Paul J. Barr, Garrett T. Wasp, Michelle D. Dannenberg, Lisa A. Mistler, Kanak Verma, Kyra Bonasia, William R. Haslett, Craig H. Ganoe, Reed W. Bratches, Karen Schifferdecker
Objective
We aimed to understand what patients, caregivers and clinicians identified as the most important information from their audio-recorded clinic visits and why.
Methods
We recruited patients, caregivers and clinicians from primary and speciality care clinics at an academic medical centre in New Hampshire, U.S. Participants reviewed a recording or transcript of their visit, identifying meaningful moments and the reasons why. Two researchers performed a summative content analysis of the data.
Results
Sixteen patients, four with caregivers, from six clinicians participated. Patients, caregivers and clinicians identified a median of 7.5 (3–20), 12.5 (6–50) and 18 (4–31) meaningful visit moments, respectively. Moments identified were similar across stakeholders, including patient education, symptoms, recommendations and medications. Four themes emerged as a rationale for finding visit information meaningful: providing and receiving information, sharing the patient experience, forming a care plan, and providing emotional support. Clinicians rarely identified patient statements as important.
Conclusion
There was considerable agreement between patients, clinicians and caregivers regarding visit information that is most valuable. Patient contributions may be undervalued by clinicians.
Practice Implications
These findings can be used to improve patient-centred visit communication by focusing visit summaries and decision support on information of the most value to participants.
{"title":"Finding the Value: Identifying the Key Elements of Recorded Clinic Visits From the Perspective of Patients, Clinicians, and Caregivers","authors":"Paul J. Barr, Garrett T. Wasp, Michelle D. Dannenberg, Lisa A. Mistler, Kanak Verma, Kyra Bonasia, William R. Haslett, Craig H. Ganoe, Reed W. Bratches, Karen Schifferdecker","doi":"10.1111/hex.70143","DOIUrl":"10.1111/hex.70143","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We aimed to understand what patients, caregivers and clinicians identified as the most important information from their audio-recorded clinic visits and why.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We recruited patients, caregivers and clinicians from primary and speciality care clinics at an academic medical centre in New Hampshire, U.S. Participants reviewed a recording or transcript of their visit, identifying meaningful moments and the reasons why. Two researchers performed a summative content analysis of the data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixteen patients, four with caregivers, from six clinicians participated. Patients, caregivers and clinicians identified a median of 7.5 (3–20), 12.5 (6–50) and 18 (4–31) meaningful visit moments, respectively. Moments identified were similar across stakeholders, including patient education, symptoms, recommendations and medications. Four themes emerged as a rationale for finding visit information meaningful: providing and receiving information, sharing the patient experience, forming a care plan, and providing emotional support. Clinicians rarely identified patient statements as important.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>There was considerable agreement between patients, clinicians and caregivers regarding visit information that is most valuable. Patient contributions may be undervalued by clinicians.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Practice Implications</h3>\u0000 \u0000 <p>These findings can be used to improve patient-centred visit communication by focusing visit summaries and decision support on information of the most value to participants.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55070,"journal":{"name":"Health Expectations","volume":"28 1","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sophie Isobel, Kahala Dixon, Alison Tutt, Bridget Clay, Sylvia Lim-Gibson
Background
A lack of social support contributes to women from culturally diverse backgrounds experiencing higher rates of perinatal distress and lower rates of service engagement.
Objective/Methods
This participatory action research study aimed to understand what a culturally appropriate social intervention may look like for pregnant women from culturally diverse backgrounds. Field notes and qualitative transcripts were descriptively synthesised.
Results
Challenges of engaging with culturally diverse communities in the context of perinatal health services were identified. Cultural factors and practices were seen to impact upon service engagement, with parents more likely to seek support outside of health settings. Community members expressed frustrations with the lack of deep cultural sensitivity in the structure and delivery of health services. Clear definitions in scope and aim of any intervention were indicated, before further community engagement.
Discussion
Challenges in engaging individuals and services from diverse communities highlighted the risks of ideas embedded in oversimplified understandings based on cultural stereotypes and assumptions of homogeneity of experiences at the intersection of cultural diversity, perinatal distress and health services.
Conclusions
Deep cultural sensitivity requires an understanding of how members of population groups perceive and understand health and wellbeing to directly inform the development of any intervention. Attempting to design a culturally sensitive intervention for socially isolated and culturally diverse parents within mainstream health services, led to a paradoxical tension between attempting to address needs in culturally insensitive ways or not attempting to address the needs at all.
Patient or Public Contribution
Members of the public and people who identified as having lived experience of social isolation, cultural diversity or mental distress were engaged in the community consultation phase of the study.
