Palliative Medicine最新文献

{"title":"Estimating the escalating future need for palliative care among people living with dementia.","authors":"Emel Yorganci, Anna E Bone, Catherine J Evans, Elizabeth L Sampson, Robert Stewart, Katherine E Sleeman","doi":"10.1177/02692163241269773","DOIUrl":"10.1177/02692163241269773","url":null,"abstract":"","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"1069-1071"},"PeriodicalIF":3.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11487904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917254","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":"Perceptions and experiences of clinicians and correctional officers facilitating palliative care for people in prison: A systematic review and meta-synthesis.","authors":"Isabelle Schaefer, Stacey Panozzo, Michelle DiGiacomo, Nicole Heneka, Jane L Phillips","doi":"10.1177/02692163241262614","DOIUrl":"10.1177/02692163241262614","url":null,"abstract":"<p><strong>Background: </strong>As the number of people ageing in prison with complex healthcare needs continues to increase, so does the need for palliative care in the restrictive prison context. Palliative care for people in prison is facilitated by correctional officers, and prison- and hospital-based clinicians. A collective analysis of existing research to identify common experiences of these stakeholders globally has not been completed.</p><p><strong>Aim: </strong>To explore the perceptions and experiences of correctional officers and prison- and hospital-based clinicians who facilitate palliative care for people in prison.</p><p><strong>Design: </strong>A systematic review and meta-synthesis.</p><p><strong>Data sources: </strong>Keywords and subject headings related to palliative care and prisons were used to search seven databases with no time limitations. Peer-reviewed research in English, containing qualitative data from stakeholders facilitating palliative care for people in prison were included, and appraised using the CASP tool.</p><p><strong>Results: </strong>Two analytical themes emerged: (i) a prison lens on a palliative approach and (ii) coping complexities. Palliative care is 'translated' into the prison setting according to security and environmental constraints. Stakeholders experienced ethical, personal and professional difficulties, because prison-based palliative care did not align with community norms. Ambiguous policy and expectations regarding prioritising care needs and balancing custodial rules led to role stress.</p><p><strong>Conclusions: </strong>Providing palliative care for people in prison is complex and impacts stakeholders and people in prison with palliative care needs. Supporting person-centred care through a multi-service approach, stakeholder education and standards will improve the quality and accessibility of care.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"951-967"},"PeriodicalIF":3.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11490060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788793","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":"Palliative care in patients with hepatocellular carcinoma: Results from a survey among hepatologists and palliative care physicians.","authors":"Massimo Iavarone, Lorenzo Canova, Eleonora Alimenti, Alessio Aghemo, Diego Taveggia, Gino Gobber, Giuseppe Cabibbo, Simone Veronese, Vincenza Calvaruso, Luciano Orsi, Paolo Caraceni, Pietro Lampertico","doi":"10.1177/02692163241269794","DOIUrl":"10.1177/02692163241269794","url":null,"abstract":"<p><strong>Background: </strong>Delays and limitations of palliative care in patients with liver transplantation-<i>ineligible</i> end-stage hepatocellular carcinoma according to Barcelona Clinic Liver Cancer staging system may be explained by different perceptions between hepatologists and palliative care physicians in the absence of shared guidelines.</p><p><strong>Aim: </strong>To assess physicians' attitudes toward palliative care in end-stage hepatocellular carcinoma and to understand what the obstacles are to more effective management and co-shared between palliative care physicians and hepatologists.</p><p><strong>Design: </strong>Members of the Italian Association for the Study of Liver Disease and the Italian Society of Palliative Care were invited to a web-based survey to investigate practical management attitude for patients with liver transplant-<i>ineligible</i> end-stage hepatocellular carcinoma.</p><p><strong>Participants: </strong>Physician members of the of the two associations, representing several hospitals and services in the country.</p><p><strong>Results: </strong>Ninety-seven hepatologists and 70 palliative care physicians completed the survey: >80% regularly follow 1-19 patients; 58% of hepatologists collaborate with palliative care physicians in the management of patients, 55% of palliative care physicians take care of patients without the aid of hepatologists. Management of cirrhosis differed significantly between the two groups in terms of prescription of albumin, esophagogastroduodenoscopy, anti-viral treatment, anticoagulation, indication to paracentesis and management of encephalopathy. Full-dose acetaminophen is widely used among hepatologists, while opioids are commonly used by both categories, at full dosage, regardless of liver function.</p><p><strong>Conclusions: </strong>This survey highlights significant differences in the approach to patients with liver transplantation-<i>ineligible</i> end-stage hepatocellular carcinoma, reinforcing the need for shared guidelines and further studies on palliative care in the setting.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"1033-1041"},"PeriodicalIF":3.