INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE最新文献

{"title":"Broad spectrum antibiotic stewardship by quality improvement methods.","authors":"Saarah Niazi-Ali,&nbsp;Joanna Bircher","doi":"10.3233/JRS-227021","DOIUrl":"https://doi.org/10.3233/JRS-227021","url":null,"abstract":"<p><strong>Background: </strong>With the majority of antibiotics being prescribed in primary care it is of utmost importance that antimicrobial stewardship principles are adhered to in order to slow down the incidence of antimicrobial resistance.</p><p><strong>Objective: </strong>Broad spectrum antibiotic prescribing is often seen as a proxy marker of increasing resistance within a population and so it is important that they are used sparingly, to avoid drug-resistant bacteria developing.</p><p><strong>Method: </strong>In Tameside and Glossop a novel approach, using quality improvement methods, was employed to allow the behaviour change to be sustained for a longer period. Practices submitted monthly broad spectrum usage data, and if over a set target they were required to submit a \"deep dive\".</p><p><strong>Results: </strong>A 10.6% reduction of broad spectrum antibiotic usage was seen over the 2019-20 financial year.</p><p><strong>Conclusion: </strong>Over time the number of practices submitting a deep dive reduced and clinicians saw the deep dive as method to peer review their prescribing. Putting the practice staff in control of their own prescribing, allowed for a better method to sustain the improvement.</p>","PeriodicalId":45237,"journal":{"name":"INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE","volume":"33 S1","pages":"S35-S40"},"PeriodicalIF":1.7,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/48/3b/jrs-33-jrs227021.PMC9844069.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9329833","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":"Never events in orthopaedics: A nationwide data analysis and guidance on preventative measures.","authors":"Ahmed T Hafez,&nbsp;Islam Omar,&nbsp;Balaji Purushothaman,&nbsp;Yusuf Michla,&nbsp;Kamal Mahawar","doi":"10.3233/JRS-210051","DOIUrl":"https://doi.org/10.3233/JRS-210051","url":null,"abstract":"<p><strong>Background: </strong>Never Events (NE) are serious clinical incidents that are wholly preventable if appropriate institutional safeguards are in place and followed. They are often used as a surrogate of the quality of healthcare delivered by an institution. Most NEs are surgical and orthopaedic surgery is one of the most involved specialties.</p><p><strong>Objective: </strong>The aim of this study was to identify common NE themes associated with orthopaedics within the National Health Service (NHS) of England.</p><p><strong>Method: </strong>We conducted an observational study analysing the annual NE data published by the NHS England from 2012 to 2020 to collate all orthopaedic surgery-related NE and construct relevant recurring themes.</p><p><strong>Results: </strong>We identified 460 orthopaedic NE out of a total of 3247 (14.16%) reported NE to NHS England. There were 206 Wrong implants/prostheses under 8 different themes. Wrong hip and knee prosthesis were the commonest \"wrong implants\" (n = 94; 45.63% and n = 91; 44.17% respectively). There were 197 \"wrong-site surgery\" incidents in 22 different themes. The commonest of these was the laterality problems accounting for 64 (32.48%) incidents followed by 63 (31.97%) incidents of wrong spinal level interventions. There were 18 (9.13%) incidents of intervention on the wrong patients and 17 (8.62%) wrong incisions. Retained pieces of instruments were the commonest retained foreign body with 15 (26.13%) incidents. The next categories were retained drill parts and retained instruments with 13 (22.80%) incidents each.</p><p><strong>Conclusion: </strong>We identified 47 different themes of NE specific to orthopaedic surgery. Awareness of these themes would help in their prevention. Site marking can be challenging in the presence of cast and on operating on the digits and spine. Addition of a real-time intra-operative implant scan to the National Joint Registry can avoid wrong implant selection while fiducial markers, intraoperative imaging, O-arm navigation, and second time-out could help prevent wrong level spinal surgery.</p>","PeriodicalId":45237,"journal":{"name":"INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE","volume":"33 3","pages":"319-332"},"PeriodicalIF":1.7,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39387635","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":"Introduction to the Rome Declaration.","authors":"Fabiana Brigante","doi":"10.3233/JRS-227001","DOIUrl":"https://doi.org/10.3233/JRS-227001","url":null,"abstract":"<p><strong>Background: </strong>The Global Health Summit was held in Rome on 21 May 2021, co-hosted by the European Commission and Italy, as chair of the G20. Leaders, heads of regional and international organizations met to share lessons learned from the COVID-19 pandemic and to define the path ahead.</p><p><strong>Objective: </strong>The present paper analyses the Rome Declaration as the first global health programme shared among the G20 Member States and based on the One-Health approach.</p><p><strong>Methods: </strong>Documents such as preparatory work, official documents and observations from international organizations were analysed in order to provide a comprehensive review of the Rome Declaration.