Journal of pain and symptom management最新文献

{"title":"Measuring the Complexity of Palliative Care: A Single-Center Retrospective Study","authors":"Hironori Ohinata RN, PhD ,&nbsp;Mitsunori Miyashita RN, PhD ,&nbsp;Isseki Maeda MD, PhD","doi":"10.1016/j.jpainsymman.2025.07.007","DOIUrl":"10.1016/j.jpainsymman.2025.07.007","url":null,"abstract":"<div><h3>Context</h3><div>International guidelines recommend specialized palliative care for patients with complex care needs. However, scales assessing patient complexity should be modified according to each country and its healthcare systems.</div></div><div><h3>Objectives</h3><div>This study aimed to develop a scale for assessing the complexity of palliative care needs among patients referred to a palliative care unit and to determine its validity.</div></div><div><h3>Methods</h3><div>We developed an 8-item COMPLEX scale (with each item scored 0–3 points) to assess patient complexity based on physicians’ clinical reasoning and a literature review. Data were collected from a palliative care unit at a Japanese hospital between September 2022 and March 2023. The inclusion criteria were: (1) referral to a palliative care unit, and (2) any age, sex, or primary cancer focus.</div></div><div><h3>Results</h3><div>A total of 305 patients were included in the analysis. During the data collection period, 148 patients (48.5%) died. Regarding survival time analysis, patients were stratified into three groups based on their COMPLEX scale scores. At the time of referral to the palliative care unit, the mean survival time was 62.0 days for those with a score of ≤8, 51.1 days for those with scores of 9–10, and 48.8 days for those with a score of ≥11. Overall, patients with higher scores had significantly shorter survival times than those with lower scores (<em>P</em> = 0.037).</div></div><div><h3>Conclusion</h3><div>The COMPLEX scale demonstrated meaningful associations with external indicators, such as survival time. Future studies should validate its reliability across diverse clinical settings, among various raters, and in relation to other external indicators.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 4","pages":"Pages 371-378.e2"},"PeriodicalIF":3.5,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing and Adapting the Education in Palliative and End-of-Life Care (EPEC)-Pediatrics Curriculum for Aotearoa (New Zealand)","authors":"Gemma Aburn ,&nbsp;Tess Moeke-Maxwell ,&nbsp;Merryn Gott ,&nbsp;Ross Drake ,&nbsp;Deborah Raphael","doi":"10.1016/j.jpainsymman.2025.07.003","DOIUrl":"10.1016/j.jpainsymman.2025.07.003","url":null,"abstract":"<div><div>Pediatric Palliative Care provision is currently inequitable for tamariki (children) with serious illness, and their whānau in Aotearoa New Zealand. A lack of access to education for health professionals has long been identified as a barrier to implementing quality delivery of pediatric palliative care. The Education in Palliative and End of Life Care for Pediatrics (EPEC-Ped) curriculum was developed in 2012 and has been internationally recognized as a high-quality curriculum with demonstrated results in changing practice. This paper explores how this curriculum has been adapted to meet the needs of clinicians working with children in Aotearoa New Zealand. We particularly explore how tikanga Māori (Indigenous customs and traditions) have been integrated into the programme to create a culturally relevant and safe space for practitioners to learn.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 4","pages":"Pages e272-e277"},"PeriodicalIF":3.5,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improvement of Fatigue Due to Placebo in Blinded and Open Labeled Cancer Fatigue Treatment Trials","authors":"Reema Singh MD ,&nbsp;Levi Jo Manuntag MD ,&nbsp;Kristofer Jennings PhD ,&nbsp;Eduardo Bruera MD ,&nbsp;Sriram Yennurajalingam MD, MS, FAAHPM","doi":"10.1016/j.jpainsymman.2025.07.005","DOIUrl":"10.1016/j.jpainsymman.2025.07.005","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study was to compare the placebo response i.e., improvement of cancer-related fatigue (CRF) between cohorts of advanced cancer patients who received placebo as part of CRF clinical trials in a blinded fashion, and as open-label for treatment of CRF.</div></div><div><h3>Materials and Methods</h3><div>In this study, data of advanced cancer patients from randomized controlled CRF clinical treatment trials who received placebo in a blinded, and as an open labeled design at a tertiary cancer center were reviewed. Demographic data, Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), and Edmonton Symptom Assessment Scale (ESAS) scores were pooled, and changes in FACIT-F (placebo response), from baseline to day eight in the two cohorts were compared. We also examined the association of placebo response with demographics factors, FACT-G, and its sub scales, ESAS symptoms, and ESAS symptom distress scores.