BMJ Simulation & Technology Enhanced Learning最新文献

{"title":"Simulation-based training programme and preparedness testing for COVID-19 using system integration methodology.","authors":"Hani M S Lababidi,&nbsp;Usamah Alzoraigi,&nbsp;Abdullah Abdulaziz Almarshed,&nbsp;Waleed AlHarbi,&nbsp;Mohamad AlAmar,&nbsp;Amer A Arab,&nbsp;Mahmoud A Mukahal,&nbsp;Faisal A AlAsmari,&nbsp;Bandar Y Mzahim,&nbsp;Husam A M AlHarastani,&nbsp;Salem S Alammi,&nbsp;Yousef I AlAwad","doi":"10.1136/bmjstel-2020-000626","DOIUrl":"https://doi.org/10.1136/bmjstel-2020-000626","url":null,"abstract":"<p><strong>Background: </strong>COVID-19 pandemic is presenting serious challenges to the world's healthcare systems. The high communicability of the COVID-19 necessitates robust medical preparedness and vigilance.</p><p><strong>Objective: </strong>To report on the simulation-based training and test preparedness activities to prepare healthcare workers (HCWs) for effective and safe handling of patients with COVID-19.</p><p><strong>Methodology: </strong>Two activities were conducted: simulation-based training to all HCWs and a full-scale unannounced simulation-based disaster exercise at King Fahad Medical City (KFMC). The online module was designed to enhance the knowledge on COVID-19. This module was available to all KFMC staff. The five hands-on practical part of the course was available to frontliner HCWs. The unannounced undercover simulated patients' full-scale COVID-19 simulation-based disaster exercise took place in the emergency department over 3 hours. Six scenarios were executed to test the existing plan in providing care of suspected COVID-19 cases.</p><p><strong>Results: </strong>2620 HCWs took the online module, 17 courses were conducted and 337 frontliner HCWs were trained. 94% of learners were satisfied and recommended the activity to others. The overall compliance rate of the full-scale COVID-19 disaster drill with infection control guidelines was 90%. Post-drill debriefing sessions recommended reinforcing PPE training, ensuring availability of different sizes of PPEs and developing an algorithm to transfer patients to designated quarantine areas.</p><p><strong>Conclusion: </strong>Simulation-based training and preparedness testing activities are vital in identifying gaps to apply corrective actions immediately. In the presence of a highly hazardous contagious disease like COVID-19, such exercises are a necessity to any healthcare institution.</p>","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjstel-2020-000626","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9987611","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":"Peer-assisted learning in simulation-based medical education: a mixed-methods exploratory study.","authors":"Leo Nunnink, Andrea Thompson, Nemat Alsaba, Victoria Brazil","doi":"10.1136/bmjstel-2020-000645","DOIUrl":"10.1136/bmjstel-2020-000645","url":null,"abstract":"<p><strong>Introduction: </strong>Peer-assisted learning (PAL) is well described in medical education but there has been little research on its application in simulation-based education (SBE). This exploratory study aimed to determine the perceptions of senior medical students at two universities to teaching and learning in SBE using PAL (PAL-SBE).</p><p><strong>Methods: </strong>Ninety-seven medical students at two universities working in small groups with facilitator oversight wrote, ran and debriefed a simulation scenario for their peers.This was a mixed-methods study. Participants completed a written free-text and Likert survey instrument, and participated in a facilitated focus group immediately after the scenario. Thematic analysis was performed on the free-text and focus group transcripts.</p><p><strong>Results: </strong>Student-led scenarios ran without major technical issues. Instructor presence was required throughout scenario delivery and debrief, making the exercise resource intensive. Participant responses were more positive regarding learning as peer teachers in simulation than they were regarding participation as a peer learner. Five themes were identified: learning in the simulated environment; teaching in the simulated environment; teaching peers and taking on an educator role; learning from peers; and time and effort expended. Perceived benefits included learning in depth through scenario writing, improved knowledge retention, understanding the patient's perspective and learning to give feedback through debriefing.</p><p><strong>Conclusion: </strong>PAL in SBE is feasible and was perceived positively by students. Perceived benefits appear to be greater for the peer teachers than for peer learners.</p>","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8936843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89921345","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":"Development of a virtual reality clinically oriented temporal bone anatomy module with randomised control study of three-dimensional display technology","authors":"Bridget Copson, S. Wijewickrema, Laurence Sorace, Randall W. Jones, S. O'Leary","doi":"10.1136/bmjstel-2020-000592","DOIUrl":"https://doi.org/10.1136/bmjstel-2020-000592","url":null,"abstract":"Objective To investigate the effectiveness of a virtual reality (VR), three-dimensional (3D) clinically orientated temporal bone anatomy module, including an assessment of different display technologies. Methods A clinically orientated, procedural and interactive anatomy module was generated from a micro-CT of a cadaveric temporal bone. The module was given in three different display technologies; 2D, 3D with monoscopic vision, and 3D