Pub Date : 2024-03-01DOI: 10.1016/j.rcsop.2024.100427
Diamantis Klimentidis
Background
Clinical pharmacists significantly improve pharmacotherapy outcomes. Patients with serious mental illness (SMI) represent a group particularly vulnerable to medication mismanagement, potentially benefiting from pharmaceutical care targeting medication appropriateness.
Objective
This study aimed to assess the prevalence of inappropriate medication for somatic comorbidities in SMI patients and to evaluate the impact of clinical pharmacist-led interventions.
Methods
A pre-post intervention audit involving clinical pharmacist intervention was conducted on SMI patients with somatic comorbidities in a psychiatric clinic in Greece. A comprehensive medication review was undertaken by a clinical pharmacist. The Medicines Appropriateness Index (MAI) and Assessment of Underutilization of medication (AOU) instruments were used to gauge pharmacotherapy appropriateness before and after intervention. Physician acceptance rates and clinical significance were also noted. Statistical analysis employed descriptive and inferential methods, with a significance level set at α = 0.05.
Results
A total of 58 patients were reviewed. Most patients (75.86%) were being inappropriately treated at baseline, versus 15.52% post-intervention. The pharmacist proposed 107 interventions of which 104 (97.2%) were physician-accepted. Changes in MAI and AOU identified improved medication appropriateness post-intervention [χ2 = 33.029, p < 0.005]. Pharmacist interventions resulted in more (52.1%, n = 25), less (16.7%, n = 8) and no changes (31.2%, n = 15) in the total number of prescribed medicines [median difference:1, p < 0.005]. From 49 medication initiation recommendations, the most prescribed medicines were statins for primary or secondary prevention (n = 21, 42.8%), aspirin for primary or secondary prevention (n = 9, 18.36%) and metformin (n = 4, 8.2%).
Conclusion
SMI patients had a high prevalence of physical comorbidities, mainly cardiovascular disease, and a high ratio of inappropriate medication treatment. Intervention by a clinical pharmacist significantly improved medication appropriateness and led to the adoption of a new standard of care, to be checked with re-auditing.
{"title":"Effectiveness of clinical pharmacist interventions in optimizing pharmacotherapy for somatic comorbidities in serious mental illness: A clinical audit","authors":"Diamantis Klimentidis","doi":"10.1016/j.rcsop.2024.100427","DOIUrl":"https://doi.org/10.1016/j.rcsop.2024.100427","url":null,"abstract":"<div><h3>Background</h3><p>Clinical pharmacists significantly improve pharmacotherapy outcomes. Patients with serious mental illness (SMI) represent a group particularly vulnerable to medication mismanagement, potentially benefiting from pharmaceutical care targeting medication appropriateness.</p></div><div><h3>Objective</h3><p>This study aimed to assess the prevalence of inappropriate medication for somatic comorbidities in SMI patients and to evaluate the impact of clinical pharmacist-led interventions.</p></div><div><h3>Methods</h3><p>A pre-post intervention audit involving clinical pharmacist intervention was conducted on SMI patients with somatic comorbidities in a psychiatric clinic in Greece. A comprehensive medication review was undertaken by a clinical pharmacist. The Medicines Appropriateness Index (MAI) and Assessment of Underutilization of medication (AOU) instruments were used to gauge pharmacotherapy appropriateness before and after intervention. Physician acceptance rates and clinical significance were also noted. Statistical analysis employed descriptive and inferential methods, with a significance level set at α = 0.05.</p></div><div><h3>Results</h3><p>A total of 58 patients were reviewed. Most patients (75.86%) were being inappropriately treated at baseline, versus 15.52% post-intervention. The pharmacist proposed 107 interventions of which 104 (97.2%) were physician-accepted. Changes in MAI and AOU identified improved medication appropriateness post-intervention [χ<sup>2</sup> = 33.029, <em>p</em> < 0.005]. Pharmacist interventions resulted in more (52.1%, <em>n</em> = 25), less (16.7%, <em>n</em> = 8) and no changes (31.2%, <em>n</em> = 15) in the total number of prescribed medicines [median difference:1, <em>p</em> < 0.005]. From 49 medication initiation recommendations, the most prescribed medicines were statins for primary or secondary prevention (<em>n</em> = 21, 42.8%), aspirin for primary or secondary prevention (<em>n</em> = 9, 18.36%) and metformin (<em>n</em> = 4, 8.2%).</p></div><div><h3>Conclusion</h3><p>SMI patients had a high prevalence of physical comorbidities, mainly cardiovascular disease, and a high ratio of inappropriate medication treatment. Intervention by a clinical pharmacist significantly improved medication appropriateness and led to the adoption of a new standard of care, to be checked with re-auditing.</p></div>","PeriodicalId":73003,"journal":{"name":"Exploratory research in clinical and social pharmacy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667276624000222/pdfft?md5=b0704fd0aa62a1324fcb4d774c2655af&pid=1-s2.0-S2667276624000222-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140030244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-15DOI: 10.1016/j.rcsop.2024.100423
Sheela Khadka, Katlyn Holt, Michael J. Peeters
Background
Academic conference posters are a key communication before journal articles. Attention to visual attributes can enhance academic poster communication.
Objective
This investigation's purpose was to create a visual impression measurement instrument, and then to describe and compare visual impression among scientific posters from an academic conference.
Methods
A mixed-approach rubric was created to quickly measure visual impression of academic posters. Then, posters from a pharmacy education conference were retrospectively reviewed and scored. Visual impression was compared for traditional versus contemporary poster-formats. Various poster characteristics (poster-format, summary statement presence, abstract presence, wordiness, QR-code presence, logical sequencing, visuals) that might have impacted visual communication were coded. These characteristics were regressed onto visual impression scores.
