Family practice最新文献

{"title":"\"Evolution of a combined baccalaureate/medical degree program as a pipeline to primary care: retention strategies and lessons learned\".","authors":"Sushilla Z Knottenbelt, Marlene P Ballejos, Diana Torrez, Richard Santos, Rebecca S Hartley, Kate Cartwright, Sally A Fortner, Robert E Sapién, Valerie Romero-Leggott","doi":"10.1093/fampra/cmae066","DOIUrl":"10.1093/fampra/cmae066","url":null,"abstract":"<p><strong>Background: </strong>The University of New Mexico School of Medicine established the combined baccalaureate/medical degree (BA/MD) program in response to critical physician shortages in New Mexico (NM). This 8-year program aims to improve health care in NM by expanding access to medical education for local students, particularly from rural and underserved communities and/or racial/ethnically underrepresented in medicine (URiM) in NM.</p><p><strong>Objectives: </strong>To describe the BA/MD program's initial design, the impact of improvements on retention, and the outcomes in terms of physicians in practice, particularly in primary care specialties.</p><p><strong>Methods: </strong>The study reviews the BA/MD program's progress from 2006 to 2023, focusing on curriculum and support enhancements. Retention rates and choice of primary care specialties were analyzed by geographic origin and racial/ethnic background.</p><p><strong>Results: </strong>From 2006 to 2023, the program graduated 81 physicians, with 53 practicing in 10 of NM's 33 counties. Approximately two-thirds specialize in primary care, and a similar proportion are URiM. Students from 31 of NM's 33 counties were admitted, with two-thirds coming from outside the state's metropolitan area. Overall retention and retention across demographic groups improved significantly in the baccalaureate phase of the program due to changes in curriculum and support services.</p><p><strong>Conclusions: </strong>The program has effectively addressed physician shortages in NM, particularly in rural and underserved areas. Its success in training and retaining physicians from diverse backgrounds, with a focus on primary care, is crucial for improving health care access in the state. Ongoing improvements in the program are essential to sustaining and enhancing these outcomes.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681085","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":"Delphi definition of general practice/family medicine specialty for a post-COVID world: in-person and remote care delivery.","authors":"Filipe Prazeres, Marc Jamoulle, Ana Kareli, Claire Collins, Csaba Móczár, Martin C S Wong, Sudip Bhattacharya, Shlomo Vinker, L Leng Low, Suraya Abdul-Razak, Joanne Brooke, Mohamud A Verjee, Hakan Yaman, Pramendra Prasad, Jens Søndergaard, Dimity Pond, Lloyd Hughes, Fatma Goksin Cihan, Zoi Tsimtsiou, Christopher Harrison, Loai Albarqouni, Beibei Yuan, Y Kong Lee, Paul Van Royen, Indiran Govender, Bengt B Arnetz, Catherine A O'Donnell","doi":"10.1093/fampra/cmae061","DOIUrl":"10.1093/fampra/cmae061","url":null,"abstract":"<p><strong>Introduction: </strong>The evolving landscape of general practice (GP)/family medicine (FM) in the post-COVID-19 era, focussing on integrating telemedicine and remote consultations requires a new definition for this specialty. Hence, a broader consensus-based definition of post-COVID-19 GP/FM is warranted.</p><p><strong>Methods: </strong>This study involved a modified electronic Delphi technique involving 27 specialists working in primary care recruited via convenient and snowball sampling. The Delphi survey was conducted online between August 2022 and April 2023, utilizing the Google Forms platform. Descriptive statistics were employed to analyse consensus across Delphi rounds.</p><p><strong>Results: </strong>Twenty-six international experts participated in the survey. The retention rate through the second and third Delphi rounds was 96.2% (n = 25). The broader consensus definition emphasizes person-centred care, collaborative patient-physician partnerships, and a holistic approach to health, including managing acute and chronic conditions through in-person or remote access based on patient preferences, medical needs, and local health system organization.</p><p><strong>Conclusion: </strong>The study highlights the importance of continuity of care, prevention, and coordination with other healthcare professionals as core values of primary care. It also reflects the role of GP/FM in addressing new challenges post-pandemic, such as healthcare delivery beyond standard face-to-face care (e.g. remote consultations) and an increasingly important role in the prevention of infectious diseases. This underscores the need for ongoing research and patient involvement to continually refine and improve primary healthcare delivery in response to changing healthcare landscapes.