Joint Commission journal on quality and patient safety最新文献

{"title":"Corrigendum to: \"Frailty Screening Using the Risk Analysis Index: A User Guide\" [The Joint Commission Journal on Quality and Patient Safety Volume 51, Issue 3 (2025) Pages 178-191].","authors":"Daniel E Hall, Carly A Jacobs, Katherine M Reitz, Shipra Arya, Michael A Jacobs, John Cashy, Jason M Johanning","doi":"10.1016/j.jcjq.2025.09.001","DOIUrl":"https://doi.org/10.1016/j.jcjq.2025.09.001","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Semistructured Safety-Focused Site Visits Between Children's Hospital.","authors":"Sarah Kandil, Michelle Vonderhaar, Patsy Sisson, Lara Wood, Patrick W Brady, Anne Lyren","doi":"10.1016/j.jcjq.2025.08.003","DOIUrl":"https://doi.org/10.1016/j.jcjq.2025.08.003","url":null,"abstract":"<p><strong>Background: </strong>Site visits are commonly used for accreditation and regulatory purposes, but little is known about how hospitals use them for safety improvement or their impact on clinical processes and outcomes.</p><p><strong>Methods: </strong>This mixed methods study describes the key components of safety-focused site visits between hospitals and their impact on hospital safety outcomes, particularly for the visiting hospital. Hospitals were recruited via the Children's Hospitals' Solutions for Patient Safety (SPS) Network. A site visit guide was developed, covering pre-visit planning, visit execution, and post-visit debriefing. A post-visit survey and follow-up interviews (6 to 12 months later) were conducted. Themes were identified using a constant comparative approach, and statistical analysis compared rates of hospital-acquired conditions (HACs) between hospitals that participated in site visits and those that did not.</p><p><strong>Results: </strong>From 2019 to 2021, 27 hospitals (19.6%) participated in site visits, with 14 in-person and 13 virtual. Key themes to drive a successful and useful visit highlighted the importance of peer rapport, interaction with frontline staff, structured planning, clear agendas, and thorough debriefing. Among hospitals that completed a follow-up interview, 76.5% completed at least one action item, with 56.8% of pre-determined SMART aims achieved. However, no significant difference in HAC rates, specifically central line-associated bloodstream infections (CLABSIs) and unplanned extubations (UEs), was found between site visit and non-site visit hospitals.</p><p><strong>Conclusion: </strong>Safety-focused site visits between hospitals provide a valuable learning experience, fostering the development of improvement strategies and high rates of action item completion. However, no significant differences in safety outcomes were observed, likely due to the small sample size.</p>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Community-Based Intervention to Address Social Determinants of Health: A Pilot Study.","authors":"Nathan L Delafield, Amogh Havanur, Timethia J Bonner, Robert Horsley, Carolyn Mead-Harvey, Sophie Bersoux, Kama White, Nyima Ali, Adam J Milam","doi":"10.1016/j.jcjq.2025.08.002","DOIUrl":"10.1016/j.jcjq.2025.08.002","url":null,"abstract":"<p><strong>Background: </strong>This Innovation Report describes the feasibility and impact of an intervention focused on community-based social support to address social determinants of health (SDoH).</p><p><strong>Methods: </strong>This study followed adult patients (N = 12) referred by primary care teams at a Federally Qualified Health Center (FQHC) due to unresolved SDoH needs. Over 12 months, community volunteers (the Open Table Network Table) were paired with patients to address their primary SDoH needs. Primary outcomes included the implementation of the Open Table Network Table and resolution of the patients' primary SDoH needs, measured by achieving patient-defined goals. Secondary outcomes evaluated intervention impact on patient resilience, healthcare utilization, and other SDoH metrics (for example, economic stability). Semistructured qualitative interviews were conducted with participants postintervention. Primary outcomes were assessed qualitatively; secondary outcomes were tested using paired analyses.</p><p><strong>Results: </strong>Twelve patients were enrolled over 12 months, and their SDoH needs ranged from healthcare access to social isolation. Community volunteers resolved 91.7% of these primary SDoH needs, with a median volunteer effort of 47.5 hours (interquartile range [IQR] 22.5-73.0) provided to each participant. No statistically significant differences were seen in patient resilience, other SDoH metrics, or healthcare utilization postintervention. The intervention was implemented (that is, the intervention was feasible), but there were challenges to implementation, including recruitment of patients, the need for multiple connections, and the time commitment required by volunteers.</p><p><strong>Conclusion: </strong>The Open Table Network Table was implemented at an FQHC but required considerable volunteer effort and creativity. Further research is needed to assess the scalability, sustainability, and long-term social and clinical impact of this intervention.