Results
Three-hundred seventy-eight posters were scored with sound inter-rater reliability. Contemporary poster-format scored significantly higher than traditional. Poster-format, abstract absence, lack of wordiness, QR-code presence, logical sequencing, and number of visuals were significant when regressed.
Conclusion
Posters at one academic conference had varied visual impression. While a contemporary poster-format appeared more helpful, it was not a panacea; variation from poor through exemplary was seen with both poster-formats. Posters are not text-filled articles; displaying a combination of visuals/text clearly and concisely can help effective communication with academic posters.
{"title":"Academic conference posters: Describing visual impression in pharmacy education","authors":"Sheela Khadka, Katlyn Holt, Michael J. Peeters","doi":"10.1016/j.rcsop.2024.100423","DOIUrl":"10.1016/j.rcsop.2024.100423","url":null,"abstract":"<div><h3>Background</h3><p>Academic conference posters are a key communication before journal articles. Attention to visual attributes can enhance academic poster communication.</p></div><div><h3>Objective</h3><p>This investigation's purpose was to create a visual impression measurement instrument, and then to describe and compare visual impression among scientific posters from an academic conference.</p></div><div><h3>Methods</h3><p>A mixed-approach rubric was created to quickly measure visual impression of academic posters. Then, posters from a pharmacy education conference were retrospectively reviewed and scored. Visual impression was compared for traditional versus contemporary poster-formats. Various poster characteristics (poster-format, summary statement presence, abstract presence, wordiness, QR-code presence, logical sequencing, visuals) that might have impacted visual communication were coded. These characteristics were regressed onto visual impression scores.</p></div><div><h3>Results</h3><p>Three-hundred seventy-eight posters were scored with sound inter-rater reliability. Contemporary poster-format scored significantly higher than traditional. Poster-format<em>,</em> abstract absence, lack of wordiness, QR-code presence, logical sequencing, and number of visuals were significant when regressed.</p></div><div><h3>Conclusion</h3><p>Posters at one academic conference had varied visual impression. While a contemporary poster-format appeared more helpful, it was not a panacea; variation from poor through exemplary was seen with both poster-formats. Posters are not text-filled articles; displaying a combination of visuals/text clearly and concisely can help effective communication with academic posters.</p></div>","PeriodicalId":73003,"journal":{"name":"Exploratory research in clinical and social pharmacy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667276624000180/pdfft?md5=4c1ae23dd4886a6cd4410a780d86dec4&pid=1-s2.0-S2667276624000180-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139824403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-14DOI: 10.1016/j.rcsop.2024.100421
A. Persson , M. Troein , S. Lundin , P. Midlöv , C. Lenander
Background
The problem with substandard and falsified (SF) medical products may grow in high-income countries when e-commerce of medicines increases. Unauthorized websites offer medicines of insufficient quality. This underscores the importance of evaluating how the problem with SF medical products can be prevented from escalating. However, little is known about what knowledge and experience professionals working primarily with medicines have about the phenomenon.
Objective
This study was conducted to explore purposively selected pharmacists' experience and knowledge about SF medical products.
Methods
Twelve individual interviews were conducted with purposively selected pharmacists between May 2021 and September 2021. An interview guide was used with specific questions about e-commerce, which focused on exploring pharmacists' experience and knowledge about SF medical products. The interviews lasted, on average, 49 min and were analyzed using inductive qualitative content analysis.
Results
A main theme ‘Pharmacists as guardians of safe medicines’ emerged. This theme consisted of three categories pinpointing ‘risk factors’, ‘protective factors’, and ‘opportunities for improvement’ regarding SF medical products. Findings suggest that pharmacists can play a role in preventing the problem with SF medical products from escalating. Participants emphasized they were in this line of work to help patients and increase patient safety.
Conclusions
Pharmacists have the opportunity to empower the public with knowledge about SF medical products since they discuss medicines with many people every day. Awareness of risk factors for SF medical products enables pharmacists to guide patients to avoid risky purchases from unauthorized websites. To do this, better communication, and cooperation with patients and other healthcare professionals are needed.
{"title":"Exploring pharmacists' perspectives about substandard and falsified medical products through interviews","authors":"A. Persson , M. Troein , S. Lundin , P. Midlöv , C. Lenander","doi":"10.1016/j.rcsop.2024.100421","DOIUrl":"10.1016/j.rcsop.2024.100421","url":null,"abstract":"<div><h3>Background</h3><p>The problem with substandard and falsified (SF) medical products may grow in high-income countries when e-commerce of medicines increases. Unauthorized websites offer medicines of insufficient quality. This underscores the importance of evaluating how the problem with SF medical products can be prevented from escalating. However, little is known about what knowledge and experience professionals working primarily with medicines have about the phenomenon.</p></div><div><h3>Objective</h3><p>This study was conducted to explore purposively selected pharmacists' experience and knowledge about SF medical products.</p></div><div><h3>Methods</h3><p>Twelve individual interviews were conducted with purposively selected pharmacists between May 2021 and September 2021. An interview guide was used with specific questions about e-commerce, which focused on exploring pharmacists' experience and knowledge about SF medical products. The interviews lasted, on average, 49 min and were analyzed using inductive qualitative content analysis.</p></div><div><h3>Results</h3><p>A main theme ‘Pharmacists as guardians of safe medicines’ emerged. This theme consisted of three categories pinpointing ‘risk factors’, ‘protective factors’, and ‘opportunities for improvement’ regarding SF medical products. Findings suggest that pharmacists can play a role in preventing the problem with SF medical products from escalating. Participants emphasized they were in this line of work to help patients and increase patient safety.</p></div><div><h3>Conclusions</h3><p>Pharmacists have the opportunity to empower the public with knowledge about SF medical products since they discuss medicines with many people every day. Awareness of risk factors for SF medical products enables pharmacists to guide patients to avoid risky purchases from unauthorized websites. To do this, better communication, and cooperation with patients and other healthcare professionals are needed.</p></div>","PeriodicalId":73003,"journal":{"name":"Exploratory research in clinical and social pharmacy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667276624000167/pdfft?md5=23f7802bf52926f48aae75102799ce33&pid=1-s2.0-S2667276624000167-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139885629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-11DOI: 10.1016/j.rcsop.2024.100422
Joanna Hikaka , Nora Parore , Brendon McIntosh , Robert Haua , Kate Mohi , Anneka Anderson
Background
In New Zealand (NZ), provision of culturally safe care by pharmacists is mandated, including an expectation of understanding issues relevant to Māori, the Indigenous people of NZ, yet there are few pharmacy-specific resources to support attainment.
