Quality Management in Health Care最新文献

{"title":"Effect of a Post-Discharge Telephone-Based Intervention Led by Social Workers to Reduce Heart Failure Readmissions.","authors":"Crystal Lihong Yan, Austin Erben, Kristel Sarmiento, Estin Kelly, Luanda Grazette, Marie Anne Sosa","doi":"10.1097/QMH.0000000000000535","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000535","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) readmission rates at our institution were often higher than the expected levels for our institution type. Social work post-discharge telephone calls were identified as an opportunity to address reasons for HF therapy noncompliance, a major reason for readmissions identified among HF patients at our institution.</p><p><strong>Methods: </strong>Our study aimed to improve existing post-discharge telephone outreach performed by social workers to reduce 30-day all-cause readmission rates in traditional Medicare patients with HF at a single academic tertiary care hospital. A multidisciplinary team of social workers, nurses, and physicians created 2 HF-specific forms based on an online resource (Target: HF telephone form) provided by the American Heart Association. The first form focused on HF transition of care-related issues, while the second form focused on HF patient education. These HF-specific forms replaced a generic checklist used by social workers during their post-discharge outreach.</p><p><strong>Results: </strong>Fifty-one patients were included in the intervention. The mean age was 76.82 years old. Most patients were male (56.9%), White (82.4%), Hispanic (58.8%), and spoke English as their preferred language (54.9%). Pre-intervention, the 30-day all-cause readmission rate ranged from 7.1% to 30.8%. Post-intervention, the 30-day all-cause readmission rate ranged from 8.3% to 25.0%. The pre-intervention mean 30-day all-cause readmission rate was 15.5% with a standard deviation of 8.1%, whereas the post-intervention mean was 16.8% and a standard deviation of 5.3% (P = .721).</p><p><strong>Conclusions: </strong>HF-specific structured telephone support by social workers post-discharge did not reduce 30-day all-cause readmission rates in an elderly, traditional Medicare population with HF.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001483","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":"Improving the Screening and Treatment of Hepatitis C in a Rural Primary Care Clinic.","authors":"Neil Langer, Pam LaBorde","doi":"10.1097/QMH.0000000000000532","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000532","url":null,"abstract":"<p><strong>Background and objectives: </strong>With the potential to lead to liver failure, cirrhosis, and death and the availability of hepatitis C Virus (HCV) treatment with direct-acting antiviral medications, primary care clinicians need to take action to improve screening and treatment of HCV. Current literature demonstrates gaps in knowledge contribute to low HCV screening and treatment rates. The project's purpose is to use a multidisciplinary approach to patient and clinician education to improve HCV care in a rural primary care clinic.</p><p><strong>Methods: </strong>This quality improvement project involved 1225 adult patients aged 18-79 seen at a rural Federally Qualified Health Center (FQHC) in Arkansas, from February 15 to April 1, 2024. The project applied the Chronic Care Model to promote change in decision support and clinical information systems by educating patients and clinicians, reinforcing care accuracy, and monitoring practice. Project interventions included provider, clinical staff, and patient education and improving the visibility of the patient's HCV screening status in the electronic medical record (EMR). The clinic manager and marketing director assisted the project leader with educational training. The laboratory director designated an area for HCV screening history in the EMR, and the quality director evaluated the program's efficacy. A manual retrospective chart review was performed to evaluate the program's effectiveness. The collected data were analyzed using descriptive statistics to demonstrate the efficacy of the quality improvement project.</p><p><strong>Results: </strong>Following the implementation of this project, providers at the clinic demonstrated an improved understanding of current HCV screening and treatment guidelines. Additionally, the HCV screening rates for eligible adults increased from the baseline screening rate of 42% to 44.8% with 549 of 1225 eligible patients screened for HCV during the project implementation period. Additionally, 100% (n = 4) of adult patients diagnosed with HCV from February 15, 2024, to April 1, 2024, initiated HCV treatment ordered by their primary care provider.</p><p><strong>Conclusions: </strong>While the short duration of the project poses a limitation, implications from this project to current practice point to the importance of innovative changes in information technologies as well as patient, staff, and clinician education to improve access to HCV screening and care in rural primary care clinics. Further, to improve the quality of care and the screening and treatment of HCV, rural health clinics and organizations should consider updating policies and procedures to standardize HCV screening for adults aged 18-79.