Journal of wound care最新文献

{"title":"The hidden costs of limiting access: clinical and economic risks of Medicare's future effective cellular, acellular and matrix-like products (CAMPs) Local Coverage Determination.","authors":"William Tettelbach, David Armstrong, Jeffery Niezgoda, Naz Wahab, Windy Cole, Travis Tucker, Martha R Kelso","doi":"10.12968/jowc.2025.0120","DOIUrl":"https://doi.org/10.12968/jowc.2025.0120","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of Medicare's future effective Local Coverage Determination (LCD) for cellular, acellular and matrix-like products (CAMPs), which, while informed by a literature review and expert input, was finalised without incorporating a detailed statistical or cost analysis of its projected clinical and economic impact across diverse wound care delivery settings (e.g., hospital-affiliated, private practice, and post-acute care). This analysis focuses on the clinical consequences for Medicare beneficiaries with chronic or hard-to-heal lower extremity diabetic ulcers (LEDUs) and venous leg ulcers (VLUs). Additionally, it aims to assess the economic implications of implementing a capitated or fixed-fee schedule on CAMPs' use, Medicare expenditures and associated medical outcomes.</p><p><strong>Method: </strong>A review of retrospective analyses of Medicare claims (2015-2020) was conducted, comparing treatment outcomes for LEDUs and VLUs using CAMPs plus medically accepted standard of care (SoC) versus SoC without CAMPs. Clinical endpoints included rates of hard- to-heal ulcer healing, amputation rates, hospitalisations and healthcare resource use. Cost-effectiveness models evaluated the impact of CAMP reimbursement structures on overall Medicare costs. Analysing the impact of a fixed-fee schedule involved evaluating Medicare claims data from 2016-2023 to determine the number of commercially available CAMPs, along with the most up-to-date average sales price (ASP). A comparative cost analysis model using an activity-based costing approach and a prospective payment system comparison was applied to evaluate two distinct reimbursement structures: an ASP fee-for- service model versus a fixed-fee schedule model.</p><p><strong>Results: </strong>Medicare beneficiaries receiving SoC plus CAMPs for stalled wounds demonstrated significantly lower amputation rates, reduced hospitalisations and improved wound healing times compared with those receiving SoC without a CAMP during the episode of care. Beneficiaries receiving CAMPs also realised annual cost savings of $3670 USD per patient and a five-year net benefit of $5003 USD per patient. When evaluating over a 12-month window, restricting CAMPs to eight applications in the treatment of hard-to-heal VLUs and LEDUs resulted in estimated treatment failure rates of 10.9% and >30%, depending on the area of investigation. Moreover, the non-real-world restriction of a 16-week treatment episode in the future effective CAMP LCD, which fails to account for care delays (e.g., cellulitis, hospital admissions), will likely drive treatment failure rates even higher. Among failed LEDU cases receiving a CAMP, 1% require an amputation at a reimbursement rate of $23,435 USD per case, 37% are readmitted at a rate of $2079 USD per admission, and 30% seek emergency care at a reimbursement rate of $8292 USD per visit. These complications could result in hundreds of millions of dollars in add","PeriodicalId":17590,"journal":{"name":"Journal of wound care","volume":"34 Sup5","pages":"S5-S14"},"PeriodicalIF":1.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042398","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":"Risk-based safety and quality management strategies in wound care trials at a tertiary, safety net hospital.","authors":"Nolan P Joyce, David Coker, Vitaliy Volansky, Marina A Malikova","doi":"10.12968/jowc.2023.0174","DOIUrl":"https://doi.org/10.12968/jowc.2023.0174","url":null,"abstract":"<p><strong>Objective: </strong>An analysis of risk factors affecting wound care clinical trials was performed to develop proactive risk mitigation strategies, and improve the safety and quality of trials conducted. Adherence to study protocol and compliance with regulatory requirements was examined, based on the rate of protocol deviations.