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675556","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":"Point-of-care ultrasonography for cardiovascular conditions in family practice: between risk and opportunity.","authors":"Valerio Massimo Magro","doi":"10.1093/fampra/cmae048","DOIUrl":"10.1093/fampra/cmae048","url":null,"abstract":"<p><p>Several articles have appeared in the medical literature on the use of ultrasound in primary care. Point-of-care ultrasound refers to ultrasound protocols performed at the bedside to evaluate many conditions such as aortic aneurysm or assessment of left ventricular function by estimation of ejection fraction. Primary care physicians can play a key role in evaluating such conditions for their patients. It should be considered that the use of ultrasound in general practice can not only be an aid to diagnosis but also an active screening tool, accessible even to those with basic training in ultrasound; the left ventricle and large abdominal vessels are indeed clearly visible with this technique, which with little training can become accessible to many. In a working organization, so few trained physicians would be sufficient to screen the target population of the entire group and extend the assessment to a large number of participants.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344374","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":"Defining quality categories for evaluation of the doctor-patient relationship assessed through the patient-doctor relationship questionnaire (PDRQ-9).","authors":"Lucas Wollmann, Lisiane Hauser, Christina van der Feltz-Cornelis, Sotero Serrate Mengue, Rudi Roman, Milena Rodrigues Agostinho Rech, Erno Harzheim","doi":"10.1093/fampra/cmae068","DOIUrl":"10.1093/fampra/cmae068","url":null,"abstract":"<p><strong>Background: </strong>The quality of the doctor-patient relationship plays a crucial role in patients' experiences with healthcare services, positively influencing clinical outcomes and satisfaction with care. The Patient-Doctor Relationship Questionnaire (PDRQ-9) is widely used to assess this relationship. However, there are no quality categories that can be derived from the instrument's score to facilitate understanding and decision-making.</p><p><strong>Objectives: </strong>This study aims to establish categories of the quality of the relationship based on the PDRQ-9 score.</p><p><strong>Methods: </strong>A latent class analysis (LCA) was conducted using interviews with 6160 users of primary health care units throughout Brazil to define different homogeneous response profiles. The Youden index was used to determine the cut point between classes.</p><p><strong>Results: </strong>LCA identified the presence of two response profiles, one associated with a high evaluation of the quality of the doctor-patient relationship and another associated with a moderate evaluation. The cut point between classes, established through the Youden index, was 3.5 (on a possible score range of 1-5) or 31 (on a possible score range of 9-45). The cut point demonstrated high accuracy (0.94), sensitivity (0.96), and specificity (0.98).</p><p><strong>Conclusions: </strong>The categorization proposed in this study enhances the interpretability of PDRQ-9 results, providing a practical framework for assessing the quality of the doctor-patient relationship. By establishing actionable quality categories, this tool could support targeted interventions, such as performance feedback and training, aimed at fostering empathy, communication, and trust in healthcare settings.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738906","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":"Association of long working hours with visceral adiposity index, anthropometric indices, and weight management behaviors: a study of Korean workers.","authors":"Seong-Uk Baek, Jin-Ha Yoon","doi":"10.1093/fampra/cmaf015","DOIUrl":"10.1093/fampra/cmaf015","url":null,"abstract":"<p><strong>Background: </strong>Long working hours constitute a significant public health risk. They may induce psychological stress or lead to behavioral changes, which, in turn, can contribute to the development of cardiovascular diseases and metabolic disorders. This study investigated the association of working hours with visceral adiposity index, anthropometric indices, and weight management behaviors.</p><p><strong>Methods: </strong>In total, 32 373 adult workers were included in this cross-sectional study. Chinese Visceral Adiposity Index (CVAI), body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and body roundness index (BRI) were assessed. Weight management behaviors over the past year, including exercise, diet control, and medication use, were self-reported. Linear or logistic regression analyses were performed. Regression models were adjusted for sex, age, education level, income level, marital status, occupation type, and survey year.</p><p><strong>Results: </strong>Among the sample, 19.4% of adults worked for ≥ 55 h per week. Compared to working 35-40 h per week, working ≥ 55 h per week was associated with higher values of 2.57 (95% confidence interval [CI:] 0.95, 4.19) in CVAI, 0.29 (95% CI: 0.14, 0.43) in BMI, 0.67 (95% CI: 0.29, 1.06) in WC, 0.47 (95% CI: 0.24, 0.69) in WHtR, and 0.09 (95% CI: 0.05, 0.14) in BRI, respectively. Working ≥ 55 h per week, in comparison with working 35-40 h per week, was linked to reduced odds of engaging in exercise for weight management (odds ratio: 0.76; 95% CI: 0.70, 0.83).</p><p><strong>Conclusions: </strong>Working hours are positively associated with CVAI, anthropometric indices, and a lower intention to engage in exercise for weight management.