{"title":"The Challenging Process of Developing an Antenatal Social Intervention for Parents From Culturally Diverse Backgrounds to Reduce Postnatal Distress: A Participatory Action Research Study","authors":"Sophie Isobel, Kahala Dixon, Alison Tutt, Bridget Clay, Sylvia Lim-Gibson","doi":"10.1111/hex.70135","DOIUrl":"10.1111/hex.70135","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>A lack of social support contributes to women from culturally diverse backgrounds experiencing higher rates of perinatal distress and lower rates of service engagement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective/Methods</h3>\u0000 \u0000 <p>This participatory action research study aimed to understand what a culturally appropriate social intervention may look like for pregnant women from culturally diverse backgrounds. Field notes and qualitative transcripts were descriptively synthesised.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Challenges of engaging with culturally diverse communities in the context of perinatal health services were identified. Cultural factors and practices were seen to impact upon service engagement, with parents more likely to seek support outside of health settings. Community members expressed frustrations with the lack of deep cultural sensitivity in the structure and delivery of health services. Clear definitions in scope and aim of any intervention were indicated, before further community engagement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Challenges in engaging individuals and services from diverse communities highlighted the risks of ideas embedded in oversimplified understandings based on cultural stereotypes and assumptions of homogeneity of experiences at the intersection of cultural diversity, perinatal distress and health services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Deep cultural sensitivity requires an understanding of how members of population groups perceive and understand health and wellbeing to directly inform the development of any intervention. Attempting to design a culturally sensitive intervention for socially isolated and culturally diverse parents within mainstream health services, led to a paradoxical tension between attempting to address needs in culturally insensitive ways or not attempting to address the needs at all.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patient or Public Contribution</h3>\u0000 \u0000 <p>Members of the public and people who identified as having lived experience of social isolation, cultural diversity or mental distress were engaged in the community consultation phase of the study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55070,"journal":{"name":"Health Expectations","volume":"28 1","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11705391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div> <section> <h3> Background</h3> <p>The Human Immunodeficiency Virus (HIV) has a major impact on a person's social and personal lives, affecting both physical and mental health. To meet the global 95-95-95 target, it is essential to understand and address the multi-level challenges to improve the continuum of care for persons living with HIV (PLWH). This study delves into the care-seeking pathways and barriers encountered by PLWH residing in rural areas of Nepal, shedding light on the complexities of accessing and navigating the continuum of care.</p> </section> <section> <h3> Design</h3> <p>This study was designed as a qualitative thematic study that consisted of in-depth interviews among 21 PLWH and key-informant interviews among four health service providers in rural districts of Koshi province in Nepal. Semi-structured interview guidelines were used to ensure consistency in the data collection process, followed by Inductive Coding to identify and categorize the data into codes. Subsequently, sub-themes and themes were developed, and manifest analysis was conducted to analyze the data. The findings of the study are presented in this paper in the form of excerpts.</p> </section> <section> <h3> Results</h3> <p>The multilevel barriers to HIV care continuum included (i) <i>socio-cultural barriers</i> such as stigma, discrimination, fear of disclosure, and heavy reliance on traditional healers; (ii) <i>socio-economic barriers</i> such as poverty, limited access to health insurance, low health literacy and the exclusion of PLWH under Social Security Act; (iii) <i>fatalistic lifestyles</i> characterized by heavy alcohol consumption, and poor adherence to antiretroviral therapy and (iv) <i>health system-related barriers</i> such as mistreatment by healthcare providers, and long distances to ART centers.</p> </section> <section> <h3> Conclusions</h3> <p>There is a need to expand services beyond treatment, including community-focused awareness and sensitization, programs led by community-based organization, economic empowerment and inclusion of PLWH under social security mechanisms in rural areas for HIV continuum of care.</p> </section> <section> <h3> Patient and Public Contribution</h3> <p>During the study design phase, two PLWH and two service providers were consulted to discuss the research gap, understand the current practices and discuss the data collection tools and their content. Similarly, four service providers supported implementation of th
