Primary Care Respiratory Journal最新文献

{"title":"Wheezing phenotypes in young children: an historical cohort study.","authors":"Alfredo Cano-Garcinuño,&nbsp;Isabel Mora-Gandarillas","doi":"10.4104/pcrj.2014.00008","DOIUrl":"https://doi.org/10.4104/pcrj.2014.00008","url":null,"abstract":"<p><strong>Background: </strong>Wheezing phenotypes in young children have usually been described on the basis of questionnaire surveys instead of prospectively doctor-diagnosed episodes, and have never been described in terms of incidence rates.</p><p><strong>Aims: </strong>To identify wheezing phenotypes in the first three years and describe their incidence trends, and to investigate their relationship with asthma at six years of age.</p><p><strong>Methods: </strong>Doctor-diagnosed wheezing episodes in the first 36 months and active asthma at six years were identified in a historical cohort of 3,739 children followed from birth in 29 primary care health centres in Spain. Wheezing phenotypes were identified by means of latent class analysis. Changes in incidence rates of wheezing were identified through joinpoint regression models and their predictive ability for asthma was analysed.</p><p><strong>Results: </strong>One never/infrequent wheeze phenotype and three wheezing phenotypes were identified. There were two early phenotypes which started wheezing at a median age of six months, one of which was transient while the other had a heavy recurrence of episodes. A third phenotype exhibited a delayed onset of wheezing, a constant rise in incidence through the first 36 months, and a relationship with allergic asthma. These three phenotypes had a higher prevalence of active asthma at six years than the never/infrequent wheeze phenotype, but the classification had a weak predictive ability for asthma due to low sensitivity.</p><p><strong>Conclusions: </strong>The use of incidence rates contributes to the clarification of the natural history of infant wheezing.</p>","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4104/pcrj.2014.00008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32142892","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":"Are GOLD ABCD groups better associated with health status and costs than GOLD 1234 grades? A cross-sectional study.","authors":"Melinde R S Boland,&nbsp;Apostolos Tsiachristas,&nbsp;Annemarije L Kruis,&nbsp;Niels H Chavannes,&nbsp;Maureen P M H Rutten-van Mölken","doi":"10.4104/pcrj.2014.00002","DOIUrl":"https://doi.org/10.4104/pcrj.2014.00002","url":null,"abstract":"<p><strong>Aims: </strong>To investigate the association of the GOLD ABCD groups classification with costs and health-related quality of life (HR-QoL) and to compare this with the GOLD 1234 grades classification that was primarily based on lung function only.</p><p><strong>Methods: </strong>In a cross-sectional study, we selected patients diagnosed with chronic obstructive pulmonary disease (COPD) from electronic medical records of general practices. Multi-level analysis was used with costs (medication, primary care, healthcare, societal), diseasespecific and generic HR-QoL as independent variables. Either the new or the old GOLD stages were included in the analysis together with several covariates (age, gender, living situation, co-morbidity, self-efficacy, smoking, education, employment).</p><p><strong>Results: </strong>611 patients from 28 general practices were categorised as GOLD-A (n=333), GOLD-B (n=110), GOLD-C (n=80) and GOLD-D (n=88). Patients in the GOLD-B and GOLD-D groups had the highest prevalence of co-morbidities and the lowest level of physical activity, self-efficacy, and employment. The models with GOLD ABCD groups were more strongly related to and explained more variance in costs and in disease-specific and generic HR-QoL than the models with GOLD 1234 grades. The mean Clinical COPD Questionnaire score worsened significantly, with scores 1.04 (GOLD-B), 0.4 (GOLD-C) and 1.21 (GOLD-D) worse than for patients in GOLD-A. Healthcare costs per patient were significantly higher in GOLD-B (72%), GOLD-C (74%) and GOLD-D (131%) patients than in GOLD-A patients.</p><p><strong>Conclusions: </strong>The GOLD ABCD groups classification is more closely associated with costs and HR-QoL than the GOLD 1234 grades classification. Furthermore, patients with GOLD-C had a better HR-QoL than those with GOLD-B but the costs of the two groups did not differ.</p>","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4104/pcrj.2014.00002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32049105","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":"Predicting asthma in preschool children at high risk presenting in primary care: development of a clinical asthma prediction score.","authors":"Lonneke B van der Mark,&nbsp;Karina E van Wonderen,&nbsp;Jacob Mohrs,&nbsp;Wim M C van Aalderen,&nbsp;Gerben ter Riet,&nbsp;Patrick J E Bindels","doi":"10.4104/pcrj.2014.00003","DOIUrl":"https://doi.org/10.4104/pcrj.2014.00003","url":null,"abstract":"<p><strong>Background: </strong>A setting-specific asthma prediction score for preschool children with wheezing and/or dyspnoea presenting in primary healthcare is needed since existing indices are mainly based on general populations.