The Mental Health Clinician最新文献

{"title":"The use of the ketogenic diet in the treatment of psychiatric disorders.","authors":"Erika E Tillery, Katie D Ellis, Tiffaney B Threatt, Hannah A Reyes, Christopher S Plummer, Logan R Barney","doi":"10.9740/mhc.2021.05.211","DOIUrl":"10.9740/mhc.2021.05.211","url":null,"abstract":"<p><strong>Introduction: </strong>The ketogenic diet (KD) is a high-fat, low-carbohydrate, and moderate-protein diet that has shown benefit as a treatment in neurologic disorders and may serve as a therapeutic option in individuals with psychiatric disorders.</p><p><strong>Methods: </strong>A search was conducted using EBSCOhost and PubMed databases for studies relating to ketogenic or low-carbohydrate diets and psychiatric disorders.</p><p><strong>Results: </strong>A total of 32 experimental or observational studies were identified by initial search strategies, 14 of which met the criteria to be included in this analysis. Although specific diet formulations varied somewhat between studies, they all generally examined low-carbohydrate dietary intake with the goal of producing a ketotic state. The studies included in this review indicated the KD was beneficial in reducing symptoms associated with various psychiatric disorders.</p><p><strong>Discussion: </strong>This review summarizes the available evidence regarding the efficacy of the ketogenic diet in psychiatric disease states. Data from the studies analyzed demonstrated a positive response in individuals who were able to remain on the diet, regardless of the disease state. However, there is a need for more data to clearly define the specific benefits the KD may provide.</p>","PeriodicalId":22710,"journal":{"name":"The Mental Health Clinician","volume":"11 3","pages":"211-219"},"PeriodicalIF":0.0,"publicationDate":"2021-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c2/82/i2168-9709-11-3-211.PMC8120987.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39011076","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":"Effectiveness of a clinical decision-support tool on adherence to prescribing and practice guidelines of high-risk antidepressant medications in geriatric patients.","authors":"Madeline A VanDaele,&nbsp;Jordan O Smith,&nbsp;Jessica Bovio Franck","doi":"10.9740/mhc.2021.05.181","DOIUrl":"https://doi.org/10.9740/mhc.2021.05.181","url":null,"abstract":"<p><strong>Introduction: </strong>TCAs and paroxetine, a SSRI, are associated with safety risks in geriatric patients because of anticholinergic properties. The purpose of this project was to evaluate the impact of a clinical decision-support tool (CDST) on adherence with medication prescribing and practice guidance to enhance patient safety.</p><p><strong>Methods: </strong>Mental health clinical pharmacy specialists and clinical pharmacy leadership led a multidisciplinary creation and integration of a CDST within a Veterans Health Administration EHR. The CDST focused on the following elements when prescribing TCAs and paroxetine in geriatric patients: clinical justification for initiation of the medication, provision of patient/caregiver education specific to the medication prescribed, evaluation of comprehension of education provided, medication reconciliation, and follow-up completed within 30 days of medication initiation. Following activation of the CDST in the EHR, measures were evaluated before intervention and after intervention.</p><p><strong>Results: </strong>After intervention, an increase was observed in the primary outcome of the proportion of patients having documentation of all of the following: clinical justification for medication initiation, provision of patient/caregiver education, evaluation of comprehension of education provided, medication reconciliation, and follow-up completed within 30 days of medication initiation (<i>P</i> = .01). Individual proportions of patients with documented medication reconciliation and follow-up completed within 30 days significantly increased. All other secondary outcomes numerically increased but did not reach statistical significance.</p><p><strong>Discussion: </strong>Improvement was seen in adherence with prescribing and practice guidance following the implementation of the CDST. This suggests the beneficial role of CDSTs within the EHR to optimize patient safety.</p>","PeriodicalId":22710,"journal":{"name":"The Mental Health Clinician","volume":"11 3","pages":"181-186"},"PeriodicalIF":0.0,"publicationDate":"2021-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/71/c2/i2168-9709-11-3-181.PMC8120984.