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001429","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":"The Promise of Barcode Medication Administration for Enhancing Medication Safety in Low-Resource Settings.","authors":"Ama Akoma Essuman, Angela Green","doi":"10.1097/QMH.0000000000000539","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000539","url":null,"abstract":"","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001486","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":"Implementing Evidence-Based Quality Improvement in Health Care Quality and Patient Safety and Clinical Research Programs.","authors":"Evelyn O'Shea, Anita O'Donovan, Sharon Sheehan, Mary Coffey, Sinead Brennan, Maureen Flynn, Mary Browne, Petar Popivanov, Charles Gillham, Patricia Daly, Sarah Bergin","doi":"10.1097/QMH.0000000000000520","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000520","url":null,"abstract":"<p><strong>Background and objectives: </strong>This paper defines quality improvement (QI), describes the differences and connections among QI, clinical audit/quality assurance, and clinical research, highlights the importance of strong organizational governance for QI, and provides a simplified, evidence-based QI methodology that can be readily used by health care staff.</p><p><strong>Methods: </strong>The authors draw on their diverse QI experiences, encompassing a university maternity hospital, a radiation oncology specialist center, an acute general hospital, senior health care management, and academia. This demonstrates the feasibility of implementing QI in diverse health care settings and by all members of the multidisciplinary team.</p><p><strong>Results: </strong>Embedding QI in clinical audit, incident, and service user feedback management enables learning from Quality and Patient Safety activities, driving evidence-based improvements by frontline staff. Strong governance and accountability are essential to ensure QI efforts are sustained and impactful. QI also supports and enhances clinical research activities, improving patient outcomes and care.</p><p><strong>Conclusion: </strong>QI is most effective when it is kept simple, includes frontline multidisciplinary teams and patients/service users, and is supported by staff with QI expertise. This paper demonstrates the successful application of a QI methodology across varied health care specialties, emphasizing its broad applicability and significant benefits for health care delivery.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001411","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":"Accelerating Clinical Practice Integration: IV Fluid Best Practice Implementation in a Merged Health System.","authors":"Ian J Howells, Timothy R Fowles, R Lynae Roberts, Danielle Groat, George Scott, Joseph Bledsoe, Rajendu Srivastava","doi":"10.1097/QMH.0000000000000553","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000553","url":null,"abstract":"","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001460","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":"Investigation of Preventive Care in Sweden: Actions Planned and Performed in Response to Health Risks in Older Adults in Care.","authors":"Deborah Finkel, Marie Ernsth Bravell, Ulrika Lindmark, Björn Westerlind, Linda Johansson","doi":"10.1097/QMH.0000000000000484","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000484","url":null,"abstract":"<p><strong>Background and objectives: </strong>Preventive care is vital in maintaining health and supporting independence among older persons. In Sweden, a national quality register (Senior Alert) was developed in elder care to support healthcare workers working to prevent malnutrition, falls, pressure ulcers, and poor oral health. However, we predicted that challenges in providing care at home result in preventive work being least used when and where it would be most effective: early in disease processes. The current study examines the preventive care actions planned and performed for older persons with identified risks, to compare quality and equity of care in different care settings.</p><p><strong>Methods: </strong>Persons from the Swedish Screening Across the Lifespan Twin Study registered in the Senior Alert were included in the study (N = 2914). Descriptive and analytical statistical analyses regarding risk assessment and planned and performed preventive actions were conducted among those persons registered in hospitals, home health care, nursing homes, dementia care homes, or short-term nursing homes.</p><p><strong>Results: </strong>Almost 80% of the sample had identified risk in at least one of the four risk areas, with falls and malnutrition being most common. Risks differed between care settings, and having any risk was most common among older persons in short-term nursing homes. The largest difference between planned and performed actions was for older persons with home health care, and especially true for the oldest persons (>80 years old).</p><p><strong>Conclusions: </strong>Preventive care is vital as it is often easier to prevent than treat, and pressure ulcers, malnutrition, poor oral health, and falls are common among older persons. However, preventive actions were less likely to be performed in the home health care, especially for the oldest adults. Reasons for this might be related to challenges of performing care in a person's home, lack of knowledge, and organizational challenges, but further investigation is needed.