Journal of the American Medical Directors Association最新文献

{"title":"Communication Technology Improves Staff, Resident, and Family Interactions in Skilled Nursing Homes Post COVID-19 Restrictions","authors":"","doi":"10.1016/j.jamda.2024.105260","DOIUrl":"10.1016/j.jamda.2024.105260","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289888","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 Frailty, Quality of Life and Resilience in Community-dwelling Retirement Village Residents","authors":"","doi":"10.1016/j.jamda.2024.105256","DOIUrl":"10.1016/j.jamda.2024.105256","url":null,"abstract":"<div><h3>Objectives</h3><div>Housing quality has significant impact on the wider determinants of health and quality of life (QoL). Retirement villages are considered age-friendly accommodation for community-dwelling older people, offering a variable range of services and supports. We wished to explore the relationship among frailty, QoL, and resilience in older people residing in retirement villages.</div></div><div><h3>Design</h3><div>Cross-sectional analysis within a longitudinal study.</div></div><div><h3>Setting and participants</h3><div>Residents from 33 retirement villages in Auckland, Aotearoa, New Zealand.</div></div><div><h3>Methods</h3><div>Frailty [using an interRAI-Community Health Assessment-based frailty index FI)], QoL [World Health Organization Quality of Life–Brief Version (WHOQOL-BREF) and WHOQOL–Older Adults Module (WHOQOL-OLD)], and resilience [Brief Resilience Scale (BRS)]. Associations among frailty, QoL, and resilience were examined using regression analysis adjusting for confounders.</div></div><div><h3>Results</h3><div>Mean (SD): FI 0.2 (0.1) in 479 residents, BRS 3.7 (0.8) in 395 residents, WHOQOL-OLD total score 69.9 (12.2). FI was inversely related to BRS [adjusted mean difference (MD) −0.35; 95% CI −0.43 to −0.26; <em>P</em> &lt; .001] and WHOQOL-OLD (MD, −5.45; 95% CI −6.89 to 4.01; <em>P</em> &lt; .001). FI inverse relationship was seen across all facets of WHOQOL-OLD and all WHOQOL-BREF facets except psychological.</div></div><div><h3>Conclusions and Implications</h3><div>Frailty was inversely related to resilience and multiple domains of QoL in those living in presumed age-friendly and relatively resource-rich environments. Studies exploring causal relationships between these facets could inform interventions necessary to improve QoL and resilience in those living with frailty. Specific multidimensional needs, wishes, and concerns of older people living with frailty needs to be explored in order to potentially intervene on frailty, QoL, and resilience.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289899","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":"Health Literacy and Health-Related Quality of Life in Older Adults with Mild Cognitive Impairment","authors":"","doi":"10.1016/j.jamda.2024.105253","DOIUrl":"10.1016/j.jamda.2024.105253","url":null,"abstract":"<div><h3>Objectives</h3><div>Health literacy is considered crucial in health status outcomes, but little is known about the association among cognitively impaired persons. This study investigated the association between health literacy and health-related quality of life (HRQoL) in older adults with mild cognitive impairment (MCI). We further examined whether the association between health literacy and HRQoL depends on age, sex, and educational attainment.</div></div><div><h3>Design</h3><div>A cross-sectional study was conducted between January and December 2022.</div></div><div><h3>Setting and Participants</h3><div>The study population was 233 older adults with MCI who visited the Veterans Health Service Medical Center in Seoul, Republic of Korea.</div></div><div><h3>Methods</h3><div>The diagnosis of MCI was confirmed by a physician based on clinical and neuropsychological assessments. The European Health Literacy Survey Questionnaire and EuroQol Five Dimensions Questionnaire were used to measure the health literacy and HRQoL of the participants.</div></div><div><h3>Results</h3><div>HRQoL was significantly correlated with health literacy (R = 0.25, <em>P</em> ≤ .001) and its 3 subdomains (R = 0.27, <em>P</em> ≤ .001 for healthcare; R = 0.19, <em>P</em> = .004 for disease prevention; and R = 0.18, <em>P</em> = .005 for health promotion). After adjustment for potential covariates, older adults with higher levels of health literacy were significantly associated with better HRQoL: β = 0.02 (<em>P</em> = .0021) for health literacy, β = 0.07 (<em>P</em> = .0001) for healthcare, and β = 0.04 (<em>P</em> = .0443) for disease prevention. The interactions between HRQoL and health literacy with the specific variables of age, sex, and education demonstrated a statistical significance (β = 0.02 with age, β = 0.03 with sex, and β = 0.06 with education).