Family practice最新文献

{"title":"Drivers of unnecessary diagnostic imaging for uncomplicated low back pain among family physicians: a theory-informed qualitative study.","authors":"Yamile Jasaui, Sameh Mortazhejri, Shannon M Ruzycki, Shawn Dowling, D'Arcy Duquette, Kim Giroux, Kelly Mrklas, Gloria Wilkinson, Jeremy M Grimshaw, Andrea M Patey","doi":"10.1093/fampra/cmag029","DOIUrl":"10.1093/fampra/cmag029","url":null,"abstract":"<p><strong>Background: </strong>Most major society guidelines recommend against diagnostic imaging for uncomplicated low back pain (LBP), referring to LBP that is not accompanied by symptoms that suggest a serious diagnosis, as it does not benefit patients. Despite this, diagnostic imaging for uncomplicated LBP remains common and contributes to overdiagnosis, overtreatment, and increased healthcare costs.</p><p><strong>Aim: </strong>The purpose of this qualitative study was to use a framework to rigorously understand the factors influencing family physicians' decisions to order diagnostic imaging for uncomplicated LBP in our context.</p><p><strong>Design and setting: </strong>This qualitative study used the Theoretical Domains Framework (TDF) to design and analyze semi-structured interviews with family physicians in Alberta, Canada, to examine drivers of diagnostic imaging for uncomplicated LBP.</p><p><strong>Methods: </strong>Family physicians in Alberta were recruited to participate in semi-structured, one-on-one interviews through a provincial physician newsletter. After deductive coding, the study team generated belief statements for each section of coded text and inductive themes that described each group of belief statements were written. We identified the themes expected to be important barriers or facilitators to ordering imaging for uncomplicated LBP using predefined criteria.</p><p><strong>Results: </strong>Data saturation occurred after 13 interviews. There were five key themes related to unnecessary imaging for uncomplicated LBP: Beliefs about consequences, Skills, Environmental context and resources, Social influences, and Reinforcement. Participants used diagnostic imaging to reassure themselves that they had not missed an important diagnosis. Though participants considered the need to maintain the therapeutic relationship with their patients, most felt that this could be achieved without unnecessary diagnostic imaging.</p><p><strong>Conclusions: </strong>Interventions to reduce unnecessary diagnostic imaging in uncomplicated LBP should address physicians' fears of missing serious diagnosis rather than only providing recommendations.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"43 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13202455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148028404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of sleep duration, sleep debt and insomnia symptoms on infection risk: a longitudinal cohort study with 1-year follow-up.","authors":"Bjørn Bjorvatn, Siri Waage, Ragnhild S Lundetræ, Leo Larsen, Nadia Pristaj, Magnus Fossum, Ingrid K Rebnord, Knut Erik Emberland","doi":"10.1093/fampra/cmag018","DOIUrl":"10.1093/fampra/cmag018","url":null,"abstract":"<p><strong>Background: </strong>To study whether sleep duration, sleep debt (difference between sleep need and duration), and insomnia severity at baseline would predict increased prevalence of infections 1 year later.</p><p><strong>Methods: </strong>In total, 861 participants recruited from the Norwegian Primary Care Research Network completed a baseline survey about sleep and were invited for follow-up 1 year later. The response rate at follow-up was 60.5%, rendering 521 patients eligible for analyses. At baseline the participants completed questions about sleep habits and insomnia symptoms (insomnia severity index), and at follow-up they responded to whether they had experienced various infections during the last 3 months and whether they experience more infections than peers.</p><p><strong>Results: </strong>Participants with normal sleep duration, no sleep debt and no insomnia at baseline reported the lowest prevalences of infections at 1-year follow-up. In the adjusted analyses, long sleep duration (>9 h, present only in 11 participants) increased the odds of influenza-like illness, gastrointestinal infection, and experiencing more infections than peers by about four times, whereas short sleep duration (<6 h) doubled the odds of skin infection. Compared to no sleep debt, ≤2 h sleep debt doubled the odds of skin infection and >2 h sleep debt tripled the odds of experiencing more infections than peers. Insomnia doubled the odds of any type of infection and influenza-like illness, and more than tripled the odds of gastrointestinal infection and experiencing more infections than peers.</p><p><strong>Conclusions: </strong>This longitudinal study supports the notion that people who have insufficient sleep are at increased risk of infections.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"43 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13093217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147722270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Family Physicians' experiences of administrative Harms.","authors":"Annie Koempel, Madeline Byrd, Andrea Anderson, Melissa K Filippi","doi":"10.1093/fampra/cmag020","DOIUrl":"10.1093/fampra/cmag020","url":null,"abstract":"<p><strong>Background: </strong>Due to the increase in corporate ownership of primary care practices, decision-making has largely shifted from physicians to administrators. Despite the increasing role of administrators in the healthcare industry, administrative harms are largely under-researched. This article explores employed or previously employed physicians' experiences of administrative harms.