BJGP Open最新文献

{"title":"Reducing pressurised metered dose inhaler prescriptions for asthma to reduce carbon emissions: a qualitative study of healthcare professional perspectives.","authors":"Lauren Franklin, Christian Mallen, Helen Twohig","doi":"10.3399/BJGPO.2024.0208","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0208","url":null,"abstract":"<p><strong>Background: </strong>Prescribing of pressurised metered dose inhalers (pMDIs) is a key NHS carbon hotspot and reducing the number of these devices prescribed will help achieve NHS net zero targets.</p><p><strong>Aim: </strong>To explore primary healthcare professionals' perspectives on reducing the prescribing of pMDIs for people with asthma to reduce associated carbon emissions.</p><p><strong>Design & setting: </strong>Qualitative study of healthcare professionals (general practitioners, practice nurses and clinical pharmacists) working in general practice in England.</p><p><strong>Method: </strong>Eighteen semi-structured interviews were conducted with healthcare professionals. Participants were recruited through professional networks and using snowball sampling. Topic guides were developed to explore participant perspectives, concerns and motivations.</p><p><strong>Results: </strong>Eight general practitioners, six practice nurses and four clinical pharmacists were interviewed. Results are presented over two topics. The first explores factors influencing inhaler device choice and discusses the themes: patient-centred care, bias and assumptions, clinician confidence and knowledge, and status quo of asthma care. The second topic identifies facilitators and barriers for prescribing fewer pMDIs through the themes: understanding, attitudes to change, confidence in DPIs, engagement with sustainable prescribing, the role of incentives, and guidelines and systems.</p><p><strong>Conclusion: </strong>Interlinking personal, consultation and external factors influence which inhaler device is prescribed for patients with asthma. There are significant actionable barriers to implementing carbon-conscious prescribing, many of which would improve the quality of asthma care.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774545","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":"Influence of GPs' unhealthy lifestyle on patients' adherence to lifestyle recommendations: a cross-sectional study in Flanders, Belgium.","authors":"Julie Kerremans, Birgitte Schoenmakers","doi":"10.3399/BJGPO.2024.0221","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0221","url":null,"abstract":"<p><strong>Background: </strong>Research has shown that a physician's lifestyle significantly affects patient adherence to lifestyle advice AIM: This study investigates the influence of general practitioners' (GPs) unhealthy lifestyles on patients' adherence to lifestyle recommendations.</p><p><strong>Design & setting: </strong>A cross-sectional study was conducted from April 19, 2023, to September 12, 2023.Adults living in Flanders or Brussels with sufficient knowledge of Dutch were included.</p><p><strong>Method: </strong>Through a survey we studied the degree of willingness to follow lifestyle advice from GPs with unhealthy lifestyles. Secondary outcomes included the need for specific lifestyle advice, the feeling of being judged, and its impact on adherence.</p><p><strong>Results: </strong>Patients were less likely to follow lifestyle advice on smoking cessation (62.3%), alcohol use (64.9%), vaccination (49.7%), and eating habits (51.2%) from GPs exhibiting unhealthy behaviors in these areas. A significant portion (68.8%) indicated they were less likely to follow advice when feeling judged. Older respondents were less likely to adhere to advice from GPs with unhealthy habits and less likely to feel judged (odds ratio 0.973 to 0.979). Higher subjective physical health correlated with lower adherence to advice on physical activity from inactive GPs (odds ratio 0.799).</p><p><strong>Conclusions: </strong>The lifestyle of GPs appears to affect patients' adherence to lifestyle advice, with unhealthy behaviors leading to decreased patient trust and adherence. Emphasizing the importance of GPs maintaining a healthy lifestyle could enhance patient outcomes in lifestyle-related chronic disease prevention and management.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774524","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":"The paper study (prescribing antidepressants in primary care: ethnic inequalities in treatment). A study protocol.","authors":"Lydia Poole, Amy Ronaldson, Hannah Frith, Paramjit Gill, Madiha Sajid, Rose Rickford, Andrea Martinez, Khaula Ali, Mel Ramasawmy","doi":"10.3399/BJGPO.2024.0311","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0311","url":null,"abstract":"<p><strong>Background: </strong>South Asians represent the largest minority ethnic group in the UK, but prior research has suggested unequal access to primary care and differences in antidepressant prescribing practices for these patients.</p><p><strong>Aim: </strong>This project aims to understand the treatment of depression in South Asian patients, with specific reference to factors affecting appropriate prescribing. The secondary aim is to understand the intersection between ethnicity, age and financial deprivation within this context.</p><p><strong>Design & setting: </strong>A mixed methods approach will be adopted, including primary and secondary analyses, to understand the ways in which inequalities may arise along the pathway from patient experience of symptoms to clinician decision to treat with antidepressants in UK primary care.