The British Journal of General Practice最新文献

{"title":"Investigating the relationship between consultation length and patient experience: a cross-sectional study in primary care.","authors":"Natasha Elmore, Jenni Burt, Gary Abel, Frances A Maratos, Jane Montague, John Campbell, Martin Roland","doi":"10.3399/bjgp16X687733","DOIUrl":"10.3399/bjgp16X687733","url":null,"abstract":"<p><strong>Background: </strong>Longer consultations in primary care have been linked with better quality of care and improved health-related outcomes. However, there is little evidence of any potential association between consultation length and patient experience.</p><p><strong>Aim: </strong>To examine the relationship between consultation length and patient-reported communication, trust and confidence in the doctor, and overall satisfaction.</p><p><strong>Design and setting: </strong>Analysis of 440 videorecorded consultations and associated patient experience questionnaires from 13 primary care practices in England.</p><p><strong>Method: </strong>Patients attending a face-to-face consultation with participating GPs consented to having their consultations videoed and completed a questionnaire. Consultation length was calculated from the videorecording. Linear regression (adjusting for patient and doctor demographics) was used to investigate associations between patient experience (overall communication, trust and confidence, and overall satisfaction) and consultation length.</p><p><strong>Results: </strong>There was no evidence that consultation length was associated with any of the three measures of patient experience (P >0.3 for all). Adjusted changes on a 0-100 scale per additional minute of consultation were: communication score 0.02 (95% confidence interval [CI] = -0.20 to 0.25), trust and confidence in the doctor 0.07 (95% CI = -0.27 to 0.41), and satisfaction -0.14 (95% CI = -0.46 to 0.18).</p><p><strong>Conclusion: </strong>The authors found no association between patient experience measures of communication and consultation length, and patients may sometimes report good experiences from very short consultations. However, longer consultations may be required to achieve clinical effectiveness and patient safety: aspects also important for achieving high quality of care. Future research should continue to study the benefits of longer consultations, particularly for patients with complex multiple conditions.</p>","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":"5 1","pages":"e896-e903"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5198642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80144139","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":"BJGP Open: a new, online-only, open access journal","authors":"Roger B. Jones, Euan Lawson","doi":"10.3399/bjgp16X688033","DOIUrl":"https://doi.org/10.3399/bjgp16X688033","url":null,"abstract":"Next month will see the launch of BJGP Open , our new open access, online-only journal of primary care research, practice, and policy. BJGP Open will have original, high-quality, peer-reviewed primary care research at its core, complemented by case studies, clinical reports, policy analysis, and the opportunity for discussion and debate.\u0000\u0000For some time we have been aware that the BJGP receives far more high quality original material that it can publish: less than one in four research articles is accepted, pressure on the non-research sections of the Journal is intense, and many of the research articles that we decline are of good scientific quality. The same goes for articles submitted to other sections of the Journal. Primary care everywhere needs to continue to build an evidence base for health care and clinical practice, and to continue to make its political and health policy arguments …","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":"83 1","pages":"603 - 603"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79334470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to managing child and adolescent mental health problems: a systematic review of primary care practitioners' perceptions.","authors":"Doireann O'Brien, Kate Harvey, Jessica Howse, Tessa Reardon, Cathy Creswell","doi":"10.3399/bjgp16X687061","DOIUrl":"10.3399/bjgp16X687061","url":null,"abstract":"<p><strong>Background: </strong>Mental health problems are common and typically have an early onset. Effective treatments for mental health problems in childhood and adolescence are available, yet only a minority of children who are affected access them. This is of serious concern, considering the far-reaching and long-term negative consequences of such problems. Primary care is usually the first port of call for concerned parents so it is important to understand how primary care practitioners manage child and adolescent mental health problems and the barriers they face.</p><p><strong>Aim: </strong>To ascertain primary care practitioners' perceptions of the barriers that prevent effective management of child and adolescent mental health problems.</p><p><strong>Design and setting: </strong>A systematic review of qualitative and quantitative literature in a primary care setting.</p><p><strong>Method: </strong>A database search of peer-reviewed articles using PsycINFO, MEDLINE(®), Embase, and Web of Science, from inception (earliest 1806) until October 2014, was conducted. Additional studies were identified through hand searches and forward-citation searches. Studies needed to have at least one search term in four categories: primary care, childhood/adolescence, mental health, and barriers.</p><p><strong>Results: </strong>A total of 4151 articles were identified, of which 43 were included (30 quantitative studies and 13 qualitative studies). The majority of the barriers related to identification, management, and/or referral. Considerable barriers included a lack of providers and resources, extensive waiting lists, and financial restrictions.