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"42 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143676775","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":"The presentation and treatment of Dupuytren's disease in Dutch general practitioner care.","authors":"Roel J M van Straalen, Dieuwke C Broekstra, Paul M N Werker, Michiel R de Boer","doi":"10.1093/fampra/cmae065","DOIUrl":"10.1093/fampra/cmae065","url":null,"abstract":"<p><strong>Background: </strong>When research and management of Dupuytren's disease (DD) shift from symptom relief to preventing contractures, general practitioner (GP) care may become more central to treatment. However, the presentation and course of DD in GP care are underexplored and this has been recognized as a knowledge gap that hinders effective treatment decisions. This study is the first to map the trajectory of DD patients in GP care.</p><p><strong>Methods: </strong>Using electronic health records from Dutch general practices in a regional research network, we conducted a registration-based cohort study in a dynamic population. Descriptive statistics detailed patient demographics, number of contacts, and symptoms per contact. The time and number of contacts before diagnosis were also analysed. Sankey diagrams illustrated the relationship between management options and symptoms.</p><p><strong>Results: </strong>Over a 16-year period, 84% of patients with a DD diagnosis had visited their GP for this reason, with 73% only having one GP contact. The diagnosis was made at first contact for 93% of patients. Initial contacts often reported a lump (57.3%), but this symptom was less frequent in subsequent visits. 'Daily life impairment' increased after the first contact. The most common management options were referral to secondary care (37.7%) and watchful waiting (35.1%).</p><p><strong>Conclusion: </strong>The diagnosis and management of DD in GP care are in line with the current guidelines. Less than half of the DD patients were referred to secondary care during follow-up. This may give room for preventive treatment that limits progression. Future studies should focus on the accuracy of diagnosis and the feasibility of effective treatments in GP care.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681095","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":"Patients' experience of integrated nursing care in general practices in Switzerland: a mixed-methods study.","authors":"Muriel Schütz Leuthold, Fatima El Hakmaoui, Renzo Scuderi, Nicolas Senn, Christine Cohidon","doi":"10.1093/fampra/cmaf011","DOIUrl":"10.1093/fampra/cmaf011","url":null,"abstract":"<p><strong>Background: </strong>In many high-income countries, nurses, including registered nurses (RNs), play a key role in primary care (PC), particularly in general practice. Their involvement enhances patients' experiences, especially in terms of accessibility and comprehensiveness of care provided. To reinforce the provision of care and enhance patients' experience in family medicine, RNs were integrated into eight private general practices in the canton of Vaud, Switzerland, creating interprofessional teams. This study assessed patients' experiences with new nursing activities in general practices.</p><p><strong>Methods: </strong>A mixed-methods approach was used to assess patients' experiences. Quantitative data were collected through a patient experience survey conducted before and after nursing follow-up, with descriptive and bivariate analyses performed. Qualitative data were obtained from interviews with ten patients.</p><p><strong>Results: </strong>A total of 109 patients completed the questionnaire before and after nursing follow-up. Descriptive analyses showed that several dimensions of patients' experience improved with new nursing follow-up. Bivariate analyses revealed significant improvements in several areas, including unmet healthcare needs, accessibility to nursing care, preventive care, and information provided. Furthermore, patients reported positive changes in their health and lifestyle due to preventive care. Qualitative data supported these results, highlighting the importance of nurses' accessibility and availability and the holistic nursing care provided.</p><p><strong>Conclusion: </strong>These findings highlight the potential of nurse-led case management to address gaps in PC delivery, particularly in managing chronic diseases. The integration of nurses into general practice settings improved the provision of preventive care, enhanced patient education, and increased accessibility to care.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"42 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920863/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656429","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 challenges experienced by Ukrainian refugees accessing General Practice: a descriptive cross-sectional study.","authors":"Niall O'Reilly, Emmet Smithwick, Eoin Murphy, Aisling A Jennings","doi":"10.1093/fampra/cmaf012","DOIUrl":"10.1093/fampra/cmaf012","url":null,"abstract":"<p><strong>Background: </strong>The war in Ukraine has led to an influx of Ukrainian refugees across Europe. Internationally, there is limited research into refugees' experiences of accessing Primary Care. Furthermore, few studies have explored the experience of one homogenous refugee group. No study has explored the specific experience of Ukrainian refugees. To improve the care provided to this marginalized group it is important to understand the challenges they experience. The aim of this research is to identify the barriers Ukrainian refugees experience when accessing General Practice in Ireland.</p><p><strong>Methods: </strong>A 63-item questionnaire was distributed via Ukraine Action Ireland, a registered charitable organization, to Ukrainian refugees in Ireland. Qualitive comments were collected through free-text responses and were analysed using thematic analysis.