{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T12:07:26Z","timestamp":1789474046238,"version":"build-2803163510"},"reference-count":67,"publisher":"Georg Thieme Verlag KG","issue":"06","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Semin Neurol"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Delirium has been recognized, documented, and examined for centuries. In 500 BC Hippocrates described hyper- and hypoactive forms of delirium. As medicine, surgery, and critical care have accelerated over the last century, so too has our understanding of delirium and its profound risks to patients, families, and health care teams. It has also been increasingly understood that it is the accumulation of risk factors that ultimately precipitates delirium and nonpharmacological interventions to reduce these risks remain the cornerstone of delirium prevention and management. However, over the last three decades, these nonpharmacological strategies have moved from a single-component approach to a multicomponent approach, targeting multiple risk factors. Additionally, our understanding of what constitutes a risk factor for delirium has evolved, and in particular, it has been recognized that delirium can sometimes be a byproduct of our interventions and health care systems. In the surgical setting, for example, optimization of risk factors prior to surgery, when possible, is now seen as a key way to prevent postoperative delirium. Similarly, critical care medicine now operates with the appreciation of the profound risk to patients of prolonged mechanical ventilation, sedation, and immobilization and seeks to minimize each to reduce the risk of delirium, among other negative effects. The future of delirium prevention and management lies in both better implementation of best practices that have been defined over the last three decades as well as taking more of a whole patient view. This includes harnessing the electronic medical record, artificial intelligence, and so on to risk assess and individualize care for each patient; restructuring care to reduce deliriogenic practices and care environments; redefining what usual care looks like (e.g., utilizing music and involving loved ones, etc.); policy changes to change systematic priorities. In this paper, we will explore the past, present, and future of nonpharmacological prevention and management of delirium across care settings.<\/jats:p>","DOI":"10.1055\/s-0044-1791696","type":"journal-article","created":{"date-parts":[[2024,10,22]],"date-time":"2024-10-22T23:26:56Z","timestamp":1729639616000},"page":"777-787","source":"Crossref","is-referenced-by-count":4,"title":["Nonpharmacological Prevention and Management of Delirium: Past, Present, and Future"],"prefix":"10.1055","volume":"44","author":[{"given":"Sophia L.","family":"Ryan","sequence":"additional","affiliation":[{"name":"Department of Neurology, Mount Sinai Health System, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2024,10,22]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1177\/0957154X07076467","article-title":"A brief review of the history of delirium as a mental disorder","volume":"18","author":"D Adamis","year":"2007","journal-title":"Hist Psychiatry"},{"issue":"12","key":"ref2","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1111\/j.1532-5415.1991.tb03572.x","article-title":"Effectiveness of geriatric psychiatry consultation in an acute care hospital: a randomized clinical trial","volume":"39","author":"M G Cole","year":"1991","journal-title":"J Am Geriatr Soc"},{"issue":"07","key":"ref3","first-page":"713","article-title":"Effect of a geriatric consultation service on management of patients in an acute care hospital","volume":"136","author":"D B Hogan","year":"1987","journal-title":"CMAJ"},{"issue":"26","key":"ref4","doi-asserted-by":"crossref","first-page":"1664","DOI":"10.1056\/NEJM198412273112604","article-title":"Effectiveness of a geriatric evaluation unit. A randomized clinical trial","volume":"311","author":"L Z Rubenstein","year":"1984","journal-title":"N Engl J Med"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1111\/j.1547-5069.1992.tb00719.x","article-title":"Functional status outcomes of a nursing intervention in hospitalized elderly","volume":"24","author":"C K Wanich","year":"1992","journal-title":"Image J Nurs Sch"},{"issue":"09","key":"ref6","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1056\/NEJM199903043400901","article-title":"A multicomponent intervention to prevent delirium in hospitalized older patients","volume":"340","author":"S K Inouye","year":"1999","journal-title":"N Engl J Med"},{"issue":"02","key":"ref7","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1378\/chest.06-1795","article-title":"The importance of diagnosing