with stereoscopic vision. A randomised control trial assessed the knowledge acquisition and attitudes of 47 medical students though a pretutorial and post-tutorial questionnaire. The questionnaire included questions identifying anatomic structures as well as understanding structural relations and clinical relevance. Furthermore, a five-point Likert scale assessed the students’ attitudes to the module and alternative learning outcomes, such as interest in otology and preparedness for clinical rotations. Results As a whole cohort, the total test score improved significantly, with a large effect size (p≤0.005, Cohen’s d=1.41). The 23 students who returned the retention questionnaire had a significant improvement in total test score compared with their pretutorial score, with a large effect size (p≤0.005, Cohen’s d=0.83). Display technology did not influence the majority of learning outcomes, with the exception of 3D technologies, showing a significantly improvement in understanding of clinical relevance and structural relations (p=0.034). Students preferred 3D technologies for ease of use, perceived effectiveness and willingness to use again. Conclusions The developed VR temporal bone anatomy tutor was an effective self-directed education tool. 3D technology remains valuable in facilitating spatial learning and superior user satisfaction.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83780463","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":"Developing open disclosure strategies to medical error using simulation in final-year medical students: linking mindset and experiential learning to lifelong reflective practice","authors":"A. Lane, C. Roberts","doi":"10.1136/bmjstel-2020-000659","DOIUrl":"https://doi.org/10.1136/bmjstel-2020-000659","url":null,"abstract":"Introduction and objectives Open disclosure is a policy outlining how healthcare practitioners should apologise for mistakes, discussing them with the harmed parties. Simulation is a training and feedback method in which learners practise tasks and processes in lifelike circumstances. We explore how final-year medical students experience the learning of open disclosure. Methods A qualitative study of final-year medical students who had been involved a high-fidelity simulation session based on open disclosure after medication error was conducted. Students were selected using purposive sampling. Focus groups illuminated their experiences and interpretation of simulated open disclosure experiences. The data were analysed using interpretative phenomenological analysis and supported two superordinate themes: (1) identifying learning needs; and (2) learning to say sorry Results The medical students constructed their learning in three different ways: negotiating environmental relationships; embracing challenge and stress; and achieving learning outcomes. The data reinforced the need for psychological safety, emphasised the need for emotional arousal and demonstrated the need for both individual and collective reflective learning. Our data linked the benefits of experiential learning to the development of growth mindset and Jarvis’s theory. Conclusions The lived experience of the final-year medical student participants in this study reinforced the notions of continuous psychological safety and the need for emotional arousal during learning. Our data also demonstrated the variety of participant experiences when preparing to give open disclosure, reinforcing the need for facilitators to optimise learning for the whole group as well as the individuals, given that participants are at different parts of their learning cycle.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80970496","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":"Gasping for air: measuring patient education and activation skillsets in two clinical assessment contexts","authors":"Jeffrey A. Wilhite, Harriet Fisher, L. Altshuler, E. Cannell, Khemraj Hardowar, K. Hanley, C. Gillespie, S. Zabar","doi":"10.1136/bmjstel-2020-000759","DOIUrl":"https://doi.org/10.1136/bmjstel-2020-000759","url":null,"abstract":"Objective structured clinical examinations (OSCEs) provide a controlled, simulated setting for competency assessments, while unannounced simulated patients (USPs) measure competency in situ or real-world settings. This exploratory study describes differences in primary care residents’ skills when caring for the same simulated patient case in OSCEs versus in a USP encounter. Data reported describe a group of residents (n=20) who were assessed following interaction with the same simulated patient case in two distinct settings: an OSCE and a USP visit at our safety-net clinic from 2009 to 2010. In both scenarios, the simulated patient presented as an asthmatic woman with limited understanding of illness management. Residents were rated through a behaviourally anchored checklist on visit completion. Summary scores (mean % well done) were calculated by domain and compared using paired sample t-tests. Residents performed significantly better with USPs on 7 of 10 items and in two of three aggregate assessment domains (p<0.05). OSCE structure may impede assessment of activation and treatment planning skills, which are better assessed in real-world settings. This exploration of outcomes from our two assessments using the same clinical case lays a foundation for future research on variation in situated performance. Using both assessments during residency will provide a more thorough understanding of learner competency.