</p>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12413544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction or Prevention? Nurse Interactions with an Electronic Early Warning System for Fall Risk.","authors":"Meriel McCollum, Yimei Wu, LeeAnna Spiva","doi":"10.1016/j.jcjq.2025.08.001","DOIUrl":"https://doi.org/10.1016/j.jcjq.2025.08.001","url":null,"abstract":"<p><strong>Background: </strong>Predictive models using machine learning technology are increasingly being incorporated into electronic health records to support staff in risk assessment and prediction of adverse outcomes. There is little research available related to how this technology fits into the nursing workflow or its effects on nurse behaviors or actual patient outcomes.</p><p><strong>Methods: </strong>Retrospective data from four medical/surgical units were examined to explore nurse interactions with the interruptive alerts produced by the model and their chronological relation to actual falls.</p><p><strong>Results: </strong>During the study period, 1.5% of all admissions resulted in at least one fall, and 87.0% of admissions resulted in at least one fall alert being produced by the system. Most alerts (57.3%) were dismissed by the receiver using the Snooze to Review option, and 22.0% of alerts were shown to staff members other than the primary nurse caring for the patient. Most falls (89.3%) were preceded by an alert being shown to any staff member, but a smaller number of falls (38.7%) were preceded by an alert being shown to the primary nurse.</p><p><strong>Conclusion: </strong>In most fall cases in this sample, the primary nurse caring for the patient had never been exposed to an alert. However, most alerts were dismissed by nurses using the Snooze to Review option. Further research is needed to understand the relationship between nurse exposure to interruptive alerts and associated actions taken by nursing staff to prevent falls. Machine learning technology should be carefully studied and optimized to suit the needs and workflow of the staff and patients it is intended to serve.</p>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Door-to-ECG Time at a Quaternary Care Emergency Department.","authors":"Michael D Stocker, Chrissie Schaeffer, Randy Cox, Emily Tew, Kaitlyn Jensen, Kimberley Smith, Mitchell Sexton, Brian Bales, Amina Belghit, Jonathan W Andereck, David P Johnson, J Christopher Champion, William B Stubblefield","doi":"10.1016/j.jcjq.2025.07.009","DOIUrl":"https://doi.org/10.1016/j.jcjq.2025.07.009","url":null,"abstract":"<p><strong>Background: </strong>Timely diagnosis of ST-segment elevation myocardial infarction (STEMI) in the emergency department (ED) is dependent on electrocardiogram (ECG) completion. The American Heart Association recommends ECG testing within 10 minutes of arrival for patients with symptoms concerning for acute coronary syndrome. The authors aimed to increase the percentage of patients with door-to-ECG (DTE) times of < 10 minutes from 53.7% to > 75%.</p><p><strong>Methods: </strong>We initiated a quality improvement project at an academic, quaternary care ED in June 2022. Patients included were adults (age > 30 years) who presented as walk-ins to ED triage with chest pain and received a cardiac troponin order. The primary measure was the percentage of patients with an ECG completed within 10 minutes of registration. Secondary measures included mean DTE time and mean time to STEMI activation. Statistical process control charts were used to analyze intervention impact.</p><p><strong>Results: </strong>Successful completion of ECGs within 10 minutes increased from 53.7% to 80.0% despite rising patient volumes. Three separate centerline shifts were associated with three interventions: (1) physical relocation of a pivot nurse to identify patients on arrival and dedicated space for rapid ECG acquisition; (2) staff education and recognition of high performers; (3) increased waiting room monitoring staff. DTE time was monitored for one year with no additional interventions, and the centerline decreased to 71.3%.</p><p><strong>Conclusion: </strong>The authors used rapid Plan-Do-Study-Act (PDSA) cycle changes to improve DTE within 10 minutes to > 80% before declining to 71.3% during the maintenance phase. Modification of nursing roles and positions, staff education, recognition of high performers, and increased staffing were drivers of improvement. These improvements are translatable to other departments seeking to improve DTE metrics and may be largely sustained without active surveillance or additional interventions.</p>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Multihospital Analysis of Clinician-Reported Safety Events in People Living with Dementia: Contributing Factors and System Recommendations.","authors":"Lauren Bangerter, Garrett Zabala, Nicole E Werner, Yijung K Kim, Katharine Adams, Allan Fong, Raj Ratwani","doi":"10.1016/j.jcjq.2025.07.010","DOIUrl":"https://doi.org/10.1016/j.jcjq.2025.07.010","url":null,"abstract":"<p><strong>Background: </strong>People living with dementia (PLWD) are hospitalized at higher rates than those without dementia and are particularly vulnerable to safety events in the hospital. This study aimed to characterize the scope of clinician-reported safety events in PLWD, identify contributing factors from the perspective of reporting clinicians, and categorize clinician recommendations for system improvement.