and managing ICU delirium","volume":"132","author":"B T Pun","year":"2007","journal-title":"Chest"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1007\/s13311-011-0102-9","article-title":"Pharmacological and nonpharmacological management of delirium in critically ill patients","volume":"9","author":"D M Hipp","year":"2012","journal-title":"Neurotherapeutics"},{"issue":"01","key":"ref9","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1097\/00006199-197901000-00007","article-title":"Nursing activities and acute confusional states in elderly hip-fractured patients","volume":"28","author":"M A Williams","year":"1979","journal-title":"Nurs Res"},{"issue":"04","key":"ref10","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1002\/nur.4770080405","article-title":"Reducing acute confusional states in elderly patients with hip fractures","volume":"8","author":"M A Williams","year":"1985","journal-title":"Res Nurs Health"},{"issue":"07","key":"ref11","doi-asserted-by":"crossref","first-page":"ITC49","DOI":"10.7326\/AITC202010060","article-title":"Delirium","volume":"173","author":"M LP Mattison","year":"2020","journal-title":"Ann Intern Med"},{"issue":"10","key":"ref12","doi-asserted-by":"crossref","first-page":"1492","DOI":"10.1111\/j.1532-5415.2006.00869.x","article-title":"Dissemination of the hospital elder life program: implementation, adaptation, and successes","volume":"54","author":"S K Inouye","year":"2006","journal-title":"J Am Geriatr Soc"},{"issue":"10","key":"ref13","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1016\/j.jagp.2018.06.007","article-title":"Hospital elder life program: systematic review and meta-analysis of effectiveness","volume":"26","author":"T T Hshieh","year":"2018","journal-title":"Am J Geriatr Psychiatry"},{"issue":"05","key":"ref14","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1055\/s-0041-1733791","article-title":"Evaluation and management of delirium","volume":"41","author":"S L Ryan","year":"2021","journal-title":"Semin Neurol"},{"issue":"03","key":"ref15","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1111\/jgs.18212","article-title":"The modified and extended hospital elder life program: a remote model of care to expand delirium prevention","volume":"71","author":"T G Fong","year":"2023","journal-title":"J Am Geriatr Soc"},{"issue":"04","key":"ref16","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1111\/j.1532-5415.2005.53210.x","article-title":"A multifactorial intervention program reduces the duration of delirium, length of hospitalization, and mortality in delirious patients","volume":"53","author":"M Lundstr\u00f6m","year":"2005","journal-title":"J Am Geriatr Soc"},{"issue":"09","key":"ref17","doi-asserted-by":"crossref","first-page":"22","DOI":"10.3928\/00989134-20100330-02","article-title":"Feasibility of family participation in a delirium prevention program for hospitalized older adults","volume":"36","author":"D A Rosenbloom-Brunton","year":"2010","journal-title":"J Gerontol Nurs"},{"issue":"12","key":"ref18","doi-asserted-by":"crossref","first-page":"941","DOI":"10.7326\/0003-4819-113-12-941","article-title":"Clarifying confusion: the confusion assessment method. A new method for detection of delirium","volume":"113","author":"S K Inouye","year":"1990","journal-title":"Ann Intern Med"},{"issue":"11","key":"ref19","doi-asserted-by":"crossref","first-page":"2121","DOI":"10.1111\/j.1532-5415.2012.04200.x","article-title":"Screening for delirium using family caregivers: convergent validity of the family confusion assessment method and interviewer-rated confusion assessment method","volume":"60","author":"M R Steis","year":"2012","journal-title":"J Am Geriatr Soc"},{"issue":"02","key":"ref21","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1080\/13607863.2013.814102","article-title":"A family approach to delirium: a review of the literature","volume":"18","author":"S Halloway","year":"2014","journal-title":"Aging Ment Health"},{"issue":"03","key":"ref22","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1093\/geront\/gnu035","article-title":"Delirium and the family caregiver: the need for evidence-based education interventions","volume":"55","author":"M K Carbone","year":"2015","journal-title":"Gerontologist"},{"issue":"01","key":"ref23","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1111\/ajag.12688","article-title":"Family intervention improves outcomes for patients with delirium: systematic review and meta-analysis","volume":"39","author":"J McKenzie","year":"2020","journal-title":"Australas J Ageing"},{"issue":"08","key":"ref25","doi-asserted-by":"crossref","first-page":"491","DOI":"10.3390\/medicina55080491","article-title":"The Scottish Intercollegiate Guidelines Network (SIGN) 157: guidelines