{"title":"HIV Care Seeking Pathways and Barriers to the Continuum of Care Faced by Persons Living With HIV in Rural Nepal: A Qualitative Study","authors":"Amit Timilsina, Anisha Shrestha, Pabitra Neupane, Sudip Nepal, Bishow Kandel, Sudha Devkota, Subash Thapa","doi":"10.1111/hex.70141","DOIUrl":"10.1111/hex.70141","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Human Immunodeficiency Virus (HIV) has a major impact on a person's social and personal lives, affecting both physical and mental health. To meet the global 95-95-95 target, it is essential to understand and address the multi-level challenges to improve the continuum of care for persons living with HIV (PLWH). This study delves into the care-seeking pathways and barriers encountered by PLWH residing in rural areas of Nepal, shedding light on the complexities of accessing and navigating the continuum of care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>This study was designed as a qualitative thematic study that consisted of in-depth interviews among 21 PLWH and key-informant interviews among four health service providers in rural districts of Koshi province in Nepal. Semi-structured interview guidelines were used to ensure consistency in the data collection process, followed by Inductive Coding to identify and categorize the data into codes. Subsequently, sub-themes and themes were developed, and manifest analysis was conducted to analyze the data. The findings of the study are presented in this paper in the form of excerpts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The multilevel barriers to HIV care continuum included (i) <i>socio-cultural barriers</i> such as stigma, discrimination, fear of disclosure, and heavy reliance on traditional healers; (ii) <i>socio-economic barriers</i> such as poverty, limited access to health insurance, low health literacy and the exclusion of PLWH under Social Security Act; (iii) <i>fatalistic lifestyles</i> characterized by heavy alcohol consumption, and poor adherence to antiretroviral therapy and (iv) <i>health system-related barriers</i> such as mistreatment by healthcare providers, and long distances to ART centers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There is a need to expand services beyond treatment, including community-focused awareness and sensitization, programs led by community-based organization, economic empowerment and inclusion of PLWH under social security mechanisms in rural areas for HIV continuum of care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patient and Public Contribution</h3>\u0000 \u0000 <p>During the study design phase, two PLWH and two service providers were consulted to discuss the research gap, understand the current practices and discuss the data collection tools and their content. Similarly, four service providers supported implementation of th","PeriodicalId":55070,"journal":{"name":"Health Expectations","volume":"28 1","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hex.70141","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mehmet Göktuğ Kılınçarslan, Büşra Dönmez, Yasemin Kaya Beştepe, Büşra Nur Kırıkcıoğlu, Merve Akbaşoğlu, Bezar Karakaya, Erkan Melih Şahin
Introduction
Medical education typically focuses on the dyadic interaction between patient and physician. However, there is another significant presence in the room that can also impact the patient's health outcomes: caregivers. This topic has been relatively underexplored until now, and there is insufficient information available regarding situations in different cultures. In this study, we aimed to separately examine the characteristics of patients that influence the frequency of being accompanied and those that affect patients' preferences regarding the presence of a companion.
Methods
This cross-sectional study was conducted in family medicine clinic of a tertiary hospital. During a period of 15 days, a total of 285 patients who visited the clinic were administered the questionnaire face-to-face. Two logistic regression models were used for dependent variables of “actual” and “desired” situations of admitting to healthcare service with companion.
Results
Of the participants, 167 (58.6%) were female, and the mean age was 36.8 ± 16.2 The sole significant factor, influencing actual visits to be occurred with a companion, was the solution for transportation issues (odds ratio [OR]: 26.25). It was found that unmarried individuals (single/divorced/widowed) (OR: 5.47), those with higher income (OR: 1.84), and older individuals (OR: 1.04) had a higher tendency to prefer visiting the clinic with companion while female are as opposite (OR: 0.50). Anxiety, perceived social support, and health literacy weren't associated with actual situation or desire to have companion.
Conclusion
Patients have companions to address tangible issues. However, different factors may influence the desire to have a companion. There is a large group of individuals who, are accompanied at clinic visits against their wishes, indicating a conflict between being accompanied and the desire for one.
Patient or Public Contribution
Our study was inspired by the unsolicited comments of patients made about their companions during clinical visits. Additionally, community provided valuable feedback during the pilot application phase, particularly in the development of the data form.
