Journal of Primary Care and Community Health最新文献

{"title":"Compliance and Performance of Hand Hygiene in Dutch General Practice Offices Using Electronic Dispensers.","authors":"Nataliya Hilt, Matthijs S Berends, Mariëtte Lokate, Bert Tent, Andreas Voss","doi":"10.1177/21501319251334218","DOIUrl":"https://doi.org/10.1177/21501319251334218","url":null,"abstract":"<p><strong>Introduction: </strong>One of the most effective measures for the reduction and prevention of healthcare-associated infections (HAI) is hand hygiene (HH). Covert direct observation of HH is difficult to realize in general practice office (GPO). The World Health Organization recognizes electronic monitoring as a form of measuring product use and estimating compliance. This is the first study to monitor HH performance electronically in Dutch GPOs.</p><p><strong>Objectives: </strong>The main aim of this study was to evaluate HH compliance in general practice offices.</p><p><strong>Methods: </strong>An observational study was conducted at 4 Dutch GPOs between 2019 and 2021. We measured HH compliance using data on HH events (HHE) from alcohol-based hand rub (ABHR) dispensers with a built-in electronic counter. Daily HH opportunities were calculated according to the 'Five Moments for Hand Hygiene' based on the continuously documented activities using general practitioners (GPs) patient electronic dossier systems.</p><p><strong>Results: </strong>In total, hand hygiene was performed during 1786 of the estimated 4322 opportunities (41%). HH compliance for the general practitioners, practice assistants, and nurse practitioners was 38%, 51%, and 43%, respectively. The overall HH compliance within the same GPOs was 42% pre-pandemic and rose to 56% during the pandemic. The overall mean volume of ABHR was 2.44 ml, varying per HHE between 1.91 to 2.55 ml. The mean volume of ABHR measured before and during the pandemic rose from 2.55 ml to 2.81 ml. The overall self-reported compliance was 86% and was highest among nurse practitioners.</p><p><strong>Conclusions: </strong>Hand hygiene compliance among HCWs in Dutch GPOs was found to be 41%, with general practitioners having the lowest compliance and practice assistants the highest compliance. While the mean volume of ABHR used per HHE seems appropriate, directed observations would be needed to ensure that an adequate hand-rub technique was used to cover the whole hand. Multi-modal interventions are needed to improve HH-compliance and stimulate the switch to ABHR with in the Dutch general practice office.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251334218"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015292","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":"Evaluating the Impact of the Medication Therapy Management Program on Patients' Blood Pressure and Obesity: A Pre-Post Study.","authors":"Hossein Zare, Augustine C Amuta, Magaly Rodriguez de Bittner, Sade Osotimehin, Laurine Thomas, Twarnisha M Stokes, Amber Allen, Jacob Riley, Caitlin L Murphy, Debra M Collier, Roland J Thorpe, Michelle Spencer, Lois Dankwa, Ernest L Carter, Darrell J Gaskin","doi":"10.1177/21501319251332721","DOIUrl":"https://doi.org/10.1177/21501319251332721","url":null,"abstract":"<p><strong>Background: </strong>Hypertension and obesity are major public health problems in the United States and Maryland.</p><p><strong>Objectives: </strong>To assess the impact of Medication Therapy Management (MTM) on controlling hypertension and obesity in a sample in Southern Maryland: Prince George's, Calvert, Charles, and St. Mary's counties.</p><p><strong>Methods: </strong>171 patients with high blood pressure were enrolled in an MTM program for 12 months. Patients received at least one pharmacist consultation between September 2021 and September 2023. We employed a pre-post prospective study design to assess the impact of MTM on patients' blood pressure management. We examined the association between MTM and systolic blood pressure (SBP) and diastolic BP (DBP) as the primary outcome, and weight and body mass index (BMI) as secondary outcomes. We used descriptive analysis and fixed effect regression models to present the association between outcome variables and enrollment time in the program.</p><p><strong>Results: </strong>Our findings showed that the MTM reduced uncontrolled hypertension by 17.5 percentage points, weight by 3.6lbs (10.2), and BMI by 0.6 kg/m² (2.1). The regression model showed that the MTM intervention reduced the prevalence of uncontrolled hypertension (-1.81, CI: [-3.11, -0.51]), and obesity (BMI > 30, -1.85 (CI: [-3.12, -0.57]), by 12 months of enrolling in the program. During this time SBP reduced to -10.37 mmHg (CI: [-19.62, 1.2]).</p><p><strong>Conclusions: </strong>Our results suggest that policymakers should prioritize promoting MTM services as an effective means of blood pressure control. Combining a community health worker (CHW) model with community-based pharmacists can further improve health outcomes for patients with hypertension.