</div></div><div><h3>Conclusions and Implications</h3><div>There was a significant association between health literacy and HRQoL among older adults with MCI. This finding suggests that improving health literacy of older adults with MCI may enhance HRQoL. An education intervention is recommended to reduce the existing health disparities due to low health literacy.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1525861024006753/pdfft?md5=a0496bb0d72858cd84cbf70bceb05484&pid=1-s2.0-S1525861024006753-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Automated Malnutrition Screening Tool Using Routinely Collected Data for Older Adults in Long-Term Care: Development and Internal Validation of AutoMal.","authors":"Jonathan Foo, Melanie Roberts, Lauren T Williams, Christian Osadnik, Judy Bauer, Marie-Claire O'Shea","doi":"10.1016/j.jamda.2024.105252","DOIUrl":"https://doi.org/10.1016/j.jamda.2024.105252","url":null,"abstract":"<p><strong>Objective: </strong>To develop and internally validate a malnutrition screening tool based on routinely collected data in the long-term care setting.</p><p><strong>Design: </strong>Diagnostic prediction model development and internal validation study.</p><p><strong>Setting and participants: </strong>Residents (n = 539) from 10 long-term care facilities in Australia.</p><p><strong>Methods: </strong>Candidate variables identified through expert consultation were collected from routinely collected data in a convenience sample of long-term care facilities. Logistic regression using the Subjective Global Assessment as the reference standard was conducted on 500 samples derived using bootstrapping from the original sample. Candidate variables were selected if included in more than 95% of samples using backwards stepwise elimination. The final model was developed using logistic regression of selected variables. Internal validation was conducted using bootstrapping to calculate the optimism-adjusted performance. Overall discrimination was evaluated via receiver operator characteristic curve and calculation of the area under the curve. Youden's Index was used to identify the optimal threshold value for classifying malnutrition. Sensitivity and specificity were calculated.</p><p><strong>Results: </strong>Body mass index and weight change % over 6 months were included in the automated malnutrition screening model (AutoMal), identified in 100% of bootstrapped samples. AutoMal demonstrated excellent discrimination of malnutrition, with area under the curve of 0.8378 (95% CI, 0.80-0.87). Youden's Index value was 0.37, resulting in sensitivity of 78% (95% CI, 71%-83%) and specificity of 77% (72%-81%). Optimism-corrected area under the curve was 0.8354.</p><p><strong>Conclusions and implications: </strong>The AutoMal demonstrates excellent ability to differentiate malnutrition status. It makes automated identification of malnutrition possible by using 2 variables commonly found in electronic health records.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289886","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":"Staffing Patterns in Nursing Homes, Assisted Living Communities, and Memory Care Units: Variation Across Shifts","authors":"","doi":"10.1016/j.jamda.2024.105254","DOIUrl":"10.1016/j.jamda.2024.105254","url":null,"abstract":"<div><h3>Objectives</h3><p>To assess the staffing patterns of direct care nursing staff by shift in nursing homes (NHs), assisted living communities (ALCs), and their corresponding memory care units (MCUs).</p></div><div><h3>Design</h3><p>Observational study of the 2021 Ohio Biennial Survey of Long-Term Care Facilities and the Payroll-Based Journal data for December 2021.</p></div><div><h3>Setting and Participants</h3><p>NHs (n = 678) and ALCs (n = 542) that reported staffing by shift in Ohio.</p></div><div><h3>Methods</h3><p>Resident-to-staff ratios in Ohio were calculated from staffing data. The proportion of daily nursing staff assigned to each shift was based on staffing data from the Biennial Survey for NHs and ALCs. Outcomes were calculated for aides and licensed nursing staff.</p></div><div><h3>Results</h3><p>Ohio's NHs and ALCs had lower resident-to-staff ratios on the day shift. Lower resident-to-staff ratios mean there were more staff per resident (ie, better staffed). For both types of staff and all shifts, overall resident-to-staff ratios were lower in NHs than ALCs. However, resident-to-staff ratios for ALC MCUs were on par with NH MCUs. This was consistent with ALC and NH MCUs staffing in a more similar manner. Across all settings, the day shift had the most staff members present, while a number of ALCs had no licensed nurses on duty during the overnight shift.</p></div><div><h3>Conclusions and Implications</h3><p>NHs and ALCs have different staffing patterns due to differences in resident needs. However, as ALCs provide for more residents that need NH level of care, ALCs may require additional staffing, especially on the overnight shift where some ALCs have no licensed nurses on duty. The evidence here can be used for decision making about future staffing policies, whether facility-wide policies that encompass MCUs or state-wide policies, so that care delivery aligns with care needs.