</p><p><strong>Methods: </strong>In-depth, semi-structured interviews were conducted via Zoom in January 2025 by a trained qualitative researcher. Interviews with 27 American Board of Family Medicine (ABFM) diplomates who completed a continuing certification questionnaire in 2024 lasted an average of 63 minutes. Inductive content analysis guided the development of codes and themes.</p><p><strong>Results: </strong>Most participants (55.5%) self-identified as women, lived in the Western US Census Region (33.3%), worked for a hospital or hospital-owned practice, and self-identified as white (48.1%). The average interview participant age was 48.6 years. Three broad types of administrative harms were identified: physician input was dismissed or devalued; physician time and activity were strictly structured; administrative decisions created a workplace environment that did not support basic biological needs.</p><p><strong>Conclusion: </strong>In this qualitative study, family physicians described experiences of administrative harms that contributed to burnout, turnover, and compromised self-care that led to perceived lower quality patient care. Continued research about administrative harms is crucial given the projected growth in administrative positions compared to clinical positions. Changes to payment policies and upstream corporate policies that prioritize profits over patients could alleviate physician frustration and administrative burdens.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"43 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147987052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insomnia in primary care: an independent risk factor or a prodromal marker of affective dysregulation?","authors":"Yadi Li, Xin Zhou, Zheng Wei","doi":"10.1093/fampra/cmag030","DOIUrl":"https://doi.org/10.1093/fampra/cmag030","url":null,"abstract":"","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"43 3","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148041677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the early effects of using an online educational module to elicit patient preferences for treatment following pre-visit screening for urinary incontinence in primary care.","authors":"Julia Geynisman-Tan, Karen John, Ji Young Lee, Tiffany Brown, Sarah A Collins, Kimberly S Kenton, Stephen D Persell","doi":"10.1093/fampra/cmag009","DOIUrl":"10.1093/fampra/cmag009","url":null,"abstract":"<p><strong>Background: </strong>Urinary incontinence (UI) is common but patients are often unaware of treatment options.</p><p><strong>Objective: </strong>To determine whether UI treatment preferences elicited by an online module are congruent with primary care provider (PCP) action.</p><p><strong>Design: </strong>Retrospective cohort study of female patients from 21 clinics over 10 months who were screened electronically for bothersome UI before preventive PCP visits. Positive screens were offered an interactive module. The results, including treatment preferences, were delivered to the PCP. We described participants who moved through the intervention and compared patient preferences with PCP action, defining congruence as any action aligned with the module results.</p><p><strong>Results: </strong>Of 1074 patients reporting bothersome UI, 128 (11.9%) completed the entire module. The PCP opened the result before the day of visit in 55% of cases and documented UI in the visit note 29 times (56%). Of 128 module completers, 16 received physical therapy referrals, 4 educational handouts, none were prescribed medications. A total of 66 patients desired procedural treatment, which requires a subspecialty referral. A total of 31 subspecialty referrals were placed; 7 for patients who were not interested in advanced treatment. Congruence was seen in 49/128 (38%) encounters and did not differ whether the PCP had reviewed the module results or not (P = 1.0).</p><p><strong>Conclusion: </strong>Completion rates of a UI educational module in primary care are low, and results were not consistently reviewed by PCPs. Congruence between module results and PCP action is low. These findings do not support continuation of our current implementation and simpler strategies to facilitate patient education and shared decision-making should be explored.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"43 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13093219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147722329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of the Dutch Triage standard in managing fever in children in out-of-hours primary care: a secondary analysis of the chili study.","authors":"Robin N Gottwald, Eefje G P M de Bont, Jochen W L Cals, Laure Wynants","doi":"10.1093/fampra/cmag015","DOIUrl":"10.1093/fampra/cmag015","url":null,"abstract":"<p><strong>Background and objectives: </strong>The Dutch Triage Standard (NTS) supports nurses in assessing case urgency in out-of-hours general practice (GP) care; however, its suitability for fever-related pediatric cases remains debated. This study examines the agreement between pre-consultation NTS urgency classifications (U-scores) and post-consultation management decisions in febrile children, and whether the NTS reduces between-center variation in decision-making.