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251332721"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12033464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006428","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":"A New Model of Care: Community Appointment Day Outcomes and Impact on Musculoskeletal Physiotherapy Waiting Times.","authors":"Helen Alexander, Alan Sinclair, Laura Dover, Brian Slattery, Ruth Currie, Mark Russell, Judith Cain","doi":"10.1177/21501319251334036","DOIUrl":"https://doi.org/10.1177/21501319251334036","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to test the introduction of Community Appointment Days (CADs) for patients on the Musculoskeletal (MSK) Physiotherapy waiting list in Lanarkshire, UK.</p><p><strong>Methods: </strong>A multi-professional team developed, implemented, and evaluated the first 2 CADs on 16th and 17th April, 2024. The mixed-methods design involved patients completing a \"passport\" (which included a survey) on the day and being followed up 4 weeks later by survey or interview. The patient management system was interrogated for waiting times and numbers returning to the service within 6 months. Structured thematic analysis was used to create a conceptual model from the qualitative data.</p><p><strong>Results: </strong>More than 3 times as many patients were booked into a CAD appointment (n = 443) compared to routine outpatient clinics (n = 133), and the vast majority reported positive outcomes. A total of 52 attendees (12%) were discharged on the day and a further 202 (46%) with Patient Initiated Review (PIR). Only 126 (28%) were given a follow-up 1:1 Physiotherapy appointment, although 63 (14%) did not attend on the day. Of the 443 booked, 26 (6%) returned for an additional review MSK outpatient appointment within 6 months.</p><p><strong>Conclusions: </strong>The CADs had positive outcomes for patients and were successful in reducing waiting times.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251334036"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987950","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":"The 5 A's Approach to Promoting Nutrition Counseling in Primary Care.","authors":"Farhad Mehrtash, JoAnn E Manson","doi":"10.1177/21501319251338566","DOIUrl":"10.1177/21501319251338566","url":null,"abstract":"<p><p>Poor dietary habits are a major contributor to chronic disease burden, yet nutrition counseling remains underutilized in primary care settings despite proven effectiveness. This article presents a novel adaptation of the 5 A's framework (Assess, Advise, Agree, Assist, Arrange) titled 'The 5 A's Approach to Promoting Nutrition Counseling in Primary Care', by incorporating validated assessment tools and evidence-based strategies to support implementation in clinical settings. To address practical challenges, implementation approaches are proposed including alternative delivery and payment models. The 5 A's adaptation can be a tool used to address the critical need for standardized nutrition counseling in primary care.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251338566"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129134","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":"Primary Care Providers Versus Abnormal Skin Lesions: Elastic Scattering Spectroscopy to the Rescue.","authors":"Svetomir N Markovic","doi":"10.1177/21501319251347905","DOIUrl":"10.1177/21501319251347905","url":null,"abstract":"","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251347905"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12206973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530241","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":"Factors Influencing Primary Care Physicians' Adjustment of Oral Anti-Diabetic Drugs in Patients with Type 2 Diabetes Mellitus: A Qualitative Research Study.","authors":"Natasha Sheng Yeng Leng, Shera Chaterji, Aminath Shiwaza Moosa, Patricia Ching Yen Chia, Lay Geok Lian, ZhengHua Li, Natalie Ming Foong Hooi, Beth Shin Rei Lau, Ngiap Chuan Tan","doi":"10.1177/21501319251348973","DOIUrl":"10.1177/21501319251348973","url":null,"abstract":"<p><strong>Background: </strong>Primary care physicians' (PCPs) prescription of oral anti-diabetic drugs (OADs) is pivotal to optimise glycaemic control of patients with type 2 diabetes mellitus (T2DM). Their decision-making process is not well-understood and is postulated to be multi-factorial. The study aimed to explore the factors influencing the prescribing behaviour of PCPs managing patients with T2DM in an urban setting.</p><p><strong>Methods: </strong>A qualitative methodology using a descriptive-interpretive approach was employed for this study. Qualitative data from 23 PCPs was collected via 3 focus group discussions and 10 in-depth interviews using a semi-structured topic guide. PCPs with various experiences, qualifications and backgrounds were purposively recruited from public and private primary care clinics in Singapore. The audio-recorded interviews were transcribed verbatim and audited for accuracy. Thematic analysis was conducted and the emergent themes were grouped under the domains of the 'Generalist Wheel of Knowledge, Understanding and Inquiry' framework. The data was managed using Nvivo qualitative management software.