Quality in health care : QHC最新文献

{"title":"The quality of general dental care: public and users' perceptions.","authors":"M Calnan,&nbsp;M Dickinson,&nbsp;G Manley","doi":"10.1136/qshc.8.3.149","DOIUrl":"https://doi.org/10.1136/qshc.8.3.149","url":null,"abstract":"<p><strong>Background: </strong>Systematic evidence about how the public and users perceive and experience the quality of general dental care is in short supply, particularly in light of the recent changes in the general dental service. The study reported here attempted to fill this gap.</p><p><strong>Objectives: </strong>To identify the criteria the public and users adopt in evaluating the quality of general dental care, and to identify the extent and nature of perceived concerns with general dental care.</p><p><strong>Design: </strong>Postal questionnaires were sent to random samples of adults living in an inner city area (I) and semi-rural area (R) in southern England. Fifty six per cent (1499) in area R and 48% (1388) in area I completed the questionnaire after four mailings. Follow up face-to-face interviews were done with a purposive subsample (n = 50) of responders from the postal survey.</p><p><strong>Main measures: </strong>Public/user views about quality of dental care were measured through groups of questions about the importance of and satisfaction with different aspects of dental care (access/availability including cost; facilities; technical skills; and interpersonal care) and a scale (Dentsat) measuring general satisfaction was constructed from questions on different aspects of care.</p><p><strong>Results: </strong>Evaluation of quality of general dental care from the users' point of view hinges on perceived technical skills, particularly pain management. Major dissatisfaction stems from concerns about costs of dental care and privatisation.</p><p><strong>Conclusions: </strong>The criteria adopted by the public/users to assess general dental care are similar to other areas of health care, apart from the priority placed on technical skills and pain management. However, the major source of decline in satisfaction with the quality of general dental care is the barrier to access created by the rising cost of dental care and the increasing involvement of dentists in private practice. This evidence suggests that the public and users find the drift towards private practice and away from NHS practice a major source of concern.</p>","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 3","pages":"149-53"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.3.149","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21691152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A framework for effective management of change in clinical practice: dissemination and implementation of clinical practice guidelines.","authors":"N T Moulding,&nbsp;C A Silagy,&nbsp;D P Weller","doi":"10.1136/qshc.8.3.177","DOIUrl":"https://doi.org/10.1136/qshc.8.3.177","url":null,"abstract":"<p><p>Theories from social and behavioural science can make an important contribution to the process of developing a conceptual framework for improving use of clinical practice guidelines and clinician performance. A conceptual framework for guideline dissemination and implementation is presented which draws on relevant concepts from diffusion of innovation theory, the transtheoretical model of behaviour change, health education theory, social influence theory, and social ecology, as well as evidence from systematic literature reviews on the effectiveness of various behaviour change strategies. The framework emphasises the need for preimplementation assessment of (a) readiness of clinicians to adopt guidelines into practice, (b) barriers to change as experienced by clinicians, and (c) the level at which interventions should be targeted. It also incorporates the need for multifaceted interventions, identifies the type of barriers which will be addressed by each strategy, and develops the concept of progression through stages of guideline adoption by clinicians, with the use of appropriately targeted support strategies. The potential value of the model is that it may enable those involved in the process of guideline dissemination and implementation to direct strategies to target groups more effectively. Clearly, the effectiveness and utility of the model in facilitating guideline dissemination and implementation requires validation by further empirical research. Until such research is available, it provides a theoretical framework that may assist in the selection of appropriate guideline dissemination and implementation strategies.</p>","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 3","pages":"177-83"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.3.177","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21692491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What type of filling? Best practice in dental restorations.","authors":"B L Chadwick,&nbsp;P M Dummer,&nbsp;F D Dunstan,&nbsp;A S Gilmour,&nbsp;R J Jones,&nbsp;C J Phillips,&nbsp;J Rees,&nbsp;S Richmond,&nbsp;J Stevens,&nbsp;E T Treasure","doi":"10.1136/qshc.8.3.202","DOIUrl":"https://doi.org/10.1136/qshc.8.3.202","url":null,"abstract":"Dental caries (tooth decay) is one of the most common diseases, with approximately 80% of the population in developed countries having experienced the condition. If decay has not been prevented cavities develop. To prevent considerable pain and tooth loss it may be necessary to remove the diseased tissues and restore the cavities (a filling). Restorations have a limited lifespan and, once a tooth is restored, the filling is likely to be replaced several times in the patient’s lifetime. Studies in the UK suggest that much of restorative dentistry is replacement of existing restorations, accounting for around 60% of all restorative work. Similar figures have been found in other parts of Europe, 4 and the USA. (Quality in Health Care 1999;8:202–207) There is a large choice of materials which can be used for fillings. Many are introduced into the market place and used on patients with limited evidence that they are more eVective or robust than existing materials. Consequently, one of the key questions is, all other