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39011072","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":"Kratom-induced transaminitis with subsequent precipitated opioid withdrawal following naltrexone.","authors":"Aimee N Jensen,&nbsp;Quynh-Nhu Truong,&nbsp;Melanie Jameson,&nbsp;Celeste N Nadal","doi":"10.9740/mhc.2021.05.220","DOIUrl":"https://doi.org/10.9740/mhc.2021.05.220","url":null,"abstract":"<p><p>Kratom is an herbal supplement that has gained popularity for recreational use within the United States. Kratom exerts opioid-like effects and, although not US FDA approved, is commonly used for self-treatment of pain, withdrawal management from opioids, and euphoria. Drug-related hepatic injury has been associated with kratom use. All of this raises concern for patient safety and monitoring. The potential for additive liver toxicity must be considered when kratom is used concurrently with hepatotoxic, over-the-counter, herbal, and prescription medications. This case report describes a case of kratom-induced liver inflammation complicated by opioid withdrawal that was precipitated by initiation of IM naltrexone. To our knowledge, there are no published case reports related to opioid withdrawal following naltrexone administration in patients using kratom (without other opioids). The purpose of this case report is to demonstrate potential complications that may arise with kratom use and considerations that should be taken prior to initiation of naltrexone in kratom users.</p>","PeriodicalId":22710,"journal":{"name":"The Mental Health Clinician","volume":"11 3","pages":"220-224"},"PeriodicalIF":0.0,"publicationDate":"2021-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b4/5e/i2168-9709-11-3-220.PMC8120986.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39011077","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":"Depression-related stigma among primary care providers.","authors":"Andrew Kluemper,&nbsp;Lauren Heath,&nbsp;Danielle Loeb,&nbsp;Miranda Kroehl,&nbsp;Katy Trinkley","doi":"10.9740/mhc.2021.05.175","DOIUrl":"https://doi.org/10.9740/mhc.2021.05.175","url":null,"abstract":"<p><strong>Introduction: </strong>Depression is one of the most common mental illnesses in the United States and is often treated in primary care settings. Despite its prevalence, depression remains underdiagnosed and undertreated for a variety of reasons, including stigma. This may result in suboptimal management of depression. Studies evaluating stigma in US primary care providers (PCP) are scarce. The main objective of this study was to describe stigma in a cohort of PCPs.</p><p><strong>Methods: </strong>We utilized a validated questionnaire to measure stigma (score range 15 to 75 with lower scores indicating lower stigma levels). PCPs in 2 academic internal medicine clinics were sent an electronic questionnaire and received a small monetary incentive for responding. In addition to the stigma survey, we collected demographic data, including age, provider type, gender, and other data related to social proximity to mental illness. To describe stigma, differences in stigma between provider characteristics were evaluated using <i>t</i> tests and ANOVA tests as appropriate.</p><p><strong>Results: </strong>Of 107 PCPs, 71 responded (66.4% response rate). Male responders displayed higher stigma scores than females (31.8 vs 27.4, <i>P</i> = .0021). Medical residents displayed higher stigma scores than nonresidents (31.3 vs 27.2, <i>P</i> = .0045). Providers with personal exposure to mental illness and those who reported they frequently treated depression had less stigma.</p><p><strong>Discussion: </strong>Overall, a range of stigma was present among PCPs surveyed. Higher levels of stigma were found in men, medical residents, those without personal exposure to mental illness, younger PCPs, and those who reported treating depression less frequently. Future studies should utilize larger sample sizes and focus on the impact of stigma on quality of care.</p>","PeriodicalId":22710,"journal":{"name":"The Mental Health Clinician","volume":"11 3","pages":"175-180"},"PeriodicalIF":0.0,"publicationDate":"2021-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/68/52/i2168-9709-11-3-175.PMC8120988.