{"title":"Investigating the Factors Behind Patients' Desire and Decision to be Accompanied: A Cross-Sectional Analysis","authors":"Mehmet Göktuğ Kılınçarslan, Büşra Dönmez, Yasemin Kaya Beştepe, Büşra Nur Kırıkcıoğlu, Merve Akbaşoğlu, Bezar Karakaya, Erkan Melih Şahin","doi":"10.1111/hex.70102","DOIUrl":"10.1111/hex.70102","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Medical education typically focuses on the dyadic interaction between patient and physician. However, there is another significant presence in the room that can also impact the patient's health outcomes: caregivers. This topic has been relatively underexplored until now, and there is insufficient information available regarding situations in different cultures. In this study, we aimed to separately examine the characteristics of patients that influence the frequency of being accompanied and those that affect patients' preferences regarding the presence of a companion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study was conducted in family medicine clinic of a tertiary hospital. During a period of 15 days, a total of 285 patients who visited the clinic were administered the questionnaire face-to-face. Two logistic regression models were used for dependent variables of “actual” and “desired” situations of admitting to healthcare service with companion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the participants, 167 (58.6%) were female, and the mean age was 36.8 ± 16.2 The sole significant factor, influencing actual visits to be occurred with a companion, was the solution for transportation issues (odds ratio [OR]: 26.25). It was found that unmarried individuals (single/divorced/widowed) (OR: 5.47), those with higher income (OR: 1.84), and older individuals (OR: 1.04) had a higher tendency to prefer visiting the clinic with companion while female are as opposite (OR: 0.50). Anxiety, perceived social support, and health literacy weren't associated with actual situation or desire to have companion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients have companions to address tangible issues. However, different factors may influence the desire to have a companion. There is a large group of individuals who, are accompanied at clinic visits against their wishes, indicating a conflict between being accompanied and the desire for one.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patient or Public Contribution</h3>\u0000 \u0000 <p>Our study was inspired by the unsolicited comments of patients made about their companions during clinical visits. Additionally, community provided valuable feedback during the pilot application phase, particularly in the development of the data form.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55070,"journal":{"name":"Health Expectations","volume":"28 1","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hex.70102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Apinya Koontalay, Mari Botti, Anastasia Hutchinson
<div> <section> <h3> Background</h3> <p>Health service leaders in Thailand face substantial challenges in addressing the needs of a growing population of patients with moderate to severe Chronic Heart Failure (CHF) who require acute care management and ongoing supportive care in the community. The large number of CHF patients requiring readmission for high-level care places a significant burden on healthcare services.</p> </section> <section> <h3> Methods</h3> <p>The design thinking model proposed by the Hasso-Plattner Institute of Design at Stanford University underpinned an approach to developing a co-designed, tailored, culturally acceptable model of chronic care for people with CHF. One consumer, 16 clinicians, and two organisational leaders participated in a codesign workshop that included three activities. The purpose of each activity was to (i) define the problem, (ii) brainstorm possible solutions and (iii) develop a prototype solution. The codesign workshop was one phase of a four-phase codesign project. Data collected included physical data such as sticky notes and storyboards and audio recordings of codesign group discussions. Data were analyses using content analysis.</p> </section> <section> <h3> Results</h3> <p>Nine prototype storyboards aimed at enhancing continuity of care for CHF patients emerged from the workshop activities. The proposed solutions focused on improving consumer access to evidence-based information, multidisciplinary expertise and ongoing community support. Participants discussed and evaluated the viability and feasibility of each prototype before reaching a final decision on an optimal model. The preferred model was a nurse-led case management service supported by a multidisciplinary team.</p> </section> <section> <h3> Conclusion</h3> <p>Key stakeholders identified the importance of moving from a short-term model of care to an integrated, multidisciplinary approach to providing long-term support in the community. The final agreed prototype of a CHF Nurse Case Management service supported by a multidisciplinary team with a focus on community outreach addressed the key concerns of participants and was considered a feasible approach to developing a CHF chronic care service for the community in urban Bangkok, Thailand.</p> </section> <section> <h3> Patient or Public Contribution</h3> <p>The process of codesign involved the engagement and participation of individuals with CHF, clinicians and organisational leaders throu
{"title":"Development of a User-Centred Chronic Care Model for Patients With Heart Failure in a Limited-Resource Setting: A Codesign Study","authors":"Apinya Koontalay, Mari Botti, Anastasia Hutchinson","doi":"10.1111/hex.70142","DOIUrl":"10.1111/hex.70142","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Health service leaders in Thailand face substantial challenges in addressing the needs of a growing population of patients with moderate to severe Chronic Heart Failure (CHF) who require acute care management and ongoing supportive care in the community. The large number of CHF patients requiring readmission for high-level care places a significant burden on healthcare services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The design thinking model proposed by the Hasso-Plattner Institute of Design at Stanford University underpinned an approach to developing a co-designed, tailored, culturally acceptable model of chronic care for people with CHF. One consumer, 16 clinicians, and two organisational leaders participated in a codesign workshop that included three activities. The purpose of each activity was to (i) define the problem, (ii) brainstorm possible solutions and (iii) develop a prototype solution. The codesign workshop was one phase of a four-phase codesign project. Data collected included physical data such as sticky notes and storyboards and audio recordings of codesign group discussions. Data were analyses using content analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Nine prototype storyboards aimed at enhancing continuity of care for CHF patients emerged from the workshop activities. The proposed solutions focused on improving consumer access to evidence-based information, multidisciplinary expertise and ongoing community support. Participants discussed and evaluated the viability and feasibility of each prototype before reaching a final decision on an optimal model. The preferred model was a nurse-led case management service supported by a multidisciplinary team.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Key stakeholders identified the importance of moving from a short-term model of care to an integrated, multidisciplinary approach to providing long-term support in the community. The final agreed prototype of a CHF Nurse Case Management service supported by a multidisciplinary team with a focus on community outreach addressed the key concerns of participants and was considered a feasible approach to developing a CHF chronic care service for the community in urban Bangkok, Thailand.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patient or Public Contribution</h3>\u0000 \u0000 <p>The process of codesign involved the engagement and participation of individuals with CHF, clinicians and organisational leaders throu","PeriodicalId":55070,"journal":{"name":"Health Expectations","volume":"28 1","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hex.70142","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lin Li, Nancy Carter, Jan Willem Gorter, Linda Till, Marcy White, Patricia H. Strachan
Introduction
The transition from paediatric to adult health care (i.e., ‘health care transition’) poses many challenges for youth with medical complexity (YMC) and their families. YMC need specific approaches to supporting transition, tailored to individual youth and family contexts. In this study, we examine the contextual factors influencing families' transition experiences and describe their recommendations for improving the experience.