Objectives
To: i) test whether a research-informed education activity (short video summarising research findings plus reflective exercises) meets NZ pharmacists' annual continuing professional development requirements including those relating to culturally safe care ii) identify suggested improvements to the education activity; and iii) identify individual pharmacists' proposed actions in response to reflection prompted by the education activity.
Methods
Previous research was utilised to develop an education activity (short, animated research summary video and reflective questions). Participants (NZ-registered pharmacists or intern pharmacists) were asked to watch the video and respond to questions online related to perceived relevance and usefulness of the video to informing practice and meeting CPD requirements. Simple descriptive analysis (quantitative data) and general inductive thematic analysis (qualitative data) were applied to the research data.
Results
Thirty-three people participated from Nov-Dec 2022. Most participants said the video was relevant/very relevant to practice (91%), that the reflective exercise was very or extremely useful (100%) and that it met their CPD requirements as relevant to cultural safety (100%).
Conclusion
The education activity appeared to be an appropriate and relevant for CPD and was seen to be concise and exposed ideas in a logical and succinct manner with the potential to benefit the populations receiving care from these providers.
{"title":"Translating research into a relevant education activity to fulfil pharmacists' continuing professional development requirements","authors":"Joanna Hikaka , Nora Parore , Brendon McIntosh , Robert Haua , Kate Mohi , Anneka Anderson","doi":"10.1016/j.rcsop.2024.100422","DOIUrl":"https://doi.org/10.1016/j.rcsop.2024.100422","url":null,"abstract":"<div><h3>Background</h3><p>In New Zealand (NZ), provision of culturally safe care by pharmacists is mandated, including an expectation of understanding issues relevant to Māori, the Indigenous people of NZ, yet there are few pharmacy-specific resources to support attainment.</p></div><div><h3>Objectives</h3><p>To: i) test whether a research-informed education activity (short video summarising research findings plus reflective exercises) meets NZ pharmacists' annual continuing professional development requirements including those relating to culturally safe care ii) identify suggested improvements to the education activity; and iii) identify individual pharmacists' proposed actions in response to reflection prompted by the education activity.</p></div><div><h3>Methods</h3><p>Previous research was utilised to develop an education activity (short, animated research summary video and reflective questions). Participants (NZ-registered pharmacists or intern pharmacists) were asked to watch the video and respond to questions online related to perceived relevance and usefulness of the video to informing practice and meeting CPD requirements. Simple descriptive analysis (quantitative data) and general inductive thematic analysis (qualitative data) were applied to the research data.</p></div><div><h3>Results</h3><p>Thirty-three people participated from Nov-Dec 2022. Most participants said the video was relevant/very relevant to practice (91%), that the reflective exercise was very or extremely useful (100%) and that it met their CPD requirements as relevant to cultural safety (100%).</p></div><div><h3>Conclusion</h3><p>The education activity appeared to be an appropriate and relevant for CPD and was seen to be concise and exposed ideas in a logical and succinct manner with the potential to benefit the populations receiving care from these providers.</p></div>","PeriodicalId":73003,"journal":{"name":"Exploratory research in clinical and social pharmacy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667276624000179/pdfft?md5=a95e00dbfca04d63c1940439ec176d4f&pid=1-s2.0-S2667276624000179-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139744408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-10DOI: 10.1016/j.rcsop.2024.100420
Xiaobei Dong , Chi Chun Steve Tsang , Jim Y. Wan , Marie A. Chisholm-Burns , Christopher K. Finch , Jack W. Tsao , Jamie A. Browning , Joseph Garuccio , Rose Zeng , Junling Wang
Background
Evidence is sparse on the effects of Medicare medication therapy management (MTM) on racial/ethnic disparities in medication adherence among patients with Alzheimer's disease and related dementias.
Objectives
This study examined the Medicare MTM program's effects on racial/ethnic disparities in the adherence to antidementia medications among patients with Alzheimer's disease and related dementias.
Methods
This is a retrospective analysis of 100% of 2010–2017 Medicare Parts A, B, and D data linked to Area Health Resources Files. The study outcome was nonadherence to antidementia medications, and intervention was defined as new MTM enrollment in 2017. Propensity score matching was conducted to create intervention and comparison groups with comparable characteristics. A difference-in-differences model was employed with logistic regression, including interaction terms of dummy variables for the intervention group and racial/ethnic minorities.