</p><p><strong>Conclusion: </strong>The identification of a broad range of significant barriers highlights the need to strengthen the ability to deal with these common difficulties in primary care. There is a particular need for tools and training to aid accurate identification and management, and for more efficient access to specialist services.</p>","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":"1 1","pages":"e693-707"},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5033306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90359293","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":"Health characteristics and consultation patterns of people with intellectual disability: a cross-sectional database study in English general practice.","authors":"Iain M Carey, Sunil M Shah, Fay J Hosking, Stephen DeWilde, Tess Harris, Carole Beighton, Derek G Cook","doi":"10.3399/bjgp16X684301","DOIUrl":"10.3399/bjgp16X684301","url":null,"abstract":"<p><strong>Background: </strong>People with intellectual disability (ID) are a group with high levels of healthcare needs; however, comprehensive information on these needs and service use is very limited.</p><p><strong>Aim: </strong>To describe chronic disease, comorbidity, disability, and general practice use among people with ID compared with the general population.</p><p><strong>Design and setting: </strong>This study is a cross-sectional analysis of a primary care database including 408 English general practices in 2012.</p><p><strong>Method: </strong>A total of 14 751 adults with ID, aged 18-84 years, were compared with 86 221 age-, sex- and practice-matched controls. Depending on the outcome, prevalence (PR), risk (RR), or odds (OR) ratios comparing patients with ID with matched controls are shown.</p><p><strong>Results: </strong>Patients with ID had a markedly higher prevalence of recorded epilepsy (18.5%, PR 25.33, 95% confidence interval [CI] = 23.29 to 27.57), severe mental illness (8.6%, PR 9.10, 95% CI = 8.34 to 9.92), and dementia (1.1%, PR 7.52, 95% CI = 5.95 to 9.49), as well as moderately increased rates of hypothyroidism and heart failure (PR>2.0). However, recorded prevalence of ischaemic heart disease and cancer was approximately 30% lower than the general population. The average annual number of primary care consultations was 6.29 for patients with ID, compared with 3.89 for matched controls. Patients with ID were less likely to have longer doctor consultations (OR 0.73, 95% CI = 0.69 to 0.77), and had lower continuity of care with the same doctor (OR 0.77, 95% CI = 0.73 to 0.82).</p><p><strong>Conclusion: </strong>Compared with the general population, people with ID have generally higher overall levels of chronic disease and greater primary care use. Ensuring access to high-quality chronic disease management, especially for epilepsy and mental illness, will help address these greater healthcare needs. Continuity of care and longer appointment times are important potential improvements in primary care.</p>","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":"60 1","pages":"e264-70"},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4809710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86786457","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":"Inequalities in the uptake of weight management interventions in a pragmatic trial: an observational study in primary care.","authors":"Amy L Ahern, Paul Aveyard, Emma J Boyland, Jason Cg Halford, Susan A Jebb","doi":"10.3399/bjgp16X684337","DOIUrl":"10.3399/bjgp16X684337","url":null,"abstract":"<p><strong>Background: </strong>Primary care referral to a commercial open-group behavioural weight-loss programme is a cost-effective intervention, but only 10% of patients receiving this intervention are male.</p><p><strong>Aim: </strong>To explore whether observed biases in participation in these interventions reflect biases in the uptake of the invitation to participate.</p><p><strong>Design and setting: </strong>Comparison of invited population and recruited participants in a multicentre randomised controlled trial of primary care referral to a commercial open-group behavioural weight-loss programme in England (WRAP [Weight loss Referrals for Adults in Primary care]).</p><p><strong>Method: </strong>Between October 2012 and February 2014, participants were recruited through 23 primary care practices in England; 17 practices provided data on the characteristics of invited participants.</p><p><strong>Results: </strong>Females were twice as likely as males to enrol in the trial (odds ratio [OR] 2.01, 95% confidence interval [CI] = 1.75 to 2.32). However, the proportion of males was threefold higher than seen in routine primary care referrals or similar trials that invited patients opportunistically. People from less deprived areas were more likely to enrol than those in more deprived areas (OR 1.77, 95% CI = 1.55 to 2.03). Older patients (≥40 years) were more likely to enrol than younger patients (OR 1.60, 95% CI = 1.34 to 1.91).</p><p><strong>Conclusion: </strong>Males, younger people, and those from more deprived areas were less likely to take up the invitation to participate in this trial. The gender bias was smaller than observed in routine practice, suggesting that a substantial proportion of the inequity observed previously is a consequence of bias with regard to the offer of intervention. This study suggests that a simple way to overcome much of the gender bias is to write to patients who are overweight and offer referral. Uptake of the invitation to participate was lower in groups of lower socioeconomic status suggesting the need to preferentially offer referrals to this group to reduce health inequalities and for research to explore barriers to uptake.