Methods
We conducted a qualitative explanatory case study in Ontario, Canada. We completed 21 interviews with 17 participants (11 mothers, 2 fathers, 2 YMC, 2 siblings) from 11 families of YMC. Six YMC (55%) were under 18 years of age (pre-transfer) and five (45%) were aged 18 years and older (post-transfer). Analytic approaches included reflexive thematic analysis and directed content analysis.
Findings
Participants described how the interplay of personal and environmental factors impacted their transition experiences. Recommendations for health care providers focused on providing instrumental and psychological support, advocacy and care continuity. Families expressed a need for better access to information and support from primary care providers. System-level recommendations included streamlining transition processes, improving adult health care services and expanding community supports. A socioecological model is presented to guide health care providers and decision makers in assessing and tackling the challenges faced by YMC and their families during transition.
Conclusion
Findings highlight the complexity and scope of issues surrounding the transition to adult care for YMC in Ontario, with evidence of major gaps in services across multiple sectors and settings. Ongoing efforts are needed to move evidence into practice and advocate for more equitable and responsive care for YMC during the transition and beyond.
Patient or Public Contribution
The research team included two parent co-researchers with lived experience, who contributed to protocol refinement, funding acquisition, recruitment, findings interpretation and ongoing knowledge translation efforts.
{"title":"A Socioecological Approach to Support the Transition to Adult Care for Youth With Medical Complexity: Family Perspectives and Recommendations","authors":"Lin Li, Nancy Carter, Jan Willem Gorter, Linda Till, Marcy White, Patricia H. Strachan","doi":"10.1111/hex.70077","DOIUrl":"10.1111/hex.70077","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The transition from paediatric to adult health care (i.e., ‘health care transition’) poses many challenges for youth with medical complexity (YMC) and their families. YMC need specific approaches to supporting transition, tailored to individual youth and family contexts. In this study, we examine the contextual factors influencing families' transition experiences and describe their recommendations for improving the experience.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a qualitative explanatory case study in Ontario, Canada. We completed 21 interviews with 17 participants (11 mothers, 2 fathers, 2 YMC, 2 siblings) from 11 families of YMC. Six YMC (55%) were under 18 years of age (pre-transfer) and five (45%) were aged 18 years and older (post-transfer). Analytic approaches included reflexive thematic analysis and directed content analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Participants described how the interplay of personal and environmental factors impacted their transition experiences. Recommendations for health care providers focused on providing instrumental and psychological support, advocacy and care continuity. Families expressed a need for better access to information and support from primary care providers. System-level recommendations included streamlining transition processes, improving adult health care services and expanding community supports. A socioecological model is presented to guide health care providers and decision makers in assessing and tackling the challenges faced by YMC and their families during transition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Findings highlight the complexity and scope of issues surrounding the transition to adult care for YMC in Ontario, with evidence of major gaps in services across multiple sectors and settings. Ongoing efforts are needed to move evidence into practice and advocate for more equitable and responsive care for YMC during the transition and beyond.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patient or Public Contribution</h3>\u0000 \u0000 <p>The research team included two parent co-researchers with lived experience, who contributed to protocol refinement, funding acquisition, recruitment, findings interpretation and ongoing knowledge translation efforts.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55070,"journal":{"name":"Health Expectations","volume":"28 1","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div> <section> <h3> Objective</h3> <p>Chronic musculoskeletal pain (CMSP) is frequent in chronic diseases, decreasing the quality of life of these patients. In a survey conducted in Belgium in 2019, chronic pain was named by patients as the main factor of complexity in their lives. The objective of our research was to provide elements to understand why and how CMSP contributes to the complexity of these people's lives.</p> </section> <section> <h3> Design</h3> <p>Qualitative study through semi-structured interviews.</p> </section> <section> <h3> Setting</h3> <p>The study was conducted in Belgium with French-speaking individuals. The interviews took place at the university, in a teaching hospital, in private clinics or in individuals' homes.</p> </section> <section> <h3> Participants</h3> <p>We included 24 individuals with CMSP and living complex situations. The recruitment was made in two phases in agreement with the grounded theory methodology and to reach the saturation of ideas.