International Journal of Technology Assessment in Health Care最新文献

{"title":"The potential of the hospital-based Health Technology Assessment: Results of a world-wide survey.","authors":"Rossella Di Bidino, Iga Lipska, Monika Kukla, Marina von Pinoci, Sara Consilia Papavero, Marco Marchetti, Laura Sampietro-Colom, Americo Cicchetti","doi":"10.1017/S0266462325000108","DOIUrl":"10.1017/S0266462325000108","url":null,"abstract":"<p><strong>Objectives: </strong>Hospital-Based Health Technology Assessment (HB-HTA) is a heterogeneous phenomenon constantly evolving to respond to the needs of decision-makers at the hospital level. In 2023, The HB-HTA Interest Group of Health Technology Assessment International (HTAi) surveyed HB-HTA activities with the aim to provide an updated description of the actual scenario.</p><p><strong>Methods: </strong>An online survey was conducted to gather data on the main characteristics of hospitals, HB-HTA activities, outputs, role in the decision-making processes, dissemination and training activities, and their interaction and collaboration with other stakeholders and HTA-related regulations. Finally, the survey collected feedback on the perception of and current barriers to HB-HTA. Three categories of responders were identified: Both hospitals performing and not performing HTA and policymakers.</p><p><strong>Results: </strong>Eighty-seven responses were collected from twenty-eight countries. Nearly half of the responders (<i>n</i> = 41) conducted HB-HTA, whereas eighteen consisted of hospitals not performing HTA, and twenty-eight were policy makers. HB-HTA was performed mainly in hospitals with >500 beds. HB-HTA units were organized in 40 percent of cases as an \"independent group.\" The survey showed that HTA units could contribute to all the steps of the decision-making processes, whereas the impact of the assessments on the decisions was mainly perceived as a medium. Furthermore, HB-HTA was not seen as a duplication of effort, even without specific regulations.</p><p><strong>Conclusions: </strong>The survey highlighted the role of HB-HTA in hospital decision-making supporting the vision of HB-HTA as one of the actors in the HTA ecosystem, the success of which depends on collaboration with other stakeholders.</p>","PeriodicalId":14467,"journal":{"name":"International Journal of Technology Assessment in Health Care","volume":" ","pages":"e19"},"PeriodicalIF":2.6,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12018856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657150","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":"Navigating change: a comparative analysis of health technology assessment reforms across agencies - processes, drivers, and interdependencies.","authors":"Gayathri Kumar, Priscila Radu, Patricia Cubi-Molla, Martina Garau, Eleanor Bell, Jia Pan, Ramiro Gilardino, Julie Van Bavel, Agnes Brandtmüller, Katherine Nelson, Melinda Goodall","doi":"10.1017/S0266462325000133","DOIUrl":"10.1017/S0266462325000133","url":null,"abstract":"<p><strong>Objectives: </strong>Health technology assessment (HTA) is a critical part of healthcare decision making in many countries. Changes in Methods and Processes (M&P) of HTA agencies can affect the time and degree of patient access to treatments. Published literature focuses on the different M&P adopted by HTA agencies, rather than on how these have come about over time. Our study investigates key HTA reforms and explores their drivers and interdependencies in a set of HTA agencies in Europe, Asia-Pacific, and North America.</p><p><strong>Methods: </strong>We conducted a targeted literature review on M&P guidelines and subsequent changes to those, for 14 HTA agencies. We supplemented and validated initial findings with 29 semi-structured interviews with country-specific experts. We used analytical tools to create process maps, proactivity and influence networks, and clusters of HTA agencies.</p><p><strong>Results: </strong>We found that processes leading to M&P reforms follow similar steps across HTA agencies. The three most important drivers to reforms were HTA practice and guidelines in other countries; the healthcare policy, legal, and political context within the agency's country; and experience of challenges in the assessment by the HTA body itself. International collaborations have the potential to accelerate the evolution of HTA systems and the implementation of reforms.