</p>","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":"104 1","pages":"e258-63"},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4809709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77728963","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":"Predicting antibiotic prescription after symptomatic treatment for urinary tract infection: development of a model using data from an RCT in general practice","authors":"I. Gágyor, J. Haasenritter, J. Bleidorn, W. McIsaac, G. Schmiemann, E. Hummers-Pradier, W. Himmel","doi":"10.3399/bjgp16X684361","DOIUrl":"https://doi.org/10.3399/bjgp16X684361","url":null,"abstract":"Background Uncomplicated urinary tract infection (UTI) is often treated with antibiotics, resulting in increasing resistance levels. A randomised controlled trial showed that two-thirds of females with UTI treated symptomatically recovered without subsequent antibiotic treatment. Aim To investigate whether there are differences between females with a UTI who were subsequently prescribed antibiotics and those who recovered with symptomatic treatment only, and to develop a model to predict those who can safely and effectively be treated symptomatically. Design and setting This is a subgroup analysis of females assigned to ibuprofen in a UTI trial in general practices. Method Multiple logistic regression analysis was used to select variables for a prediction model, The discriminative value of the model was estimated by the area under the receiver operator curve (AUC) and the effects of different thresholds were calculated within the model predicting antibiotic prescription and need for follow-up visits. Results Of the 235 females in the ibuprofen group, 79 were subsequently prescribed antibiotics within 28 days of follow-up. The final model included five predictors: urgency/frequency, impaired daily activities, and positive dipstick test results for erythrocytes, leucocytes, and nitrite. The AUC was 0.73 (95% CI = 0.67 to 0.80). A reasonable threshold for antibiotic initiation would result in 58% of females presenting with UTI being treated with antibiotics. Of the remaining females, only 6% would return to the practice because of symptomatic treatment failure. Conclusion The present model revealed moderately good accuracy and could be the basis for a decision aid for GPs and females to find the treatment option that fits best.","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":"33 1","pages":"e234 - e240"},"PeriodicalIF":0.0,"publicationDate":"2016-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90429014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National community pharmacy NHS influenza vaccination service in Wales: a primary care mixed methods study","authors":"A. Evans, F. Wood, B. Carter","doi":"10.3399/bjgp16X684349","DOIUrl":"https://doi.org/10.3399/bjgp16X684349","url":null,"abstract":"Background Influenza is a significant cause of morbidity and excess mortality, yet vaccine coverage in the UK remains below target. Community pharmacies are increasingly being promoted as an alternative to vaccination by GPs. Aim To explore and verify the factors that influence the relative performance of pharmacies providing NHS influenza vaccinations. Design and setting A mixed methods study utilising qualitative, semi-structured interviews and quantitative analysis of predictors of vaccination numbers in community pharmacies in Wales. Method Interviews were conducted with 16 pharmacists who participated in the Welsh national pharmacy influenza service in 2013–2014. A purposive sampling strategy was used. Qualitative findings were analysed using framework analysis. Potential predictors of vaccination numbers were identified from interviews and a literature review, and included in a multivariable regression model. Results The contribution of community pharmacies towards vaccination in Wales is small. Findings suggest that community pharmacies reach younger at-risk individuals, in whom vaccine uptake is low, in greater proportion than influenza vaccination programmes as a whole. Extended opening hours and urban locations were positively associated with the number of vaccinations given, although pharmacists reported that workload, vaccine costs, unforeseen delays, lack of public awareness, and GPs’ views of the service limited their contribution. Pharmacists, aware of the potential for conflict with GPs, moderated their behaviour to mitigate such risk. Conclusion Before community pharmacies take greater responsibility for delivering healthcare services, obstacles including increasing pharmacist capacity, vaccine procurement, health service delays, managing GP–pharmacy relationships, and improving public awareness must be overcome.","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":"53 1","pages":"e248 - e257"},"PeriodicalIF":0.0,"publicationDate":"2016-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82632205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary care clinician antibiotic prescribing decisions in consultations for children with RTIs: a qualitative interview study.","authors":"Jeremy Horwood, Christie Cabral, Alastair D Hay, Jenny Ingram","doi":"10.3399/bjgp16X683821","DOIUrl":"10.3399/bjgp16X683821","url":null,"abstract":"<p><strong>Background: </strong>Respiratory tract infections (RTIs) are a major primary care challenge in children because they are common and costly, there is uncertainty regarding their diagnosis, prognosis, and management, and the overuse of antibiotics leads to illness medicalisation and bacterial resistance.</p><p><strong>Aim: </strong>To investigate healthcare professional (HCP) diagnostic and antibiotic prescribing decisions for children with RTIs.</p><p><strong>Design and setting: </strong>Semi-structured interviews conducted with 22 GPs and six nurses. HCPs were recruited from six general practices and one walk-in centre, serving a mix of deprived and affluent areas.