</p><p><strong>Methods: </strong>The authors analyzed safety events reported by clinicians between January 2018 and July 2023 through a voluntary reporting system at a 10-hospital health system in the mid-Atlantic region, representing a broad spectrum of hospitals and patient populations. A total of 1,287 clinician-reported safety events in PLWD were identified using a keyword search. Two researchers coded the event reports using validated taxonomies to classify contributing factors and clinician recommendations for improvement.</p><p><strong>Results: </strong>The most common clinician-reported safety events among PLWD were skin/tissue injuries (59.4%), falls (17.2%), and safety/security issues (6.9%). The most frequently cited contributing factors were situational factors (70.0%) and active failures (11.2%). Most clinician reports (65.6%) did not include any recommendation for improvement; 30.0% included person-based recommendations, and only 4.4% included system-based recommendations.</p><p><strong>Conclusion: </strong>Health systems should prioritize the prevention of pressure injuries and falls-two of the most common and preventable safety events. Effective interventions should integrate both person-based (for example, staff training, patient/family education) and system-based (for example, policies, protocols) strategies to improve safety for PLWD in the hospital.</p>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145053497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Age-Friendly Hospital Care and Patient Outcomes for Older Adults.","authors":"Kathleen Drago, Bryanna De Lima","doi":"10.1016/j.jcjq.2025.07.008","DOIUrl":"https://doi.org/10.1016/j.jcjq.2025.07.008","url":null,"abstract":"<p><strong>Background: </strong>Hospitalized older adults are at greater risk for hospital-acquired complications than their younger counterparts. The Age-Friendly Health Systems 4Ms care delivery framework-What Matters, Mentation, Mobility, and Medication-provides evidence-based practices to improve care for older adults. This study assessed if 4Ms care in the hospital was associated with better patient outcomes and lower costs.</p><p><strong>Methods: </strong>The authors retrospectively analyzed adults aged 65 years and older hospitalized at an academic hospital from September 2020 through December 2023 based on age-friendly status. Primary outcomes were length of stay (LOS), total charges, and 30-day hospital and emergency department (ED) readmissions. Linear regression models were used for LOS and total charges. Survival analyses and Cox proportional hazards models analyzed the 30-day hospital and ED readmissions. All models used propensity score matching to minimize confounding. Subgroup analyses were based on high and low case mix index (CMI).</p><p><strong>Results: </strong>The sample included 20,202 admissions for patients aged 65 years and older. The hospitalized older adults receiving 4Ms care had 15.5% lower hospital charges (95% confidence interval [CI] 13.02-17.92), 5.2% shorter stays (95% CI 2.91-7.37), and had a 10.4% lower rate of hospital and ED readmissions (hazard ratio 0.90, 95% CI 0.84-0.95) than those not receiving 4Ms care. The 4Ms recipients with a higher CMI had lower charges, shorter lengths of stay, and a lower risk of readmission than recipients with a lower CMI.</p><p><strong>Conclusion: </strong>The 4Ms care delivery framework was associated with reduced inpatient utilization and overall cost of care. These results support reliable delivery of the 4Ms to benefit older hospitalized adults.</p>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Déjà Vu? How Might Lessons Learned from Electronic Health Record Implementation Apply to Artificial Intelligence?","authors":"Eric G Poon, Andrew L Rosenberg, Adam B Landman, Tejal K Gandhi","doi":"10.1016/j.jcjq.2025.07.007","DOIUrl":"https://doi.org/10.1016/j.jcjq.2025.07.007","url":null,"abstract":"<p><strong>Background: </strong>The US healthcare system is currently facing significant challenges in quality, affordability, and labor shortages. Artificial intelligence (AI) promises to transform healthcare delivery by making it safer, more effective, less wasteful, and more patient-centered. With more than $30 billion invested in healthcare AI companies in the past three years, the proliferation of AI solutions is expected to bring much-needed relief to the strained healthcare industry. To harness the current enthusiasm for AI in healthcare, we can draw parallels to the adoption of electronic health records (EHRs) under the HITECH Act of 2009. EHR adoption has been widespread and has contributed to significant health information technology spending, but it has also brought unintended consequences, such as clinician burnout, workarounds, and mixed impacts on patient safety and quality measures. THE EHR ERA VS.