</p><p><strong>Conclusion: </strong>We identified PBAC (Australia), CDA-AMC (Canada), NICE (England), IQWiG (Germany), and ZIN (the Netherlands) as HTA agencies that are catalysts of HTA reforms as well as internationally influential. International collaborations may represent a useful route to accelerate changes as long as they ensure wide stakeholder engagement at an early stage.</p>","PeriodicalId":14467,"journal":{"name":"International Journal of Technology Assessment in Health Care","volume":" ","pages":"e21"},"PeriodicalIF":2.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12018853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624807","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":"Standards for the conduct and reporting of health technology assessments: Ghana reference case of HTA and economic evaluations.","authors":"Richmond Owusu, Brian Adu Asare, Genevieve Cecilia Aryeetey, Ivy Amankwah, Emmanuella Abassah-Konadu, Godwin Gulbi, Saviour Yevutsey, Sergio Torres Rueda, Joseph Kazibwe, Francis Ruiz, Joycelyn Zeez, Justice Nonvignon","doi":"10.1017/S026646232500011X","DOIUrl":"10.1017/S026646232500011X","url":null,"abstract":"<p><strong>Background: </strong>The methods of economic evaluation and HTA should be based on best practices and standards, tailored to unique country contexts that can be systematically applied to inform decisions. This paper outlines standards for the conduct of economic evaluations for HTA in Ghana.</p><p><strong>Methods: </strong>A five-step process was followed to develop the HTA reference case as a methodological and reporting benchmark. These include (a) a review of literature and evidence synthesis, (b) a review of country policies, (c) a review and adaption of international frameworks, (d) expert/stakeholder consultations, and (e) the development of a methodological framework. A series of stakeholder consultations were done to refine, finalize, and validate the outcomes of the processes to generate a finalized reference case.</p><p><strong>Results: </strong>The Ghana reference case is made up of 14 components comprising: evidence synthesis, evaluation type, perspectives on cost, perspectives of outcomes, choice of comparator, data sources, outcome measures, discount rate, uncertainty, equity considerations, time horizon, heterogeneity, transparency, and budget impact. These provide methodological considerations and reporting requirements for economic evaluations for HTA. It provides a framework to ensure the best research methods are adopted to harmonize the evidence-generation process with the expectations of policy and decision-makers and ensure that policy decisions are based on uniform evidence.</p><p><strong>Conclusion: </strong>Recommendations set out in this reference case when followed can provide context-specific evidence to support a rigorous and transparent system for evaluating healthcare interventions and technologies. It will support decision-making, ultimately improving the quality and efficiency of healthcare delivery in the country.</p>","PeriodicalId":14467,"journal":{"name":"International Journal of Technology Assessment in Health Care","volume":" ","pages":"e17"},"PeriodicalIF":2.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11950332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536921","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":"HTA responsiveness to today's challenges to health systems: a responsible innovation in health perspective.","authors":"P Lehoux, I Ganache, O Demers-Payette, H P Silva, G Plamondon, M de Guise","doi":"10.1017/S0266462325000121","DOIUrl":"10.1017/S0266462325000121","url":null,"abstract":"<p><strong>Introduction: </strong>Though Health Technology Assessment (HTA) has steadily grown over the past decades, less attention has been paid to the way HTA may prove more responsive to the broader economic, social, and environmental challenges that health systems are facing today. In view of climate change, chronic diseases, an aging population, inequalities, and workforce issues, the HTA community's unique set of skills nonetheless holds great potential to help decision-makers strengthen many publicly funded health systems around the world.</p><p><strong>Methods: </strong>This article adopts an integrated system-wide perspective guided by the Responsible Innovation in Health (RIH) framework to explore how the HTA community may not only adapt to the <i>speed</i> of innovation but also consider its direction.