</p><p><strong>Aims: </strong>To find an optimally informative yet practical set of predictors for the prediction of asthma in preschool children at high risk who present in primary healthcare.</p><p><strong>Methods: </strong>A total of 771 Dutch preschool children at high risk of asthma were followed prospectively until the age of six years. Data on asthma symptoms and environmental conditions were obtained using validated questionnaires and specific IgE was measured. At the age of six years the presence of asthma was assessed based on asthma symptoms, medication, and bronchial hyper-responsiveness. A clinical asthma prediction score (CAPS) was developed using bootstrapped multivariable regression methods.</p><p><strong>Results: </strong>In all, 438 children (56.8%) completed the study; the asthma prevalence at six years was 42.7%. Five parameters optimally predicted asthma: age, family history of asthma or allergy, wheezing-induced sleep disturbances, wheezing in the absence of common colds, and specific IgE. CAPS scores range from 0 to 11 points; scores <3 signified a negative predictive value of 78.4% while scores of >7 signified a positive predictive value of 74.3%.</p><p><strong>Conclusions: </strong>We have developed an easy-to-use CAPS for preschool children with symptoms suggesting asthma who present in primary healthcare. After suitable validation, the CAPS may assist in guiding shared decision-making to tailor the need for medical or non-medical interventions. External validation of the CAPS is needed.</p>","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4104/pcrj.2014.00003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32089725","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":"Can nurses successfully diagnose and manage patients with COPD?","authors":"Paul Enright,&nbsp;Elizabeth Halcomb,&nbsp;Luis Torre-Bouscoulet","doi":"10.4104/pcrj.2014.00016","DOIUrl":"https://doi.org/10.4104/pcrj.2014.00016","url":null,"abstract":"COPD is a highly prevalent chronic disease which can cost a country hundreds of millions of dollars per year. So it seems appropriate for as much of the diagnosis and care of patients with COPD to be managed by the most cost-effective health care providers as possible whilst maintaining quality outcomes. Disciplines Medicine and Health Sciences | Social and Behavioral Sciences Publication Details Enright, P., Halcomb, E. & Torre-Bouscoulet, L. (2014). Can nurses successfully diagnose and manage patients with COPD?. Primary Care Respiratory Journal, 23 (1), 12-13. This journal article is available at Research Online: http://ro.uow.edu.au/smhpapers/1542 Can nurses successfully diagnose and manage patients with COPD? An editorial invited by the PCRJ Draft of 2 February 2014 Authors: Elizabeth Halcomb RN, PhD, University of Wollongong, NSW Email: ehalcomb@uow.edu.au , Luis Torre-Bouscoulet, MD, INER (Instituto Nacional de Enfermedades Respiratorias), Mexico City, Email: luistorreb@gmail.com ; Paul Enright (The University of Arizona, retired, email: lungguy@gmail.com ) COPD is a highly prevalent chronic disease which can cost a country hundreds of millions (Euros, pounds, or dollars) per year. So it seems appropriate for as much of the diagnosis and care of patients with COPD to be managed by the most cost-effective health care providers as possible whilst maintaining quality outcomes [Fletcher 2003, Nici 2011]. The important study of Strong and colleagues in this month's issue of the PCRJ [Strong 2014] examines a step forward in this process. In addition to the usual care system for patients with COPD, the city of Rotherham, England also has a specialist nurse-led respiratory care centre called “BreathingSpace”. This service is led by a respiratory nurse consultant and has a team of nursing, physiotherapy and occupational therapy staff providing outpatient assessment, diagnosis, and treatment of COPD. The authors evaluated the accuracy of a diagnosis of COPD from over 1200 consecutive patients referred to Breathing Space from the 36 general practices in the city. Around half of these patients were referred for pulmonary rehabilitation. About one in five patients did not have airway obstruction on pre-bronchodilator spirometry testing, indicating that the primary care provider's diagnosis of COPD was incorrect. There was poor agreement between the airflow obstruction grade recorded on the referral and that based on spirometry. Patients referred by a practice nurse were more likely to have been correctly classified when compared to patients referred from a general practitioner (GP). A similar study of the ability of practice nurses to correctly perform spirometry and diagnose COPD was recently completed in 36 GP offices in Sydney, Australia [Bunker 2012]. Of 287 patients given a