Results
Unadjusted comparisons revealed that Black, Hispanic, and Asian/Pacific Islander patients were more likely to be nonadherent than non-Hispanic White (White) patients in 2016. Differences in odds of nonadherence between Black and White patients among the intervention group were lower in 2017 than in 2016 by 27% (odds ratios [OR]: 0.73, 95% confidence interval [CI]: 0.65–0.82). A similar lowering was seen between Hispanic and White patients by 26% (OR: 0.74, 95% CI: 0.63–0.87). MTM enrollment was associated with reduced disparities in nonadherence for Black-White patients of 33% (OR: 0.67, 95% CI: 0.57–0.78) and Hispanic-White patients of 19% (OR: 0.81, 95% CI: 0.67–0.99).
Discussion
The Medicare MTM program was associated with lower disparities in adherence to antidementia medications between Black and White patients, and between Hispanic and White patients in the population with Alzheimer's disease and related dementias.
Conclusions
Expanding the MTM program may particularly benefit racial/ethnic minorities in Alzheimer's disease and related dementia care.
{"title":"Effects of Medicare Part D medication therapy management on racial/ethnic disparities in adherence to antidementia medications among patients with Alzheimer's disease and related dementias: An observational study","authors":"Xiaobei Dong , Chi Chun Steve Tsang , Jim Y. Wan , Marie A. Chisholm-Burns , Christopher K. Finch , Jack W. Tsao , Jamie A. Browning , Joseph Garuccio , Rose Zeng , Junling Wang","doi":"10.1016/j.rcsop.2024.100420","DOIUrl":"10.1016/j.rcsop.2024.100420","url":null,"abstract":"<div><h3>Background</h3><p>Evidence is sparse on the effects of Medicare medication therapy management (MTM) on racial/ethnic disparities in medication adherence among patients with Alzheimer's disease and related dementias.</p></div><div><h3>Objectives</h3><p>This study examined the Medicare MTM program's effects on racial/ethnic disparities in the adherence to antidementia medications among patients with Alzheimer's disease and related dementias.</p></div><div><h3>Methods</h3><p>This is a retrospective analysis of 100% of 2010–2017 Medicare Parts A, B, and D data linked to Area Health Resources Files. The study outcome was nonadherence to antidementia medications, and intervention was defined as new MTM enrollment in 2017. Propensity score matching was conducted to create intervention and comparison groups with comparable characteristics. A difference-in-differences model was employed with logistic regression, including interaction terms of dummy variables for the intervention group and racial/ethnic minorities.</p></div><div><h3>Results</h3><p>Unadjusted comparisons revealed that Black, Hispanic, and Asian/Pacific Islander patients were more likely to be nonadherent than non-Hispanic White (White) patients in 2016. Differences in odds of nonadherence between Black and White patients among the intervention group were lower in 2017 than in 2016 by 27% (odds ratios [OR]: 0.73, 95% confidence interval [CI]: 0.65–0.82). A similar lowering was seen between Hispanic and White patients by 26% (OR: 0.74, 95% CI: 0.63–0.87). MTM enrollment was associated with reduced disparities in nonadherence for Black-White patients of 33% (OR: 0.67, 95% CI: 0.57–0.78) and Hispanic-White patients of 19% (OR: 0.81, 95% CI: 0.67–0.99).</p></div><div><h3>Discussion</h3><p>The Medicare MTM program was associated with lower disparities in adherence to antidementia medications between Black and White patients, and between Hispanic and White patients in the population with Alzheimer's disease and related dementias.</p></div><div><h3>Conclusions</h3><p>Expanding the MTM program may particularly benefit racial/ethnic minorities in Alzheimer's disease and related dementia care.</p></div>","PeriodicalId":73003,"journal":{"name":"Exploratory research in clinical and social pharmacy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667276624000155/pdfft?md5=93485ccc14797e1ed970cea6d7897dc2&pid=1-s2.0-S2667276624000155-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139814162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patients on hemodialysis have complex medical diagnoses and medication regimens, requiring access to numerous health services and consultation with various healthcare providers. While interprofessional collaboration can optimize care among hemodialysis patients, these patients commonly experience medication-related problems and frequent hospitalizations resulting from miscommunications and mismanagement of medications.
Objectives
This study aims to capture the lived experiences of patients on hemodialysis to reveal their medication management needs as they navigate ongoing care between various outpatient services.
Methods
A qualitative methodology was used to explore the perspectives of hemodialysis patients. One-on-one, in-person, semi-structured interviews were conducted at an outpatient hemodialysis clinic located inside an urban teaching hospital. English-speaking adults 18 years and older who have been followed at the clinic for at least three months were selected through random, convenience sampling. Interviews were recorded and transcribed verbatim. Patients were recruited and data were collected iteratively and continued until data saturation was reached. Data was analyzed through the lens of the Picker Principles of Patient Centered Care using a general inductive approach.
Results
A total of nine interviews were conducted. Two major themes, medication management and care navigation, were identified. Though patients had a wealth of knowledge about their medications, and they were motivated to self-manage their medications to enhance their well-being, they experienced barriers with medication management. Patients further expressed challenges with navigating care and spoke of the importance of having good rapport with healthcare providers who are attentive to their needs.
Conclusions
The results revealed a need for improved support for self-care and interprofessional collaboration to possibly reduce the burden of medications and care fragmentation experienced by patients and improve continuity of care for patients.
