Journal of the American Pharmacists Association最新文献

{"title":"Implementing a pharmacist collaborative practice agreement to improve a Medicare quality measure: Statin use in persons with diabetes","authors":"Anna Sandalidis,&nbsp;Christina M. Polomoff,&nbsp;Sean M. Jeffery","doi":"10.1016/j.japh.2025.102347","DOIUrl":"10.1016/j.japh.2025.102347","url":null,"abstract":"<div><h3>Background</h3><div>Statin use in persons with diabetes (SUPD) is a Centers for Medicare and Medicaid Services star quality measure used in Medicare Part D. This measure assesses the Part D plans' success in prescribing statins to individuals with diabetes between the age of 40–75 years. This paper illustrates how pharmacists can improve SUPD star ratings by using a collaborative drug therapy management (CDTM) agreement to initiate statin therapy.</div></div><div><h3>Methods</h3><div>In 2023, pharmacists in a clinically integrated delivery network implemented a CDTM for closing SUPD gaps in care (GICs). Utilizing payer claims data, the pharmacists analyzed multiple years of SUPD results. Open GICs were categorized by practice location, provider, and measurement year. Results were stratified into providers with lower SUPD closure rates (less than 80%) and higher open GIC. Practice locations with the highest number of GIC were prioritized for the pharmacist intervention.</div></div><div><h3>Results</h3><div>By close of member year 2022, 7529 individuals were identified as SUPD eligible individuals from within the employed medical group. Of the 7529 patients, 85.4% were prescribed a statin, leaving 1098 individuals, cared for by 277 providers with open GICs. There were 76 practice locations showing a range of 5–48 open GICs. Provider open GIC ranged from 1 to 13 (mean 2.57). By the end of measurement year 2023, pharmacists increased SUPD star ratings from 2 to 4 stars with two payers and from 2 to 3 stars with 1 payer.</div></div><div><h3>Conclusion</h3><div>Expanded CDTM law enables qualified pharmacists to play a pivotal role in influencing population health outcomes. With a CDTM agreement, pharmacists can overcome barriers to initiating statins for eligible individuals and thereby directly impact star ratings.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 3","pages":"Article 102347"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Marginal structural models to evaluate the association between adherence to direct oral anticoagulants and safety or efficacy outcomes among patients with atrial fibrillation","authors":"Anjana Mohan,&nbsp;Hua Chen,&nbsp;Ashish A. Deshmukh,&nbsp;Matthew Wanat,&nbsp;Ekere James Essien,&nbsp;Rutugandha Paranjpe,&nbsp;Bilqees Fatima,&nbsp;Susan Abughosh","doi":"10.1016/j.japh.2025.102355","DOIUrl":"10.1016/j.japh.2025.102355","url":null,"abstract":"<div><h3>Background</h3><div>Although the management of atrial fibrillation (AF) has improved over the years, suboptimal adherence to direct oral anticoagulants (DOACs) is a major health concern. Adherence and long-term persistence to DOACs decline over time resulting in increased risks of stroke, major bleeding, and death.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate the association between adherence to DOACs and composite or bleeding events using marginal structural models (MSMs).</div></div><div><h3>Methods</h3><div>A retrospective study was conducted using the Medicare Advantage Plan from January 2016 to December 2020. Patients with AF prescribed any DOACs were identified. Adherence was calculated using the proportion of days covered (PDC). Patients with PDC ≥ 0.80 were considered adherent. Composite (stroke, systemic embolism, acute coronary syndrome) and bleeding (major and minor) events were calculated for each of the 4 time periods. An MSM was conducted to estimate the association between adherence and composite efficacy or bleeding events by controlling for time-dependent covariates and time-dependent exposure affected by the previous exposure.</div></div><div><h3>Results</h3><div>A total of 1969 patients with AF were included in the study. Adherence was suboptimal during all the 5 time periods, and it ranged from 39.8% to 53.12%. This study did not find any significant association between adherence to DOACs and composite efficacy or bleeding events. The safety and efficacy outcomes were comparable among apixaban, rivaroxaban, and dabigatran.</div></div><div><h3>Conclusion</h3><div>This study revealed that adherence declined over time among old patients with AF. Future studies should explore the association between adherence to DOACs and health outcomes for a longer duration of follow-up using MSM.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 3","pages":"Article 102355"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mixed-methods systematic review of pharmacist-administered injectable contraception: Insights from patients, pharmacists, and other health care professionals","authors":"Nicole E. Cieri-Hutcherson,&nbsp;Timothy C. Hutcherson,&nbsp;Elizabeth M. Bradley,&nbsp;John Rizk,&nbsp;Nicholas D. Steele","doi":"10.1016/j.japh.2025.102360","DOIUrl":"10.1016/j.japh.2025.102360","url":null,"abstract":"<div><h3>Background</h3><div>The role of the pharmacist in reproductive health and contraception management continues to expand. Examination of the perspectives of patients, pharmacists, and other health care professionals can highlight both the benefits and challenges associated with pharmacist administration of injectable contraception.