</p><p><strong>Method: </strong>Prospective, randomised clinical trials for diabetic foot ulcers (DFUs) and venous leg ulcers (VLUs) were compared for rates/types of deviations from study protocols. Adverse events were analysed in enrolled participants. The rate and patterns of serious adverse events (SAEs) and non-serious adverse events (AEs) were compared between the two wound indications.</p><p><strong>Results: </strong>In all, 15 trials with a total of 261 participants and 223 adverse events were included in the analysis. The DFU group was noted to have a 10.4% higher incidence of SAEs and a 7.3% higher incidence of having any AEs compared with the VLU group. Analysis showed a higher number of deviations (n=325) in VLU trials compared with DFU trials (n=128). Overall, VLUs and DFUs had rates of deviation of 1.9 and 1.4 per enrolled patient, respectively.</p><p><strong>Conclusion: </strong>An understanding of the frequency/types of adverse events can contribute to the development of safety monitoring plans and risk mitigation strategies for wound care trials. Effective training and retention of research coordinators can reduce the number of deviations, and an understanding of the frequency and types of adverse events can inform safety management/risk mitigation plans.</p>","PeriodicalId":17590,"journal":{"name":"Journal of wound care","volume":"34 Sup5","pages":"S34-S44"},"PeriodicalIF":1.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028620","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":"Comparing oxygenation assessment methods for the interventional management of hard-to-heal wounds.","authors":"Caroline Mussatto, Adam Nygard, Kris Butler, Lucas Richards, Brenden Bombardier, Lauren Clark, Yanming Li, Kate Young, Carissa Walter, Peyton Ackerman, Steven Orr, Aaron Rohr, Kamal Gupta, Adam Alli","doi":"10.12968/jowc.2023.0022","DOIUrl":"https://doi.org/10.12968/jowc.2023.0022","url":null,"abstract":"<p><strong>Objective: </strong>To compare transcutaneous oxygen measurement (TCOM) and near infrared spectroscopy (NIRS) measurement of tissue oxygen levels in hard-to-heal (chronic) wounds.</p><p><strong>Method: </strong>Patients aged 18-85 years presenting with hard-to-heal lower extremity wounds between 1 December 2019 and 31 July 2020 were included in this cross-sectional study. TCOM and NIRS measurements of tissue oxygenation were obtained. Data were stratified by wound severity (Wagner score), skin pigmentation (Fitzpatrick skin type), and use of melanin correction for NIRS measurement.</p><p><strong>Results: </strong>A total of 76 patients were included. Correlation coefficients between TCOM and NIRS with melanin correction were obtained for: Fitzpatrick I-III (p=0.41); Fitzpatrick IV-VI (p=0.08); Wagner 0-2 (p=0.22); Wagner 3-5 (p=0.34). Results without melanin correction were: Fitzpatrick I-III (p=0.19); Fitzpatrick IV-VI (p=0.08); Wagner 0-2 (p=0.05); and Wagner 3-5 (p=0.34).</p><p><strong>Conclusion: </strong>There was only one significant correlation between TCOM and NIRS measurements of tissue oxygenation in patients with hard-to-heal lower extremity wounds and that was for patients with Wagner scores of 0-2 without melanin correction. Further investigation is needed on the application of NIRS to guide the interventional management of hard-to-heal wounds.</p>","PeriodicalId":17590,"journal":{"name":"Journal of wound care","volume":"34 Sup5","pages":"S26-S32"},"PeriodicalIF":1.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006983","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":"Automating collection of patient-reported outcome measures in a high-volume tertiary wound care centre.","authors":"Samuel S Huffman, Daisy L Spoer, Lauren E Berger, John S Steinberg, Christopher E Attinger, Kenneth L Fan, Karen K Evans","doi":"10.12968/jowc.2023.0025","DOIUrl":"https://doi.org/10.12968/jowc.2023.0025","url":null,"abstract":"<p><p>Wound care centres offer opportunities to assess and compare treatment strategies and experiences across different sites through clinical research, with the ultimate goal of optimising patient care. However, recruitment of eligible participants is critical to successful and timely study completion. In this article, the authors describe the implementation of a patient-initiated approach to patient-reported outcome measure research in hard-to-heal (chronic) lower extremity wounds. The approach uses quick-response (QR) codes and automated patient identification. This process enables recruitment of patients without the need for in-person research personnel, results in minimal disruptions to clinic workflow, and captures an important dimension of wound care during under-used time in patient waiting rooms.