things being equal, what type of filling is best? This paper summarises the results of a systematic review of the relative longevity and cost eVectiveness of routine intracoronal dental restorations, which formed the basis of a recent issue of EVective Health Care. The reasons for replacing a restoration are numerous and vary with tooth type and restorative material. Once inserted, restorations may fail at variable rates due to various “objective” factors aVecting both the failure of the filling material and further decay of the tooth around the filling. These factors include the characteristics of the filling material and eVect modifiers related to operator skill and technique, patients’ dental characteristics, and the environment around the tooth. The decision to replace a restoration is also influenced by more subjective factors such as dentists’ interpretation of the restoration’s condition and the health of the tooth, the criteria used to define failure, and patient demand. These decisions are subject to much variation. 10 A lack of standardisation exists, and no generally agreed criteria are used to decide when a restoration requires replacement. Types of restoration Tooth restorations may be classified as intracoronal, when they are placed within a cavity prepared in the crown of a tooth, or extracoronal, when they are placed around (outside) the tooth as in the case of a crown. Intracoronal restorations are usually placed directly into the tooth cavity and normally consist of a mouldable material that sets and becomes rigid; the material is retained by the surrounding walls of the remaining tooth tissue. An alternative intracoronal restoration uses an indirect technique; here an impression of the cavity is taken and a laboratory constructed inlay is produced and subsequently cemented into the prepared cavity. The materials currently used to restore intracoronal preparations are: dental amalgam, composite resins, glass ionomer cemen","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 3","pages":"202-7"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.3.202","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21692495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influences on clinical practice: the case of glue ear.","authors":"S Dopson,&nbsp;R Miller,&nbsp;S Dawson,&nbsp;K Sutherland","doi":"10.1136/qshc.8.2.108","DOIUrl":"https://doi.org/10.1136/qshc.8.2.108","url":null,"abstract":"<p><p>A case study of clinical practice in children with glue ear is presented. The case is part of a larger project, funded by the North Thames Research and Development Programme, that sought to explore the part played by clinicians in the implementation of research and development into practice in two areas: adult asthma and glue ear in children. What is striking about this case is the differences found in every area of the analysis. That is, diversity was found in views about diagnosis and treatment of glue ear; the organisation of related services; and in the reported practice of our interviewees, both between particular groupings of clinical staff and within these groupings. The challenge inherent in the case is to go beyond describing the complexity and differences that were found, and look for patterns in the accounts of practice and tease out why such patterns may occur.</p>","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 2","pages":"108-18"},"PeriodicalIF":0.0,"publicationDate":"1999-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.2.108","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21417986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A new structure for quality improvement reports.","authors":"F Moss,&nbsp;R Thompson","doi":"10.1136/qshc.8.2.76","DOIUrl":"https://doi.org/10.1136/qshc.8.2.76","url":null,"abstract":"Finding out about how others’ schemes to implement change succeed or why they fail can be extremely helpful. It can save time and eVort and may accelerate improvements in service delivery. One of the stated aims of this journal is to publish such quality improvement reports alongside papers that report the results of relevant research. The editorial team are aware through discussion with colleagues, from papers presented at meetings, and reading local reports that many people are involved in useful and informative quality improvement projects that could have valuable messages for others. And yet in the past seven and a half years we have only published 12 quality improvement reports—the most recent one in December 1995. We rely on submitted reports, and one of the reasons for this dearth of published quality improvement reports may be that people are simply too busy improving care to have time to write. But there may be other barriers. The standard form for writing papers in medical journals is the scientific IMRaD (introduction, methods, results, and discussion) structure. This is a convenient and helpful structure for writing about research. When writing a quality improvement report this structure does not quite fit, however. For example, there will be a first methods section—when the measurements are made—and a first results section—when the results are analysed. However, there follows a second methods section describing the implementation of change, perhaps followed by a third methods section when the measurements are repeated to assess progress, and then a second results section describing the improvements. Writing quality improvement reports in this way may not only be diYcult but may result in a paper that does not convey the lessons that others would find useful. The editorial team has therefore developed a new structure (box) for describing quality improvement work that we think will reflect this work more accurately and which we hope will encourage authors to write about their experience. The first quality improvement report using this structure is published in this issue of Quality in Health Care (page 119). There is also another fundamental diVerence between quality improvement reports and the reports of original research. Research seeks broadly to produce generalisable results. Thus, trials of thrombolytic treatment in acute myocardial infarction sought to determine whether trombolysis