</p><p><strong>Results: </strong>The 4 main themes identified were clinician experience and knowledge, patient clinical risk stratification and preference, diabetes severity and drug factors, and healthcare system. PCPs' prior experience with OADs, years of practice, academic roles and knowledge resources influenced their decision-making when prescribing OADs. Their prescription was guided by patient preferences and comorbidities, such as selecting sodium-glucose cotransporter-2 inhibitors for patients with proteinuria. Disease severity, OADs safety profile, efficacy, stipulations in the drug formulary, cost and availability of OADs in their pharmacy, and social worker support were other factors affecting PCPs' prescribing habits of OADs. Clinical decision support functionality in the electronic medical record (EMR) system prompted PCPs to select the type of OADs during the consultation.</p><p><strong>Conclusions: </strong>The study highlights the multifaceted factors influencing PCPs' prescribing of OADs, including clinical experience, patient preferences, drug formulary limitations, medication costs and EMR utilisation. To enhance prescribing habits, interventions should focus on continuous education for PCPs, expanding drug formularies, addressing patients' preferences, cost and access barriers through subsidies and promoting the adoption of EMRs with clinical decision support systems in both public and private sectors.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251348973"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486555","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":"The Impact of Trusted Community Navigators in Improving Care Utilization Patterns for a Population With Chronic Kidney Disease Enrolled in Medicare Advantage: A Longitudinal Claims Based Study.","authors":"Claude Pinnock, Francesca Gordon, Jordan Ziskin, Tom Carlough, Ken Wake","doi":"10.1177/21501319251347133","DOIUrl":"10.1177/21501319251347133","url":null,"abstract":"<p><strong>Background: </strong>Chronic Kidney disease (CKD) accounts for approximately 82 billion dollars of Medicare spend. Implementing culturally competent, community-based programs may be a strategy for changing utilization behaviors and lowering cost while maintaining quality in this population.</p><p><strong>Methods: </strong>A longitudinal claims based study was carried out from April 2023 to August 2024 in the state of CA to assess the impact of the program on cost, utilization, and quality metrics. A propensity matched approach was leveraged yielding of 203 pairs of CKD Medicare Advantage (MA) enrollees. A comparison of the difference of differences was performed between utilization, and available claims-based quality metrics.</p><p><strong>Results: </strong>Enrollees in the peer support program, Connect For Life (CFL) generated significantly lower costs of $461 pmpm (95% CI = -1037 to -10 037; <i>P</i> = .016) significantly lower inpatient utilization of 172 per 1000 (95% CI = -10 to -330; <i>P</i> = .037) and significantly higher outpatient utilization of 1212 per 1000 (95% CI = 90 to 2340; <i>P</i> = .035). No differences were found in available quality metrics.</p><p><strong>Conclusions: </strong>For CKD MA enrollees in the intervention population, more efficient utilization patterns and lower costs while maintaining quality were observed. The tight propensity match left the study underpowered to detect significant changes for other care settings or individual stages of CKD.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251347133"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310594","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":"Current Approaches to Addressing Burnout and Moral Injury: Experiences from Four Community Health Centers.","authors":"Patricia Pittman, Samantha Meeker","doi":"10.1177/21501319251342103","DOIUrl":"10.1177/21501319251342103","url":null,"abstract":"<p><strong>Background: </strong>Burnout among Community Health Center (CHC) providers has worsened post-COVID-19, exacerbated by understaffing and heightened recruitment challenges due to competition from higher-paying hospitals and private practices.</p><p><strong>Objective: </strong>This exploratory qualitative study investigates strategies used by four leading CHCs to address perceived drivers of burnout among their providers.</p><p><strong>Methods: </strong>The study used qualitative interviews with CHC staff to explore approaches to mitigating burnout. Focus was placed on organizational strategies, staff engagement, and operational changes aimed at enhancing provider wellbeing.</p><p><strong>Results: </strong>Key challenges included low funding and rapid growth, leading to staffing shortages and strained relationships between staff and leadership. Common strategies to combat burnout involved: (1) emphasizing the CHC mission of supporting staff wellbeing, (2) creating onboarding and workforce development programs focused on support, (3) implementing operational changes to reduce workloads and maximize patient care time, (4) fostering staff involvement in decision-making, and (5) using wellness surveys with the expectation of visible changes based on feedback.