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142081134","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":"Factors associated with the place of death of persons with advanced dementia: A systematic review of international literature with meta-analysis.","authors":"RiYin Tay, Joyce Ys Tan, BinYan Lim, Allyn Ym Hum, Jane Simpson, Nancy Preston","doi":"10.1177/02692163241265231","DOIUrl":"10.1177/02692163241265231","url":null,"abstract":"<p><strong>Background: </strong>Many individuals with advanced dementia die in hospital, despite preferring home death. Existing evidence of factors affecting their place of death is inconsistent. To inform policies/practices for meeting needs/preferences, systematically establishing the evidence is pertinent, particularly given the exponential rise in advanced dementia prevalence.</p><p><strong>Aim: </strong>To identify factors influencing where people with advanced dementia die.</p><p><strong>Design and data sources: </strong>This systematic review with meta-analysis was registered on PROSPERO (CRD42022366722). Medline, CINAHL, PsycINFO, SocINDEX and a grey literature database, Overton, were searched on 21/12/2022, supplemented by hand-searching/citation tracking. Papers reporting quantitative data on factors associated with place of death in advanced dementia were included and appraised using QualSyst. Data were analysed using random effects with the certainty of evidence determined using the GRADE criteria.</p><p><strong>Results: </strong>Thirty-three papers involving >5 million individuals (mean age = 89.2 years) were included. Long-term care setting deaths were relatively common but hospice deaths were rarer. Marriage's association with home death underscores social networks' importance, while younger age's and male gender's associations with hospital death demonstrate patients' and families' interdependency. Pneumonia/COPD's opposing effects on hospital deaths with cancer/functional impairment highlight the challenges of advanced dementia care. Unlike hospital/nursing home bed availability's lack of effect, capitated funding (fixed-amount-per-patient-per-period) decreased hospital death likelihood.</p><p><strong>Conclusion: </strong>This comprehensive review of place of death determinants highlight the profound challenges of advanced dementia end-of-life care. Given that bed capacity did not affect place of death, a capitation-based, integrated palliative care model would appear more likely to meet patients' needs in a resource-constrained environment.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"896-922"},"PeriodicalIF":3.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141875594","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 double awareness of the wish to hasten death and the will to live: A secondary analysis of outlier patients from a mixed-methods study.","authors":"Kathleen Boström, Thomas Dojan, Martin Hellmich, Kerstin Kremeike, Raymond Voltz","doi":"10.1177/02692163241269689","DOIUrl":"10.1177/02692163241269689","url":null,"abstract":"<p><strong>Background: </strong>Patients with serious illness frequently report (temporary) wishes to hasten death. Even until the end-of-life, many patients also harbor a will to live. Although both phenomena are negatively correlated according to some studies, they can also co-exist. Knowledge about the complex relationship between the seemingly opposing wish to hasten death and will to live is limited, but crucial for delivering adequate care and understanding potential requests for assisted dying.</p><p><strong>Aim: </strong>To study the correlation of and explore the relationship between wish to hasten death and will to live over 6 weeks.</p><p><strong>Design: </strong>Observatory, prospective cohort study following a mixed methods design. Analysis of quantitative (Schedules of Attitudes Toward Hastened Death, a visual numerical scale and (additional) validated questionnaires) and qualitative (semi-structured interviews) data with illustrative case descriptions.</p><p><strong>Setting/participants: </strong>Patients receiving palliative care with heterogenous underlying diseases from various care settings, before and after an open conversation on a possible desire to die.</p><p><strong>Results: </strong>In <i>n</i> = 85 patients, wish to hasten death and will to live were strongly negatively correlated at three time points (baseline: <i>r</i>(65) = -0.647, <i>p</i> ⩽ 0.001; after 1 week: <i>r</i>(55) = -0.457, <i>p</i> ⩽ 0.001 and after 4-6 weeks: <i>r</i>(43) = -0.727, <i>p</i> ⩽ 0.001). However, visual assessment of scatterplots revealed a small, but substantial number of outliers. When focusing on these outlier patients, they showed clinically relevant changes between baseline and 6 weeks with the wish to hasten death changing in <i>n</i> = 9 (15% of <i>n</i> = 60) and the will to live changing in <i>n</i> = 11 (18.6% of <i>n</i> = 59). Interview data of three outlier cases illustrates unusual trajectories and possible factors which may influence them.</p><p><strong>Conclusions: </strong>As they can co-exist in different possible combinations, a high wish to hasten death does not necessarily imply a low will to live and vice versa. Patients receiving palliative care can hold such seemingly opposing positions in mind as a form of coping when confronted with an existential threat of serious illness. Therefore, health professionals are encouraged to proactively engage patients in conversation about both phenomena.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"1042-1053"},"PeriodicalIF":3.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11487875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141996304","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":"Recognising dying in motor neurone disease: A scoping review.","authors":"Elizabeth Abbey, Maimoona Ali, Matthew Cooper, Paul Taylor, Catriona R Mayland","doi":"10.1177/02692163241263231","DOIUrl":"10.1177/02692163241263231","url":null,"abstract":"<p><strong>Introduction: </strong>Timely identification of dying in motor neurone disease enables optimal care, yet we know that healthcare professionals can fail to recognise when death is approaching. Clinical factors help predict the end of life in other terminal conditions. Examining these principles in motor neurone disease would help guide more accurate recognition of this critical phase.