</p><p><strong>Methods: </strong>We performed a secondary analysis of the CHILI study, including 22 089 consultations for children under 12 with fever, across 18 out-of-hours GP centers (2015- 2016). Adjusted logistic regression models, with natural cubic splines and random intercepts, explored the associations between U-scores and three outcomes: referral to secondary care, antibiotic prescription, and other medication use. Intraclass correlation coefficients assessed between-center variability.</p><p><strong>Results: </strong>Unadjusted and adjusted percentages of the three outcomes showed similar trends. 24.5% of consultations were classified at low urgency levels (U4-5) before the consultation. Adjusted referral probabilities decreased with lower urgency: 29% (U1) to 0.8% (U5). Strikingly, antibiotic prescription rates were highest for U3 (26.2%) and U4 (25.1%). The probability of other medication prescriptions decreased steadily across urgency levels. ICCs revealed low between-center variability, which did not decrease after accounting for U-scores.</p><p><strong>Conclusions: </strong>Higher NTS urgency classifications are associated with increased referral rates during fever-related out-of-hours GP consultations. However, overall referral rates remain low, while a substantial number of consultations are pre-classified by the NTS as low urgency, contributing to a high workload of unnecessary consultations that highlights the need for more efficient triage and resource allocation.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"43 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13064533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring determinants of patient attitudes toward telemedicine in primary care: a cross-sectional study in Türkiye.","authors":"Rana Baykan Gürüz, Leyla Tekdemir, Semiha Zeynep Özsaydı, Rabiye Özlem Ulutabanca","doi":"10.1093/fampra/cmaf107","DOIUrl":"10.1093/fampra/cmaf107","url":null,"abstract":"<p><strong>Background: </strong>Telemedicine is a promising tool for integration into primary care, where it can enhance access and continuity of care. In Türkiye, telemedicine has not yet been routinely implemented in primary care, although regulatory and infrastructural preparations are underway. The success of such services depends not only on technical and legal frameworks but also on patients' attitudes.</p><p><strong>Objective: </strong>This study aimed to assess patients' attitudes toward telemedicine and identify associated factors among adult attendees of family health centers (FHCs) in Türkiye, to inform the planning and implementation of telemedicine services at the primary care level.</p><p><strong>Methods: </strong>This cross-sectional study was conducted in five FHCs between January and March 2025. Individuals aged 18 and over with Turkish literacy were included. Data were collected via a face-to-face questionnaire, which included demographic items and the validated 18-item Attitude Scale Toward the Use of Telemedicine Services.</p><p><strong>Results: </strong>Four hundred twenty participants (mean age 30.59 ± 12.67) completed the study; 75.5% were female, and 50% had university-level education. The mean scale score was 58.06 ± 14.88. Higher scores were associated with higher education (P < .001) and better economic status (P = .030). Participants who used mobile health applications (P = .043) and owned an internet-enabled device (P = .007) also had higher scores. Lower scores were observed among those with a disabled or dependent person at home (P = .006) and those with more frequent family physician visits (P = .045).</p><p><strong>Conclusion: </strong>Patients who were younger, more highly educated, and with greater digital access exhibited more positive attitudes toward telemedicine.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"43 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146149563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibiotic treatment for acute sinusitis and subsequent health care use and work absence: a nationwide registry study from Norway.","authors":"Marius Skow, Anja Maria Brænd, Louise Emilsson, Sigurd Høye, Jørund Straand, Guro Haugen Fossum","doi":"10.1093/fampra/cmag001","DOIUrl":"10.1093/fampra/cmag001","url":null,"abstract":"<p><strong>Background: </strong>Acute sinusitis is common in general practice. Although typically self-limiting, antibiotics are frequently prescribed despite guideline recommendations to restrict use. It remains unclear whether antibiotic treatment reduces subsequent health care use or work absence.</p><p><strong>Objective: </strong>To assess how initial treatment with or without antibiotics for acute sinusitis is associated with subsequent health care use and work absence, and to compare phenoxymethylpenicillin (PcV) versus other antibiotics.</p><p><strong>Methods: </strong>Nationwide registry-based observational cohort study of adults with acute sinusitis (ICPC-2: R75) diagnosed in Norwegian general practice 2012-2019. We compared GP visits, Ear, Nose, and Throat (ENT) specialist visits, repeat antibiotic prescriptions, and sick leave days in antibiotic-treated and untreated episodes. We estimated adjusted differences in outcomes between groups using linear regression (daily outcomes) and negative binomial regression (weekly counts).</p><p><strong>Results: </strong>We included 627 211 episodes from 413 449 patients. Antibiotics were prescribed in 59% of episodes; 53% received PcV. During the index week, antibiotic use was associated with 1.7 fewer GP visits, 0.1 fewer ENT visits, and 25.1 more sick leave days per 100 episodes. Corresponding figures for the following 4 weeks were: 0.9 fewer GP contacts, 10.7 fewer sick leave days, and 0.6 more antibiotic prescriptions. PcV was associated with slightly more GP visits and re-prescribing than other antibiotics.