背景血液透析患者的医疗诊断和用药方案都很复杂,需要获得众多医疗服务并向不同的医疗服务提供者咨询。虽然跨专业合作可以优化血液透析患者的护理,但这些患者通常会遇到与用药相关的问题,并经常因沟通不畅和用药管理不当而住院。本研究旨在捕捉血液透析患者的生活经历,以揭示他们在接受各种门诊服务时的用药管理需求。我们在一家城市教学医院内的血液透析门诊进行了一对一、面对面、半结构化访谈。通过随机、方便抽样的方式,选取了在该诊所接受过至少三个月随访的 18 岁及以上讲英语的成年人。访谈内容逐字记录和转录。患者招募和数据收集工作反复进行,直到数据达到饱和为止。通过 "以患者为中心的护理原则"(Picker Principles of Patient Centered Care)的视角,采用一般归纳法对数据进行了分析。确定了两大主题,即药物管理和护理导航。虽然患者对自己的用药有丰富的了解,而且他们有动力自我管理用药以提高自身健康水平,但他们在用药管理方面遇到了障碍。患者进一步表达了在护理导航方面遇到的挑战,并谈到了与关注他们需求的医疗服务提供者保持良好关系的重要性。结论 研究结果表明,需要加强对自我护理的支持和跨专业合作,以减轻患者的用药负担和护理分散性,并改善患者护理的连续性。
{"title":"Patients' experiences of medication management while navigating ongoing care between outpatient services: A qualitative case study of patients on hemodialysis","authors":"Tracy Zhang , Mai Mohsen , Angelina Abbaticchio , Marisa Battistella","doi":"10.1016/j.rcsop.2024.100418","DOIUrl":"https://doi.org/10.1016/j.rcsop.2024.100418","url":null,"abstract":"<div><h3>Background</h3><p>Patients on hemodialysis have complex medical diagnoses and medication regimens, requiring access to numerous health services and consultation with various healthcare providers. While interprofessional collaboration can optimize care among hemodialysis patients, these patients commonly experience medication-related problems and frequent hospitalizations resulting from miscommunications and mismanagement of medications.</p></div><div><h3>Objectives</h3><p>This study aims to capture the lived experiences of patients on hemodialysis to reveal their medication management needs as they navigate ongoing care between various outpatient services.</p></div><div><h3>Methods</h3><p>A qualitative methodology was used to explore the perspectives of hemodialysis patients. One-on-one, in-person, semi-structured interviews were conducted at an outpatient hemodialysis clinic located inside an urban teaching hospital. English-speaking adults 18 years and older who have been followed at the clinic for at least three months were selected through random, convenience sampling. Interviews were recorded and transcribed verbatim. Patients were recruited and data were collected iteratively and continued until data saturation was reached. Data was analyzed through the lens of the Picker Principles of Patient Centered Care using a general inductive approach.</p></div><div><h3>Results</h3><p>A total of nine interviews were conducted. Two major themes, medication management and care navigation, were identified. Though patients had a wealth of knowledge about their medications, and they were motivated to self-manage their medications to enhance their well-being, they experienced barriers with medication management. Patients further expressed challenges with navigating care and spoke of the importance of having good rapport with healthcare providers who are attentive to their needs.</p></div><div><h3>Conclusions</h3><p>The results revealed a need for improved support for self-care and interprofessional collaboration to possibly reduce the burden of medications and care fragmentation experienced by patients and improve continuity of care for patients.</p></div>","PeriodicalId":73003,"journal":{"name":"Exploratory research in clinical and social pharmacy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667276624000131/pdfft?md5=e1dbf18bbb9230026c0479e2be6777ba&pid=1-s2.0-S2667276624000131-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139733071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.1016/j.rcsop.2024.100417
Fiona Cairns , Robyn Patrick , Gillian Calderhead , Paul Forsyth , Gazala Akram
Background
With patients developing more complex healthcare and medicine needs, it is imperative pharmacy professionals enhance their knowledge and skills to enable an advanced level of pharmaceutical practice, improving service provision and supporting patient care. The UK Royal Pharmaceutical Society (RPS) is urging employers to incorporate protected time within the working week to facilitate this development. Currently protected development time (PDT) is not well established within the pharmacy profession and there is little qualitative data available about the utility of this.
Objective
To explore how pharmacy professionals in primary care currently utilise planned protected ‘development time’ and their perception of this.
Methods
One-to-one semi-structured interviews were conducted between February and March 2023 via Microsoft Teams® with pharmacists, pharmacy technicians (PTs) and pharmacy support workers (PSWs), working in a large Health board area in Scotland who had established PDT since August 2021. Interview recordings were transcribed verbatim and analysed using an inductive thematic framework approach.
Results
Interviews were conducted with 13 participants (12 female); 6 pharmacists, 5 PTs and 2 PSWs. Five core themes were derived from the data: logistics, competing priorities, methods for development, inequalities and benefits. Participants utility of PDT was variable, most focused on self-development to improve clinical knowledge however, supporting the development of others often taking precedence. Disparities in utility and inequity of protection from service delivery were highlighted. All participants befitted from PDT reporting a self-assessed improvement in confidence and competence.
Conclusion
The experience of participants who had PDT was typically perceived as positive including supporting development and improving wellbeing however, it fostered inequalities which needs addressing. Educational input is required to provide direction for development across all four pillars of professional practice; clinical practice, leadership, education and research, promoting advanced practice. Further research is required to assess the impact of PDT on health outcomes of the local population.