</p><p><strong>Method: </strong>Interviews were audiorecorded, transcribed, imported into NVivo 9, and analysed thematically.</p><p><strong>Results: </strong>HCPs varied in the symptom and clinical examination findings used to identify children they thought might benefit from antibiotics. Their diagnostic reasoning and assessment of perceived clinical need for antibiotics used a dual process, combining an initial rapid assessment with subsequent detailed deductive reasoning. HCPs reported confidence diagnosing and managing most minor and severe RTIs. However, residual prognostic uncertainty, particularly for the intermediate illness severity group, frequently led to antibiotic prescribing to mitigate the perceived risk of subsequent illness deterioration. Some HCPs perceived a need for more paediatrics training to aid treatment decisions. The study also identified a number of non-clinical factors influencing prescribing.</p><p><strong>Conclusion: </strong>Prognostic uncertainty remains an important driver of HCPs' antibiotic prescribing. Experience and training in recognising severe RTIs, together with more evidence to help HCPs identify the children at risk of future illness deterioration, may support HCPs' identification of the children most and least likely to benefit from antibiotics.</p>","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":"66 1","pages":"e207-13"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4758501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89330834","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":"Zika virus infection during pregnancy: what, where, and why?","authors":"R. Burke, P. Pandya, E. Nastouli, P. Gothard","doi":"10.3399/bjgp16X683917","DOIUrl":"https://doi.org/10.3399/bjgp16X683917","url":null,"abstract":"On 1 February 2016 the World Health Organization declared a Public Health Emergency of International Concern following reports of large clusters of microcephaly and Guillain-Barre Syndrome associated with an increase in cases of Zika virus (ZIKV) infection in French Polynesia (2014) and Brazil (2015– 2016).1 The Committee emphasised that there was ‘... no public health justification for restrictions on travel or trade’ and the main interventions were to control mosquito populations and prevent bites in pregnant women. Why has this happened and how might it affect patients attending primary care in the UK?\u0000\u0000ZIKV was first isolated from a Rhesus monkey in Uganda in 1947.2 The following year it was identified in Aedes mosquitoes, which differ from malaria-transmitting Anopheles mosquitoes by biting during the day. ZIKV has been found throughout Africa and South East Asia where infection is asymptomatic or produces a mild febrile illness and rash which goes undiagnosed. The first outbreak was not recorded until 2007 when three-quarters of the population of Yap Island in Micronesia became infected.3\u0000\u0000The current epidemic of ZIKV infection began in early 2015 in northeastern Brazil. Since then ZIKV transmission has been confirmed in 35 countries.4 One theory is that ZIKV was carried to Brazil by infected Pacific Islanders visiting an international canoeing event in Rio de Janeiro in August 2014. In September 2015 clinicians working in Pernambuco state noticed an increase in newborn babies with microcephaly. The Ministry of Health quickly established a register and within 3 months recorded 4180 suspected cases, including 68 deaths, compared to a total of 147 reports in …","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":"2000 1","pages":"122 - 123"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82803880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"‘I’m fishing really’ — inflammatory marker testing in primary care: a qualitative study","authors":"J. Watson, Isabel de Salis, W. Hamilton, C. Salisbury","doi":"10.3399/bjgp16X683857","DOIUrl":"https://doi.org/10.3399/bjgp16X683857","url":null,"abstract":"Background Inflammatory markers can be helpful as part of the diagnostic workup for specific diseases or for monitoring disease activity. A third use is as a screening and/or triage tool to differentiate between the presence or absence of disease. Most research into inflammatory markers looks at diagnosis of specific diseases and comes from secondary care. Qualitative studies to explore when and why clinicians use these tests in primary care are lacking. Aim To identify clinicians’ approaches to inflammatory marker testing in primary care. Design and setting Qualitative study with 26 GPs and nurse practitioners. Method Interviews were conducted using a semi-structured topic guide. Clinicians reviewed recent cases of inflammatory marker testing in their pathology inbox. Interviews were audiorecorded and transcribed. Qualitative analysis was conducted by two of the authors. Results Clinicians are uncertain about the appropriate use of inflammatory markers and differ in their approach to testing patients with undifferentiated symptoms. Normal or significantly elevated inflammatory markers are seen as helpful, but mildly raised inflammatory markers in the context of non-specific symptoms are difficult to interpret. Clinicians describe a tension between not wanting to ‘miss anything’ and, on the other hand, being wary of picking up borderline abnormalities that can lead to cascades of further tests. Diagnostic uncertainty is a common reason for inflammatory marker testing, with the aim to reassure; however, paradoxically, inconclusive results can generate a cycle of uncertainty and anxiety. Conclusion Further research is needed to define when inflammatory marker testing is useful in primary care and how to interpret results.","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":"61 1","pages":"e200 - e206"},"PeriodicalIF":0.0,"publicationDate":"2016-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87059860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}