</p><p><strong>Results: </strong>Because RIH aims to steer innovation toward a more sustainable pathway, it can help HTA agencies anticipate decision-makers' informational needs regarding four systemic challenges: (1) equitable access; (2) workforce issues; (3) accountable policy trade-offs; and (4) environmental sustainability. We clarify how key elements of the RIH framework may be used by HTA agencies to: (1) supplement their evaluation process; (2) align their priority-setting or strategic planning activities with their health system challenges; or (3) inform the production of early HTAs, horizon scans, or reports that are broader in scope than a single technology review.</p><p><strong>Conclusions: </strong>The article concludes with three practical implications that were identified by the <i>Institut National d'Excellence en Santé et Services Sociaux</i> (INESSS) (Québec, Canada) and may inspire other HTA agencies.</p>","PeriodicalId":14467,"journal":{"name":"International Journal of Technology Assessment in Health Care","volume":" ","pages":"e16"},"PeriodicalIF":2.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536746","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":"Value and Implementation of Patient and Public Involvement and Engagement in Health Technology Assessment for Japan: implications from systematic searches.","authors":"Takako Kaneyasu","doi":"10.1017/S026646232500008X","DOIUrl":"10.1017/S026646232500008X","url":null,"abstract":"<p><strong>Objectives: </strong>This study comprehensively reviewed reports on patient and public involvement and engagement (PPIE) in health technology assessment (HTA) overseas and identified the status and possible future measures, of PPIE in Japanese HTA.</p><p><strong>Methods: </strong>The series of reviews targeted systematic reviews (SR#1), references in SR#1 (SR#2), and new articles after SR#1 (SR#3). The MEDLINE and Embase databases were searched through August 2024 using the terms \"patient involvement/engagement,\" \"patient participation,\" \"community participation,\" \"public involvement/engagement,\" and \"health technology assessment.\" The implementation details were extracted from information published on the websites of the HTA agencies.</p><p><strong>Results: </strong>Three review articles in SR#1, 12 references in SR#2, and 10 articles in SR#3 were selected. The opportunities for countries, including Japan, to participate in discussions on the HTA process did not differ significantly; however, information on PPIE in Japan was scarce and did not indicate their purpose and value.</p><p><strong>Conclusions: </strong>Collected articles indicated that the value of PPIE in HTA includes relevance, equity, fairness, legitimacy, and capacity building. The participation of patient and public representatives in Japanese discussions since 2005 appeared to be very limited to consider PPIE in HTA. In countries that implement PPIE in HTA, the value of PPIE is explicit: the process guidelines are specific and provide an appropriate environment for input that includes education, training, and feedback. Future reforms of the Japanese system will require discussions on PPIE purpose and value, implementation, and creating an environment in which a diverse range of patients and the public can easily express their views.</p>","PeriodicalId":14467,"journal":{"name":"International Journal of Technology Assessment in Health Care","volume":"41 1","pages":"e14"},"PeriodicalIF":2.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523454","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":"Health technology assessment capacity to support Zambia's health benefits package reform policy.","authors":"Warren Mukelabai Simangolwa, Kaymarlin Govender, Josue Mbonigaba","doi":"10.1017/S0266462325000030","DOIUrl":"10.1017/S0266462325000030","url":null,"abstract":"<p><strong>Background: </strong>The need for more local technical capacity in Health Technology Assessment (HTA) is a leading challenge to its use in low- and middle-income countries. Zambia has been considering using HTA to support its universal health coverage initiative, which includes health benefits package design and implementation. This study assesses the local HTA capacity for the steering committee tasked with supporting the design and implementation of the national health benefits package in Zambia.</p><p><strong>Methods: </strong>The study applied a cross-sectional web-based survey design and the consensus-based Checklist for Reporting of Survey Studies. Data were collected from the steering committee of the benefits package working group, tasked with leading the design process of the health benefits package using the Instrument for the Assessment of Skills to Conduct a Health Technology Assessment tool.