diagnosis of COPD by the practice nurse, about one-third did not have COPD according to a review and repeat spirometry done by the project officer (a pulmonary subspecialist). ","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4104/pcrj.2014.00016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32140055","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":"Vitamin D and the HLA locus help to explain the relationship between autoimmune and allergic diseases.","authors":"Scott T Weiss","doi":"10.4104/pcrj.2014.00009","DOIUrl":"https://doi.org/10.4104/pcrj.2014.00009","url":null,"abstract":"Vitamin D and the HLA locus help to explain the relationship between autoimmune and allergic diseases","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4104/pcrj.2014.00009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32140056","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":"Challenges of tuberculosis management in high and low prevalence countries in a mobile world.","authors":"Chris Griffiths,&nbsp;Monica Barne,&nbsp;Puneet Saxena,&nbsp;John Yaphe","doi":"10.4104/pcrj.2014.00019","DOIUrl":"https://doi.org/10.4104/pcrj.2014.00019","url":null,"abstract":"Challenges of tuberculosis management in high and low prevalence countries in a mobile world","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4104/pcrj.2014.00019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40299045","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":"Performance of a brief asthma control screening tool in community pharmacy: a cross-sectional and prospective longitudinal analysis.","authors":"Kate S LeMay, Carol L Armour, Helen K Reddel","doi":"10.4104/pcrj.2014.00011","DOIUrl":"10.4104/pcrj.2014.00011","url":null,"abstract":"<p><strong>Background: </strong>Guidelines recommend basing asthma management on assessment of asthma control. Validated control tools, while suitable for clinical research, may not be feasible for routine use in primary care.</p><p><strong>Aims: </strong>To describe the performance of the Pharmacy Asthma Control Screening tool (PACS) compared with the Asthma Control Questionnaire (ACQ-6).</p><p><strong>Methods: </strong>Data were obtained from a multicentre study of a community pharmacy asthma management programme in Australia, with three or four visits over six months. Eligible participants had suboptimal asthma control or no recent visit to their doctor for asthma. Asthma control was assessed at baseline and at six months with the PACS tool and ACQ-6.</p><p><strong>Results: </strong>A total of 570 patients were enrolled and 398 (70%) completed the programme. The average ACQ-6 score was 1.58±1.05 at baseline and 0.96±0.88 (n=392) after six months. Sensitivity and specificity of PACS 'poor control' for not well-controlled asthma (ACQ- 6 >1.0) were 0.92 and 0.66, respectively, at baseline and 0.76 and 0.83 at six months. Agreement between the two tools at six months was moderate (κ=0.54). Both tools showed highly significant change during the study (p<0.0001 for each), but agreement between the change in the two tools was only fair (κ=0.31).</p><p><strong>Conclusions: </strong>This study shows that a simple asthma control screening tool is feasible for use in community pharmacies and has good sensitivity for identifying patients with not well-controlled asthma. Screening tools are useful in primary care to identify patients who require more detailed assessment of their asthma status, whereas for monitoring asthma control over time, a continuous control measure is more appropriate.</p>","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32153256","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":"Management, morbidity and mortality of COPD during an 11-year period: an observational retrospective epidemiological register study in Sweden (PATHOS).","authors":"Björn Ställberg, Christer Janson, Gunnar Johansson, Kjell Larsson, Georgios Stratelis, Gunilla Telg, Karin H Lisspers","doi":"10.4104/pcrj.2013.00106","DOIUrl":"10.4104/pcrj.2013.00106","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) is one of the most common causes of mortality and a major contributor to morbidity. Longitudinal clinical practice data yielding information on the characteristics of the disease, its natural course, and management are limited.</p><p><strong>Aims: </strong>To investigate and describe the COPD population from a nationwide perspective during an 11-year period (1999-2009) with a focus on management, co-morbidity, and mortality.</p><p><strong>Methods: </strong>This observational retrospective epidemiological study linked electronic medical records data from patients with COPD in primary care to mandatory Swedish hospital, drug and Cause of Death registry data from 1999 to 2009 (PATHOS).