</p><p><strong>Aim: </strong>To examine and map out what is known about dying in patients with motor neurone disease, and the recognition of dying by healthcare professionals.</p><p><strong>Design: </strong>A scoping review was conducted following the Arksey and O'Malley methodological framework.</p><p><strong>Data sources: </strong>Four electronic databases (MEDLINE, Scopus, PsycINFO and CINAHL) and grey literature were searched on the 10th May 2023. Reference lists and citations were also reviewed.</p><p><strong>Results: </strong>From 1512 articles, 13 studies were included. Dyspnoea, anxiety and pain were the most common symptoms associated with the dying phase. Worsening respiratory function, the development of specific new symptoms and deteriorating symptom control suggested approaching death. No studies reported changes in vital signs or biomarkers associated with dying. Barriers to the recognition of dying by healthcare professionals included a rapid and unpredictable terminal decline.</p><p><strong>Conclusions: </strong>Dying in motor neurone disease is associated with patterns of symptoms and signs, however evidence is limited compared with other terminal conditions and requires further exploration. The characteristic sudden and unpredictable terminal decline is a key barrier to recognition of dying by healthcare professionals. Optimising advance care planning is one approach to navigate these complex, unpredictable clinical situations.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"923-934"},"PeriodicalIF":3.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11481408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788794","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":"Practice review: Pharmacological management of severe chronic breathlessness in adults with advanced life-limiting diseases.","authors":"Steffen T Simon,Irene J Higginson,Claudia Bausewein,Caroline J Jolley,Sabrina Bajwah,Matthew Maddocks,Carolin Wilharm,Adejoke O Oluyase,Anne Pralong,","doi":"10.1177/02692163241270945","DOIUrl":"https://doi.org/10.1177/02692163241270945","url":null,"abstract":"BACKGROUNDSevere and refractory chronic breathlessness is a common and burdensome symptom in patients with advanced life-limiting disease. Its clinical management is challenging because of the lack of effective interventions.AIMTo provide practice recommendations on the safe use of pharmacological therapies for severe chronic breathlessness.DESIGNScoping review of (inter)national guidelines and systematic reviews. We additionally searched for primary studies where no systematic review could be identified. Consensus on the recommendations was reached by 75% approval within an international expert panel.DATA SOURCESSearches in MEDLINE, Cochrane Library and Guideline International Network until March 2023. Inclusion of publications on the use of antidepressants, benzodiazepines, opioids or corticosteroids for chronic breathlessness in adults with cancer, chronic obstructive pulmonary disease, interstitial lung disease or chronic heart failure.RESULTSOverall, the evidence from eight guidelines, 14 systematic reviews and 3 randomised controlled trials (RCTs) on antidepressants is limited. There is low quality evidence favouring opioids in patients with chronic obstructive pulmonary disease, cancer and interstitial lung disease. For chronic heart failure, evidence is inconclusive. Benzodiazepines should only be considered for anxiety associated with severe breathlessness. Antidepressants and corticosteroids should not be used.CONCLUSIONManagement of breathlessness remains challenging with only few pharmacological options with limited and partially conflicting evidence. Therefore, pharmacological treatment should be reserved for patients with advanced disease under monitoring of side effects, after optimisation of the underlying condition and use of evidence-based non-pharmacological interventions as first-line treatment.","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":"4 1","pages":"2692163241270945"},"PeriodicalIF":4.4,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142207806","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":"Patient and family perspectives on rural palliative care models: A systematic review and meta-synthesis","authors":"Claire Marshall, Claudia Virdun, Jane L. Phillips","doi":"10.1177/02692163241269796","DOIUrl":"https://doi.org/10.1177/02692163241269796","url":null,"abstract":"Background:Almost half the world’s population lives in rural areas. How best to provide palliative care to rural populations is unclear. Privileging rural patient and family voices about their experiences of receiving care delivered via rural palliative care models is necessary.Aim:To identify the key palliative care elements that rural patients with palliative care needs and their families perceive to be critical to receiving the care and support they need to live well.Design and Data Sources:A systematic review and meta-synthesis registered with Prospero (CRD42020154273). Three databases were searched in June 2024. Raw qualitative data were extracted and analysed using Thomas and Harden’s three-stage thematic synthesis methodology. Findings reported according to the PRISMA statement.Results:Of the 10,834 identified papers, 11 met the inclusion criteria. Meta-synthesis of extracted, raw quotes (n = 209) revealed three major themes: (1) Honouring the patient’s existing relationship