in sepsis","authors":"Nicolás Contrera Rolón , Joaquín Cantos , Iván Huespe , Eduardo Prado , Griselda I. Bratti , Carlos Schreck , Sergio Giannasi , Guillermo Rosa Diez , Carlos F. Varela","doi":"10.1016/j.medin.2024.01.004","DOIUrl":"10.1016/j.medin.2024.01.004","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the diagnostic performance of FENa (Fractional excretion of sodium), FEK (fractional excretion of potassium) and uSID (urinary strong ion difference) in predicting pAKI in sepsis and septic shock.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Two intensive care units in Argentina.</div></div><div><h3>Patients</h3><div>Adult patients with a confirmed diagnosis of sepsis or septic shock and AKI, and had a urinary biochemistry within 24<!--> <!-->h of the AKI diagnosis.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Main variables of interest</h3><div>We evaluated the diagnostic accuracy of FENa, FEK and uSID through a ROC (Receiver Operating Characteristic) curve analysis.</div></div><div><h3>Results</h3><div>80 patients were included. 40 patients presented pAKI. pAKI group had higher APACHE, SOFA score, and mortality rate. In the ROC curve analysis, uSID had no diagnostic utility (AUC<!--> <!-->=<!--> <!-->0.52, <em>p</em> <!-->=<!--> <!-->0.69). FENa presented moderate accuracy showing an AUC of 0.71 (95% CI 0.60−0.83; <em>p</em> <!-->=<!--> <!-->0.001), while FEK presented low accuracy with an AUC of 0.69 (95% CI 0.57−0.80; <em>p</em> <!-->=<!--> <!-->0.04). The optimal Youden point for identifying pAKI was at a FENa higher than 0.51 % with a specificity of 72.5% and a sensitivity of 65.0%. In the case of FEK, a value higher than 21.9 % presented the best relation, with a specificity of 67.5% and a sensitivity of 65.0%.</div></div><div><h3>Conclusions</h3><div>urine biochemistry interpretation in septic patients must be revised. FENa and FEK are related to the severity of AKI and could be helpful complementary tools for diagnosing pAKI.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 1","pages":"Pages 1-7"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143160865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.medin.2024.03.015
Paz Merino
The severity of the critically ill patient, the practice of diagnostic procedures and invasive treatments, the high number of drugs administered, a high volume of data generated during the care of the critically ill patient along with a technical work environment, the stress and workload of work of professionals, are circumstances that favor the appearance of errors, turning Intensive Medicine Services into risk areas for adverse events to occur. Knowing their epidemiology is the first step to improve the safety of the care we provide to our patients, because it allows us to identify risk areas, analyze them and develop strategies to prevent the adverse events, or if this is not possible, be able to manage them.
This article analyzes the main studies published to date on incidents related to safety in the field of critically ill patients.
{"title":"Epidemiología de los eventos adversos en los servicios de medicina intensiva","authors":"Paz Merino","doi":"10.1016/j.medin.2024.03.015","DOIUrl":"10.1016/j.medin.2024.03.015","url":null,"abstract":"<div><div>The severity of the critically ill patient, the practice of diagnostic procedures and invasive treatments, the high number of drugs administered, a high volume of data generated during the care of the critically ill patient along with a technical work environment, the stress and workload of work of professionals, are circumstances that favor the appearance of errors, turning Intensive Medicine Services into risk areas for adverse events to occur. Knowing their epidemiology is the first step to improve the safety of the care we provide to our patients, because it allows us to identify risk areas, analyze them and develop strategies to prevent the adverse events, or if this is not possible, be able to manage them.</div><div>This article analyzes the main studies published to date on incidents related to safety in the field of critically ill patients.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 1","pages":"Pages 32-39"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143160860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.medin.2024.07.011
Fernando Clau Terré , Raul Vicho Pereira , Jose Maria Ayuela Azcárate , Manuel Ruiz Bailén
The present study highlights the advances in ultrasound, especially regarding its clinical applications to critically ill patients.