{"title":"A qualitative exploration of how pharmacy professionals in primary care utilise planned protected development time","authors":"Fiona Cairns , Robyn Patrick , Gillian Calderhead , Paul Forsyth , Gazala Akram","doi":"10.1016/j.rcsop.2024.100417","DOIUrl":"https://doi.org/10.1016/j.rcsop.2024.100417","url":null,"abstract":"<div><h3>Background</h3><p>With patients developing more complex healthcare and medicine needs, it is imperative pharmacy professionals enhance their knowledge and skills to enable an advanced level of pharmaceutical practice, improving service provision and supporting patient care. The UK Royal Pharmaceutical Society (RPS) is urging employers to incorporate protected time within the working week to facilitate this development. Currently protected development time (PDT) is not well established within the pharmacy profession and there is little qualitative data available about the utility of this.</p></div><div><h3>Objective</h3><p>To explore how pharmacy professionals in primary care currently utilise planned protected ‘development time’ and their perception of this.</p></div><div><h3>Methods</h3><p>One-to-one semi-structured interviews were conducted between February and March 2023 via Microsoft Teams® with pharmacists, pharmacy technicians (PTs) and pharmacy support workers (PSWs), working in a large Health board area in Scotland who had established PDT since August 2021. Interview recordings were transcribed verbatim and analysed using an inductive thematic framework approach.</p></div><div><h3>Results</h3><p>Interviews were conducted with 13 participants (12 female); 6 pharmacists, 5 PTs and 2 PSWs. Five core themes were derived from the data: logistics, competing priorities, methods for development, inequalities and benefits. Participants utility of PDT was variable, most focused on self-development to improve clinical knowledge however, supporting the development of others often taking precedence. Disparities in utility and inequity of protection from service delivery were highlighted. All participants befitted from PDT reporting a self-assessed improvement in confidence and competence.</p></div><div><h3>Conclusion</h3><p>The experience of participants who had PDT was typically perceived as positive including supporting development and improving wellbeing however, it fostered inequalities which needs addressing. Educational input is required to provide direction for development across all four pillars of professional practice; clinical practice, leadership, education and research, promoting advanced practice. Further research is required to assess the impact of PDT on health outcomes of the local population.</p></div>","PeriodicalId":73003,"journal":{"name":"Exploratory research in clinical and social pharmacy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266727662400012X/pdfft?md5=bfaaa3281d1ce9e1f03725ea0b3484c4&pid=1-s2.0-S266727662400012X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139713994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Self-care during pregnancy is a crucial topic to be discussed due to its effects on both the mother and fetus. In Sri Lanka, specifically regarding self-care with over-the-counter (OTC) medicines, usage among the pregnant population is scarce.
Objective
This study assessed knowledge, attitudes, and practices (KAP) on self-care with OTC medicine usage among pregnant women attending maternity clinics in the Colombo Medical Officer of Health (MOH) areas, Sri Lanka.
Method
A cross-sectional study was conducted among 399 pregnant women enrolled through simple random sampling using a self-administered questionnaire. Data were collected on knowledge, attitudes, practices, and sociodemographic characteristics. SPSS version 27 was used for descriptive statistical analysis.
Results
There were satisfactory levels of KAP on self-care with OTC medicines identified among participants. The Mean ± SD for knowledge was 4.38 ± 0.873, and for attitude and practice, 27.56 ± 3.752 and 20.35 ± 4.235, respectively. Significant positive linear correlation between knowledge and attitude (r = 0.375, p < 0.001), attitude and practice (r = 0.518, p < 0.001), and knowledge and practice (r = 0.224, p < 0.001) were observed. It refers to participants with higher levels of knowledge being more likely to exhibit certain attitudes and engage in good practice regarding self-care. However, 93% of the participants had a wrong intention that any medicine could be used at any stage of pregnancy, and 26.3% of the participants didn't know that the medications taken during pregnancy could impact the fetus. Surprisingly, 87% had misperceived that antibiotics can be purchased as OTC medicines. Additionally, the majority of the participants (96%) believed that they could use old prescriptions to purchase medicines during pregnancy.
Conclusion
Greater awareness regarding self-care with OTC medication usage is suggested to be provided during pregnancy.