</p><p><strong>Results: </strong>The majority of respondents had not served on a selection and reimbursement committee. Clinical effectiveness skills in structuring a search strategy, handling missing data, conducting qualitative evidence synthesis, and grading the certainty of evidence were low. Skills for leadership, networking, conflict management, and project coordination, public and patient involvement were mid-level to low. Most of the respondents were aware of ethical issues with health technologies. Health economics skills in economic evaluations and decision analytic modeling, equity and health system efficiency measurement, budget impact analysis, and quality of life were identified for capacity strengthening.</p><p><strong>Conclusion: </strong>Available technical capacities to revise and implement the national benefits package were lower in health economics, synthesis for clinical effectiveness evidence, ethics, patient and public involvement, and soft skills, in that order.</p>","PeriodicalId":14467,"journal":{"name":"International Journal of Technology Assessment in Health Care","volume":"41 1","pages":"e15"},"PeriodicalIF":2.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523442","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":"Perception of non-layperson advisory committee members on the application of a discrete choice experiment instrument to patients and advisory committee members: a qualitative study.","authors":"Hung Manh Nguyen, Jason Robert Guertin, Daniel Reinharz","doi":"10.1017/S0266462325000029","DOIUrl":"10.1017/S0266462325000029","url":null,"abstract":"<p><strong>Objectives: </strong>To explore the view of nonlayperson committee members on the added value of a discrete choice experiment (DCE) instrument to measure patient and committee member preferences for a health intervention.</p><p><strong>Methods: </strong>Nine semistructured interviews were conducted with voting members from two types of advisory committees in Quebec, Canada: one from the Ministry of Health and Social Services, and eight from the Health Technology Assessment (HTA) agency. The DCE instrument, administrable to patients (i.e., pregnant women) and committee members, was developed and administered to both groups to measure their preferences about the addition of fetal chromosomal anomalies to a prenatal screening program. A conceptual framework consisting of three dimensions (relative advantage, compatibility, and complexity) was used for data collection and analyses.</p><p><strong>Results: </strong>Committee members considered the DCE instrument, when used with both patients and committee members, to be particularly valuable in raising awareness of potential biases. These biases, generated by committee members' interests and disciplinary perspectives, can reduce the importance of the patient perspective in decision making by advisory committees.</p><p><strong>Conclusions: </strong>This qualitative study provides insight into the perceptions of nonlayperson advisory committee members regarding the added value of a DCE instrument administered to patients and committee members regarding an intervention. Additional studies are required to explore the perceptions of other stakeholders (e.g., managers, patients, and public representatives) regarding the application of DCE and to assess its impact on HTA recommendations regarding the value of new health interventions.</p>","PeriodicalId":14467,"journal":{"name":"International Journal of Technology Assessment in Health Care","volume":" ","pages":"e31"},"PeriodicalIF":2.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12123159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143492102","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":"Use of surrogate endpoints in health technology assessment: a review of selected NICE technology appraisals in oncology.","authors":"Lorna Wheaton, Sylwia Bujkiewicz","doi":"10.1017/S0266462325000017","DOIUrl":"10.1017/S0266462325000017","url":null,"abstract":"<p><strong>Objectives: </strong>Surrogate endpoints, used to substitute for and predict final clinical outcomes, are increasingly being used to support submissions to health technology assessment agencies. The increase in the use of surrogate endpoints has been accompanied by literature describing the frameworks and statistical methods to ensure their robust validation. The aim of this review was to assess how surrogate endpoints have recently been used in oncology technology appraisals by the National Institute for Health and Care Excellence (NICE) in England and Wales.</p><p><strong>Methods: </strong>This article identifies technology appraisals in oncology published by NICE between February 2022 and May 2023. Data are extracted on the use and validation of surrogate endpoints including purpose, evidence base, and methods used.