</p><p><strong>Method: </strong>Two scoping reviews will inform our approach. Quantitative data analysis of UK Biobank will allow us to examine prevalence and heterogeneity in depressive symptoms, and antidepressant prescribing over time, stratified by ethnicity. Qualitative data will be generated through interviews and focus group discussions with patients and healthcare professionals to understand experiences of depression and document the depression management decision-making process.</p><p><strong>Ethics and dissemination: </strong>Ethical approval was obtained from Wales 6 Research Ethics Committee (reference 24/WA/0087). The dissemination plan will be informed by patient and public involvement (PPI) group members and engagement with stakeholders and will aim to produce a toolkit of resources for use in primary care.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774551","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":"Patients' acceptance of a penicillin allergy de-labelling programme in primary care.","authors":"Marta Santillo, Caity Roleston, Kelsey Armitage, Catherine Porter, Joanne Fielding, Marta Wanat, Shadia Ahmed, Sinisa Savic, Christopher Butler, Sue Pavitt, Jonathan Sandoe, Sarah Tonkin-Crine","doi":"10.3399/BJGPO.2024.0136","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0136","url":null,"abstract":"<p><strong>Background: </strong>About 6% of the UK general practice population has a record of a penicillin allergy but fewer than 10% of these people are likely to be truly allergic. Consequently, a significant portion of the population is denied first line antibiotics. The ALABAMA trial aimed to determine if a penicillin allergy assessment pathway (PAAP) was safe and effective in de-labelling patients as allergic and improving antibiotic prescribing and patient health outcomes.</p><p><strong>Aims: </strong>To investigate patients' experience of penicillin allergy testing (PAT) and their acceptance of de-labelling following a negative allergy test.</p><p><strong>Design & setting: </strong>This was a qualitative study using semi-structured interviews with patients who took part in the PAAP intervention arm of the ALABAMA trial.</p><p><strong>Method: </strong>As part of a mixed-methods process evaluation embedded in the ALABAMA trial, we conducted interviews with patients in the PAAP intervention arm. Data from interviews with patients was analysed using thematic analysis.</p><p><strong>Results: </strong>Of the 28 participants interviewed, two received a positive PAT result and 26 received a negative PAT result; of these, 24 accepted and two declined de-labelling. At point of trial recruitment, many patients already doubted that they were allergic to penicillin. Patients were happy to attend PAT and felt cared for and safe at the hospital. These factors led to most people trusting their negative test result and accepting de-labelling.</p><p><strong>Conclusion: </strong>The patients we interviewed engaged with the PAAP intervention and, when testing negative, were predominantly willing to have their allergy record changed and to take penicillin in future. We highlight factors which influenced patients' acceptance of de-labelling to facilitate future adoption of PAAP. These factors, which we should consider when planning for penicillin allergy testing services, were: patients identifying themselves as low risk before the test, PAT being perceived as trustful and safe, patients previous experience of penicillin allergy and reactions, patients understanding of penicillin reactions and clear communication after de-labelling.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765201","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":"GPs' acceptability and feasibility for using point-of-care tests for cancer in primary care: a qualitative interview study.","authors":"Anam A Ayaz-Shah, Richard D Neal, Kelly E Lloyd, Matthew J Thompson, Samuel G Smith","doi":"10.3399/BJGPO.2024.0191","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0191","url":null,"abstract":"<p><strong>Background: </strong>Primary care is the first point of contact for patients with symptoms suspicious of cancer. The availability of reliable, rapid diagnostic cancer tests, at the 'point of care', have the potential to expedite diagnosis, and support timely management of patients.</p><p><strong>Aim: </strong>To explore the acceptability and feasibility of using Point of Care tests (POCTs) for detecting cancer among UK general practitioners (GPs), including barriers and facilitators to uptake.</p><p><strong>Design & setting: </strong>A qualitative semi-structured interview study with thirty-two UK GPs.</p><p><strong>Method: </strong>Online and telephone interviews guided by the Theoretical Framework of Acceptability were conducted. The data was analysed inductively using framework analysis.</p><p><strong>Results: </strong>GPs found POCTs acceptable if they were accurate, well-designed, and supported by robust evidence. Funding for tests and implementation resources were crucial, with an expectation of remuneration for their time. GPs believed POCTs could improve patient triage, reduce secondary care referrals, and facilitate clearer communication of referral decisions with patients. Concerns included potential workload increase, and over-testing in patients. Facilitators for uptake included recommendations in guidelines, peer acceptance, and comprehensive training. However, low awareness of POCTs among GPs and slow innovation adoption within the NHS were significant barriers.