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39011071","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":"Veteran adherence to oral versus injectable AUD medication treatment.","authors":"Hayden Stewart,&nbsp;Brian G Mitchell,&nbsp;Daniel Ayanga,&nbsp;Annette Walder","doi":"10.9740/mhc.2021.05.194","DOIUrl":"https://doi.org/10.9740/mhc.2021.05.194","url":null,"abstract":"<p><strong>Introduction: </strong>AUD medication treatment has been shown to improve outcomes compared with placebo when confined to per-protocol analysis. The same outcomes, however, have not always been maintained in intent-to-treat analysis, thus suggesting adherence may have a significant impact on efficacy outcomes. There is conflicting evidence present in the literature comparing adherence to oral versus injectable AUD pharmacotherapy and a paucity of information in the veteran population on risk factors for low adherence.</p><p><strong>Methods: </strong>The primary end point of this retrospective chart review was to determine whether adherence rates differ between oral and injectable AUD treatments in veterans during the first year of treatment (at 3, 6, 9, and 12 months) using the portion of days covered model. Secondary end points were to determine differing characteristics between patients with high versus low adherence and compare alcohol-related readmission rates and discontinuation rates between groups.</p><p><strong>Results: </strong>Adherence to injectable extended-release (XR) naltrexone was significantly higher than oral naltrexone at all time points and was significantly higher than disulfiram at 3, 6, and 9 months, but it was not significantly different from acamprosate at any time point. At months 9 and 12, acamprosate had significantly higher adherence compared with oral naltrexone. Patients with higher adherence were seen more frequently in the mental health clinic and had previously tried more AUD medications. The discontinuation rates and alcohol-related admission rates were not significantly different between groups at 1 year.</p><p><strong>Discussion: </strong>XR naltrexone may improve adherence rates compared with oral naltrexone or disulfiram, but not acamprosate based on these outcomes. Patients may have increased adherence if they are seen more often in clinic and have trialed more AUD medications.</p>","PeriodicalId":22710,"journal":{"name":"The Mental Health Clinician","volume":"11 3","pages":"194-199"},"PeriodicalIF":0.0,"publicationDate":"2021-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/16/ef/i2168-9709-11-3-194.PMC8120985.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39011074","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":"Specialty pharmacist integration into an outpatient neurology clinic improves pimavanserin access.","authors":"Sabrina Livezey,&nbsp;Nisha B Shah,&nbsp;Robert McCormick,&nbsp;Josh DeClercq,&nbsp;Leena Choi,&nbsp;Autumn D Zuckerman","doi":"10.9740/mhc.2021.05.187","DOIUrl":"https://doi.org/10.9740/mhc.2021.05.187","url":null,"abstract":"<p><strong>Introduction: </strong>Access to pimavanserin, the only Parkinson disease-related psychosis treatment approved by the FDA, is restricted by insurance requirements, a limited distribution network, and high costs. Following initiation, patients require monitoring for safety and effectiveness. The primary objective of this study was to evaluate impact of specialty pharmacist (SP) integration on time to insurance approval. Additionally, we describe a pharmacist-led monitoring program.</p><p><strong>Methods: </strong>This was a single-center, retrospective study of adults prescribed pimavanserin by the neurology clinic from June 2016 to June 2018. Patients receiving pimavanserin externally or through clinical trials were excluded. Pre- (June 2016 to December 2016) and post-SP integration (January 2017 to June 2018) periods were assessed. Proportional odds logistic regression was performed to test association of approval time with patient characteristics (age, gender, insurance type) postintegration. Interventions were categorized as clinical care, care coordination, management of adverse event, or adherence.</p><p><strong>Results: </strong>We included 94 patients (32 preintegration, 62 postintegration), 80% male (n = 75) and 96% white (n = 90) with a mean age of 73 years. Median time to approval was 22 days preintegration and 3 days postintegration. Higher rates of approval (81% vs 95%) and initiation (78% vs 94%) were observed postintegration. Proportional odds logistic regression suggested patients with commercial insurance were likely to have longer time to approval compared with patients with Medicare/Medicaid (odds ratio 7.1; 95% confidence interval: 1.9, 26.7; <i>P</i> = .004). Most interventions were clinical (51%, n = 47) or care coordination (42%, n = 39).