Artificial intelligence (AI) is crucial in automating image interpretation, improving accuracy and efficiency. Software has been developed to make it easier to perform accurate bedside ultrasound examinations, even by professionals lacking prior experience, with automatic image optimization. In addition, some applications identify cardiac structures, perform planimetry of the Doppler wave, and measure the size of vessels, which is especially useful in hemodynamic monitoring and continuous recording. The «strain» and «strain rate» parameters evaluate ventricular function, while «auto strain» automates its calculation from bedside images. These advances, and the automatic determination of ventricular volume, make ultrasound monitoring more precise and faster. The next step is continuous monitoring using gel devices attached to the skin.
{"title":"Nuevas técnicas ecográficas. Presente y futuro","authors":"Fernando Clau Terré , Raul Vicho Pereira , Jose Maria Ayuela Azcárate , Manuel Ruiz Bailén","doi":"10.1016/j.medin.2024.07.011","DOIUrl":"10.1016/j.medin.2024.07.011","url":null,"abstract":"<div><div>The present study highlights the advances in ultrasound, especially regarding its clinical applications to critically ill patients.</div><div>Artificial intelligence (AI) is crucial in automating image interpretation, improving accuracy and efficiency. Software has been developed to make it easier to perform accurate bedside ultrasound examinations, even by professionals lacking prior experience, with automatic image optimization. In addition, some applications identify cardiac structures, perform planimetry of the Doppler wave, and measure the size of vessels, which is especially useful in hemodynamic monitoring and continuous recording. The «strain» and «strain rate» parameters evaluate ventricular function, while «auto strain» automates its calculation from bedside images. These advances, and the automatic determination of ventricular volume, make ultrasound monitoring more precise and faster. The next step is continuous monitoring using gel devices attached to the skin.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 1","pages":"Pages 40-49"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143160859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.medin.2024.06.002
Iban Oliva , Cristina Ferré , Xavier Daniel , Marc Cartanyà , Christian Villavicencio , Melina Salgado , Loreto Vidaur , Elisabeth Papiol , FJ González de Molina , María Bodí , Manuel Herrera , Alejandro Rodríguez , on behalf of the COVID-19 SEMICYUC Working Group
Objective
To assess incidence, risk factors and impact of acute kidney injury(AKI) within 48 h of intensive care unit(ICU) admission on ICU mortality in patients with SARS-CoV-2 pneumonia. To assess ICU mortality and risk factors for continuous renal replacement therapy (CRRT) in AKI I and II patients.
Design
Retrospective observational study.
Setting
Sixty-seven ICU from Spain, Andorra, Ireland.
Patients
5399 patients March 2020 to April 2022.
Main variables of interest
Demographic variables, comorbidities, laboratory data (worst values) during the first two days of ICU admission to generate a logistic regression model describing independent risk factors for AKI and ICU mortality. AKI was defined according to current international guidelines (kidney disease improving global outcomes, KDIGO).
Results
Of 5399 patients included 1879 (34.8%) developed AKI. These patients had higher ICU mortality and AKI was independently associated with a higher ICU mortality (HR 1.32 CI 1.17–1.48; p < 0.001).
Male gender, hypertension, diabetes, obesity, chronic heart failure, myocardial dysfunction, higher severity scores, and procalcitonine were independently associated with the development of AKI.
In AKI I and II patients the need for CRRT was 12.6% (217/1710). In these patients, APACHE II, need for mechanical ventilation in the first 24 h after ICU admission and myocardial dysfunction were associated with risk of needing CRRT. AKI I and II patients had a high ICU mortality (38.5%), especially if CRRT were required (64.1% vs. 34,8%; p < 0.001).
Conclusions
Critically ill patients with SARS-CoV-2 pneumonia and AKI have a high ICU mortality. Even AKI I and II stages are associated with high risk of needing CRRT and ICU mortality.