</p>","PeriodicalId":17590,"journal":{"name":"Journal of wound care","volume":"34 Sup5","pages":"S45-S48"},"PeriodicalIF":1.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989431","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":"Efficacy of continuous topical oxygen therapy in hard-to-heal wounds in Colombia: a retrospective analysis.","authors":"Wolmark Xiques Molina, Katrwin M Pérez Camacho, Windy Cole, Emma Woodmansey, Stacey Martin, Thomas Serena, Leandro Tapia Garcia, Bruna Nakayama, Julián Suárez, Julio Daza, Juan Valle, Uriel Orozco, German Munive","doi":"10.12968/jowc.2025.0191","DOIUrl":"10.12968/jowc.2025.0191","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the use of continuous topical oxygen therapy (cTOT) in hard-to-heal or chronic wounds in Colombia, South America.</p><p><strong>Method: </strong>This multicentre, retrospective analysis studied the efficacy of treating hard-to-heal wounds using a cTOT device in patients over a 3-6-month period. Data were collected retrospectively from patient records. Descriptive statistics were used to summarise the characteristics of the patient population, types of wounds and treatment outcomes. Patients were divided into two groups: a continuous cTOT-treated group (n=47) and a discontinuous cTOT-treated group (n=22). The duration of treatment and wound size reduction were compared. Changes in pain medication usage and the incidence of infections were also analysed.</p><p><strong>Results: </strong>A total of 69 patients were included in the analysis. Complete healing was achieved in 64% of the continuous cTOT-treated group and 36% of the discontinuous cTOT-treated group, with most patients being pain-free and not requiring medication after treatment.</p><p><strong>Conclusion: </strong>The results of this study suggest the benefits of cTOT over traditional treatments in accelerating wound healing and reducing pain, medication necessity and wound infection.</p>","PeriodicalId":17590,"journal":{"name":"Journal of wound care","volume":"34 Sup5","pages":"S15-S24"},"PeriodicalIF":1.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028619","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":"Topical treatment modalities in pressure ulcers: a retrospective analysis.","authors":"Pinar Oztas, Emine Karabulut Demirci, F Nur Baran Aksakal, Mucahit Yildiz","doi":"10.12968/jowc.2021.0395","DOIUrl":"https://doi.org/10.12968/jowc.2021.0395","url":null,"abstract":"<p><strong>Objective: </strong>Pressure ulcers (PUs) are areas of localised tissue damage affecting the skin, soft tissue, muscle or underlying tissues which is caused by continuous pressure, friction or shear. Medical caregivers should primarily focus on patients at high risk of developing these injuries to prevent their development. However, once a PU has developed, different therapy options and proper surgical intervention are the main treatment options. The aim of this study was to investigate the effectiveness of PU topical therapeutic alternatives retrospectively.</p><p><strong>Method: </strong>In this single-centre study, the medical records of hospitalised patients with stage 2 and deeper PUs were screened retrospectively. The patients' age, sex, Waterlow score, mobilisation status, hospitalisation period, PU stage, PU stage on day of discharge, and PU therapy used were recorded. Any evidence of healing was accepted as a successful treatment outcome.</p><p><strong>Results: </strong>The medical records of 511 patients were screened for this study. At discharge day, 55.4% of patients with PUs did not show any evidence of healing. In suspected deep tissue injury (SDTI) PUs, there was a higher rate of therapy success (59.4% at day of discharge) (p<0.05). With regards to the hospitalisation period, when patients stayed >30 days, the rate of therapy success increased (p<0.05). The most effective topical therapy was multilayer silicone foam dressing (p<0.05). The topical application of rifamycin and povidone-iodine solution appeared to worsen the condition of the PU (p<0.05).