{"title":"Assessment of knowledge, attitude, and practice on self-care with over-the-counter medicines among pregnant women","authors":"Kavindya Nirmani , Chanidi Danthanarayana , P.M. Thilini Nisansala , Jeniffer Michael , Achala Shyamali , Jayani Dunukara , Mohammed Dauda Goni , Thilini Nisansala","doi":"10.1016/j.rcsop.2024.100413","DOIUrl":"https://doi.org/10.1016/j.rcsop.2024.100413","url":null,"abstract":"<div><h3>Background</h3><p>Self-care during pregnancy is a crucial topic to be discussed due to its effects on both the mother and fetus. In Sri Lanka, specifically regarding self-care with over-the-counter (OTC) medicines, usage among the pregnant population is scarce.</p></div><div><h3>Objective</h3><p>This study assessed knowledge, attitudes, and practices (KAP) on self-care with OTC medicine usage among pregnant women attending maternity clinics in the Colombo Medical Officer of Health (MOH) areas, Sri Lanka.</p></div><div><h3>Method</h3><p>A cross-sectional study was conducted among 399 pregnant women enrolled through simple random sampling using a self-administered questionnaire. Data were collected on knowledge, attitudes, practices, and sociodemographic characteristics. SPSS version 27 was used for descriptive statistical analysis.</p></div><div><h3>Results</h3><p>There were satisfactory levels of KAP on self-care with OTC medicines identified among participants. The Mean ± SD for knowledge was 4.38 ± 0.873, and for attitude and practice, 27.56 ± 3.752 and 20.35 ± 4.235, respectively. Significant positive linear correlation between knowledge and attitude (<em>r</em> = 0.375, <em>p</em> < 0.001), attitude and practice (<em>r</em> = 0.518, p < 0.001), and knowledge and practice (<em>r</em> = 0.224, p < 0.001) were observed. It refers to participants with higher levels of knowledge being more likely to exhibit certain attitudes and engage in good practice regarding self-care. However, 93% of the participants had a wrong intention that any medicine could be used at any stage of pregnancy, and 26.3% of the participants didn't know that the medications taken during pregnancy could impact the fetus. Surprisingly, 87% had misperceived that antibiotics can be purchased as OTC medicines. Additionally, the majority of the participants (96%) believed that they could use old prescriptions to purchase medicines during pregnancy.</p></div><div><h3>Conclusion</h3><p>Greater awareness regarding self-care with OTC medication usage is suggested to be provided during pregnancy.</p></div>","PeriodicalId":73003,"journal":{"name":"Exploratory research in clinical and social pharmacy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667276624000088/pdfft?md5=91da2958457e73b5d4c05983cb478248&pid=1-s2.0-S2667276624000088-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139709841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-30DOI: 10.1016/j.rcsop.2024.100414
V. Hernández-García , C. Rubio-Armendáriz , D. Alberto-Armas , A. Hardisson-de la Torre
The use of prescribed major opioid analgesics (fentanyl, tapentadol, morphine and oxycodone and combinations) for non-cancer chronic pain is fraught with risks that may generate Negative Medicine Outcomes (NMO). Among the factors associated with these risks, those related to the patient's characteristics and aberrant behavior, the treatment conditions, and the prescription health settings should be evaluated with the aim of minimizing unsafety during the health care process. The present study addresses, from a community pharmacy, the analysis of Drug Related Problems (DRP) and Negative Medicine Outcomes (NMO) in patients using these major opioid analgesics while it aims to demonstrate the role of pharmaceutical care interventions in promoting safety during the use of these molecules. A three step Pharmacotherapeutic Follow-up (PFT) protocol was designed to prevent, detect, and solve DRP and NMO associated with the use of opioid analgesics. 74.6% of the patients used opioid analgesics to treat musculoskeletal pain. Polypharmacy with benzodiazepines (61.9%); antidepressants (57.1%) and antiepileptics (30.2%) was detected in patients using these opioids. The Morisky-Green Adherence test revealed that 30.2% were nonadherent. It was observed, with statistical significance, that in all patients (63), the impact of the 14-week PFT supervised by the community pharmacist achieved an overall reduction in the prevalence of DRP and NMO. While the reduction in the number of DRPs reached 66.7%. Community pharmacies are a strategic point to promote and implement effective opioid stewardship due to both their central role in healthcare services and frequent interaction with patients.
{"title":"Impact of a Community Pharmacy Pharmacotherapy Follow-up (PTF) service in patients using opioid analgesic","authors":"V. Hernández-García , C. Rubio-Armendáriz , D. Alberto-Armas , A. Hardisson-de la Torre","doi":"10.1016/j.rcsop.2024.100414","DOIUrl":"https://doi.org/10.1016/j.rcsop.2024.100414","url":null,"abstract":"<div><p>The use of prescribed major opioid analgesics (fentanyl, tapentadol, morphine and oxycodone and combinations) for non-cancer chronic pain is fraught with risks that may generate Negative Medicine Outcomes (NMO). Among the factors associated with these risks, those related to the patient's characteristics and aberrant behavior, the treatment conditions, and the prescription health settings should be evaluated with the aim of minimizing unsafety during the health care process. The present study addresses, from a community pharmacy, the analysis of Drug Related Problems (DRP) and Negative Medicine Outcomes (NMO) in patients using these major opioid analgesics while it aims to demonstrate the role of pharmaceutical care interventions in promoting safety during the use of these molecules. A three step Pharmacotherapeutic Follow-up (PFT) protocol was designed to prevent, detect, and solve DRP and NMO associated with the use of opioid analgesics. 74.6% of the patients used opioid analgesics to treat musculoskeletal pain. Polypharmacy with benzodiazepines (61.9%); antidepressants (57.1%) and antiepileptics (30.2%) was detected in patients using these opioids. The Morisky-Green Adherence test revealed that 30.2% were nonadherent. It was observed, with statistical significance, that in all patients (63), the impact of the 14-week PFT supervised by the community pharmacist achieved an overall reduction in the prevalence of DRP and NMO. While the reduction in the number of DRPs reached 66.7%. Community pharmacies are a strategic point to promote and implement effective opioid stewardship due to both their central role in healthcare services and frequent interaction with patients.</p></div>","PeriodicalId":73003,"journal":{"name":"Exploratory research in clinical and social pharmacy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266727662400009X/pdfft?md5=9dea3b66cae643106f02c94617f2a906&pid=1-s2.0-S266727662400009X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139694013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-30DOI: 10.1016/j.rcsop.2024.100416
Nour Bourgi , Abd Alrahman Olaby , Ali Najdi , Georges Hatem
Introduction
Antibiogram use is crucial in the fight against antibiotic resistance in Syria, helping to guide treatment decisions, monitor resistance trends, and implement measures to mitigate this global health threat. This study explores the predictors of antibiogram performance and antibiotic resistance patterns in hospital settings in the Northern Syrian region.
Methods
An observational cross-sectional study was performed over six months, from the beginning of September 2022 to February 2023, targeting patients admitted to two hospitals in Syria with susceptibility to infection. The study excluded patients who did not consent or were unwilling to participate, while all individuals admitted due to infectious diseases, regardless of age, sex, or race, were included in the research. Data were collected prospectively, and antimicrobial susceptibility evaluations were performed using the disc diffusion method (the Kirby-Bauer test). Statistical analyses, including the analysis of the results, were conducted utilizing the Statistical Package for Social Sciences (SPSS Inc., Chicago, Illinois) Version 29.