reduced subsequent mortality, such that the results could be generalised to coronary care units and medical wards treating such patients. On the other hand, a local audit or quality improvement project, which seeks to assess whether patients are appropriately treated with thrombolytic therapy does so to monitor and ensure the implementation of evidence based treatment in practice. The results of such a study are not generalisable to other coronary care units in the same way as the preceding research evidence, and for many this would suggest that the wo","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 2","pages":"76"},"PeriodicalIF":0.0,"publicationDate":"1999-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.2.76","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21417992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the repeat prescribing process in a busy general practice. A study using continuous quality improvement methodology.","authors":"S Cox,&nbsp;P Wilcock,&nbsp;J Young","doi":"10.1136/qshc.8.2.119","DOIUrl":"https://doi.org/10.1136/qshc.8.2.119","url":null,"abstract":"<p><strong>Problem: </strong>A need to improve service to patients by reducing the time wasted by reception staff so that the 48 hour target for processing repeat prescription requests for patient collection could be achieved.</p><p><strong>Design: </strong>An interprofessional team was established within the practice to tackle the area of repeat prescribing which had been identified as a priority by practice reception staff. The team met four times in three months and used continuous quality improvement (CQI) methodology (including the Plan-Do-Study-Act cycle) with the assistance of an external facilitator.</p><p><strong>Background and setting: </strong>A seven partner practice serving the 14,000 patients on the northern outskirts of Bournemouth including a large council estate and a substantial student population from Bournemouth University. The repeat prescribing process is computerised.</p><p><strong>Key measures for improvement: </strong>Reducing turn around times for repeat prescription requests. Reducing numbers of requests which need medical records to be checked to issue the script. Feedback to staff about the working of the process.</p><p><strong>Strategies for change: </strong>Using a Plan-Do-Study-Act cycle for guidance, the team decided to (a) coincide repeat medications and to record on the computer drugs prescribed during visits; (b) give signing of prescriptions a higher priority and bring them to doctors' desks at an agreed time; and (c) move the site for printing prescriptions to the reception desk so as to facilitate face to face queries.</p><p><strong>Effects of change: </strong>Prescription turnaround within 48 hours increased from 95% to 99% with reduced variability case to case and at a reduced cost. The number of prescriptions needing records to be looked at was reduced from 18% to 8.6%. This saved at least one working day of receptionist time each month. Feedback from all staff within the practice indicated greatly increased satisfaction with the newly designed process.</p><p><strong>Lessons learnt: </strong>The team's experience suggests that a combination of audit and improvement methodology offers a powerful way to learn about, and improve, practice. The interventions used by the team not only produced measurable and sustainable improvements but also helped the team to learn about the cost of achieving the results and provided them with tools to accomplish the aims. The importance of feedback to all staff about CQI measures was also recognised.</p>","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 2","pages":"119-25"},"PeriodicalIF":0.0,"publicationDate":"1999-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.2.119","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21417987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deliberate self harm.","authors":"A House,&nbsp;D Owens,&nbsp;L Patchett","doi":"10.1136/qshc.8.2.137","DOIUrl":"https://doi.org/10.1136/qshc.8.2.137","url":null,"abstract":"Self poisoning is the most common form ofdeliberate self harm. Most cases of deliberateself poisoning present to general hospitals; inthe UK there are more than 150 000 suchattendances annually. The most common sub-stances ingested are analgesics, particularlyparacetamol and paracetamol containingcompounds.","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 2","pages":"137-43"},"PeriodicalIF":0.0,"publicationDate":"1999-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.2.137","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21417991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can small group education and peer review improve care for patients with asthma/chronic obstructive pulmonary disease?","authors":"I J Smeele,&nbsp;R P Grol,&nbsp;C P van Schayck,&nbsp;W J van den Bosch,&nbsp;H J van den Hoogen,&nbsp;J W Muris","doi":"10.1136/qshc.8.2.92","DOIUrl":"https://doi.org/10.1136/qshc.8.2.92","url":null,"abstract":"<p><strong>Objective: </strong>To study the effectiveness of an intensive small group education and peer review programme aimed at implementing national guidelines on asthma/chronic obstructive pulmonary disease (COPD) on care provision by general practitioners (GPs) and on patient outcomes.</p><p><strong>Design: </strong>A randomised experimental study with pre-measurement and post-measurement (after one year) in an experimental group and a control group in Dutch general practice.</p><p><strong>Subjects and intervention: </strong>Two groups of GPs were formed and randomised. The education and peer review group (17 GPs with 210 patients) had an intervention consisting of an interactive group education and peer review programme (four sessions each lasting two hours). The control group consisted of 17 GPs with 223 patients (no intervention).</p><p><strong>Main outcome measures: </strong>Knowledge, skills, opinion about asthma and COPD care, presence of equipment in practice; actual performance about peakflow measurement, non-pharmacological and pharmacological treatment; asthma symptoms (Dutch Medical Research Council), smoking habits, exacerbation ratio, and disease specific quality of life (QOL-RIQ). Data were collected by a written questionnaire for GPs, by self recording of consultations by GPs, and by a written self administered questionnaire for adult patients with asthma/COPD.