</p><p><strong>Conclusion: </strong>In patients with PUs in this study, the topical therapy was more effective in SDTIs and if the hospitalisation was of long enough duration for the treatment to take effect. Multilayer silicone foam dressing therapy was found to be the most effective.</p>","PeriodicalId":17590,"journal":{"name":"Journal of wound care","volume":"34 4","pages":"312-318"},"PeriodicalIF":1.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971024","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":"Treating diabetic foot ulcers with antimicrobial wound dressing impregnated with dialkylcarbamoyl chloride.","authors":"Carlos Ramirez Mañas, Raquel Alarcón Rodríguez, José Puentes Sánchez, Carmen María Pardo González, Jéssica García Gonzalez, María Del Mar Requena Mullor","doi":"10.12968/jowc.2024.0170","DOIUrl":"https://doi.org/10.12968/jowc.2024.0170","url":null,"abstract":"<p><strong>Objective: </strong>Diabetic foot ulcers (DFUs) are at significant risk of becoming infected, with an associated elevated risk of amputation. Choosing an appropriate treatment would help prevent infection, improve healing and patients' quality of life, as well as reduce healthcare costs. The aim of this study was to assess the efficacy of a dialkylcarbamoyl chloride (DACC)-coated wound dressing to reduce bacterial load in the treatment of infected diabetic foot ulcers with signs of biofilm.</p><p><strong>Method: </strong>In this prospective, descriptive observational study, patients with infected DFUs were treated with a DACC-coated wound dressing, and were followed until complete healing was achieved. Levels of bacterial load and the presence of biofilm were also assessed.</p><p><strong>Results: </strong>The patients consisted of 42 males and 19 females, with a mean age of 54.4 years. All wounds exhibited complete wound closure upon treatment with the DACC-coated wound dressing, with an average time to heal of 71.8 days. A total of 53 patients had received systemic antibiotic treatment prior to study enrolment, and the number of patients requiring antibiotic treatment reduced to 20 during the study. The level of bacterial load (including biofilm) was reduced, leading to wound progression in a proportion of wounds.</p><p><strong>Conclusion: </strong>The findings of this study revealed that treatment with a non-medicated antimicrobial wound dressing was an appropriate dressing choice to reduce microbial load and aid promotion of healing in infected DFUs with the presence of biofilm.</p>","PeriodicalId":17590,"journal":{"name":"Journal of wound care","volume":"34 4","pages":"278-284"},"PeriodicalIF":1.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024700","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":"Incisional negative pressure wound therapy following abdominoplasty and abdominal free flap surgery: a meta-analysis of outcomes and review of costs.","authors":"Christopher F Brewer, Zaki Manan, Benjamin H Miranda","doi":"10.12968/jowc.2023.0113","DOIUrl":"https://doi.org/10.12968/jowc.2023.0113","url":null,"abstract":"<p><strong>Objective: </strong>Incisional negative pressure wound therapy (iNPWT) is purported to enhance wound healing and reduce the incidence of surgical site wound complications (SSWCs). This systematic review and meta-analysis aimed to evaluate the efficacy and associated costs of iNPWT for abdominoplasty or abdominal free flap donor site surgeries.</p><p><strong>Method: </strong>A literature review was undertaken for studies relating to iNPWT and SSWCs following abdominoplasty or abdominal free flap procedures.</p><p><strong>Results: </strong>After applying the exclusion criteria, 12 studies were identified, incorporating 517 and 589 patients in the iNPWT and control groups, respectively. Pooled analysis identified a significant reduction in the incidence of wound dehiscence in the iNPWT group compared with the control arm (11.7% versus 20.2%, respectively; p<0.05), with meta-analysis demonstrating a relative risk (RR) of 0.60 in the iNPWT group versus controls (RR: 0.60, 95% confidence interval: 0.42-0.87, I²=0%; p=0.85). Incidence of all other SSWCs was comparable between both groups. The two studies which reported associated healthcare costs found iNPWT to be comparable with standard of care.