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90195386","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":"Failure modes and effects analysis to assess COVID-19 protocols in the management of obstetric emergencies","authors":"Sam Curtis, Rebecca L. Flower, Lola Emanuel-Kole, P. Nadarajah","doi":"10.1136/bmjstel-2020-000747","DOIUrl":"https://doi.org/10.1136/bmjstel-2020-000747","url":null,"abstract":"The Royal Free Hospital is one of four High Consequence Infectious Disease centres in England and as of the end of May 2020, seven women were confirmed COVID-19 peri-delivery. We developed a standard operating procedure (SOP) for suspected and confirmed COVID-19 women undergoing operative delivery. This was revised in response to our ongoing clinical experience and changes in guidance from medical and public health organisations. Following 10 weeks of clinical practice, we formally tested the SOP using point-of-care simulation to enable optimisation for a potential second surge. Our high-fidelity simulation of a COVID-19-positive parturient requiring an emergency caesarean was facilitated by the simulation team in our obstetric unit. It was designed to test the performance and safety of our SOP as well as staff performance. We used the Failure Modes and Effect Analysis tool (a systematic, prospective method of process mapping) to identify how a complex task might fail and assess the relative impact of different failures. The decision-to-delivery was 17 minutes, which we considered to be successful. However, a number of operational deficiencies were identified. The main failures related to lack of situational awareness, ill-fitting personal protective equipment and difficulties communicating between theatre and the neonatal teams located outside, posing serious potential risks to safe neonatal care. Subsequently, we have modified our SOP to include a communication check, implemented communication training for the neonatal team and organised further simulation training for theatre staff unfamiliar with COVID-19 considerations.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80563599","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":"Job role and stress influence student movement during postpartum haemorrhage simulation: an exploratory study.","authors":"Rachel Bican, Jill C Heathcock, Flora Jedryszek, Veronique Debarge, Julien DeJonckheere, M C Cybalski, Sandy Hanssens","doi":"10.1136/bmjstel-2020-000646","DOIUrl":"10.1136/bmjstel-2020-000646","url":null,"abstract":"<p><strong>Introduction: </strong>Postpartum haemorrhage is the leading cause of maternal death. Healthcare simulations are an educational tool to prepare students for infrequent high-risk emergencies without risking patient safety. Efficiency of movement in the simulation environment is important to minimize the risk of medical error. The purpose of this study was to quantify the movement behaviours of the participants in the simulation and evaluate the relationship between perceived stress and movement.</p><p><strong>Methods: </strong>N=30 students participated in 10 high-fidelity medical simulations using an adult patient simulator experiencing a postpartum haemorrhage. The participants completed the State-Trait Anxiety Inventory prior to the simulation to measure perceived stress. Physical movement behaviours included walking around the simulation, time spent at bedside, arm movements, movements without purpose, looking at charts/vitals and total movement.</p><p><strong>Results: </strong>Midwife (MW) students spent significantly more time walking (p=0.004) and looking at charts/vitals (p=<0.001) and significantly less time at bedside (p=<0.001) compared to obstetric (OB) students. The MW students demonstrated significantly more total movements compared to the OB students (p=<0.001). There was a significant, moderate, positive relationship between perceived stress and total movement during the simulation for the MW group (r=0.50, p=0.05). There was a trend for a moderate, positive relationship between perceived stress and total movement during the simulation for the OB group (r=0.46, p=0.10).</p><p><strong>Conclusions: </strong>Physical movement during a simulation varies by job role and is influenced by perceived stress. Improved understanding of physical movement in the simulation environment can improve feedback, training and environmental set-up.</p>","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8936709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85060357","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":"Apple Siri as communication conduit during COVID-19: between inside and outside the OR.","authors":"Ahed Zeidan, Hany Tallat Abdelgelil, Edward Edwin, Dhafer Alqarni","doi":"10.1136/bmjstel-2020-000740","DOIUrl":"10.1136/bmjstel-2020-000740","url":null,"abstract":"","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8936690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83877326","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":"PG76 Remote Simulation","authors":"R. Edwards, Carl Heffernan","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.124","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.124","url":null,"abstract":"When Covid-19 hit, all student placements were suspended. Whilst some students were given honorary employment contracts, others had to isolate to care for families, or shield. This created anxiety from those at home, worried that they would be left behind with their learning. They were still able to have remote teaching from their lecturers, so we looked to add some remote simulation (sim) to this. Through an online learning platform, we were able to share the audio-visual directly from the sim suite. Students could talk in