</p> </section> <section> <h3> Results</h3> <p>The complexity experienced by people with CMSP turns around the notion of recognition, which can be broken down into 3 spheres: intimate, social and legal. The poor quality of listening and the fragmented vision of aid and care professionals generate a feeling of loneliness and incomprehension in the face of illness. The unsuitability of the world of work, the opacity of protocols and the attitude of medical experts reveal inequalities in access to recognition for immigrants and people of low socio-professional status.</p> </section> <section> <h3> Conclusion</h3> <p>The complexity of the situations experienced could be reduced by implementing health policies that facilitate: legal recognition of this illness; adaptability in the workplace; raising awareness about pain mechanisms; the risks of stigmatization and the need of interprofessional collaboration.</p> </section> <section> <h3> Patient or Public Contribution</h3> <p>Patients and the public participated in the dissemination of our research and were able to help us with recruitment through social networks (call for participation published on Facebook by the association ‘Aidants proches’) or word of mouth. The presentation of preliminary results at conferences as well a
{"title":"Recognition at the Heart of the Complex Situations Experienced by People With Chronic Musculoskeletal Pain","authors":"Mellier Jessica, Balis Aurélie, Defraine Fabian, Vanderhofstadt Quentin, Di Biagi Léa, Schetgen Marco, D'Ans Pierre, Foucart Jennifer, Mahieu Céline, Bengoetxea Ana","doi":"10.1111/hex.70129","DOIUrl":"10.1111/hex.70129","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Chronic musculoskeletal pain (CMSP) is frequent in chronic diseases, decreasing the quality of life of these patients. In a survey conducted in Belgium in 2019, chronic pain was named by patients as the main factor of complexity in their lives. The objective of our research was to provide elements to understand why and how CMSP contributes to the complexity of these people's lives.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Qualitative study through semi-structured interviews.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>The study was conducted in Belgium with French-speaking individuals. The interviews took place at the university, in a teaching hospital, in private clinics or in individuals' homes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>We included 24 individuals with CMSP and living complex situations. The recruitment was made in two phases in agreement with the grounded theory methodology and to reach the saturation of ideas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The complexity experienced by people with CMSP turns around the notion of recognition, which can be broken down into 3 spheres: intimate, social and legal. The poor quality of listening and the fragmented vision of aid and care professionals generate a feeling of loneliness and incomprehension in the face of illness. The unsuitability of the world of work, the opacity of protocols and the attitude of medical experts reveal inequalities in access to recognition for immigrants and people of low socio-professional status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The complexity of the situations experienced could be reduced by implementing health policies that facilitate: legal recognition of this illness; adaptability in the workplace; raising awareness about pain mechanisms; the risks of stigmatization and the need of interprofessional collaboration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patient or Public Contribution</h3>\u0000 \u0000 <p>Patients and the public participated in the dissemination of our research and were able to help us with recruitment through social networks (call for participation published on Facebook by the association ‘Aidants proches’) or word of mouth. The presentation of preliminary results at conferences as well a","PeriodicalId":55070,"journal":{"name":"Health Expectations","volume":"28 1","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Helene Lundgaard Søberg, Per Koren Solvang, Nada Andelic, Cecilie Røe, Marit Kirkevold
<div> <section> <h3> Background</h3> <p>User organizations for people with disabilities in Norway work for social equality and participation, and quality of health services for people with disabilities, chronic illnesses and reduced functional capacity. Consideration of the experiences from user representatives is necessary when determining the quality and appropriateness of the rehabilitation services. Rehabilitation services constitute the provision and delivery of intangible products to maintain or improve functioning in individual patients or patient groups. Rehabilitation services can be characterized at the policy (macro), organizational (meso) and individual (micro) levels.</p> </section> <section> <h3> Objectives</h3> <p>To explore user representatives' perspectives on rehabilitation service provision and organization and how they experience the influence they exert.</p> </section> <section> <h3> Methods</h3> <p>Focus group interviews with 14 representatives nominated from 11 user organizations in Norway conducted in 2021. Two online focus groups using a semi-structured interview guide were conducted. Data analysis was performed according to Braun and Clarke's thematic data analysis.