</div></div><div><h3>Results</h3><div>We found no significant differences in placebo response between the blinded and open label cohorts (6.6 vs. 7.9, −1.3 [<em>P</em> = 0.87]). We found significant association between placebo response and baseline FACIT-F -3.5 (<em>P</em> = 0.0001), gastrointestinal cancers 5.2 (<em>P</em> = 0.02), ESAS- pain 0.70 (<em>P</em> = 0.04), ESAS anxiety 1.3 (<em>P</em> = 0.003), and ESAS-Symptom Distress Score −0.53 (<em>P</em> = 0.012).</div></div><div><h3>Conclusions</h3><div>In this study we found placebo response was not significantly different between patients receiving placebo in a blinded and open-labeled design in randomized controlled CRF clinical trials. In this study we found a significant association between placebo response and baseline CRF, gastrointestinal cancers, ESAS- pain, anxiety and ESAS–Symptom Distress Score. Further research is needed.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 4","pages":"Pages e244-e249"},"PeriodicalIF":3.5,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When Methadone Fails in Cancer Pain Management: A Retrospective Analysis","authors":"Sebastiano Mercadante MD,&nbsp;Alessio Lo Cascio RN","doi":"10.1016/j.jpainsymman.2025.07.010","DOIUrl":"10.1016/j.jpainsymman.2025.07.010","url":null,"abstract":"<div><h3>Background</h3><div>Methadone is increasingly used. It is expected that some patients will lose the analgesic response or develop adverse effects. Opioid switching (OS) from methadone to other opioids has not been well described</div></div><div><h3>Methods</h3><div>The charts of patients with cancer pain receiving methadone, both intravenously and orally were reviewed for a period of two years (2023–2024). Patients who were switched from methadone, prescribed prior to or during admission to APCU were collected and analyzed. Epidemiological data were recorded. Opioid drugs, doses and route of administration prior to admission, at admission and at discharge were recorded.</div></div><div><h3>Results</h3><div>In the period taken into consideration ten patients were switched from methadone to other opioids. The final treatment included morphine and transdermal buprenorphine, in four and four patients, respectively, intravenous fentanyl in one patient, and spinal analgesia in one patient. Significant improvements were reported at time of discharge for most symptoms, with a decrease of total burden (<em>P</em> = 0.005).</div></div><div><h3>Conclusion</h3><div>OS from methadone was effective in most cases, but the treatment was challenging as higher doses of opioids are expected, due to the loss of the extra-opioid analgesic effects of methadone.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 4","pages":"Pages e266-e271"},"PeriodicalIF":3.5,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Patient Prescriber Agreement on Aberrant Urine Drug Tests Among Patients Receiving Opioids for Cancer Pain","authors":"Joseph A. Arthur MD ,&nbsp;Soraira Pacheco DO ,&nbsp;Rex A.D. Paulino MD ,&nbsp;Christopher Manuel PhD ,&nbsp;Wei Qiao PhD ,&nbsp;David Hui MD","doi":"10.1016/j.jpainsymman.2025.07.002","DOIUrl":"10.1016/j.jpainsymman.2025.07.002","url":null,"abstract":"<div><h3>Context</h3><div>Best practices recommend the use of patient prescriber agreement (PPA) to improve patient adherence and reduce nonmedical opioid use (NMOU) during opioid therapy but evidence for this is lacking. No study has examined its efficacy among patients with cancer.</div></div><div><h3>Objectives</h3><div>We examined the impact of PPA completion on aberrant urine drug test (UDT), an NMOU indicator, within 3 and 6 months post-PPA completion.</div></div><div><h3>Methods</h3><div>Demographic and clinical information of consecutive patients receiving opioids for cancer pain who completed a PPA were retrospectively reviewed and compared with those without a PPA. Univariable and multivariable regression models were used to determine factors associated with aberrant UDT.</div></div><div><h3>Results</h3><div>126/236 (53%) and 150/236 (64%) of eligible patients had UDT results within 3 and 6 months respectively; among these patients, 92/126 (73%) and 107/150 (71%) signed a PPA. PPA completion was associated with significantly lower rates of an aberrant UDT within 3 months (OR 0.28, 95% CI: 0.09, 0.76; <em>P</em> = 0.02). Higher baseline pain expression (OR 1.22, 95% CI: 1.04, 1.46; <em>P</em> = 0.02), higher Morphine Equivalent Daily Dose (OR 1.07, 95% CI: 1.02, 1.14; <em>P</em> = 0.02), and history of illicit drug use (OR8.39, 95% CI: 3.31, 23.57; <em>P</em> &lt; 0.001) were associated with aberrant UDT within 3 months post-PPA completion and remained significant at 6 months.</div></div><div><h3>Conclusion</h3><div>Patients who signed a PPA had significantly lower rates of aberrant UDT within the following 3 months compared to patients who did not. The findings suggest that PPA may decrease NMOU behaviors, highlighting its potential as a risk mitigation strategy.