</p><p><strong>Results: </strong>Core principles of the Rome Declarations have emerged as well as the goal to improve cooperation among existing international organisations and national authorities.</p><p><strong>Conclusions: </strong>Governments' future decisions will be the key to determine the end of the pandemic. The interconnected impacts on health, the environment, and social and economic dimensions will be a central theme of the overall narrative aiming at bringing the G20 process towards achieving a more inclusive and sustainable society.</p>","PeriodicalId":45237,"journal":{"name":"INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE","volume":"33 2","pages":"95-102"},"PeriodicalIF":1.7,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39909098","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":"Can the emergency response be coordinated?","authors":"Federico Laus","doi":"10.3233/JRS-227006","DOIUrl":"https://doi.org/10.3233/JRS-227006","url":null,"abstract":"<p><strong>Background: </strong>In the COVID-19 pandemic, coordination was certainly late, also due to the scarcity of information disseminated at the very beginning of the pandemic, when countries were inevitably taken by surprise. The lack of information, mainly attributable to the country from which everything seems to have started, has produced a huge delay and numerous uncertainties in the feedback of the WHO and international organizations.</p><p><strong>Objective: </strong>The inevitably relevant issue, from a legal point of view, concerns the legitimacy, formal or in any case shared, of the authority in charge of coordinating reactions and policies. The paper analyses the current legislation, soft and hard law, and the undertaken policies concerning emergency responses.</p><p><strong>Methods: </strong>International and EU legislation analysis.</p><p><strong>Results: </strong>The G20 understood that sustainable, flexible and agile funding systems for health emergencies are essential elements of pandemic prevention, preparedness and response. In EU there are many regulations about coordination and response to emergencies in practice in the EU and the Regulation (EU) 2021/522 (EU4Health programme), broadly extends the Union's competence in the field of health and has the objective of strengthening the Union's capacity for prevention, preparedness and rapid response in the event of serious cross-border threats to health.</p><p><strong>Conclusions: </strong>It is essential to formalize, within international agreements, the institutionalization of relationships, procedures, and the possible recognition of the reference figure. If in the European Union, at least partially, the protocols are there (even if the COVID-19 emergency has blown them up in principle), certainly in relations with non-EU countries the story is complicated, requiring specific agreements. This is the goal of the path started by the Rome Declaration of 21 May 2021 within the G20 - Global Health Summit.</p>","PeriodicalId":45237,"journal":{"name":"INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE","volume":"33 2","pages":"103-109"},"PeriodicalIF":1.7,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39910019","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":"Abortion in Europe: Recent legislative changes and risk of inequality.","authors":"Andrea Cioffi,&nbsp;Camilla Cecannecchia,&nbsp;Fernanda Cioffi,&nbsp;Giorgio Bolino,&nbsp;Raffaella Rinaldi","doi":"10.3233/JRS-200095","DOIUrl":"https://doi.org/10.3233/JRS-200095","url":null,"abstract":"<p><strong>Background: </strong>Induced abortion is a medical practice that has always been much discussed all over the world. Abortion is allowed in most European countries at the request of the woman with limitations that are imposed mainly by the gestational age. However, there are legislative differences between European countries which impose stringent limits on the use of induced abortion.</p><p><strong>Objective: </strong>This article analyzes the European legislation on abortion, with a particular focus on countries in which there have been recent legislative changes in recent years, and the possible consequent risk of inequality among European women.</p><p><strong>Methods: </strong>Government and ministerial websites of the countries analyzed have been consulted to investigate abortion laws in Europe. In addition, the Global Abortion Policies Database of the World Health Organization was also consulted for a regulatory comparison.</p><p><strong>Results: </strong>The differences between the various European countries are considerable. Although guaranteed by most legislation, abortion remains a fragile right in some European countries.</p><p><strong>Conclusion: </strong>Different legislation in the various countries of Europe causes difficulties for women who want to have an abortion but who reside in states where there are strict limits to abortion. In addressing the issue of induced abortion, we must not forget that the center of this practice is the woman. For this reason, it is essential to apply a reasoning based on respect for women's rights: freedom, health, and self-determination.