</div></div><div><h3>Objectives</h3><div>The objective of this systematic review was to assess the feasibility, applicability, and satisfaction of patients, pharmacists, and other health care professionals regarding pharmacist-administered injectable contraception.</div></div><div><h3>Methods</h3><div>Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a search of Medline and Embase databases, from inception through June 3, 2024, was conducted using a predefined search strategy to capture relevant records. Initial records were screened based on the prespecified inclusion criteria focusing on patient, pharmacist, and other health care professional outcomes related to the pharmacist administration of injectable contraceptives. After deduplication and screening, 3 independent reviewers (E.M.B., J.R., N.D.S.) extracted data, with any disagreements resolved through discussion by a fourth reviewer (T.C.H.). Risk of bias (RoB) was assessed using the revised Cochrane RoB tool for randomized studies and the Appraisal Tool for Cross-Sectional Studies. A convergent, integrated, mixed-methods approach was utilized to analyze both qualitative and quantitative data.</div></div><div><h3>Results</h3><div>Five cross-sectional studies and 1 randomized controlled trial were included. Pharmacists were interested in administering injectable contraceptives and reported that implementation would positively impact patient access and convenience. Quantitative analysis demonstrated that pharmacists felt confident and capable in this role and expressed the need for further training and resources. Qualitative analysis highlighted patient satisfaction for the convenience and accessibility, specifically in rural areas. Barriers included insufficient training, lack of infrastructure, mixed acceptance among other health care professionals, reimbursement, and regulatory frameworks.</div></div><div><h3>Conclusion</h3><div>Pharmacist-administered injectable contraception appears to be beneficial, accessible, and convenient for patients while aligning with pharmacists' capabilities and professional roles. Barriers should be addressed when considering implementation. Future research should aim to broaden the evidence-based research across different regions and explore long-term outcomes.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 3","pages":"Article 102360"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of different intervention models to decrease no-show rates of embedded pharmacy visits","authors":"Lyric Chaplin,&nbsp;Patrick Gregory,&nbsp;Benjamin Smith,&nbsp;Brittney Champagne,&nbsp;Amit Patel,&nbsp;Holly Alvarado,&nbsp;Marie Tuft,&nbsp;Joshua Burrows,&nbsp;Alice Parish,&nbsp;Alaattin Erkanli","doi":"10.1016/j.japh.2025.102364","DOIUrl":"10.1016/j.japh.2025.102364","url":null,"abstract":"<div><h3>Background</h3><div>Clinical pharmacist practitioners (CPPs) are embedded in several Duke Primary Care (DPC) clinic locations. CPPs are able to independently modify medications and order labs within protocol in collaboration with a supervising physician. Patient no-shows for CPP appointments are costly to clinics. The purpose of this study was to determine the impact of 2 interventions on patient no-show rates for CPP appointments and to identify barriers patients may face that lead to no-shows.</div></div><div><h3>Objective</h3><div>Determine if the interventions were associated with a change in the no-show rate for embedded DPC CPP appointments.</div></div><div><h3>Methods</h3><div>Single-center, prospective, intervention study of no-show rates of DPC clinical pharmacist appointments. Appointments with patients under 18 years of age were excluded. Interventions were implemented between September 2023 and November 2023. The interventions consisted of a reminder message sent to the patient or a conversion of an in-person visit to a virtual visit if the patient was more than 5 minutes late. The intervention groups were compared to a control group from 1 year prior. A chi-square test was used to compare no-show rates.</div></div><div><h3>Results</h3><div>Total of 1645 appointments were included. The no-show rate was 20.4% in the control arm, 18.0% in the patient portal message arm, and 15.7% in the virtual arm. Average estimated financial loss per day due to no-shows was numerically lower in the intervention groups compared to the control group.</div></div><div><h3>Conclusion</h3><div>The 2 intervention groups experienced numerically lower no-show rates in comparison to the control, but the differences were not statistically significant. We were not able to identify specific patient barriers that were associated with increased likelihood to no-show. More studies are needed to further evaluate the impact of these interventions. Next steps involve the feasibility and implementation of these interventions into clinic workflow on a long-term basis.