</p> </section> <section> <h3> Results</h3> <p>Six core themes were developed when analyzing the participants' experiences and opinions regarding rehabilitation services. The themes were inter-connected and addressed perspectives on Access to services, Integration of care, Rehabilitation team, Person centeredness, System and governance and Modes of user representation and contribution.</p> </section> <section> <h3> Conclusion</h3> <p>The user representatives revealed tension and complexity influencing the provision and organization of rehabilitation services from individual access to health policy and regulation. Empowering user representatives through training was important to fight tokenism. Filling the role of a user representative at the meso level requires the integration of personal and peer experiences at the micro level, and knowledge of health policy regulations at the macro level.</p> </section> <section> <h3> Patient or Public Contribution</h3> <p>The Norwegian Federation of Organisations of Persons with Disabilities recruited user representatives in this study. The user representatives participated in the assessment and discussion of the results of t
{"title":"Users' Perspectives on the Organization of Rehabilitation Services – A Focus Group Study of User Organization Representatives in Norway","authors":"Helene Lundgaard Søberg, Per Koren Solvang, Nada Andelic, Cecilie Røe, Marit Kirkevold","doi":"10.1111/hex.70139","DOIUrl":"10.1111/hex.70139","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>User organizations for people with disabilities in Norway work for social equality and participation, and quality of health services for people with disabilities, chronic illnesses and reduced functional capacity. Consideration of the experiences from user representatives is necessary when determining the quality and appropriateness of the rehabilitation services. Rehabilitation services constitute the provision and delivery of intangible products to maintain or improve functioning in individual patients or patient groups. Rehabilitation services can be characterized at the policy (macro), organizational (meso) and individual (micro) levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To explore user representatives' perspectives on rehabilitation service provision and organization and how they experience the influence they exert.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Focus group interviews with 14 representatives nominated from 11 user organizations in Norway conducted in 2021. Two online focus groups using a semi-structured interview guide were conducted. Data analysis was performed according to Braun and Clarke's thematic data analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Six core themes were developed when analyzing the participants' experiences and opinions regarding rehabilitation services. The themes were inter-connected and addressed perspectives on Access to services, Integration of care, Rehabilitation team, Person centeredness, System and governance and Modes of user representation and contribution.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The user representatives revealed tension and complexity influencing the provision and organization of rehabilitation services from individual access to health policy and regulation. Empowering user representatives through training was important to fight tokenism. Filling the role of a user representative at the meso level requires the integration of personal and peer experiences at the micro level, and knowledge of health policy regulations at the macro level.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patient or Public Contribution</h3>\u0000 \u0000 <p>The Norwegian Federation of Organisations of Persons with Disabilities recruited user representatives in this study. The user representatives participated in the assessment and discussion of the results of t","PeriodicalId":55070,"journal":{"name":"Health Expectations","volume":"27 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11669625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Basharat Hussain, Hannah Wheat, Tomasina M. Oh, Richard Byng
Introduction
In this viewpoint we highlight a gap in the literature relating to the involvement of professional stakeholders in healthcare evaluation research.
Method
Using the Dementia—PersonAlised Care Team (D-PACT) project as an example, we illustrate how professional stakeholder work can serve various functions, from understanding commissioning and policy context to contributing to detail of intervention components.
Outcome
We argue that identifying these project-specific functions can help researchers to effectively plan when, how and for whom they will engage in professional stakeholder work across the course of an evaluation. In addition, we call for further evidence-based guidance and sufficient allocation of resources (provided by those funding research projects) to support effective stakeholder work.
Conclusion
Such support will not only enhance evaluation findings but also promote continued learning on best practice for professional stakeholder work.
Patient or Public Contribution
Public and patient involvement contributors were involved in the main D-PACT study design, development of data collection tools and interpretation of study findings.