</p><p><strong>Results: </strong>Of the 47 technology appraisals in oncology available for review, 18 (38 percent) utilized surrogate endpoints, with 37 separate surrogate endpoints being discussed. However, the evidence supporting the validity of the surrogate relationship varied significantly across putative surrogate relationships with 11 providing randomized controlled trial evidence, 7 providing evidence from observational studies, 12 based on the clinical opinion, and 7 providing no evidence for the use of surrogate endpoints.</p><p><strong>Conclusions: </strong>This review supports the assertion that surrogate endpoints are frequently used in oncology technology appraisals in England and Wales and despite the increasing availability of statistical methods and guidance on appropriate validation of surrogate endpoints, this review highlights that use and validation of surrogate endpoints can vary between technology appraisals, which can lead to uncertainty in decision making.</p>","PeriodicalId":14467,"journal":{"name":"International Journal of Technology Assessment in Health Care","volume":"41 1","pages":"e11"},"PeriodicalIF":2.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448363","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":"Development and validation of the NICE artificial intelligence (AI) medical device intervention search filters for MEDLINE and Embase (Ovid).","authors":"Lynda Ayiku, Amy Finnegan, Thomas Hudson, Nicola Walsh, Rachel Adams","doi":"10.1017/S0266462324004823","DOIUrl":"https://doi.org/10.1017/S0266462324004823","url":null,"abstract":"","PeriodicalId":14467,"journal":{"name":"International Journal of Technology Assessment in Health Care","volume":" ","pages":"1-27"},"PeriodicalIF":2.6,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382468","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":"Trial-based economic evaluation of the BrainACT study: acceptance and commitment therapy for anxiety and/or depressive symptoms after acquired brain injury.","authors":"Sander Osstyn, Johanne Rauwenhoff, Ron Handels, Marjolein E de Vugt, Silvia Evers, Ghislaine A P G van Mastrigt, Caroline M van Heugten","doi":"10.1017/S0266462324004811","DOIUrl":"10.1017/S0266462324004811","url":null,"abstract":"<p><strong>Introduction: </strong>Following acquired brain injury (ABI), individuals often experience anxiety and/or depressive symptoms. BrainACT is an adapted form of Acceptance and Commitment Therapy (ACT) tailored to this target group. The current study is a trial-based health-economic evaluation comparing BrainACT to a psychoeducation and relaxation control treatment.</p><p><strong>Methods: </strong>An economic evaluation from a societal perspective was conducted in the Netherlands alongside a multicenter randomized controlled two-armed parallel trial including 72 participants. A cost-utility and cost-effectiveness analysis was conducted where incremental costs, quality-adjusted life-years (QALYs), and anxiety/depression (Hospital Anxiety and Depression Scale (HADS) score) were collected and presented over a 1-year follow-up period. Bootstrapping, scenario, and subgroup analyses were performed to test the robustness of the results.</p><p><strong>Results: </strong>The BrainACT arm reported non-significant lower total costs (incremental difference of €-4,881; bootstrap interval €-12,139 to €2,330) combined with significantly decreased anxiety/depression (HADS) (3.2; bootstrap intervals 0.7-5.7). However, the total QALYs were non-significantly lower (-0.008; bootstrap interval -0.060 to 0.042) for BrainACT. The probability of the intervention being cost-effective was 86 percent at a willingness-to-accept threshold of €50,000/QALY. The scenario and subgroup analyses confirmed the robustness of the results.</p><p><strong>Conclusion: </strong>BrainACT may be a more cost-effective alternative to a psychoeducation and relaxation intervention for anxiety and/or depressive symptoms following ABI. Despite limitations, BrainACT appears to be a promising addition to treatment options in the Netherlands. Further research is needed to validate these findings, and consideration should be given to implementing BrainACT in Dutch clinical settings with ongoing monitoring.</p>","PeriodicalId":14467,"journal":{"name":"International Journal of Technology Assessment in Health Care","volume":"41 1","pages":"e10"},"PeriodicalIF":2.6,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382459","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}