Results
Of 300 hospitalized patients taking antibiotics, an antibiogram was performed for 200 individuals (cases), while 100 patients (controls) received direct treatment. One-hundred eighty-five cases had a positive culture (69.7% Gram-negative and 30.3% Gram-positive) and subsequently underwent assessment for antibiotic resistance. Cases comprised more females (56.0%) than controls (48.0%), with no statistically significant differences (p > 0.05). Significantly more patients between 25 and 63 were cases (63.8%) than controls (51.0%), while older ages were notably higher among controls (31.7%; p = 0.044), history of cardiovascular diseases was higher among controls (59.0%) than cases (47.0%; p = 0.050). Escherichia coli (N = 60; 30%), Klebsiella (N = 37; 18.5%), and Streptococcus (N = 32; 16%) were the most common bacteria. The study explored antibiotic resistance patterns among identified germs, emphasizing the high sensitivity of all identified germs for broad-spectrum antibiotics, including meropenem, amikacin, gentamicin, and fluoroquinolones (levofloxacin, ciprofloxacin). High resistance (%Sensitivity below 60%) was noted for Sulfamethoxazole, nalidixic acid, amoxiclav, lincomycin cefotaxime, ceftriaxone, and cefixime. Specifically, Escherichia coli exhibited robust sensitivity to meropenem (100%), amikacin (93.2%), and ciprofloxacin (92.7%). However, notable resistance was observed against sulfamethoxazole (68.8%), amoxicillin-clavulanate (78.3%), and cefotaxime (88.3%). For Klebsiella, resistance rates were prominent, particularly against sulfamethoxazole (69.4%), amoxicillin (83.8%), and nalidixic acid (100%). Among Gram-positive bacteria, Staphylococcus demonstrated significant resis
{"title":"Predictors of antibiogram performance and antibiotic resistance patterns in the northern Syrian region: A cross-sectional investigation","authors":"Nour Bourgi , Abd Alrahman Olaby , Ali Najdi , Georges Hatem","doi":"10.1016/j.rcsop.2024.100416","DOIUrl":"https://doi.org/10.1016/j.rcsop.2024.100416","url":null,"abstract":"<div><h3>Introduction</h3><p>Antibiogram use is crucial in the fight against antibiotic resistance in Syria, helping to guide treatment decisions, monitor resistance trends, and implement measures to mitigate this global health threat. This study explores the predictors of antibiogram performance and antibiotic resistance patterns in hospital settings in the Northern Syrian region.</p></div><div><h3>Methods</h3><p>An observational cross-sectional study was performed over six months, from the beginning of September 2022 to February 2023, targeting patients admitted to two hospitals in Syria with susceptibility to infection. The study excluded patients who did not consent or were unwilling to participate, while all individuals admitted due to infectious diseases, regardless of age, sex, or race, were included in the research. Data were collected prospectively, and antimicrobial susceptibility evaluations were performed using the disc diffusion method (the Kirby-Bauer test). Statistical analyses, including the analysis of the results, were conducted utilizing the Statistical Package for Social Sciences (SPSS Inc., Chicago, Illinois) Version 29.</p></div><div><h3>Results</h3><p>Of 300 hospitalized patients taking antibiotics, an antibiogram was performed for 200 individuals (cases), while 100 patients (controls) received direct treatment. One-hundred eighty-five cases had a positive culture (69.7% Gram-negative and 30.3% Gram-positive) and subsequently underwent assessment for antibiotic resistance. Cases comprised more females (56.0%) than controls (48.0%), with no statistically significant differences (<em>p</em> > 0.05). Significantly more patients between 25 and 63 were cases (63.8%) than controls (51.0%), while older ages were notably higher among controls (31.7%; <em>p</em> = 0.044), history of cardiovascular diseases was higher among controls (59.0%) than cases (47.0%; <em>p</em> = 0.050). <em>Escherichia coli</em> (<em>N</em> = 60; 30%), <em>Klebsiella</em> (<em>N</em> = 37; 18.5%), and <em>Streptococcus</em> (<em>N</em> = 32; 16%) were the most common bacteria. The study explored antibiotic resistance patterns among identified germs, emphasizing the high sensitivity of all identified germs for broad-spectrum antibiotics, including meropenem, amikacin, gentamicin, and fluoroquinolones (levofloxacin, ciprofloxacin). High resistance (%Sensitivity below 60%) was noted for Sulfamethoxazole, nalidixic acid, amoxiclav, lincomycin cefotaxime, ceftriaxone, and cefixime. Specifically, <em>Escherichia coli</em> exhibited robust sensitivity to meropenem (100%), amikacin (93.2%), and ciprofloxacin (92.7%). However, notable resistance was observed against sulfamethoxazole (68.8%), amoxicillin-clavulanate (78.3%), and cefotaxime (88.3%). For Klebsiella, resistance rates were prominent, particularly against sulfamethoxazole (69.4%), amoxicillin (83.8%), and nalidixic acid (100%). Among Gram-positive bacteria, Staphylococcus demonstrated significant resis","PeriodicalId":73003,"journal":{"name":"Exploratory research in clinical and social pharmacy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2667276624000118/pdfft?md5=b2c654d1122f8c98b0cc36f77f018f24&pid=1-s2.0-S2667276624000118-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139675984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}