</p></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1525861024006765/pdfft?md5=342d99fbe7d7191581fcadf22c4ffe4b&pid=1-s2.0-S1525861024006765-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delirium Incidence and Predictors in SARS-CoV-2 Vaccinated Residents in Long-Term Care Facilities (LTCF): Insights from the GeroCovid Vax Study","authors":"","doi":"10.1016/j.jamda.2024.105251","DOIUrl":"10.1016/j.jamda.2024.105251","url":null,"abstract":"<div><h3>Objective</h3><p>SARS-CoV-2 vaccination can bring an important benefit for older people in terms of reduction of mortality and hospitalization; however, reports of rare adverse effects like altered consciousness and delirium among this demographic have raised concerns. This study aimed to assess delirium incidence post-SARS-CoV-2 vaccination and its predictors in older residents across 60 Italian long-term care facilities (LTCFs).</p></div><div><h3>Design</h3><p>This is a prospective cohort study considering data from GeroCovid Vax, a multicenter cohort study jointly performed by the Italian Society of Gerontology and Geriatrics (SIGG) (Florence, Italy) and the Italian National Institute of Health (Istituto Superiore di Sanità—ISS, Rome, Italy), and sponsored by the Italian Medicines Agency (Agenzia Italiana del Farmaco—AIFA).</p></div><div><h3>Setting and Participants</h3><p>GeroCovid Vax enrolled LTCFs residents aged ≥60 who received at least 1 anti–SARS-CoV-2 vaccine dose.</p></div><div><h3>Methods</h3><p>Baseline data covered sociodemographic details, chronic diseases, medications, nutritional status, cognitive and functional assessments, mobility, and frailty. Delirium was assessed post-first, second, and booster vaccine doses using DSM-5 criteria. Data analysis involved descriptive statistics, multivariate logistic regression, and network analysis.</p></div><div><h3>Results</h3><p>A total of 2521 participants (mean age 83.10 ± 9.21 years, 70.7% female) were analyzed. Delirium incidence post-first, second, and booster doses was 3.5%, 1.6%, and 1.5%, respectively. Age, preexisting cognitive disorders, and frailty were significant predictors of delirium, with odds ratios (ORs) of 1.70 (95% CI, 1.08–2.77), 2.05 (95% CI, 1.40–2.97), and 1.77 (95% CI, 1.25–2.52), respectively. Prior use of antipsychotics (OR, 1.75; 95% CI, 1.22–2.51) and antidepressants (OR, 1.77; 95% CI, 1.25–2.52) correlated significantly with delirium. Network analysis indicated a strong association between anorexia and delirium.</p></div><div><h3>Conclusion and Implications</h3><p>Post-vaccination delirium is infrequent and decreases with subsequent doses. Timely assessments for frailty and cognitive impairment could aid in stratifying delirium risk among LTCF residents, facilitating enhanced prevention measures and close monitoring for delirium indicators.</p></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S152586102400673X/pdfft?md5=4e4ac7fe66a04a4739589e49323a2627&pid=1-s2.0-S152586102400673X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance Indicators for the Assessment of Aging-In-Place Reform Policies: A Scoping Review and Evidence Map","authors":"","doi":"10.1016/j.jamda.2024.105249","DOIUrl":"10.1016/j.jamda.2024.105249","url":null,"abstract":"<div><h3>Objectives</h3><div>Many countries have reformed their long-term care system to promote aging-in-place. Currently, there is no framework for evaluating these reforms. This review aimed to identify performance indicators used for aging-in-place reform evaluation.</div></div><div><h3>Design</h3><div>A scoping review and evidence map of literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist.</div></div><div><h3>Setting and participants</h3><div>Long-term care reforms aimed at aging-in-place.</div></div><div><h3>Methods</h3><div>The databases Medline, Embase, and Academic Search Premier were searched. Three independent reviewers screened the articles. Pairs of data collectors extracted the data, with conflicts determined by agreement or by a third reviewer. Performance indicators were classified into the Donabedian framework as structure, process, or outcome.</div></div><div><h3>Results</h3><div>We retained 58 articles. From the included articles, 28 discussed structure indicators, comprising of 71 indicators in the domains expenditures, care availability, and workforce; 36 articles included process indicators comprising 80 indicators about care utilization, service quality, and service satisfaction; and 20 articles reported on outcome indicators comprising 34 indicators about health status and informal caregiving.</div></div><div><h3>Conclusion and Implications</h3><div>Most articles focused on the performance domains care expenditures and care utilization, whereas measuring effects on older adults and society was less common. A framework assessing system and services delivery indicators and the effects on those aging-in-place with actionable performance indicators is recommended.