{"title":"Engagement With Professional Stakeholders in Healthcare Research—The Case of the Dementia PersonAlised Care Team (D-PACT) Project in the United Kingdom","authors":"Basharat Hussain, Hannah Wheat, Tomasina M. Oh, Richard Byng","doi":"10.1111/hex.70133","DOIUrl":"10.1111/hex.70133","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>In this viewpoint we highlight a gap in the literature relating to the involvement of professional stakeholders in healthcare evaluation research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Using the Dementia—PersonAlised Care Team (D-PACT) project as an example, we illustrate how professional stakeholder work can serve various functions, from understanding commissioning and policy context to contributing to detail of intervention components.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Outcome</h3>\u0000 \u0000 <p>We argue that identifying these project-specific functions can help researchers to effectively plan when, how and for whom they will engage in professional stakeholder work across the course of an evaluation. In addition, we call for further evidence-based guidance and sufficient allocation of resources (provided by those funding research projects) to support effective stakeholder work.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Such support will not only enhance evaluation findings but also promote continued learning on best practice for professional stakeholder work.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patient or Public Contribution</h3>\u0000 \u0000 <p>Public and patient involvement contributors were involved in the main D-PACT study design, development of data collection tools and interpretation of study findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55070,"journal":{"name":"Health Expectations","volume":"27 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11668272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Isabelle Bogard, Julie Ayre, Jenna Smith, Joshua W. Pate, Andrew Sortwell, Jonah Gorringe, Georgia Gordon, Steven J. Kamper, Tie P. Yamato
Background
Pain is prevalent across the lifespan and contributes to significant societal and economic burdens. The public often holds misconceptions about pain and pain management. Despite this, there are no well-resourced public health initiatives delivering information about pain and pain management to the public. Adolescence is an opportune time to educate the public about pain. Health interventions designed for adolescents should reflect their understanding, beliefs and experiences; however, no studies explore this in non-clinical populations of adolescents. We aimed to explore adolescents' understanding, experiences and beliefs about pain to inform the development of a school-based pain education module.
Methods
We conducted semi-structured interviews with 25 adolescents in grades 7–10 (ages 11–16) attending Australian secondary schools. Interviews were conducted on video-conferencing software, audio-recorded, transcribed verbatim and analysed using Framework Analysis.
Results
We generated three themes: (i) physical and psychological pain are distinct, (ii) psychological and contextual factors influence how someone feels or reacts to physical pain and (iii) physical pain matters if it impacts participation in meaningful activities.
Conclusions
Adolescents' understanding and beliefs about pain do not always align with current scientific understanding of pain. School-based pain education programmes should target these areas of misalignment. Addressing adolescents' misconceptions about pain through pain education could also create a more supportive school environment for adolescents experiencing pain. Interactive approaches to learning, such as discussions that encourage adolescents to reflect on their experiences of pain, could be a promising avenue for pain education.
Patient or Public Contribution
Two co-authors are part of the study population and contributed to the study design and analysis. Their input ensured the interview guide was appropriate for the target population and provided an adolescent perspective on the findings. They were remunerated for their time in accordance with consumer involvement guidelines.
{"title":"Exploring Adolescents' Understanding, Experiences and Beliefs About Pain: A Qualitative Study","authors":"Isabelle Bogard, Julie Ayre, Jenna Smith, Joshua W. Pate, Andrew Sortwell, Jonah Gorringe, Georgia Gordon, Steven J. Kamper, Tie P. Yamato","doi":"10.1111/hex.70132","DOIUrl":"10.1111/hex.70132","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pain is prevalent across the lifespan and contributes to significant societal and economic burdens. The public often holds misconceptions about pain and pain management. Despite this, there are no well-resourced public health initiatives delivering information about pain and pain management to the public. Adolescence is an opportune time to educate the public about pain. Health interventions designed for adolescents should reflect their understanding, beliefs and experiences; however, no studies explore this in non-clinical populations of adolescents. We aimed to explore adolescents' understanding, experiences and beliefs about pain to inform the development of a school-based pain education module.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted semi-structured interviews with 25 adolescents in grades 7–10 (ages 11–16) attending Australian secondary schools. Interviews were conducted on video-conferencing software, audio-recorded, transcribed verbatim and analysed using Framework Analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We generated three themes: (i) physical and psychological pain are distinct, (ii) psychological and contextual factors influence how someone feels or reacts to physical pain and (iii) physical pain matters if it impacts participation in meaningful activities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Adolescents' understanding and beliefs about pain do not always align with current scientific understanding of pain. School-based pain education programmes should target these areas of misalignment. Addressing adolescents' misconceptions about pain through pain education could also create a more supportive school environment for adolescents experiencing pain. Interactive approaches to learning, such as discussions that encourage adolescents to reflect on their experiences of pain, could be a promising avenue for pain education.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patient or Public Contribution</h3>\u0000 \u0000 <p>Two co-authors are part of the study population and contributed to the study design and analysis. Their input ensured the interview guide was appropriate for the target population and provided an adolescent perspective on the findings. They were remunerated for their time in accordance with consumer involvement guidelines.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55070,"journal":{"name":"Health Expectations","volume":"27 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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