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 3","pages":"Article 102364"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacist-led sulfonylurea deprescribing in older adults","authors":"Katherine Busque,&nbsp;Emma R. Blackmore,&nbsp;David Fox,&nbsp;Kristen Foli,&nbsp;Karina Wold,&nbsp;Joshua Fendelander","doi":"10.1016/j.japh.2025.102387","DOIUrl":"10.1016/j.japh.2025.102387","url":null,"abstract":"<div><h3>Background</h3><div>Sulfonylureas are a high-risk medication in the elderly due to risk of hypoglycemia. Given the continued use of these low-cost medications in elderly patients over recent decades and guideline recommendations for individualized glycosylated hemoglobin (A1c) goals in the elderly, opportunities exist to reduce use in patients with well-controlled diabetes. Hypoglycemia is a costly and potentially deadly adverse effect of inappropriate treatment with sulfonylureas in older adults.</div></div><div><h3>Objectives</h3><div>To decrease hypoglycemia risk with a clinical pharmacist-led intervention by systematically deprescribing sulfonylureas in a cohort of elderly patients.</div></div><div><h3>Methods</h3><div>Patients in a managed care setting aged ≥ 80 years with a tightly controlled A1c (≤ 6.5%) and a sulfonylurea pharmacy claim in the previous 120 days were identified as candidates for deprescribing. Medical data were reviewed to determine the clinical appropriateness of sulfonylurea discontinuation for each patient. Physicians were contacted to consider deprescribing based on pertinent clinical characteristics of identified patients, current guideline recommendations, and rationale for deprescribing.</div></div><div><h3>Results</h3><div>Eighty-nine patients were identified as candidates for discontinuation. Of these, sulfonylurea was discontinued in 41% (n = 37) of patients following pharmacist intervention. Average A1c following intervention remained within generalized guideline goals.</div></div><div><h3>Conclusion</h3><div>Pharmacist-led interventions can facilitate successful deprescribing by providing systematic guidance, medication therapy expertise, and collaborative decision-making support for physicians.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 3","pages":"Article 102387"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cover","authors":"","doi":"10.1016/S1544-3191(25)00087-1","DOIUrl":"10.1016/S1544-3191(25)00087-1","url":null,"abstract":"","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 3","pages":"Article 102408"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144099367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacy harm reduction practices to help reduce opioid overdoses, Arizona 2023","authors":"Beth E. Meyerson,&nbsp;Sara Richter,&nbsp;Rosalie Gordon,&nbsp;Ethan P.Y. Chang,&nbsp;Nina Vadiei,&nbsp;Lori A. Eldridge,&nbsp;Elias O. Higbie,&nbsp;Ava A. Pal,&nbsp;Addison Seckar-Martinez,&nbsp;Kylee Newgass,&nbsp;Heather M. Lorenz,&nbsp;Irene Garnett","doi":"10.1016/j.japh.2025.102348","DOIUrl":"10.1016/j.japh.2025.102348","url":null,"abstract":"<div><h3>Background</h3><div>Characterizing pharmacies based on their practices, community need for such practices and pharmacy type could advance pharmacy-based intervention precision to reinforce or increase pharmacy practices related to reducing opioid overdose deaths.</div></div><div><h3>Objective</h3><div>To measure a combination of 3 pharmacy practices focused on opioid overdose death reduction and explore whether there are discernable groupings related to practices, pharmacy characteristics, and community characteristics.</div></div><div><h3>Methods</h3><div>A telephone survey was conducted between August 1, 2023 and October 8, 2023 with the pharmacist on duty at 921 Arizona community pharmacies. The survey measured pharmacy characteristics, buprenorphine stocking, buprenorphine and naltrexone dispensing, likelihood of methadone dispensing for opioid use disorder (OUD) when legally permitted, and interest in state-subsidized naloxone dispensing.</div></div><div><h3>Results</h3><div>A response rate of 22.6% was achieved (N = 208). The vast majority (93.8%) of pharmacies stocked buprenorphine and dispensed buprenorphine or naltrexone. About half (47.6%) were very likely or somewhat likely to dispense methadone for OUD when permitted. Metropolitan pharmacies were less likely to dispense methadone compared to rural pharmacies (45.1% Vs. 75.0%). Among pharmacies not likely to dispense methadone, 85.3% were located in counties with opioid overdose death rates above the national average. About half of pharmacies indicated interest in enrolling as a distributor of state-subsidized naloxone. When considered together as pharmacy practices, 26% of pharmacies reported frequent buprenorphine or naltrexone dispensing, expressed interest in subsidized naloxone dispensing and a likelihood of methadone dispensing. Latent class analysis yielded 4 distinct groups of pharmacies ranging from those only dispensing buprenorphine or naltrexone frequently to adopters of the 3 pharmacy practices related to opioid overdose reduction in the community. The ‘adopters’ who frequently dispensed buprenorphine or naltrexone, who had interest in subsidized naloxone, and would likely dispense methadone for OUD tended to be in metropolitan or small/rural areas but tended not to be mass merchandizers.