</p><p><strong>The ai era: </strong>DIFFERENCES: This article grounds the discussion by first reviewing the key differences between the EHR implementation era that followed the passage of HITECH and the current AI era. The authors identified three characteristics of the AI era that distinguish it from the EHR implementation era: different regulatory and legislative context, diminished capacity of the workforce to absorb new work, and an accelerated pace of change. LESSONS FROM EHR IMPLEMENTATION TO CARRY FORWARD TO AI IMPLEMENTATION: Based on the collective experience of the authorship team and published literature on EHR and AI implementation, the authors identified five critical lessons from the EHR implementation era that organizations deploying AI must consider: (1) respect the human element, (2) build strong organizational governance, (3) adapt leadership and culture, (4) ready the workforce, and (5) build for the long term.</p><p><strong>Conclusion: </strong>By applying these lessons, organizational leaders can realize the potential of AI to improve patient outcomes and transform healthcare delivery.</p>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telehealth for Pediatric Patients: Facilitators, Barriers, and Impact on Disparities","authors":"Courtney Sump MD, MSc (Assistant Professor, Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine.),&nbsp;Hadley Sauers-Ford MPH, CCRP (is Senior Clinical Research Coordinator, Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center.),&nbsp;Sinem Toraman Turk PhD (is Associate Research Scientist, Yale Global Health Leadership Initiative, Department of Health Policy and Management, Yale School of Public Health.),&nbsp;Kylee Denker MSN, RN, NE-BC (is Clinical Director, Home Care Agency and Remote Patient Monitoring, Cincinnati Children’s Hospital Medical Center.),&nbsp;Carlos Casillas MD, MPH (is Assistant Professor, Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine.),&nbsp;Joanna Thomson MD, MPH (is Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, and Professor, Department of Pediatrics, University of Cincinnati College of Medicine. Please send correspondence to Courtney Sump)","doi":"10.1016/j.jcjq.2025.07.006","DOIUrl":"10.1016/j.jcjq.2025.07.006","url":null,"abstract":"<div><h3>Background</h3><div>Although telehealth has potential to improve access to care by eliminating barriers such as transportation and childcare, it also may result in disparate access for certain populations. The aim of this study was to gain an in-depth understanding of telehealth access at a large quaternary care children’s hospital.</div></div><div><h3>Methods</h3><div>This qualitative study employed purposive sampling and semistructured interviews of key personnel across our institution, including caregivers, clinical providers, and telehealth operational leads and staff. Interviews targeting access to telehealth were recorded and transcribed verbatim. Using an inductive, thematic approach, each interview was coded independently by two study team members. The authors identified preliminary themes and iteratively reviewed interviews and codes to finalize themes with illustrative quotes.</div></div><div><h3>Results</h3><div>The authors interviewed 25 participants and identified four themes: (1) Telehealth may perpetuate health disparities, including provider reluctance to offer telehealth to patients with a preferred language other than English; (2) Telehealth can help patients receive the right care, at the right place and time; (3) There are numerous facilitators to telehealth’s uptake, including provider and caregiver buy-in and optimal physical workspace; and (4) There are challenges in its execution that lead to decreased uptake.</div></div><div><h3>Conclusion</h3><div>Telehealth has many challenges to successful execution but is an integral component to providing the right care at the right place and time. This study was unique in capturing perspectives of multidisciplinary members of the healthcare team in addition to patient caregivers to provide a wide variety of perspectives on access to telehealth. The findings in this single-site, qualitative study identify that real and perceived assumptions about who is best suited for telehealth care may perpetuate health disparities and exacerbate gaps in access to care.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 10","pages":"Pages 632-641"},"PeriodicalIF":2.4,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remembering Lucian Leape","authors":"Elizabeth Mort MD, MPH (is Editor-in-Chief, The Joint Commission Journal on Quality and Patient Safety, and Vice President and Chief Medical Officer, Joint Commission, Oakbrook Terrace, Illinois. Please address correspondence to Dr. Elizabeth Mort)","doi":"10.1016/j.jcjq.2025.07.004","DOIUrl":"10.1016/j.jcjq.2025.07.004","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 9","pages":"Page 514"},"PeriodicalIF":2.4,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}