on risk reduction and management of delirium","volume":"55","author":"R L Soiza","year":"2019","journal-title":"Medicina (Kaunas)"},{"issue":"06","key":"ref27","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/j.gerinurse.2017.04.006","article-title":"Predicting inpatient delirium: the AWOL delirium risk-stratification score in clinical practice","volume":"38","author":"E G Brown","year":"2017","journal-title":"Geriatr Nurs"},{"issue":"01","key":"ref28","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1186\/s12913-018-2906-3","article-title":"Evaluation of a multicomponent pathway to address inpatient delirium on a neurosciences ward","volume":"18","author":"E G Brown","year":"2018","journal-title":"BMC Health Serv Res"},{"issue":"08","key":"ref29","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1177\/1054773817721400","article-title":"The effects of delirium prevention guidelines on elderly stroke patients","volume":"27","author":"J Song","year":"2018","journal-title":"Clin Nurs Res"},{"issue":"01","key":"ref30","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1097\/00000542-200601000-00005","article-title":"Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients","volume":"104","author":"P Pandharipande","year":"2006","journal-title":"Anesthesiology"},{"issue":"25","key":"ref31","doi-asserted-by":"crossref","first-page":"1864","DOI":"10.1056\/NEJM199612193352502","article-title":"Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously","volume":"335","author":"E W Ely","year":"1996","journal-title":"N Engl J Med"},{"issue":"20","key":"ref32","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1056\/NEJM200005183422002","article-title":"Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation","volume":"342","author":"J P Kress","year":"2000","journal-title":"N Engl J Med"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/S0140-6736(08)60105-1","article-title":"Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial","volume":"371","author":"T D Girard","year":"2008","journal-title":"Lancet"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"1874","DOI":"10.1016\/S0140-6736(09)60658-9","article-title":"Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial","volume":"373","author":"W D Schweickert","year":"2009","journal-title":"Lancet"},{"issue":"01","key":"ref35","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1055\/s-0029-1246284","article-title":"Liberation and animation: strategies to minimize brain dysfunction in critically ill patients","volume":"31","author":"M S King","year":"2010","journal-title":"Semin Respir Crit Care Med"},{"issue":"14","key":"ref36","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1001\/jama.291.14.1753","article-title":"Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit","volume":"291","author":"E W Ely","year":"2004","journal-title":"JAMA"},{"issue":"05","key":"ref38","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1378\/chest.10-0466","article-title":"Reducing iatrogenic risks: ICU-acquired delirium and weakness\u2013crossing the quality chasm","volume":"138","author":"E E Vasilevskis","year":"2010","journal-title":"Chest"},{"key":"ref39","doi-asserted-by":"crossref","first-page":"S683","DOI":"10.1097\/CCM.0b013e3181f245d3","article-title":"A screening, prevention, and restoration model for saving the injured brain in intensive care unit survivors","volume":"38","author":"E E Vasilevskis","year":"2010","journal-title":"Crit Care Med"},{"issue":"02","key":"ref41","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1097\/CCM.0000000000002149","article-title":"Improving hospital survival and reducing brain dysfunction at seven California community hospitals: implementing PAD guidelines via the ABCDEF bundle in 6,064 patients","volume":"45","author":"M A Barnes-Daly","year":"2017","journal-title":"Crit Care Med"},{"issue":"01","key":"ref42","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1097\/CCM.0000000000003482","article-title":"Caring for critically ill patients with the ABCDEF bundle: results of the ICU liberation collaborative in over 15,000 adults","volume":"47","author":"B T Pun","year":"2019","journal-title":"Crit Care Med"},{"issue":"01","key":"ref43","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1097\/CCM.0b013e3182783b72","article-title":"Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit","volume":"41","author":"J Barr","year":"2013","journal-title":"Crit Care Med"},{"issue":"11","key":"ref44","first-page":"CD009783","article-title":"Interventions for preventing intensive care unit delirium in adults","volume":"11","author":"S F Herling","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"ref45","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.jcrc.2020.08.019","article-title":"Non-pharmacological