</div></div><div><h3>Conclusion</h3><div>An emerging group of pharmacies shows potential for greater adoption of pharmacy practices to reduce opioid overdose. Larger, multistate studies will help verify pharmacy latent class groups for greater precision of pharmacy practice interventions to reduce opioid overdose in communities. It is crucial to explore why pharmacies in higher need counties are not likely to adopt practices related to opioid overdose reduction.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 3","pages":"Article 102348"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ensuring safety in cytotoxic drug preparation: A systematic review of guidelines addressing education for pharmacy professionals","authors":"Fernando Moreira,&nbsp;Ângelo Jesus,&nbsp;Cláudia Pinho,&nbsp;Marlene Santos,&nbsp;Mélanie Serdoura,&nbsp;Agostinho Cruz","doi":"10.1016/j.japh.2025.102352","DOIUrl":"10.1016/j.japh.2025.102352","url":null,"abstract":"<div><h3>Background</h3><div>Chemotherapy preparation involves the use of specific techniques and equipment, given the need to maintain preparation sterility and its strict prescribed composition, and avoid occupational exposure to cytotoxic agents.</div></div><div><h3>Objective</h3><div>This study aims to identify the most relevant contents for pharmacy professionals' education and training programs and to elucidate the evaluation procedure these professionals should follow when handling cytotoxics.</div></div><div><h3>Methods</h3><div>We adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in conducting and reporting this systematic review. We conducted a literature search in PubMed, Cochrane, and Literatura Latino-Americana e do Caribe em Ciências da Saúde to identify guidelines on cytotoxic drug preparation published between 2004 and 2024. Inclusion criteria included guidelines written in English, Spanish, or Portuguese that addressed the education, training, and/or evaluation of pharmacy professionals involved in handling cytotoxic drugs. We excluded guidelines developed for other health professionals (e.g. nurses) and guidelines exclusively addressing the manipulation of oral dosage forms. Citation searching was also performed to avoid search biases. Three researchers independently selected 20 guidelines that met the inclusion criteria, out of 3781 unique references identified. Four appraisers assessed the guidelines using the Appraisal of Guidelines for Research and Evaluation-II tool.</div></div><div><h3>Results</h3><div>Recommendations for training in cytotoxic drug handling generally included preinitiation and periodic assessment. Personal protective equipment and engineering controls use, spill management, and aseptic technique were the most frequently mentioned specific training contents. We have developed a training proposal based on the guidelines, with 4 training levels that address the specific identified content. Each level presents potential competency assessment strategies.</div></div><div><h3>Conclusion</h3><div>Included publications frequently recognized that conducting educational programs before and during the preparation of cytotoxic drugs was important and the combination of theoretical and practical learning seems of the utmost relevance. The development or update of guidelines in this area should prioritize their effective applicability to facilitate their implementation.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 3","pages":"Article 102352"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laying the foundation for success: A guide to pharmacy residency research projects","authors":"Sarah E. Vordenberg,&nbsp;Adriane N. Irwin,&nbsp;Yvonne Mai,&nbsp;Jeffrey G. Hamper,&nbsp;Michael R. Gionfriddo,&nbsp;Kenneth C. Hohmeier,&nbsp;Jordan R. Covvey","doi":"10.1016/j.japh.2025.102358","DOIUrl":"10.1016/j.japh.2025.102358","url":null,"abstract":"<div><div>Thousands of pharmacy graduates in the United States enter postgraduate pharmacy residency programs each year in various practice settings. While these programs primarily focus on clinical training, residents must also complete longitudinal projects, often in the form of research. However, programs and residents face challenges in the execution of research, including time constraints, limited resources, and variable expertise, often contributing to project redundancy and low publication rates. This paper provides a guide to the early planning phases of structuring a successful residency research project. Using the analogy of building a house, we outline essential steps, including necessary resources from programs, as well as the value of rigorous research questions, literature reviews, and study design. We emphasize the importance of feasible project scope, institutional support, and effective mentorship.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 3","pages":"Article 102358"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Celebrating our peer reviewers and authors!","authors":"Pamela C. Heaton BSPharm, PhD, FAPhA","doi":"10.1016/j.japh.2025.102365","DOIUrl":"10.1016/j.japh.2025.102365","url":null,"abstract":"","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 3","pages":"Article 102365"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144099366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}