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966640","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":"Effectiveness of Resident Education on Thromboembolism Prophylaxis: Insights From a Quality Improvement Project Improving the Appropriate Use of Thromboembolism Prophylaxis Among Resident Inpatient Teams: A Quality Improvement Project.","authors":"Saeed Hassan, Simrat Gill, Varun Bhalla, Yishan Dong, Utsav Joshi, Zeni Kharel, Basil Verghese","doi":"10.1097/QMH.0000000000000518","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000518","url":null,"abstract":"<p><strong>Background and objectives: </strong>Venous thromboembolism (VTE) prophylaxis remains important in managing hospitalized patients. Many studies have been done to incorporate educational interventions and other measures to help achieve better rates of appropriate VTE prophylaxis usage. Our objective was to study the sole impact of resident education, focusing on reducing heparin usage compared to low molecular weight heparin.</p><p><strong>Methods: </strong>This study was carried out in a single upstate New York hospital. Preintervention data were collected regarding VTE prophylaxis usage among the resident team for 5 weeks followed by a month of educational intervention where residents were given PowerPoint presentations and handouts during our educational conferences. Postintervention data were then collected for a 5-week period and subsequently analyzed.</p><p><strong>Results: </strong>The preintervention arm had 579 patients, while the postintervention arm had 311 patients. Our results did not show a statistically significant decrease in inappropriate heparin use after the intervention (20.8% vs 17.5%, P value = .326). A higher nonstatistically significant percentage of patients were shifted from Heparin to Enoxaparin on resolution of acute kidney injury in the postintervention group (73.9% vs 55.2%, P value = .077). There was no difference in adverse events of heparin induced thrombocytopenia, bleeding, and deep venous thrombosis/pulmonary embolism between the groups.</p><p><strong>Conclusions: </strong>Our study suggests that education alone cannot significantly change appropriate VTE usage rates. Other means of increasing appropriate VTE usage or a combination of education with other means need to be explored further.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144754133","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":"Factors Associated With Acceptance of an Optional Diagnosis.","authors":"Cortney Matthews, David Ring, Teun Teunis, Sina Ramtin","doi":"10.1097/QMH.0000000000000476","DOIUrl":"10.1097/QMH.0000000000000476","url":null,"abstract":"<p><strong>Background and objectives: </strong>A sensation becomes a symptom (a concern) when a person associates it with potential illness. In the absence of objective evidence of a pathophysiological process that has important health consequences without treatment, assigning a diagnosis to the sensation is optional. This is important because labeling of benign bodily sensations as pathophysiology has potential advantages and disadvantages. We asked what patient and clinician factors are associated with willingness to accept an optional diagnosis.</p><p><strong>Methods: </strong>In a survey administered using Amazon M-Turk, 536 people anonymously completed validated measures for symptoms of anxiety and depression, intolerance of uncertainty, and skepticism regarding the healthcare system. They then viewed fictional personal medical scenarios in which they were asked to imagine they experienced certain symptoms, and were offered an optional diagnosis of a nerve problem, muscle pain syndrome, or fatigue syndrome, and were asked to rate their willingness to accept the diagnosis on an 12-point ordinal scale from 0 indicating \"I do not accept it at all\" to 11 indicating \"I accept it with enthusiasm.\" The language of the scenarios was varied to attempt to reflect critical thinking, denigration of other doctors, an alternative mental health focus, or a hopeful outlook. Multilevel linear regression was used to identify factors associated with likelihood of accepting an optional diagnosis.</p><p><strong>Results: </strong>Threshold likelihood of accepting an optional diagnosis greater than 5.5 on a 0 to 11 ordinal scale was independently associated with greater symptoms of anxiety (regression coefficient [RC] = 0.38, 95% confidence interval [95% CI] = 0.30-0.47, P < .001), greater skepticism regarding the healthcare system (RC = 0.11, 95% CI = 0.076-0.13, P < .001), and delivery tones characterized by either denigration of other doctors (RC = 0.39, 95% CI = 0.19-0.60, P < .001) or a hopeful outlook (RC = 0.50, 95% CI = 0.26-0.73, P < .001).</p><p><strong>Conclusion: </strong>Likelihood of accepting an optional diagnosis may be a sign of relative vulnerability from feelings of distress or distrust of medical evidence. Given this potential vulnerability, clinicians can take care to limit persuasive communication styles that can influence acceptance of optional diagnoses.