</p><p><strong>Conclusion: </strong>The study found that employee voice is crucial in addressing burnout, contrasting with wellness approaches that focus solely on individual staff members. Involving staff in decision-making and addressing systemic issues are viewed by participants as essential strategies for mitigating burnout in CHCs.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251342103"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12166234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144289693","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":"Family Physicians' Perceived Needs Regarding Their Mental Health and Wellbeing in Infectious Catastrophic Events: A Mixed Studies Literature Review.","authors":"Sima Zahedi, Pierre-Paul Tellier, Francesca Luconi, Genevieve Gore, Charo Rodríguez","doi":"10.1177/21501319251356557","DOIUrl":"10.1177/21501319251356557","url":null,"abstract":"<p><strong>Introduction: </strong>During catastrophes, physicians face significant stress and emotional challenges. This review explored existing evidence about the challenges family physicians face during infectious catastrophes, and their perceived well-being needs.</p><p><strong>Materials and methods: </strong>We conducted a mixed studies literature review using 2 databases, Ovid MEDLINE ALL (1946 to February 2023) and PsycInfo on Ovid (1806 to February 2023). To assess methodological quality, we used Mixed Methods Appraisal Tool. The extracted data were analyzed employing a data-based convergent mixed methods design.</p><p><strong>Results: </strong>Thirty-four (34) studies met the criteria for data extraction. Line-by-line coding for thematic analysis was applied to Result and Discussion sections of included articles. Findings were categorized into 4 levels: Societal, Institutional, Organizational, and Individual. Seven themes were identified in total.</p><p><strong>Discussion: </strong>Public health authorities should focus on systemic changes, including organizational development to improve coordination within and across organizations. Clinician involvement in decision-making, clear communication, mental health support, and adequate resources are crucial. Policy implications underscore the necessity for healthcare policies prioritizing physician well-being, and organizational support during infectious catastrophes. Improving work conditions extends beyond personal protective equipment (PPE) access, requiring swift betterment of service innovations, with ongoing reassessment for sustainable care planning, financing, and delivery beyond emergencies.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251356557"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12290357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691985","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":"Integrated Care for People Living With Rare Disease: A Scoping Review on Primary Care Models in Organization for Economic Cooperation and Development Countries.","authors":"Nada Vidic, Anna McGlynn, Fatemeh Abdi, Chun Wah Michael Tam, Reginald Michael Crampton, Kean-Seng Lim, Elizabeth Emma Palmer, Natalie Taylor, Ben Harris-Roxas","doi":"10.1177/21501319241311567","DOIUrl":"10.1177/21501319241311567","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>Individually rare, rare diseases are collectively common resulting in frequent health system use. Navigating the health system persists as a challenge. Primary care provides longitudinal contact with the health system and is placed to provide integrated rare-disease-care.</p><p><strong>Methods: </strong>This scoping review used Joanna Briggs Institute and PRISMA methods with a Consolidated Framework for Implementation Research based data extraction tool to find how integrated rare-disease-care is delivered, enablers and barriers to the same, in primary care settings in contemporary literature in OECD countries.</p><p><strong>Results: </strong>The Primary Care Provider (PCP) role varies from routine primary care to shared-rare-disease-care models. In the 26 papers, the most frequently cited PCP roles included involvement in diagnosis (n = 14), care coordination (n = 16), primary and preventative care (n = 18), management of components of rare-disease-care (n = 13), and treatment monitoring (n = 10). Individuals whose PCP was actively involved in their care were reported to have shortened diagnostic delay, improved transitions of care across the lifespan, reduced unplanned utilization of emergency and hospital services, comprehensive psychosocial care, improved quality of life across environments including home, school and work and improved palliative care experiences.</p><p><strong>Conclusions: </strong>Sufficient communication from specialists, information, resources, time and reimbursement for complex care are still needed. Future integrated-rare-disease-care models should be developed by, or with, PCPs.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319241311567"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956796","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}