</p><p><strong>Conclusion: </strong>Most GPs welcome the use of POCTs for cancer detection in primary care, however, this will require substantial system-level changes. We highlight the relevant considerations and challenges that need to be addressed prior to uptake. This study also calls attention to wider innovation implementation issues that should be considered by GPs, test developers, policy makers and stakeholders.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755060","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":"Changes in heart failure healthcare in general practice during the COVID-19 pandemic.","authors":"Raphael Rothenberger, Thomas Blakeman, Carolyn A Chew-Graham, Faye Forsyth, Muhammad Hossain, Emma Sowden, Christi Deaton","doi":"10.3399/BJGPO.2024.0138","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0138","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic accelerated the adoption of remote healthcare for long-term condition management, including heart failure (HF). However, little is known about the experiences of this transition, knowledge developed during service transformation, and/or the preferences of clinicians and HF patients going forward.</p><p><strong>Aim: </strong>This study aimed to determine the perspectives and consensus of healthcare providers, patients, and carers in the UK regarding the transition to remote HF healthcare during the pandemic.</p><p><strong>Design & setting: </strong>A survey was conducted among individuals with HF and healthcare providers.</p><p><strong>Method: </strong>An evaluation of stakeholders' views and a consensus-development exercise regarding the utilisation of telehealth and home monitoring devices were conducted using a modified Delphi process on an online platform. This study primarily included patients with HF with preserved ejection fraction (HFpEF).</p><p><strong>Results: </strong>Findings revealed a significant reliance on telehealth, which reportedly enhanced accessibility for patients. Integration of home monitoring devices and systems was deemed crucial for care continuity. Although there was some consensus concerning the usefulness of remote consultations and communication, findings also highlighted their limitations and disparities in digital access and literacy.</p><p><strong>Conclusion: </strong>Remote healthcare presents opportunities and risks, emphasising the need for equitable access to telehealth technologies and thoughtful integration into healthcare systems. Balancing remote and in-person care, along with targeted training for healthcare providers, is essential for effective management and support of people with long-term conditions.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755046","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":"Declining number of home visits to older adults by general practitioners - an observational study using data from electronic health records in the Netherlands; 2017-2023.","authors":"Chantal J Leemrijse, Marianne J Heins, Bart J Knottnerus, Mariette Hooiveld, Judith N de Boer, Ron F Schipper, Joost W Vanhommerig","doi":"10.3399/BJGPO.2024.0255","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0255","url":null,"abstract":"<p><strong>Background: </strong>Despite an aging population that have higher care demand, home visits by general practitioners (GPs) have been declining.</p><p><strong>Aim: </strong>To analyze the number of GP home visits from 2017 to 2023 in the Netherlands, and to investigate whether this trend differed according to age, sex, multimorbidity, and neighborhood deprivation. In addition, the most common reasons for home visits between 2017 and 2023 are presented.</p><p><strong>Design & setting: </strong>Data were derived from Nivel Primary Care Database (Nivel-PCD), containing routinely recorded data from approximately 500 Dutch GP practices.</p><p><strong>Method: </strong>The number of home visits was calculated by age, sex, multimorbidity, and neighborhood deprivation. Visual inspection was used to investigate the relation between the trend in number of home visits and age, sex, multimorbidity, and neighborhood deprivation of patients.</p><p><strong>Results: </strong>A large decrease in the overall number of home visits was observed between 2017 and 2023 (-32%). The largest decrease was between 2019 and 2020, (-15%), but the downward trend continued in 2021 through 2023 (-5% per year). The most profound decline between 2023 and 2017 was found in the number of short home visits (-52%). The number of home visits for intensive GP care increased by 12% between 2017 and 2023.</p><p><strong>Conclusion: </strong>We report a continuing decline in the number of home visits by GPs, comparing 2023 to 2017. Home visits for intensive GP care, often for patients at the end of life, increased since 2017. GPs may be forced to make choices due to the increasing workload.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755050","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":"Evaluating ChatGPT for converting clinic letters into patient-friendly language.","authors":"Simon Cork, Keith Hopcroft","doi":"10.3399/BJGPO.2024.0300","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0300","url":null,"abstract":"<p><strong>Background: </strong>Previous research has shown that communication with patients in language they understand leads to greater comprehension of treatment and diagnoses but can be time consuming for clinicians.