</p><p><strong>Results: </strong>A total of 368 questionnaires were completed. About 75.4% of respondents reported that they were not asked about their mental health during consultations with their GP. About 25% of respondents could not attend GP due to transport difficulties. About 55% of respondents reported that a translator was needed but only one-third of respondents reported that one was offered. Self-reported health was relatively poor when compared with refugees in other countries and with Irish citizens. Three themes were developed; disparity in patient autonomy, perceived disregard for the refugee experience, and challenges in health care access.</p><p><strong>Conclusion: </strong>At a time of significant capacity challenges in General Practice it is paramount that resources are provided at a national level to address the challenges Ukrainian refuges currently experience.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"42 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656363","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":"Point-of-care ultrasound to assess left ventricular ejection fraction in heart failure in unselected patients in primary care: a systematic review.","authors":"Perrine Allimant, Lucas Guillo, Thomas Fierling, Andry Rabiaza, Isabelle Cibois-Honnorat","doi":"10.1093/fampra/cmae040","DOIUrl":"10.1093/fampra/cmae040","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is the most frequent cardiovascular pathology in primary care. Echocardiography is the gold standard for diagnosis, follow-up, and prognosis of HF. Point-of-care ultrasound (POCUS) is of growing interest in daily practice.</p><p><strong>Aim: </strong>This study aimed to systematically review the literature to evaluate left ventricular ejection fraction (LVEF) assessment of unselected patients in primary care by non-expert physicians with cardiac POCUS (cPOCUS).</p><p><strong>Methods: </strong>We searched in Medline, Embase, and Pubmed up to January 2024 for interventional and non-interventional studies assessing LVEF with cPOCUS in unselected patients with suspected or diagnosed HF in hospital or outpatient settings, performed by non-expert physicians.</p><p><strong>Results: </strong>Forty-two studies were included, involving 6598 patients, of whom 60.2% were outpatients. LVEF was assessed by 351 non-expert physicians after an initial ultrasound training course. The LVEF was mainly assessed by visual estimation (90.2%). The most frequent views were parasternal long/short axis, and apical 4-chamber. The median time of cPOCUS was 8 minutes. A strong agreement was found (κ = 0.72 [0.63; 0.83]) compared to experts when using different types of ultrasound devices (hand-held and standard), and agreement was excellent (κ = 0.84 [0.71; 0.89]) with the same device. Training course combined a median of 4.5 hours for theory and 25 cPOCUS for practice.</p><p><strong>Conclusion: </strong>The use of cPOCUS by non-expert physicians after a short training course appears to be an accurate complementary tool for LVEF assessment in daily practice. Its diffusion in primary care could optimize patient management, without replacing specialist assessment.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003992","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":"Telemedicine and time management in primary care.","authors":"Yael Keshet, Ariela Popper-Giveon, Tamar Adar","doi":"10.1093/fampra/cmae051","DOIUrl":"10.1093/fampra/cmae051","url":null,"abstract":"<p><strong>Background: </strong>Information and communication technologies (ICTs) can enable workers to structure work in novel ways, allow for better time management, and increase work scheduling autonomy. Time management and work scheduling are important factors in the field of clinical practice in primary care. Time limits on consultation are a key constraint on the delivery of good care since the length of patient-physician consultation impacts its quality.</p><p><strong>Objectives: </strong>This research aimed to examine the experiences of primary care physicians (PCPs) when using telemedicine technologies (TTs), a type of ICT, in their communication with patients.</p><p><strong>Methods: </strong>During 2023 in-depth interviews were conducted with 20 Israeli PCPs: family physicians and pediatricians.</p><p><strong>Findings: </strong>Perception and management of time emerged as a focal subject in the interviews. The PCPs interviewed described several effects of TTs on time management in primary care. They portrayed TTs as saving time for patients and having a mixed effect on the healthcare organization: both saving and wasting their work time. TTs were described as impacting their time management in the context of work-life balance, allowing them to manage their time during and between appointments.</p><p><strong>Discussion: </strong>For PCPs, TTs can be beneficial for managing time in the clinic, which can contribute to better healthcare. This article, concerning TTs as a type of ICT, contributes to the existing literature which suggests that ICTs can allow for better time management and increase work scheduling autonomy. It also presents several recommendations for better implementation of TTs in healthcare organizations.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461447","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}