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 4","pages":"Pages e236-e243"},"PeriodicalIF":3.5,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association Between Coping Styles, Meaning in Life, Death Preparedness of Advanced Cancer Patients","authors":"Xi Zhang PhD ,&nbsp;Jingxin Wang MSc ,&nbsp;Mei Liu MSc ,&nbsp;Feng Li BSn ,&nbsp;Tieying Zeng PhD","doi":"10.1016/j.jpainsymman.2025.07.001","DOIUrl":"10.1016/j.jpainsymman.2025.07.001","url":null,"abstract":"<div><h3>Context</h3><div>The current level of death preparedness in advanced cancer patients is low. However, death preparedness is an important prerequisite for quality of life and quality of death for these patients.</div></div><div><h3>Objectives</h3><div>This study aimed to explore the unique relationship between coping styles, meaning in life, and death preparedness in advanced cancer patients, and whether meaning in life mediates the relationship between coping styles and death preparedness.</div></div><div><h3>Methods</h3><div>A cross-sectional study design was used. A convenience sampling method was used to recruit 1100 advanced cancer patients from seven hospitals in Hubei and Anhui provinces, China. Data were collected using the medical coping modes questionnaire, the meaning in life questionnaire, and the death preparedness scale. Pearson's correlation was used to examine the relationship between coping styles, meaning in life, and death preparedness. Mediation analyses examined whether meaning in life mediated the relationship between coping styles and death preparedness.</div></div><div><h3>Results</h3><div>The coping style of confrontation and meaning in life are positively correlated with death preparedness. The coping style of avoidance is negatively correlated with death preparedness. Meaning in life plays a partial mediating role between the coping styles of confrontation, avoidance and death preparedness.</div></div><div><h3>Conclusion</h3><div>These findings provide new knowledge and perspectives to promote death preparedness in advanced cancer patients. Meaning in life played a partial mediating role between coping styles of confrontation, avoidance and death preparedness. Therefore, to improve patients’ death preparedness, taking effective measures to enhance patients’ meaning in life is particularly important.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 4","pages":"Pages 363-370"},"PeriodicalIF":3.5,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Amnesia Resulting in Complete Relief of Pain, Depression, and Anxiety","authors":"Jacqueline Ohmura MD, PhD ,&nbsp;Chad B. Sussman MD ,&nbsp;Amir Zamani MD ,&nbsp;Srdjan S. Nedeljkovic MD ,&nbsp;Stanley Lyndon MD","doi":"10.1016/j.jpainsymman.2025.06.015","DOIUrl":"10.1016/j.jpainsymman.2025.06.015","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 4","pages":"Pages e280-e283"},"PeriodicalIF":3.5,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of an Explanatory Model of Resuscitation Preference Decision Making","authors":"Mark Goldszmidt MDCM, MHPE, PhD, FRCPC ,&nbsp;Rachelle Lassaline MD ,&nbsp;Kristen A. Bishop MSc, PhD ,&nbsp;Ravi Taneja MD, FFARCSI, FRCA, FRCPC","doi":"10.1016/j.jpainsymman.2025.06.012","DOIUrl":"10.1016/j.jpainsymman.2025.06.012","url":null,"abstract":"<div><h3>Context</h3><div>Establishing resuscitation preferences prior to a medical emergency is a well-recognized component of hospital practice. When done effectively, these help to ensure that care received aligns with patient wishes. In practice however, these conversations can be challenging and influences on choice are not well understood.</div></div><div><h3>Objectives</h3><div>Objectives: The purpose of this study was to identify influences on patient resuscitation preferences and their relationship to each other, with the aim of developing an explanatory model.</div></div><div><h3>Methods</h3><div>Constructivist grounded theory was used to analyze 107 clinical notes from a dataset of detail-rich resuscitation preference conversation narratives. Sampling was purposeful and focused on maximum variation. Iterative data collection and analysis and constant comparison was used to enhance rigor as was the incorporation, in later stages of the analysis, of existing theories and models.</div></div><div><h3>Results</h3><div>Twenty-seven coding categories were developed and integrated into the resuscitation preferences conversation model that described the interaction and relationship between influences. Within the model, three categories (<em>Ability to Engage in Meaningful Activity, Trajectory</em>, and <em>Perceptions and Beliefs</em>) informed patient and Substitute Decision Maker (SDM) preferences, while an additional two categories <em>(Social and Knowing</em>, and <em>Experiences</em>) informed substitute decision maker choice.</div></div><div><h3>Conclusions</h3><div>The developed model builds on prior work and helps explain the relationship between influences and preferences. The integration of both patient and substitute decision maker perspective into the model shows the complexity of the substitute decision maker role in decision-making. The model should be used in conjunction with existing conversation guides to support effective resuscitation preference conversations.