</p><p><strong>Aim: </strong>Here we sought to investigate the utility of ChatGPT to translate clinic letters into language patients understood, without loss of clinical information and to assess what impact this had on patients understanding of letter content.</p><p><strong>Design & setting: </strong>Single blinded quantitative study using objective and subjective analysis of language complexity.</p><p><strong>Method: </strong>Twenty-three clinic letters were provided by consultants across 8 specialties. Letters were inputted into ChatGPT with a prompt related to improve understanding for patients. Patient representatives were then asked to rate their understanding of the content of letters.</p><p><strong>Results: </strong>Translation of letters by ChatGPT resulted in no loss of clinical information, but did result in significant increase in understanding, satisfaction and decrease in the need to obtain medical help to translate the letter contents by patient representatives compared with clinician written originals.</p><p><strong>Conclusion: </strong>Overall, we conclude that ChatGPT can be used to translate clinic letters into patient friendly language without loss of clinical content, and that these letters are preferred by patients.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755054","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":"Pathways to diagnosis of atrial fibrillation: findings from a qualitative study in primary care.","authors":"Patricia N Apenteng, Veronica Nanton, Trudie Lobban, Richard Lilford","doi":"10.3399/BJGPO.2025.0006","DOIUrl":"https://doi.org/10.3399/BJGPO.2025.0006","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is underdiagnosed and approximately 10% of ischemic strokes occur in people with unrecognised AF.</p><p><strong>Aim: </strong>To explore the patient path to diagnosis of AF and identify ways to improve detection DESIGN & SETTING: Qualitative study in UK primary care METHOD: We interviewed patients with a recent diagnosis of AF (<6 months) to understand their path to diagnosis, and primary care clinicians to explore their experience of detecting AF. The data were analysed using framework analysis.</p><p><strong>Results: </strong>Thirty patients and ten primary care clinicians were interviewed. Patients with non-specific symptoms generally did not perceive the symptoms as serious, and many delayed seeing a healthcare professional. Their experiences in primary care aligned with findings from interviews with primary care clinicians, who acknowledged AF may not necessarily be the initial suspicion when a patient presents with certain non-specific symptoms. Primary care clinicians described narratives of good practice in the form of opportunistic pulse palpation, and challenges of detecting AF in primary care such as lack of access to holter tests and limited opportunities to detect AF due to remote consultations and healthcare assistants taking on more responsibilities.</p><p><strong>Conclusions: </strong>Our findings suggest that increased public awareness of AF could improve symptom appraisal and help-seeking from healthcare professionals. Recommending opportunistic pulse palpation in primary care is also indicated. Access to holter tests and other devices in primary care may help reduce delays in diagnosis.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754559","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":"Physical activity support for people with heart failure: mixed-methods study protocol.","authors":"Vincent Singh, John Percival, Olivia Skrobot, Rasha Okasheh, Rachel Johnson, Alison Huntley","doi":"10.3399/BJGPO.2025.0030","DOIUrl":"https://doi.org/10.3399/BJGPO.2025.0030","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is a common condition affecting 1-2 in every hundred adults in the UK and one in six people aged over 85 years. Physical activity is important for people with HF (PWHF) as it can increase exercise capacity and is shown to improve quality of life. We know that people with heart failure often seek advice from healthcare professionals about participating in physical activity safely, but healthcare professionals are not always sure what physical activity advice is best for their patients. It is also important to understand what physical activity services are available for healthcare professionals to refer patients to, and to explore how patients are referred into these physical activity services AIM: To explore the barriers and enablers to primary and community healthcare professionals (GPs and nurses) referring people with heart failure to community physical activity services.</p><p><strong>Design & setting: </strong>Mixed-methods study conducted across GP practices in England.</p><p><strong>Method: </strong>The following approaches will be used: (i) in-depth qualitative interviews with GPs (<i>n</i>=12) and nurses (<i>n</i>=12) to understand their experiences of talking to people with heart failure about referral to physical activity services; (ii) find out what commissioned physical activity services are available to people with heart failure and how primary and community healthcare professionals can refer patients to the services; (iii) two workshops will be conducted to examine the findings with our stakeholders.</p><p><strong>Conclusion: </strong>The findings will be used to inform the development of an intervention for healthcare professionals referring to physical activity services and support the community service configuration.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754565","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}