real time into the sim suite. Due to social distancing, we invited only two employed students to physically be in the sim suite for the session, with everyone else participating remotely. One remote learner was nominated to lead each sim, as if running a scenario in a ‘hands-off’ style. The nominated remote learner could ask questions directly to the patient and act on the responses. The two employed students acted as team members, taking a blood pressure and listening to the chest, under the instruction of the remote leader. Summary of Results We have made changes throughout, such as the number of participants or who should talk out loud and lead. Feedback has been constructive and has helped guide some of these changes over the weeks, it’s also been overwhelmingly positive and attendance has been high. Discussion, Conclusions and Recommendations Studies addressing ‘remote simulation’ currently only refer to the facilitator being remote (Hayden, 2012) and participants on the whole are physically present in educational facilities (Ikeyama, 2012). We will be continuing this method of sim and it’s likely to be a method we will adopt to complement hands-on sim. We are trialling varying numbers of participants to find the optimal number; currently we invite 15 remote learners. We ironed-out initial issues such as audio quality and session format. This method allows for social distancing and reduced travelling between sites. It could also allow more students access to sim, if larger group sizes prove to be effective. Feedback suggests that it should be used to supplement in-person sim rather than replace it, as in-person sim allows for the practice of hands on skills and inter-personal interactions. References Hayden E, Navedo D, Gordon J. Web-conferenced simulation sessions: a satisfaction survey of clinical simulation encounters via remote supervision. Telemedicine journal and e-health 2012:18 (7);p525–529. Ikeyama T, Shimizu N, Ohta K. Low-cost and ready-to-go remote-facilitated simulation-based learning. Simulation in healthcare 2012;7(1); p35–39.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74600542","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":"PG121 Masterclass for key-skills and remote simulation in covid times for international medical graduates (IMG): an innovative educational programme","authors":"R. Makker, Emma Prince, Bruce Kerr","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.169","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.169","url":null,"abstract":"Introduction Overseas doctors (International Medical Graduates) constitute an important and significant workforce for provision of healthcare in NHS. Most of them have demonstrated their knowledge and skills to practice Medicine. However, to be able to deliver healthcare successfully in the NHS, they need to adapt to the culture within the NHS. It is incumbent on employers to provide an educational program to help IMG integrate in the NHS. However, the Covid crisis has posed a challenge to deliver conventional teaching. We describe an innovative educational programme for IMG working at six NHS hospitals, commissioned by Health Education, East of England (HEEE). Methodology The programme consisted of two days of interactive zoom sessions over a month delivered by experts in skills and simulation. The two sessions focussed on developing their personal and clinical skills. IMGs were informed about the programme via e mail and twenty participants attended. The programme on Day one dealt with building self-awareness of key skills to progress in NHS safely, with confidence. We designed a bespoke programme to develop their personal skills by introducing concepts of mindfulness, being proactive, building resilience to deal with rejection and setbacks, building optimism, understanding the importance of robust well- being strategies. It was delivered by the Director of an external educational platform, as an interactive zoom meeting complemented by power point presentation. Clinical skills session on day two was delivered as remote simulation with pre-recorded scenarios to demonstrate structured A to E assessment of a critically ill patient, handover and communication within a team using SBAR, management of sepsis and Asthma and efficacy of simulation in immediate performance improvement by demonstrating same team management of a cardiac arrest scenario. Debriefing was conducted via zoom, inviting the participants to comment on the actors’ performance. Summary of Results/Outcomes We found that in the current constraints of the Covid crisis, it was possible to construct a two-day programme for IMGs delivered by expert, using remote technology. Minimal resources were required. On reflection, educators found a high level of interest, engagement and interaction by the IMGs. Written feedback from the participants supported the educators’ perception. Additionally, they reported satisfactory quality of audio visual technology, and usefulness of the power point presentations. IMGs reported that debriefing in simulation about the actors’ performance was realistic. Discussion, Conclusions and Recommendations We conclude that it is possible to deliver education to develop personal and clinical skills to IMGs remotely. Debriefing by zoom was engaging, powerful and an educationally effective, innovative method. Recommendations Remote simulation preceded by skills introduction for IMG may be useful for large audiences, in different geographical areas in crisis times and","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75895139","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}