</p><p><strong>Conclusion: </strong>Median time to approval decreased postintegration. The SP performed valuable monitoring and interventions.</p>","PeriodicalId":22710,"journal":{"name":"The Mental Health Clinician","volume":"11 3","pages":"187-193"},"PeriodicalIF":0.0,"publicationDate":"2021-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8f/50/i2168-9709-11-3-187.PMC8120983.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39011073","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":"Retracing our steps to understand ketamine in depression: A focused review of hypothesized mechanisms of action.","authors":"Madison N Irwin,&nbsp;Amy VandenBerg","doi":"10.9740/mhc.2021.05.200","DOIUrl":"https://doi.org/10.9740/mhc.2021.05.200","url":null,"abstract":"<p><strong>Introduction: </strong>MDD represents a significant burden worldwide, and while a number of approved treatments exist, there are high rates of treatment resistance and refractoriness. Ketamine, an <i>N</i>-methyl-d-aspartate receptor (NMDAR) antagonist, is a novel, rapid-acting antidepressant, however the mechanisms underlying the efficacy of ketamine are not well understood and many other mechanisms outside of NMDAR antagonism have been postulated based on preclinical data. This focused review aims to present a summary of the proposed mechanisms of action by which ketamine functions in depressive disorders supported by preclinical data and clinical studies in humans.</p><p><strong>Methods: </strong>A literature search was completed using the PubMed and Google Scholar databases. Results were limited to clinical trials and case studies in humans that were published in English. The findings were used to compile this article.</p><p><strong>Results: </strong>The antidepressant effects associated with ketamine are mediated via a complex interplay of mechanisms; key steps include NMDAR blockade on γ-aminobutyric acid interneurons, glutamate surge, and subsequent activation and upregulation of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor.</p><p><strong>Discussion: </strong>Coadministration of ketamine for MDD with other psychotropic agents, for example benzodiazepines, may attenuate antidepressant effects. Limited evidence exists for these effects and should be evaluated on a case-by-case basis.</p>","PeriodicalId":22710,"journal":{"name":"The Mental Health Clinician","volume":"11 3","pages":"200-210"},"PeriodicalIF":0.0,"publicationDate":"2021-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b6/a9/i2168-9709-11-3-200.PMC8120982.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39011075","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":"Opioid toxicity due to CNS depressant polypharmacy: A case report.","authors":"Christine Lee,&nbsp;Annabelle Wanson,&nbsp;Sarah Frangou,&nbsp;David Chong,&nbsp;Katelyn Halpape","doi":"10.9740/mhc.2021.03.070","DOIUrl":"https://doi.org/10.9740/mhc.2021.03.070","url":null,"abstract":"<p><p>The interaction between methadone and central nervous system depressants can cause serious adverse effects, including profound sedation, respiratory depression, coma, and death. This poses a challenge in the treatment of patients with concurrent psychiatric and substance use disorders as the combined use is often unavoidable. We report a case of a patient with opioid use disorder, mood disorder unspecified, chronic pain, and chronic obstructive pulmonary disease who experienced 2 serious episodes of CNS and respiratory depression due to polypharmacy-induced opioid toxicity. Careful consideration of pharmacokinetics, pharmacodynamics, and patient-specific factors was imperative to identify the suspected contributing medications: methadone, lorazepam, divalproex, gabapentin, and cyclobenzaprine. Cognitive and system factors that contributed to these adverse events and strategies to mitigate risk of recurrence were also identified.</p>","PeriodicalId":22710,"journal":{"name":"The Mental Health Clinician","volume":"11 2","pages":"70-74"},"PeriodicalIF":0.0,"publicationDate":"2021-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d6/cc/i2168-9709-11-2-70.PMC8019539.