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"214-219"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522838","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":"The Effect of Hospital-to-Home Discharge Interventions on Reducing Unplanned Hospital Readmissions: A Systematic Review and Meta-analysis.","authors":"Yasemin Demir Avcı, Sebahat Gözüm, Engin Karadag","doi":"10.1097/QMH.0000000000000454","DOIUrl":"10.1097/QMH.0000000000000454","url":null,"abstract":"<p><strong>Background and objectives: </strong>Unplanned hospital readmissions (UHRs) constitute a persistent health concern worldwide. A high level of UHRs imposes a burden on individuals, their families, and health care system budgets. This systematic review and meta-analysis aimed to evaluate the effectiveness of discharge interventions in the transition from hospital to home in the context of reducing UHRs.</p><p><strong>Methods: </strong>The study design was a meta-analysis of randomized and nonrandomized controlled trials. Eight databases were searched. The effect on UHR rates (odds ratio [OR]) of discharge interventions in the transition from hospital to home was calculated at a 95% confidence interval (95% CI) based on meta-regression and meta-analysis of random-effects models.</p><p><strong>Results: </strong>Results showed that discharge interventions were effective in reducing rehospitalizations (effectiveness/OR =1.39; 95% CI, 1.24-1.55). It was furthermore determined that the studies showed heterogeneous characteristics ( P ≤ .001, Q = 50.083, I2 = 44.093; df = 28). According to Duval and Tweedie's trim and fill results, there was no publication bias. Interventions in which telephone communications and hospital visits (OR = 1.64; 95% CI, 1.25-2.16; P < .001) were applied together were effective among patients with cardiovascular diseases (OR = 1.54; 95% CI, 1.28-2.09; P < .001), and it was found that UHRs were reduced within a period of 90 days (OR = 1.68; 95% CI, 1.16-2.42; P < .001). It was also found that discharge interventions applied to transitions from hospital to home had a diminishing effect on UHRs as the publication dates of the reviewed studies advanced from the past to the present (OR = 0.015; 95% CI, 0.002-0.003; P < .001).</p><p><strong>Conclusion: </strong>Supporting and facilitating cooperation between health care professionals and families should be a key focus of discharge interventions.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"234-242"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473467","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":"Differences in Utilization of Preventive Services for Primary Care Clinicians Participating in MIPS and ACOs.","authors":"Mina Shrestha, Hari Sharma, Keith J Mueller","doi":"10.1097/QMH.0000000000000483","DOIUrl":"10.1097/QMH.0000000000000483","url":null,"abstract":"<p><strong>Background and objective: </strong>Value-based payment programs link payments to the performance of providers on cost and quality of care to incentivize high-value care. To improve quality and lower costs, the Centers for Medicare and Medicaid Services (CMS) implemented the Quality Payment Program (QPP) for clinicians in 2017. Under the Medicare QPP, most eligible clinicians participate in one of the payment models: (a) Advanced Alternative Payment Models (A-APMs) through eligible APMs like Accountable Care Organizations (ACOs) or (b) the Merit-based Incentive Payment System (MIPS). ACO and MIPS clinicians participating in QPP differ in quality reporting requirements, and these differences are likely to affect the utilization of different quality measures, including preventive services. This study evaluated the differences in the utilization of preventive services by primary care clinicians participating in MIPS and ACOs.</p><p><strong>Methods: </strong>We use difference-in-difference regressions to compare preventive services in MIPS versus ACOs. Since preventive services like immunization and certain cancer screening are mandatory reporting measures for ACOs and voluntary measures for MIPS, the treatment group for this study is ACO clinicians and the comparison group is non-ACO MIPS clinicians. We obtained the rates of influenza immunization, pneumonia vaccination, tobacco use cessation intervention, depression screening, colorectal cancer screening, breast cancer screening, and wellness visits per 10 000 Medicare beneficiaries from Medicare Provider Utilization and Payment Public Use File (2012-2018).</p><p><strong>Results: </strong>We had 508 144 total observations (ACO = 25.78% and MIPS = 74.22%) from 72 592 unique primary care clinicians. Compared to MIPS clinicians, ACO clinicians had significantly higher rates of pneumonia vaccination (incidence rate ratio [IRR] 1.25; 95% confidence interval [CI], 1.10-1.43) but lower rates of colorectal cancer screening (IRR 0.69; 95% CI, 0.50-0.96). Similarly, clinicians in ACO shared savings-only models had significantly higher rates of pneumonia vaccination (IRR 1.28; 95% CI, 1.11-1.48), depression screening (IRR 1.72; 95% CI, 1.09-2.71), and wellness visits (IRR 1.27; 95% CI, 1.09-1.47) compared to MIPS clinicians. There were no differences between ACO and MIPS clinicians on the utilization of breast cancer screening procedures and tobacco use cessation interventions.</p><p><strong>Conclusions: </strong>ACO clinicians may have prioritized relatively low-cost services such as pneumonia vaccination, depression screening, and wellness visits to improve their performance under QPP. Policymakers may need to alter incentives in performance-based payment programs to ensure that clinicians are improving all types of quality measures, including cancer screening.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"195-203"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584203","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}