</p><p><strong>Conclusion: </strong>This systematic review and meta-analysis provides evidence to support the judicious use of iNPWT to reduce wound dehiscence in high-risk abdominoplasty and abdominal free flap donor site surgeries. The evidence for reduction of other SSWCs is lacking, and any effect is likely to be minimal. Heterogeneity and poor study design limit the strength of these quantitative findings, and higher quality randomised controlled trials are required in this area.</p>","PeriodicalId":17590,"journal":{"name":"Journal of wound care","volume":"34 4","pages":"286-293"},"PeriodicalIF":1.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000188","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":"Palliative care with negative pressure wound therapy application in malignant wounds: a systematic review.","authors":"Xiao-Feng Yao, Yen-Jen Wang, Yang-Sheng Lin","doi":"10.12968/jowc.2021.0254","DOIUrl":"https://doi.org/10.12968/jowc.2021.0254","url":null,"abstract":"<p><strong>Objective: </strong>To synthesise and appraise the evidence for and benefits of palliative application of negative pressure wound therapy (NPWT) in malignant wounds.</p><p><strong>Method: </strong>We performed a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). MEDLINE, Embase, Cochrane Library and trial registers (www.clinicaltrials.gov) from inception to 1 June 2021 were searched. Quality was assessed using the tool of methodological quality and synthesis from the 2018 <i>BMJ Evidence-Based Medicine</i> article on case series and case report synthesis.</p><p><strong>Results: </strong>Of 765 articles screened, 14 eligible studies were included in the review. All were case reports and included a total of 22 patients. The mean age of the patients was 60.7 (range: 33-77) years. The location of the hard-to-heal wounds was widely distributed: five wounds on the scalp; three wounds over the anogenital area; and the remaining wounds on the trunk and extremities. The reported outcomes included: improvement of wound healing; decreased exudation and malodour of the wound; decreased pain sensation; eligibility for further treatment; and a shift to the homecare system.</p><p><strong>Conclusion: </strong>The findings of this study suggested NPWT could be a choice in palliative care for patients with malignant wounds. However, more studies are needed to evaluate the efficacy of NPWT in these wounds.</p>","PeriodicalId":17590,"journal":{"name":"Journal of wound care","volume":"34 4","pages":"304-311"},"PeriodicalIF":1.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970950","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":"Validation of a compression pressure measuring device and its clinical impact.","authors":"Giovanni Mosti, Giorgio Bergamo","doi":"10.12968/jowc.2024.0111","DOIUrl":"https://doi.org/10.12968/jowc.2024.0111","url":null,"abstract":"<p><strong>Objective: </strong>Compression pressure (CP) measurement is necessary as it represents the dosage of compression therapy (CT). It is almost always neglected, leading to a poor understanding of compression outcomes, especially when applying bandages or wraps. This work aims to present a measuring compression device validation system and underline the clinical impact of CP measurement.</p><p><strong>Method: </strong>The tested device was submitted to validation tests to assess its accuracy, linearity and repeatability. The tests included measuring the pressure under a known weight, along and on the bottom of a water column, in parallel with a sphygmomanometer and under a sphygmomanometer applied to a plastic tube, as well as to a human leg.</p><p><strong>Results: </strong>The tested device showed good concordance with the theoretical pressure exerted by a known weight, water, a sphygmomanometer cuff, and when paralleled to a sphygmomanometer.</p><p><strong>Conclusion: </strong>The tested device provided accurate, linear and repeatable data in all tested conditions. Its use is recommended to improve healthcare providers' skills in applying the correct pressure and to increase the scientific value of studies on CT.</p>","PeriodicalId":17590,"journal":{"name":"Journal of wound care","volume":"34 4","pages":"328-337"},"PeriodicalIF":1.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989429","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}