</p><p><strong>Results: </strong>A total of 21,361 patients with a COPD diagnosis were included (mean age 68.0 years, 53% females). The proportion of patients diagnosed in primary care increased from 59% in 1999 to 81% in 2009 and the mean age at diagnosis decreased from 73 to 66 years. The number of exacerbations decreased from 3.0 to 1.3 and COPD-related hospitalisations decreased from 1.02 to 0.20 per patient per year. Prescriptions of long-acting muscarinic antagonists and fixed combinations of inhaled corticosteroid/long-acting β2-agonist inhalers increased from 0% to 36% and 37%, respectively. The most common co-morbidities were hypertension, heart failure, ischaemic heart disease, and diabetes. Overall life expectancy was 8.3±6.8 years shorter in patients with COPD than in the general population, and all- cause mortality was 3.5 times higher.</p><p><strong>Conclusions: </strong>Management of COPD in Sweden has improved during the 11-year study period. Despite this, patients with COPD have a substantially reduced life expectancy than the general population.</p>","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6443109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31962366","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 Global Alliance against Respiratory Diseases (GARD) Country Report.","authors":"Arzu Yorgancioglu,&nbsp;Alvaro A Cruz,&nbsp;Jean Bousquet,&nbsp;Nikolai Khaltaev,&nbsp;Shanti Mendis,&nbsp;Alexander Chuchalin,&nbsp;Eric D Bateman,&nbsp;Paulo Camargos,&nbsp;Niels H Chavannes,&nbsp;Chunxue Bai,&nbsp;Diana Deleanu,&nbsp;Vitezslav Kolek,&nbsp;Piotr Kuna,&nbsp;Giovanna Laurendi,&nbsp;Mohammed Reza Masjedi,&nbsp;Sonia Mele,&nbsp;Florin Mihaltan,&nbsp;José Rosado Pinto,&nbsp;Boleslaw Samolinski,&nbsp;Giselda Scalera,&nbsp;Talant Sooronbaev,&nbsp;Mohamed Awad Tageldin,&nbsp;Le Thi Tuyetlan,&nbsp;Osman Yusuf,&nbsp;Cezmi Akdis,&nbsp;Abay Baigenzhin,&nbsp;Carlos Baena Cagnani,&nbsp;Monica Fletcher,&nbsp;Bilun Gemicioglu,&nbsp;Yousser Muhammed,&nbsp;Hironori Sagra,&nbsp;Teresa To,&nbsp;Antje-H Fink Wagner","doi":"10.4104/pcrj.2014.00014","DOIUrl":"https://doi.org/10.4104/pcrj.2014.00014","url":null,"abstract":"The Global Alliance against Respiratory Diseases (GARD) is a network led by the World Health Organization (WHO), which aims to raise the recognition of the importance of chronic respiratory diseases (CRDs) as one of the most important health problems globally . GARD member countries develop activities against CRD to meet the needs of their own country . This paper aims to evaluate the ongoing activities in member countries while emphasizing the importance of CRDs.","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4104/pcrj.2014.00014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32155508","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":"Accuracy of diagnosis and classification of COPD in primary and specialist nurse-led respiratory care in Rotherham, UK: a cross-sectional study.","authors":"Mark Strong, Angela Green, Elizabeth Goyder, Gail Miles, Andrew C K Lee, Gurnam Basran, Jo Cooke","doi":"10.4104/pcrj.2014.00005","DOIUrl":"10.4104/pcrj.2014.00005","url":null,"abstract":"<p><strong>Background: </strong>Studies have suggested that chronic obstructive pulmonary disease (COPD) is commonly misdiagnosed and misclassified in primary care, but less is known about the quality of diagnosis in specialist respiratory care.</p><p><strong>Aims: </strong>To measure the accuracy of COPD diagnosis and classification of airway obstruction in primary care and at a specialist respiratory centre, and to explore associations between misdiagnosis and misclassification and a range of explanatory factors.</p><p><strong>Methods: </strong>Data were obtained for 1,205 referrals to a specialist respiratory centre between 2007 and 2010. Standard analysis methods were used.</p><p><strong>Results: </strong>The majority of patients were referred for pulmonary rehabilitation (676/1,205, 56%). Of 1,044 patients with a primary care diagnosis of COPD, 211 (20%) had spirometry inconsistent with COPD. In comparison, of 993 specialist centre diagnoses, 65 (6.5%) had inconsistent spirometry. There was poor agreement between the airflow obstruction grade recorded on the referral and that based on spirometry (kappa=0.26, n=448), whereas agreement between the respiratory centre assessment of airflow obstruction and spirometry was good (kappa=0.88, n=1,016). Referral by practice nurse was associated with accuracy of airflow obstruction classification in primary care (OR 1.85, 95% CI 1.33 to 2.57). Males were more likely than females to have an accurate specialist care classification of airway obstruction (OR 1.40, 95% CI 1.01 to 1.93). Grade of airway obstruction changed between referral and assessment in 56% of cases.</p><p><strong>Conclusions: </strong>In primary care, a proportion of patients diagnosed with COPD do not have COPD, and misclassification of grade of airflow obstruction is common. Misdiagnosis and misclassification is less common in the specialist care setting of BreathingSpace.</p>","PeriodicalId":48998,"journal":{"name":"Primary Care Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32074257","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}