interventions to reduce the incidence and duration of delirium in critically ill patients: a systematic review and network meta-analysis","volume":"60","author":"L X Deng","year":"2020","journal-title":"J Crit Care"},{"issue":"04","key":"ref46","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1016\/j.bja.2020.06.063","article-title":"Postoperative delirium: perioperative assessment, risk reduction, and management","volume":"125","author":"Z Jin","year":"2020","journal-title":"Br J Anaesth"},{"issue":"06","key":"ref47","doi-asserted-by":"crossref","first-page":"474","DOI":"10.7326\/0003-4819-119-6-199309150-00005","article-title":"A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics","volume":"119","author":"S K Inouye","year":"1993","journal-title":"Ann Intern Med"},{"issue":"12","key":"ref48","doi-asserted-by":"crossref","first-page":"e3072","DOI":"10.1097\/MD.0000000000003072","article-title":"DELirium prediction based on hospital information (Delphi) in general surgery patients","volume":"95","author":"M Y Kim","year":"2016","journal-title":"Medicine (Baltimore)"},{"issue":"02","key":"ref49","first-page":"81","article-title":"Update of the European Society of Anaesthesiology and intensive care medicine evidence-based and consensus-based guideline on postoperative delirium in adult patients","volume":"41","author":"C Aldecoa","year":"2024","journal-title":"Eur J Anaesthesiol"},{"issue":"01","key":"ref50","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1111\/jgs.13281","article-title":"American Geriatrics Society abstracted clinical practice guideline for postoperative delirium in older adults","volume":"63","author":"American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults","year":"2015","journal-title":"J Am Geriatr Soc"},{"issue":"05","key":"ref51","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1097\/EJA.0b013e3283335cee","article-title":"Duration of fluid fasting and choice of analgesic are modifiable factors for early postoperative delirium","volume":"27","author":"F M Radtke","year":"2010","journal-title":"Eur J Anaesthesiol"},{"issue":"03","key":"ref52","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1177\/1089253213476957","article-title":"Delirium: past, present, and future","volume":"17","author":"R R Field","year":"2013","journal-title":"Semin Cardiothorac Vasc Anesth"},{"issue":"01","key":"ref53","doi-asserted-by":"crossref","first-page":"18","DOI":"10.4065\/mcp.2009.0469","article-title":"Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair","volume":"85","author":"F E Sieber","year":"2010","journal-title":"Mayo Clin Proc"},{"issue":"05","key":"ref54","first-page":"CD011283","article-title":"Processed electroencephalogram and evoked potential techniques for amelioration of postoperative delirium and cognitive dysfunction following non-cardiac and non-neurosurgical procedures in adults","volume":"5","author":"Y Punjasawadwong","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"issue":"05","key":"ref55","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1001\/jama.2018.22005","article-title":"Effect of electroencephalography-guided anesthetic administration on postoperative delirium among older adults undergoing major surgery: the ENGAGES randomized clinical trial","volume":"321","author":"T S Wildes","year":"2019","journal-title":"JAMA"},{"issue":"02","key":"ref56","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1001\/jama.2024.8144","article-title":"Electroencephalography-guided anesthesia and delirium in older adults after cardiac surgery: the ENGAGES-Canada randomized clinical trial","volume":"332","author":"A Deschamps","year":"2024","journal-title":"JAMA"},{"issue":"05","key":"ref57","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1097\/ALN.0b013e3181b6a783","article-title":"Prevalence of delirium with dexmedetomidine compared with morphine based therapy after cardiac surgery: a randomized controlled trial (DEXmedetomidine COmpared to Morphine-DEXCOM Study)","volume":"111","author":"Y Shehabi","year":"2009","journal-title":"Anesthesiology"},{"issue":"03","key":"ref58","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1176\/appi.psy.50.3.206","article-title":"Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery","volume":"50","author":"J R Maldonado","year":"2009","journal-title":"Psychosomatics"},{"issue":"02","key":"ref59","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1016\/j.bja.2018.04.046","article-title":"Efficacy of perioperative dexmedetomidine on postoperative delirium: systematic review and meta-analysis with trial sequential analysis of randomised controlled trials","volume":"121","author":"X Duan","year":"2018","journal-title":"Br J