</p>","PeriodicalId":45237,"journal":{"name":"INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE","volume":"33 3","pages":"281-286"},"PeriodicalIF":1.7,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39594313","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":"Challenges in setting permitted daily exposure limits for pharmaceuticals: A review.","authors":"Varun Ahuja,&nbsp;Mohan Krishnappa","doi":"10.3233/JRS-210021","DOIUrl":"https://doi.org/10.3233/JRS-210021","url":null,"abstract":"<p><strong>Background: </strong>When more than one drug is manufactured at a shared facility or equipment in pharmaceutical manufacturing, the potential carry-over of the retained residue of existing drug product on product contact parts of the equipment to the next product can be a source of cross contamination. Permitted daily exposure (PDE) is derived based on the complete nonclinical and clinical data available and is a dose that is unlikely to cause adverse effects if an individual is exposed, by any route, at or below this dose every day over a lifetime.</p><p><strong>Objective: </strong>The objective was to present a comprehensive review of available scientific knowledge for derivation of PDE.</p><p><strong>Methods: </strong>PubMed and ScienceDirect databases were searched using keywords \"PDE\" and \"pharmaceuticals\" and all the relevant literature up to March 2021 was reviewed. We have also calculated PDEs for Tobramycin (CAS No. 32986-56-4) and Acetyl Salicylic Acid (ASA, CAS No. 50-78-2).</p><p><strong>Results: </strong>This research will be useful for scientists working in the PDE domain. The given examples emphasize the importance of use of human data in calculating PDE.</p><p><strong>Conclusion: </strong>The duty of the risk assessor entrusted with setting PDEs is to derive a data driven, scientifically justified value that is safe for patients, while avoiding unjustified conservativeness that puts unnecessary burden on manufacturing.</p>","PeriodicalId":45237,"journal":{"name":"INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE","volume":"33 1","pages":"49-64"},"PeriodicalIF":1.7,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39614954","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":"Social distance capacity to control the COVID-19 pandemic: A systematic review on time series analysis.","authors":"Omid Khosravizadeh,&nbsp;Bahman Ahadinezhad,&nbsp;Aisa Maleki,&nbsp;Zahra Najafpour,&nbsp;Rohollah Golmohammadi","doi":"10.3233/JRS-210037","DOIUrl":"https://doi.org/10.3233/JRS-210037","url":null,"abstract":"<p><strong>Background: </strong>Reducing interpersonal contact has been one of the least expensive and most widely used COVID-19 control strategies.</p><p><strong>Objective: </strong>This systematic review has been conducted with the aim of identifying social distancing strategies and policies and their impact on the COVID-19 pandemic.</p><p><strong>Methods: </strong>In order to compile this systematic review, Google Scholar, PubMed, Scopus, Web of Science, Science Direct, Magiran, SID, and Irandoc databases were searched from the COVID-19 outbreak until March 2021. Keywords included \"social\", \"physical\", \"distance\", \"outbreak\", \"incidence\", \"prevalence\", \"spread\", \"new case\", \"death*\", \"mortality*\", \"morbidity*\" , \"covid-19\", \"coronavirus\", \"sars-cov-2\" and \"time series*\". The articles were qualitatively evaluated by two researchers using the STROBE tool. Finally, the study data were divided into three conceptual categories by three researchers, who then agreed on one category. The practical suggestions were also categorized in the same way.</p><p><strong>Results: </strong>The policies and strategies adopted to implement social distancing were included in five categories of restrictions, prohibitions, closures, incentives, and punishments. Transportation and travel restrictions, crowded places and schools closure, use of telecommunications and virtual communications, and financial and psychological support to society members were the main policies in this area.</p><p><strong>Conclusion: </strong>Rapid and complete vaccination of all people around the world is out of reach, therefore social distancing and the implementation of physical restraints, especially in crowded and densely populated environments, should be done extensively until COVID-19 is eradicated.</p>","PeriodicalId":45237,"journal":{"name":"INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE","volume":"33 1","pages":"5-22"},"PeriodicalIF":1.7,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39830631","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":"Documentation of Just in Case (JiC) medication for end of life patients in care homes looked after by a general practice.","authors":"Eve Barnes,&nbsp;Caroline Parfit","doi":"10.3233/JRS-227023","DOIUrl":"https://doi.org/10.3233/JRS-227023","url":null,"abstract":"<p><strong>Background: </strong>This project was undertaken to improve the documentation of Just in Case (JiC) medication in a general practice. The outcome of a Strengths, Weaknesses, Opportunities, Threats (SWOT) analysis highlighted this as an area where awareness within the practice could be improved.</p><p><strong>Objective: </strong>A Plan-Do-Study-Act (PDSA) approach was taken to the project and involved collaborative working and data collection from the general practice and relevant care homes.</p><p><strong>Method: </strong>JiC medications are used to promptly manage symptoms experienced at the end of a patient's life and are part of the Gold Standard Framework (2006).</p><p><strong>Results: </strong>Of the patients registered at the practice with JiC medication, 37.5% were incorrectly documented. This included errors/ inaccuracy with the clinical coding, or the medication. Three patients on practice generated searches had no JiC medication in the care homes, and 4 patients had JiC boxes in the care home that was not identified by the search.