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25605935","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":"Impact of holding home stimulant(s) on agitation in a child and adolescent inpatient psychiatric population.","authors":"Anupha M Mathew,&nbsp;Sophie Robert,&nbsp;Clint Ross,&nbsp;Erin Weeda,&nbsp;Adrienne Pruitt","doi":"10.9740/mhc.2021.03.050","DOIUrl":"https://doi.org/10.9740/mhc.2021.03.050","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to compare the rates of agitation-related interventions associated with initial holding versus continuation of home stimulant(s) in a child and adolescent population at the time of admission to an inpatient psychiatric facility.</p><p><strong>Methods: </strong>This retrospective chart review included patients less than 18 years of age who were admitted to an academic medical center between July 1, 2017, and July 1, 2018. Patients were divided into 2 groups: those continued on their home stimulant(s) and those who had them held. We compared both groups on agitation-related outcomes by examining the difference in the number of level I or II events or as-needed medication administrations. Mechanical restraints and closed-door seclusions were grouped as level I events, and level II events consisted of nonmechanical restraint.</p><p><strong>Results: </strong>The analysis included 169 patients. In total, 126 (75%) patients were continued on their home stimulant, and 43 (25%) had them held. The occurrence of the composite endpoint of level I or II events or as-needed intramuscular medication administration was numerically higher in the group that had their home stimulant held (27.9% vs 23%; <i>P</i> = .52). Level I events were also numerically higher but not statistically significant in the group that had their home stimulant held (16.3% vs 11.9%; <i>P</i> = .46).</p><p><strong>Discussion: </strong>The composite outcome of as-needed intramuscular medication administration and level I or II events was numerically higher in the group that had their home stimulant held. Use of a larger sample size and adjusted analyses may help elucidate covariates that impact agitation-related outcomes.</p>","PeriodicalId":22710,"journal":{"name":"The Mental Health Clinician","volume":"11 2","pages":"50-54"},"PeriodicalIF":0.0,"publicationDate":"2021-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/18/00/i2168-9709-11-2-50.PMC8019544.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25605931","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":"Evaluation of the use of chlorpromazine for agitation in pediatric patients.","authors":"Rajwoana Ahmed,&nbsp;Megan Maroney,&nbsp;Germin Fahim,&nbsp;Hoytin Lee Ghin,&nbsp;Andrew Scott Mathis","doi":"10.9740/mhc.2021.03.040","DOIUrl":"https://doi.org/10.9740/mhc.2021.03.040","url":null,"abstract":"<p><strong>Introduction: </strong>Chlorpromazine is a first-generation antipsychotic used for behavioral problems in pediatric patients. However, other therapies may demonstrate both improved outcomes and fewer side effects. Within our institution, chlorpromazine has been the standard medication used for treatment of pediatric agitation. The study objective was to evaluate the appropriateness of chlorpromazine use (including efficacy, appropriate dosing, drug interactions, and tolerability) to optimize the treatment of pediatric agitation.</p><p><strong>Methods: </strong>Data regarding drug interactions, patient behavior, dosing, and side effects was collected for each patient administered chlorpromazine from January 2019 through June 2019. Data were analyzed using descriptive statistics assessing the incidence of drug-drug interactions (DDIs), incidences of inefficacy, inappropriate dosing, and side effects.</p><p><strong>Results: </strong>A total of 70 patients and 130 administrations of oral or intramuscular chlorpromazine were evaluated. Of these administrations, 49 (38%) resulted in a DDI. Eighteen (14%) administrations were ineffective for managing symptoms of agitation. Eleven (8%) administrations were dosed inappropriately, and 46 (35%) administrations resulted in side effects possibly caused by chlorpromazine.</p><p><strong>Discussion: </strong>Results from this study demonstrate opportunities for improvement in patient care due to instances of drug interactions, inefficacy, inappropriate dosing, and side effects with the use of chlorpromazine.</p>","PeriodicalId":22710,"journal":{"name":"The Mental Health Clinician","volume":"11 2","pages":"40-44"},"PeriodicalIF":0.0,"publicationDate":"2021-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6d/15/i2168-9709-11-2-40.PMC8019542.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25605929","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}