{"title":"Risk factors and outcome of acute kidney injury in critically ill patients with SARS-CoV-2 pneumonia: a multicenter study","authors":"Iban Oliva , Cristina Ferré , Xavier Daniel , Marc Cartanyà , Christian Villavicencio , Melina Salgado , Loreto Vidaur , Elisabeth Papiol , FJ González de Molina , María Bodí , Manuel Herrera , Alejandro Rodríguez , on behalf of the COVID-19 SEMICYUC Working Group","doi":"10.1016/j.medin.2024.06.002","DOIUrl":"10.1016/j.medin.2024.06.002","url":null,"abstract":"<div><h3>Objective</h3><div>To assess incidence, risk factors and impact of acute kidney injury(AKI) within 48 h of intensive care unit(ICU) admission on ICU mortality in patients with SARS-CoV-2 pneumonia. To assess ICU mortality and risk factors for continuous renal replacement therapy (CRRT) in AKI I and II patients.</div></div><div><h3>Design</h3><div>Retrospective observational study.</div></div><div><h3>Setting</h3><div>Sixty-seven ICU from Spain, Andorra, Ireland.</div></div><div><h3>Patients</h3><div>5399 patients March 2020 to April 2022.</div></div><div><h3>Main variables of interest</h3><div>Demographic variables, comorbidities, laboratory data (worst values) during the first two days of ICU admission to generate a logistic regression model describing independent risk factors for AKI and ICU mortality. AKI was defined according to current international guidelines (kidney disease improving global outcomes, KDIGO).</div></div><div><h3>Results</h3><div>Of 5399 patients included 1879 (34.8%) developed AKI. These patients had higher ICU mortality and AKI was independently associated with a higher ICU mortality (HR 1.32 CI 1.17–1.48; p < 0.001).</div><div>Male gender, hypertension, diabetes, obesity, chronic heart failure, myocardial dysfunction, higher severity scores, and procalcitonine were independently associated with the development of AKI.</div><div>In AKI I and II patients the need for CRRT was 12.6% (217/1710). In these patients, APACHE II, need for mechanical ventilation in the first 24 h after ICU admission and myocardial dysfunction were associated with risk of needing CRRT. AKI I and II patients had a high ICU mortality (38.5%), especially if CRRT were required (64.1% vs. 34,8%; p < 0.001).</div></div><div><h3>Conclusions</h3><div>Critically ill patients with SARS-CoV-2 pneumonia and AKI have a high ICU mortality. Even AKI I and II stages are associated with high risk of needing CRRT and ICU mortality.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 1","pages":"Pages 15-24"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143160864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.medin.2024.05.016
Facundo J. Gutierrez , Mario O. Pozo , Matías Mugno , Sebastián P. Chapela , Natalia Llobera , María J. Reberendo , Gastón E. Murias , Paolo N. Rubatto Birri , Vanina S. Kanoore Edul , Arnaldo Dubin
Objective
Central venous-arterial PCO2 to arterial-central venous O2 content ratio (Pcv-aCO2/Ca-cvO2) is commonly used as a surrogate for respiratory quotient (RQ) and tissue oxygenation. Although Pcv-aCO2/Ca-cvO2 might be associated with hyperlactatemia and outcome, neither the interchangeability with RQ nor the correlation with conclusive variables of anaerobic metabolism has never been demonstrated in septic shock. Our goal was to compare Pcv-aCO2/Ca-cvO2 and RQ in patients with septic shock.
Design
Prospective, observational study.
Setting
Two adult ICUs.
Patients
Forty-seven patients with septic shock on mechanical ventilation with stable respiratory settings and vasopressor dose after initial resuscitation.
Interventions
None.
Main variables of interest
We measured arterial and central venous gases, Hb, and O2Hb. Pcv-aCO2/Ca-cvO2 and the ratio of central venous-arterial CO2 content to arterial-central venous O2 content (Ccv-aCO2/Ca-cvO2) were calculated. RQ was determined by indirect calorimetry.
Results
Pcv-aCO2/Ca-cvO2 and Ccv-aCO2/Ca-cvO2 were not correlated with RQ (R2 = 0.01, P = 0.50 and R2 = 0.01, P = 0.58, respectively), showing large bias and wide 95 % limits of agreement with RQ (1.09, -1.10−3.27 and 0.42, -1.53−2.37). A multiple linear regression model showed Hb, and central venous PCO2 and O2Hb, but not RQ, as Pcv-aCO2/Ca-cvO2 determinants (R2 = 0.36, P = 0.0007).