</p><p><strong>Conclusion: </strong>This evaluation has identified documentation errors and discrepancies between practice and community records of JiC medication. A newly generated practice specific flowchart was created, with an aim of reducing the discrepancies. A guide of how to carry out a QI project like this was created for the RCGP and can be found on their website. A seminar at Bristol, North Somerset, and South Gloucestershire (BNSSG) CCG to present this project took place in 2021.</p>","PeriodicalId":45237,"journal":{"name":"INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE","volume":"33 S1","pages":"S47-S51"},"PeriodicalIF":1.7,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c9/5c/jrs-33-jrs227023.PMC9844067.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10839544","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":"Improving the delivery of acute NIV at Kings Mill Hospital: A closed loop quality improvement project.","authors":"Bhavandeep Slaich,&nbsp;Frederick Garrett","doi":"10.3233/JRS-227028","DOIUrl":"https://doi.org/10.3233/JRS-227028","url":null,"abstract":"<p><strong>Background: </strong>The British Thoracic Society (BTS) Acute Non-Invasive Ventilation (NIV) standards state all patients who require acute NIV should be initiated on NIV within two hours of hospital admission. The delivery of acute NIV is a time critical intervention as prompt application of acute NIV substantially reduces mortality for patients with acute hypercapnic respiratory failure.</p><p><strong>Objective: </strong>This audit aimed to assess the number of patients for whom there is a delay in the initiation of acute NIV. We also assessed the outcome of admission for patients started on acute NIV.</p><p><strong>Methods: </strong>Data was collected on patients admitted to Kings Mill Hospital for acute NIV between 1/2/2019 and 31/3/2019. Awareness and knowledge of acute NIV was highlighted as an area for improvement. E-learning packages on 'Acute NIV' were designed and sent to medical-staff. The audit was repeated for patients admitted for acute NIV between 1/2/2020 and 31/3/2020 and analysed using chi-square tests.</p><p><strong>Results: </strong>25 patients were included in the initial audit and 30 patients in the re-audit. Prior to intervention 31% of patients had a delay in the initiation of acute NIV, which increased to 77% post-intervention (p < 0.0001). Prior to intervention there was a mortality rate of 17% and a mortality rate of 13% post-intervention (p > 0.05).</p><p><strong>Conclusion: </strong>Further work is required to ensure the sustained delivery of acute NIV to BTS standards, however variable achievements in the targets does not seem to have a significant adverse effect on patient outcomes.</p>","PeriodicalId":45237,"journal":{"name":"INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE","volume":"33 S1","pages":"S73-S77"},"PeriodicalIF":1.7,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7b/02/jrs-33-jrs227028.PMC9844061.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10839546","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":"Proactive care post-discharge to reduce 30 day readmissions to hospital.","authors":"J Choudhury,&nbsp;S Perrio,&nbsp;M Scobell,&nbsp;T Bertram,&nbsp;A Gray","doi":"10.3233/JRS-227022","DOIUrl":"https://doi.org/10.3233/JRS-227022","url":null,"abstract":"<p><strong>Background: </strong>Healthwatch England estimated emergency readmissions have risen by 22.8% between 2012-13 and 2016-17. Some emergency readmissions could be avoided by providing patients with urgent out of hospital medical care or support. Sovereign Health Network (SHN) comprises of three GP practices, with a combined population of 38,000.</p><p><strong>Objective: </strong>We will decrease the number of SHN patients readmitted within 30 days of discharge from Portsmouth Hospitals Trust following a non-elective admission (excluding Emergency Department attendance) by 40-60% by July 2020.</p><p><strong>Methods: </strong>Four Plan, Do, Study, Act (PDSA) cycles were used to test the administrative and clinical processes. Our Advanced Nurse Practitioner reviewed all discharge summaries, added alerts to records, and proactively contacted patients either by text, telephone or home visit.</p><p><strong>Results: </strong>92 patients aged 23 days to 97 years were admitted onto the recent discharge scheme. Half of discharge summaries were received on the day of discharge, whilst 29% of discharge summaries were received more than 24 hours post-discharge, and one was received 11 days post-discharge. Following our interventions, there were 55% less than expected readmissions during the same time period.</p><p><strong>Conclusion: </strong>To allow proactive interventions to be instigated in a timely manner, discharge summaries need to be received promptly. The average readmission length of stay following a non-elective admission is seven days. Our proactive interventions saved approximately 102.9 bed days, with potential savings of 1,775 bed days over a year. We feel the results from our model are promising and could be replicated by other Primary Care Networks to result in larger savings in bed days.</p>","PeriodicalId":45237,"journal":{"name":"INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE","volume":"33 S1","pages":"S41-S45"},"PeriodicalIF":1.7,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b7/ee/jrs-33-jrs227022.PMC9844062.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9329835","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}