</p><p><strong>Conclusions: </strong>Acute sinusitis is followed by a short-term increase in health care use and work absence. Initial antibiotic use was associated with modest short-term differences, but no meaningful reduction in overall follow-up. Findings are consistent with recommendations for restrictive prescribing and narrow-spectrum use when appropriate.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"43 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13017361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146131697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment burden in complex versus simple multimorbidity: nationwide cross-sectional study in Japan.","authors":"Takuya Aoki, Masato Matsushima","doi":"10.1093/fampra/cmag016","DOIUrl":"10.1093/fampra/cmag016","url":null,"abstract":"<p><strong>Background: </strong>The concept of \"complex multimorbidity\", defined as the coexistence of three or more long-term conditions affecting at least three different body systems, has recently emerged in medical literature. However, it remains unclear whether this concept effectively identifies patients with greater complexity of care needs.</p><p><strong>Objective: </strong>We aimed to evaluate how treatment burden differs between complex and simple multimorbidity.</p><p><strong>Methods: </strong>We conducted a nationwide cross-sectional survey of the Japanese adult population. The primary outcome measure was high treatment burden, as assessed by the Japanese version of the Multimorbidity Treatment Burden Questionnaire (MTBQ). We used a multivariable modified Poisson regression analysis to adjust for possible confounders.</p><p><strong>Results: </strong>Of the 1341 participants, 384 (28.6%) had multimorbidity, and 130 (9.7%) had complex multimorbidity. The presence of complex multimorbidity tended to increase with age. After adjusting for possible confounders, complex multimorbidity was associated with an increase in high treatment burden, compared with simple multimorbidity (adjusted prevalence ratio = 1.47, 95% CI: 1.14-1.90).</p><p><strong>Conclusion: </strong>Patients with complex multimorbidity experienced a higher treatment burden than those with simple multimorbidity in a nationally representative sample of Japanese adults. These findings support the conceptual distinction of complex multimorbidity for identifying patients with complex healthcare needs. Recognizing these subgroups and implementing strategies to reduce treatment burden may contribute to improved health outcomes for patients with multimorbidity.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"43 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147591166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of an interdisciplinary electronic consultation service between general practitioners and medical specialists in The Netherlands: a prospective cohort study.","authors":"Ken M M Peeters, Dennis M J Muris, Juliette Klein Hesselink, Kirsten R A Laeven, Tessa Schotman, Guus G de Vries, Roel Hendrickx, Ladbon Khajeh, Jan Stoot, Paul Bergmans, Mariëlle Krekels, Jochen W L Cals","doi":"10.1093/fampra/cmag004","DOIUrl":"10.1093/fampra/cmag004","url":null,"abstract":"<p><strong>Background: </strong>General practitioners (GPs) frequently encounter complex cases that require specialist input. Traditionally, this support is sought via telephone consultations, which are often constrained by time and availability, or through initiating a hospital referral. Interdisciplinary electronic consultations enable timely specialist advice while possibly reducing unnecessary referrals. Though prior research has shown promising outcomes for e-consultations, evidence remains limited, particularly from healthcare systems where GPs act as gatekeepers, such as in The Netherlands. It is also unclear whether similar benefits apply across other hospital departments.</p><p><strong>Objective: </strong>This study aimed to evaluate how GPs in a Dutch healthcare setting used e-consultations across multiple hospital departments, focusing on both the content of the consultations and their impact on referral decisions.</p><p><strong>Methods: </strong>We analyzed 2183 e-consultations submitted to Zuyderland Medical Centre between 2019 and 2022, with at least 24 months of data collected per department. Consultations were categorized by topic, and referral outcomes were assessed-specifically avoided versus additional referrals prompted by the e-consult.</p><p><strong>Results: </strong>E-consultations were used across all departments and addressed a wide range of clinical questions, most commonly related to diagnosis, diagnostic testing, and pharmacological treatment. In surgical departments, questions more often concerned general advice. Overall, 36.8% were avoided, while 11.9% additional referrals followed the e-consult. Avoided referral rates ranged from 32.6% in Pediatrics to 49.0% in Urology.</p><p><strong>Conclusion: </strong>E-consultations support GPs in managing clinical uncertainty and may reduce unnecessary referrals, particularly when tailored to departmental contexts.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"43 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13016908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147354371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}