Conclusions
In patients with septic shock, Pcv-aCO2/Ca-cvO2 did not correlate with RQ and was mainly determined by factors that modify the dissociation of CO2 from Hb. Pcv-aCO2/Ca-cvO2 seems to be a poor surrogate for RQ; therefore, its values should be interpreted with caution.
{"title":"Lack of correlation between central venous minus arterial PCO2 to arterial minus central venous O2 content ratio and respiratory quotient in patients with septic shock: A prospective observational study","authors":"Facundo J. Gutierrez , Mario O. Pozo , Matías Mugno , Sebastián P. Chapela , Natalia Llobera , María J. Reberendo , Gastón E. Murias , Paolo N. Rubatto Birri , Vanina S. Kanoore Edul , Arnaldo Dubin","doi":"10.1016/j.medin.2024.05.016","DOIUrl":"10.1016/j.medin.2024.05.016","url":null,"abstract":"<div><h3>Objective</h3><div>Central venous-arterial PCO<sub>2</sub> to arterial-central venous O<sub>2</sub> content ratio (P<sub>cv-a</sub>CO<sub>2</sub>/C<sub>a-cv</sub>O<sub>2</sub>) is commonly used as a surrogate for respiratory quotient (RQ) and tissue oxygenation. Although P<sub>cv-a</sub>CO<sub>2</sub>/C<sub>a-cv</sub>O<sub>2</sub> might be associated with hyperlactatemia and outcome, neither the interchangeability with RQ nor the correlation with conclusive variables of anaerobic metabolism has never been demonstrated in septic shock. Our goal was to compare P<sub>cv-a</sub>CO<sub>2</sub>/C<sub>a-cv</sub>O<sub>2</sub> and RQ in patients with septic shock.</div></div><div><h3>Design</h3><div>Prospective, observational study.</div></div><div><h3>Setting</h3><div>Two adult ICUs.</div></div><div><h3>Patients</h3><div>Forty-seven patients with septic shock on mechanical ventilation with stable respiratory settings and vasopressor dose after initial resuscitation.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Main variables of interest</h3><div>We measured arterial and central venous gases, Hb, and O<sub>2</sub>Hb. P<sub>cv-a</sub>CO<sub>2</sub>/C<sub>a-cv</sub>O<sub>2</sub> and the ratio of central venous-arterial CO<sub>2</sub> content to arterial-central venous O<sub>2</sub> content (C<sub>cv-a</sub>CO<sub>2</sub>/C<sub>a-cv</sub>O<sub>2</sub>) were calculated. RQ was determined by indirect calorimetry.</div></div><div><h3>Results</h3><div>P<sub>cv-a</sub>CO<sub>2</sub>/C<sub>a-cv</sub>O<sub>2</sub> and C<sub>cv-a</sub>CO<sub>2</sub>/C<sub>a-cv</sub>O<sub>2</sub> were not correlated with RQ (R<sup>2</sup> = 0.01, <em>P</em> = 0.50 and R<sup>2</sup> = 0.01, <em>P</em> = 0.58, respectively), showing large bias and wide 95 % limits of agreement with RQ (1.09, -1.10−3.27 and 0.42, -1.53−2.37). A multiple linear regression model showed Hb, and central venous PCO<sub>2</sub> and O<sub>2</sub>Hb, but not RQ, as P<sub>cv-a</sub>CO<sub>2</sub>/C<sub>a-cv</sub>O<sub>2</sub> determinants (R<sup>2</sup> = 0.36, <em>P</em> = 0.0007).</div></div><div><h3>Conclusions</h3><div>In patients with septic shock, P<sub>cv-a</sub>CO<sub>2</sub>/C<sub>a-cv</sub>O<sub>2</sub> did not correlate with RQ and was mainly determined by factors that modify the dissociation of CO<sub>2</sub> from Hb. P<sub>cv-a</sub>CO<sub>2</sub>/C<sub>a-cv</sub>O<sub>2</sub> seems to be a poor surrogate for RQ; therefore, its values should be interpreted with caution.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 1","pages":"Pages 8-14"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143160528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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