with their General Practitioner (GP); (2) strategically timed access to specialist services, clinicians and equipment is critical; and (3) a need to feel safe, prepared and supported.Conclusion:The strategic inclusion of specialists alongside primary care providers is integral to optimising rural palliative care models. General Practioners are central to these models, through being embedded in their communities and as the conduit to specialist palliative care services. Rural palliative care patients and families value responsive care, trajectory signposting, effective communication, 24/7 support and recognise the value of virtual health. Globally, positive public policy and funding is critical to ensuring access to GP-led, specialist-supported, rural palliative care models.","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":"17 1","pages":"2692163241269796"},"PeriodicalIF":4.4,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142207808","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":"Communication processes in an advance care planning initiative: A socio-ecological perspective for service evaluation","authors":"Marie C Haverfield, Jessica Ma, Anne Walling, David B Bekelman, Cati Brown-Johnson, Natalie Lo, Karl A Lorenz, Karleen F Giannitrapani","doi":"10.1177/02692163241277394","DOIUrl":"https://doi.org/10.1177/02692163241277394","url":null,"abstract":"Background:Advance care planning initiatives are becoming more widespread, increasing expectations for providers to engage in goals of care conversations. However, less is known about how providers communicate advance care planning within and throughout a health care system.Aim:To explore perspectives of communication processes in the rollout of an advance care planning initiative.Design:Theoretically informed secondary analysis of 31 semi-structured interviews.Setting/Participants:Key partners in a Veterans Health Administration goals of care initiative.Results:Using the constant comparative approach followed by qualitative mapping of themes to the layers of the Socio-Ecological Model, four themes and corresponding Socio-Ecological layers were identified: Goals of Care Communication Training (Policy, Community, and Institutional) requires more resources across sites and better messaging to reduce provider misconceptions and promote an institutional culture invested in advance care planning; Interprofessional Communication (Interpersonal) suggests care team coordination is needed to facilitate continuity in goals of care messaging; Communication in Documentation (Institutional, Interpersonal, and Intrapersonal) highlights the need for capturing the context for goals of care preferences; and Patient/Family Communication (Interpersonal and Intrapersonal) encourages offering materials and informational resources early to facilitate rapport building and readiness to determine goals of care.Conclusions:Findings support the need for initiatives to incorporate an evaluation of how goals of care are discussed beyond the interpersonal exchange between patient and provider and signal opportunities for applying the Socio-Ecological Model to better understand goals of care communication processes, including opportunities to improve initiation and documentation of goals of care.","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":"17 1","pages":"2692163241277394"},"PeriodicalIF":4.4,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142207807","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":"Fostering nurse-patient relationships in palliative care: An integrative review with narrative synthesis","authors":"Suzanne Bishaw, Elisabeth Coyne, Georgia KB Halkett, Melissa J Bloomer","doi":"10.1177/02692163241277380","DOIUrl":"https://doi.org/10.1177/02692163241277380","url":null,"abstract":"Background:Nurse-patient relationships are an integral component of person-centred palliative care. Greater understanding of how nurse-patient relationships are fostered and perceived by patients and nurses can be used to inform nursing practice.Aim:To systematically identify and synthesise how nurse-patient relationships are fostered in specialist inpatient palliative care settings, and how nurse-patient relationships were perceived by patients and nurses.Design:Integrative review with narrative synthesis. The review protocol was registered with PROSPERO (CRD42022336148, updated April, 2023).Data Sources:Five electronic databases (PubMed, CINAHL Complete, Medline, Web of Science and PsycINFO) were searched for articles published from their inception to December 2023. Studies were included if they (i) examined nurse and/or patient perspectives and experiences of nurse-patient relationships in specialist inpatient palliative care, (ii) were published in English in a (iii) peer-reviewed journal. The Mixed Methods Appraisal Tool was used to evaluate study quality. Data were synthesised using narrative synthesis.Results:Thirty-four papers from 31 studies were included in this review. Studies were mostly qualitative and were of high methodological quality. Four themes were identified: (a) creating connections; (b) fostering meaningful patient engagement; (c) negotiating choices and (d) building trust.Conclusions:Nurses and patients are invested in the nurse-patient relationship, benefitting when it is positive, therapeutic and both parties are valued partners in the care. Key elements of fostering the nurse-patient relationship in palliative care were revealed, however, the dominance of the nurses’ perspectives signifies that the nature and impact of these relationships may not be well understood.","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":"14 1","pages":"2692163241277380"},"PeriodicalIF":4.4,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142207809","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}