Anaesth"},{"issue":"01","key":"ref60","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1001\/jamainternmed.2019.4446","article-title":"Effect of the tailored, family-involved hospital elder life program on postoperative delirium and function in older adults: a randomized clinical trial","volume":"180","author":"Y Y Wang","year":"2020","journal-title":"JAMA Intern Med"},{"issue":"07","key":"ref61","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1111\/j.1532-5415.1991.tb03618.x","article-title":"A geriatric-anesthesiologic program to reduce acute confusional states in elderly patients treated for femoral neck fractures","volume":"39","author":"Y Gustafson","year":"1991","journal-title":"J Am Geriatr Soc"},{"issue":"06","key":"ref62","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1002\/bjs.10459","article-title":"Randomized clinical trial of comprehensive geriatric assessment and optimization in vascular surgery","volume":"104","author":"J SL Partridge","year":"2017","journal-title":"Br J Surg"},{"issue":"23","key":"ref63","doi-asserted-by":"crossref","first-page":"2268","DOI":"10.1056\/NEJMc2008597","article-title":"Neurologic features in severe SARS-CoV-2 infection","volume":"382","author":"J Helms","year":"2020","journal-title":"N Engl J Med"},{"issue":"04","key":"ref64","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1093\/ageing\/afaa094","article-title":"Delirium: a missing piece in the COVID-19 pandemic puzzle","volume":"49","author":"S O'Hanlon","year":"2020","journal-title":"Age Ageing"},{"issue":"06","key":"ref65","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1056\/NEJMp1910499","article-title":"Joining forces against delirium - from organ-system care to whole-human care","volume":"382","author":"S K Inouye","year":"2020","journal-title":"N Engl J Med"},{"issue":"01","key":"ref66","doi-asserted-by":"crossref","first-page":"69","DOI":"10.2217\/1745509X.4.1.69","article-title":"Does \u2018Hospital in the Home\u2019 treatment prevent delirium?","volume":"4","author":"G Caplan","year":"2008","journal-title":"Aging Health"},{"issue":"01","key":"ref67","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1007\/s12028-019-00703-w","article-title":"Continuous EEG monitoring in a consecutive patient cohort with sepsis and delirium","volume":"32","author":"R M Nielsen","year":"2020","journal-title":"Neurocrit Care"},{"issue":"06","key":"ref68","first-page":"1","article-title":"Evaluation of point-of-care thumb-size bispectral electroencephalography device to quantify delirium severity and predict mortality","volume":"220","author":"T Yamanashi","year":"2021","journal-title":"Br J Psychiatry"},{"issue":"12","key":"ref69","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1111\/pcn.13478","article-title":"An automated electroencephalography algorithm to detect polymorphic delta activity in acute encephalopathy presenting as postoperative delirium","volume":"76","author":"F L Ditzel","year":"2022","journal-title":"Psychiatry Clin Neurosci"},{"issue":"08","key":"ref70","doi-asserted-by":"crossref","first-page":"e26079","DOI":"10.2196\/26079","article-title":"Overview and strategy analysis of technology-based nonpharmacological interventions for in-hospital delirium prevention and reduction: systematic scoping review","volume":"23","author":"C M Kim","year":"2021","journal-title":"J Med Internet Res"},{"issue":"02","key":"ref71","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.jopan.2018.05.006","article-title":"Bach to the basics: Implementation and impact of a postoperative, inpatient personalized music program for older adults","volume":"34","author":"N Sharda","year":"2019","journal-title":"J Perianesth Nurs"},{"issue":"05","key":"ref72","first-page":"e0267474","article-title":"Effects of non-pharmacological interventions for preventing delirium in general ward inpatients: A systematic review and meta-analysis of randomized controlled trials","volume":"17","author":"Y H Kim","year":"2022","journal-title":"PLoS One"}],"container-title":["Seminars in Neurology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0044-1791696.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,12]],"date-time":"2024-11-12T23:42:55Z","timestamp":1731454975000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0044-1791696"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,22]]},"references-count":67,"journal-issue":{"issue":"06","published-online":{"date-parts":[[2024,11,12]]},"published-print":{"date-parts":[[2024,12]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0044-1791696","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0271-8235","1098-9021"],"issn-type":[{"value":"0271-8235","type":"print"},{"value":"1098-9021","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,22]]}}}