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 4","pages":"Pages 351-362"},"PeriodicalIF":3.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variations in End-of-Life Symptom Management Medication Prescribing Among Home Care Recipients in Ontario, Canada","authors":"Deena Fremont MSc ,&nbsp;James Downar MD, MSc ,&nbsp;Hsien Seow PhD ,&nbsp;Peter Tanuseputro MD, MHSc ,&nbsp;Colleen Webber PhD","doi":"10.1016/j.jpainsymman.2025.06.013","DOIUrl":"10.1016/j.jpainsymman.2025.06.013","url":null,"abstract":"<div><h3>Context</h3><div>Nearing the end of life (EOL), a variety of medications can be prescribed for symptom management during the dying process.</div></div><div><h3>Objectives</h3><div>To describe the prescribing of subcutaneous symptom management medications during the last six weeks of life among home care recipients in Ontario, Canada, and to assess the association of prescribing medications with EOL outcomes.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included individuals in Ontario who died between January 1, 2017, and March 17, 2020, aged 66–105 at death and who received publicly-funded home care at least one month prior to death. End-of-life symptom management medications were identified based on an extensive literature review and consultation with Ontario palliative care physicians. We measured the proportion of decedents prescribed an EOL medication in the last six weeks of life. We used log-binomial regression models to evaluate the association between EOL medication prescribing and emergency department visits and hospitalizations in the last two weeks of life, and location of death (community vs. institution).</div></div><div><h3>Results</h3><div>Of the 55,903 home care decedents identified, 28.6% received an EOL symptom management prescription. Those who received a prescription had a decreased risk of dying in an institution (adjusted risk ratio (aRR): 0.59, 95% confidence interval (CI): 0.57–0.60), having an emergency department visit (aRR: 0.22, CI: 0.20–0.24), and being hospitalized (aRR: 0.20, CI: 0.18–0.22) compared to those without a prescription.</div></div><div><h3>Conclusion</h3><div>Our findings suggest that EOL prescribing is associated with a decreased risk of late acute care use and death in hospital among home care decedents.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 4","pages":"Pages 341-350.e6"},"PeriodicalIF":3.5,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality Indicators for Home-Based Palliative Care: A Systematic Review","authors":"Yinshi Kan RN, MSN ,&nbsp;Yao Xiao RN, MSN(c) ,&nbsp;Zhaoyu Li RN, PhD,&nbsp;Ziyue Chen RN,&nbsp;Peng Yue RN, PhD","doi":"10.1016/j.jpainsymman.2025.06.011","DOIUrl":"10.1016/j.jpainsymman.2025.06.011","url":null,"abstract":"<div><h3>Context</h3><div>The advantages of home-based palliative care (HPC) are becoming increasingly acknowledged, resulting in a growing demand for this care model. The quality indicators (QIs) required for HPC may differ in scope and focus from those used in other care settings.</div></div><div><h3>Objectives</h3><div>This review aimed to identify and integrate QIs for the provision of HPC.</div></div><div><h3>Methods</h3><div>We searched PubMed, Medline, CINAHL, Cochrane Library, Web of Science and Embase databases to identify all articles on QIs for HPC. The QIs extracted from these articles were categorized by structure, process, or outcome, mapped to 8 care domains, and their methodological characteristics were evaluated.</div></div><div><h3>Results</h3><div>Fifteen articles were ultimately included, comprising 312 unique QIs. Among these, 45.5% were outcome indicators, 39.1% were process indicators. The most frequently addressed care domain were “Structure and Process of Care” (44.2%) and “Physical Aspects of Care” (28.8%), whereas the fewest QIs pertained to “Spiritual, Religious and Existential Aspects of Care” (2.2%) and “Cultural Aspects of Care” (1.6%). Methodological quality assessment varied considerably across the studies, with 7 articles rated as high quality.</div></div><div><h3>Conclusions</h3><div>This study integrated QIs for HPC. The majority of identified QIs were outcome or process indicators. However, fewer addressed social, cultural, and spiritual care domains. Validation was also limited, as only a small proportion of these QIs met sufficient criteria for warrant further testing. Future research could consider expanding QIs related to cultural sensitivity, home telehealth regulations, and subjective experiences and preferences to facilitate a more thorough and reliable assessment to improve the quality assessment of HPC services.</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"70 4","pages":"Pages e213-e227"},"PeriodicalIF":3.5,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}