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty in Persons with Down Syndrome: Results from the REVIVIS Study","authors":"","doi":"10.1016/j.jamda.2024.105239","DOIUrl":"10.1016/j.jamda.2024.105239","url":null,"abstract":"<div><h3>Objectives</h3><p>To determine frailty prevalence and identify possible nonclinical factors associated with this condition in community-dwelling individuals with Down syndrome (DS).</p></div><div><h3>Design</h3><p>Cross-sectional analysis of the registry study REVIVIS, a single-center, prospective study on the geriatric management of persons with DS.</p></div><div><h3>Setting and Participants</h3><p>Individuals with DS (n = 139) referred to a geriatric clinic.</p></div><div><h3>Methods</h3><p>Frailty was assessed through a 38-item Frailty Index (FI). A multivariable linear regression model was performed to assess the relationship between frailty and different variables of interest: age, number of prescribed drugs, and employment status (unemployed vs employed).</p></div><div><h3>Results</h3><p>Among 139 subjects (54.5% male), mean (SD) aged 42.9 (6.9) years, the median (interquartile range) FI was 0.24 (0.16-0.30) with 60 participants (43.2%) classified as frail. The number of prescribed medications was associated with higher FI levels (<em>P</em> &lt; .001), whereas being employed was associated with lower FI levels (<em>P</em> &lt; .001) compared with being unemployed. No association was found between chronological age and FI.</p></div><div><h3>Conclusions and Implications</h3><p>Our findings suggest that chronological age is insufficient to encompass the complexity of a subject with DS, underscoring the importance of a standardized evaluation of the FI among this population. Access to geriatric care might become an important opportunity for people with DS, a population characterized by high vulnerability (or frailty).</p></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145841","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":"Olfactory Stimulation for Memory Retrieval and Cognitive Improvement in Dementia: A Narrative Review","authors":"","doi":"10.1016/j.jamda.2024.105240","DOIUrl":"10.1016/j.jamda.2024.105240","url":null,"abstract":"","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145842","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":"Prevalence and Prognostic Impact of Multiple Frailty Domain in Japanese Older Adults","authors":"","doi":"10.1016/j.jamda.2024.105238","DOIUrl":"10.1016/j.jamda.2024.105238","url":null,"abstract":"<div><h3>Objectives</h3><p>In this observational study, we aimed to evaluate the independent and overlapping effects of multiple frailty domains on long-term care insurance (LTCI) use.</p></div><div><h3>Design</h3><p>Population-based cohort design.</p></div><div><h3>Setting and Participants</h3><p>In total, 9804 community-dwelling older adults were recruited from the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes.</p></div><div><h3>Methods</h3><p>The physical domain of frailty was assessed using the revised Japanese version of the Cardiovascular Health Study criteria. The cognitive domain of frailty was identified as impairment of memory, attention, executive function, or processing speed using standardized thresholds established for each domain in population-based cohorts. The social domain was operationalized using the National Center for Geriatrics and Gerontology-Social Frailty Scale. The use of LTCI was prospectively determined over 60 months using data extracted from the Japanese long-term care insurance system.</p></div><div><h3>Results</h3><p>The data from 7745 participants were analyzed, of whom 793 (10.2%) required LTCI certification within 60 months (interquartile range: 60–60 months). The Kaplan–Meier curve analysis demonstrated that a high number of frailty domains was associated with incident LTCI use. The proportions of incident LTCI use were 6.0%, 12.4%, 30.1%, and 43.9% for non-frail participants and those with impairments in 1, 2, and 3 frailty domains, respectively. In the multivariate Cox regression model, physical, cognitive, and social domain impairments independently increased the risk of incident LTCI use [physical domain impairment, hazard ratio (HR), 1.67; 95% CI, 1.39–2.01; cognitive domain impairment, HR, 1.59; 95% CI, 1.37–1.84; social domain impairment, HR, 1.26; 95% CI, 1.05–1.50].</p></div><div><h3>Conclusions and Implications</h3><p>Overlapping frailty domains were strongly associated with incident LTCI use among community-dwelling older adults. These findings emphasize the importance of assessing multiple frailty domains and tailoring interventions according to the unique circumstances of older adults to prevent functional disabilities.</p></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145843","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}