</p><p><strong>Results: </strong>Data from 34 GP questionnaires, 433 patient questionnaires, and recordings from 934 consultations/visits and 350 repeat prescriptions were available. Compared with the control group there were only significant changes for self estimated skills (+16%, 95% confidence interval 4% to 26%) and presence of peakflow meters in practice (+18%, p < 0.05). No significant changes were found for provided care and patient outcomes compared with the control group. In the subgroup of more severe patients, the group of older patients, and in the group of patients not using anti-inflammatory medication at baseline, no significant changes compared with the control group were seen in patient outcomes.</p><p><strong>Conclusion: </strong>Except for two aspects, intensive small group education and peer review in asthma and COPD care do not seem to be effective in changing relevant aspects of the provided care by GPs in accordance with guidelines, nor in changing patients' health status.</p>","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 2","pages":"92-8"},"PeriodicalIF":0.0,"publicationDate":"1999-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.2.92","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21417813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case studies as a research tool.","authors":"L Fitzgerald","doi":"10.1136/qshc.8.2.75","DOIUrl":"https://doi.org/10.1136/qshc.8.2.75","url":null,"abstract":"In many fields of knowledge, there is increasing recognition that a range of research methodologies can enrich and extend the available evidence and knowledge base. Understandably, in medical research and in clinical bench sciences, quantitative research methodologies have predominated. In the social sciences, however, qualitative methodologies such as case studies have long been accepted, and indeed developed as useful research tools. As with any methodology, case studies are best suited to particular forms of enquiry. Under what conditions therefore would one consider using a case study methodology? One appropriate use would be for conducting exploratory research, where the field of enquiry is novel and underresearched. If there is minimal or no foundation of previous research evidence, it is diYcult to formulate the critical research questions and useful hypotheses. In these circumstances, case studies can be used to explore and describe the issues within a given context. Appropriate research questions can then be formulated on a foundation of data. For example, there has been limited research on the problems of eYcient service delivery in primary care partnerships. We know from some previous research in the private sector that partnerships have unique problems of control and accountability. A case study approach to research, particularly using multiple or comparative case studies would be useful. Case studies are also useful as research tools in complex and dynamic contexts where it is diYcult to isolate variables or where there are multiple, influencing variables. Because many organisational contexts have these characteristics, this is one explanation for the use of case study methods in organisational research. Case studies are a fruitful method to answer the “why” questions in such contexts. For example, in the two cases published in this edition of Quality in Health Care (pages 99 and 108), the authors seek to explore and answer questions about why and under what conditions, clinical professionals decide to adopt an innovation or change their clinical practice. The argument has been posed that if there is strong scientific evidence to support an innovation, then professionals, once they know this evidence, will adopt the innovation. But do we know if this is why clinical professionals change their practice? If it is an influence, is it the only or even the major influence? Many of the critics of case study methods would simply see a case study as a loosely constructed “story”, selected at random (or worse because the researcher is connected to the case in some manner). In many respects this undervalues the approach and certainly underestimates the current stage of development of the case study approach. Yinn, provides a resource which helps researchers wishing to construct well rounded cases. The selection of the case or cases is a critical stage. Some of the issues of generalisation may be mitigated by a purposeful approach to case selec","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 2","pages":"75"},"PeriodicalIF":0.0,"publicationDate":"1999-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.2.75","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21417990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing continuous quality improvement in general practice: the whole package or a series of projects?","authors":"H Geboers","doi":"10.1136/qshc.8.2.77","DOIUrl":"https://doi.org/10.1136/qshc.8.2.77","url":null,"abstract":"Continuous quality improvement is a complex approach to improvement that describes an all encompassing “package” of principles, methods, and techniques (box). For large organisations setting out to change working practices in line with the principles of continuous quality improvement, implementation of the complete package may be appropriate. But for much smaller organisations with fewer resources—such as general practices—such a task may seem overwhelming. Yet continuous quality improvement has been shown to work in general practice. 2 The evidence suggests, however, that implementing it gradually, starting with small scale projects, may be more successful in general practice, and a quality improvement report in this issue adds further support for this approach.","PeriodicalId":20773,"journal":{"name":"Quality in health care : QHC","volume":"8 2","pages":"77"},"PeriodicalIF":0.0,"publicationDate":"1999-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/qshc.8.2.77","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21417810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}