Journal of the American Pharmacists Association最新文献

{"title":"Bridging PrEP access gaps: Mapping geospatial accessibility across the United States and leveraging community pharmacies for expansion","authors":"Jacinda Tran,&nbsp;Anu Mishra,&nbsp;Marita Zimmermann,&nbsp;Ryan Hansen","doi":"10.1016/j.japh.2024.102274","DOIUrl":"10.1016/j.japh.2024.102274","url":null,"abstract":"<div><h3>Background</h3><div>Pre-exposure prophylaxis (PrEP) is key to ending the US HIV epidemic, but uptake remains low. Federal legislation permitting community pharmacists to initiate PrEP nationwide could expand access to PrEP services.</div></div><div><h3>Objectives</h3><div>This study aimed to evaluate census tract-level geospatial access to PrEP facilities and community pharmacies across the US and characterize geographic areas and populations where community pharmacies could help bridge the gap in care.</div></div><div><h3>Methods</h3><div>We identified census tracts with limited or no access (“deserts”) to PrEP facilities and community pharmacies in 2022 using 2 primary definitions: 1) a tract with no PrEP facilities or pharmacies within a 30-minute drive of the tract centroid; and 2) a tract with low income and low access (no PrEP facilities or pharmacies within one mile of the centroid for low vehicle access tracts, 2 miles in urban tracts, 10 miles in suburban tracts, 20 miles in rural tracts). Tracts with access were “oases,” and “PrEP desert, pharmacy oasis” tracts represented areas without PrEP facilities where community pharmacies could expand access. We characterized the social determinants of health associated with desert status and conducted sensitivity analyses exploring additional access definitions.</div></div><div><h3>Results</h3><div>Of the 82,729 census tracts in our analysis, most were classified as dual PrEP and pharmacy oases. We categorized 13.3% as PrEP deserts under the 30-minute definition, and 94.3% of these tracts were pharmacy oases. Under the low income and low access definition, 17.0% of all tracts were PrEP deserts, 78.2% of which were pharmacy oases. PrEP deserts were predominantly located in the Midwest and South and associated with higher poverty, social vulnerability, and uninsurance.</div></div><div><h3>Conclusion</h3><div>Our analysis confirmed inequitable access to PrEP facilities across the US. Federal recognition of pharmacists as health care providers empowered to initiate PrEP nationwide has the potential to substantially bridge access gaps for underserved communities.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 2","pages":"Article 102274"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512051","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":"Development and Implementation of a Best Practice Alerting Process (BPA) for Naloxone Prescribing at Rural Community Pharmacies in Wisconsin: A Pilot Study.","authors":"Sura O AlMahasis, Martha A Maurer","doi":"10.1016/j.japh.2025.102382","DOIUrl":"https://doi.org/10.1016/j.japh.2025.102382","url":null,"abstract":"<p><strong>Background: </strong>The opioid overdose epidemic continues to worsen in the United States, with opioid-related deaths increasing by 13 folds from 2000 to 2022 in Wisconsin. Naloxone, an opioid antagonist, can save lives by reversing opioid overdose in a matter of minutes. However, naloxone access and utilization remain suboptimal.</p><p><strong>Objective: </strong>This study examined the development and implementation of best practice alerting (BPA) processes within community pharmacies. This study assessed to what extent the BPA processes (1a) prompted pharmacists to discuss naloxone with high-risk patients; (1b) increased the number of naloxone prescriptions dispensed; and (2) evaluated the facilitators and barriers to implementing the BPA processes.</p><p><strong>Methods: </strong>A pilot study was conducted to develop and implement a BPA process in three rural community pharmacies in Wisconsin. The process involved staff identifying high-risk patients, initiating naloxone discussions, and offering naloxone prescriptions. Quantitative monthly data were recorded by pharmacies. Semi-structured interviews were conducted with one pharmacist from each pharmacy to assess the implementation process and outcomes. Descriptive statistics were used to analyze quantitative data. Interview transcripts were analyzed for key themes describing facilitators and barriers to the implementation process.</p><p><strong>Results: </strong>The naloxone alerting process resulted in a notable increase in naloxone discussions and naloxone prescriptions dispensed. Pharmacists reported that pharmacy staff buy-in and engagement, adequate staffing, developing meaningful partnerships, and using depersonalizing, destigmatizing, and normalizing approaches in discussing naloxone with patients were key facilitators. Key barriers included naloxone cost or co-payment and time constraints.</p><p><strong>Conclusion: </strong>Implementing a BPA process in community pharmacies can notably increase naloxone prescribing for high-risk patients. Positive message framing, staffing, meaningful partnerships, and staff buy-in were key facilitators of implementation. Identified barriers were cost or co-payment and time constraints.</p>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":" ","pages":"102382"},"PeriodicalIF":2.5,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537960","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":"Perioperative Management of Alpha-Gal Syndrome in Bariatric Surgery: A Case Study of Venous Thromboembolism Prophylaxis.","authors":"Kaelen Glaze, Sareidenn Ancayan, Susan Dodge","doi":"10.1016/j.japh.2025.102381","DOIUrl":"https://doi.org/10.1016/j.japh.2025.102381","url":null,"abstract":"","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":" ","pages":"102381"},"PeriodicalIF":2.5,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532070","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 and categorization of medication errors in a veterinary teaching hospital.","authors":"Jessica A Barazowski, Lauren R Forsythe, Alexandria E Gochenauer","doi":"10.1016/j.japh.2025.102362","DOIUrl":"10.1016/j.japh.2025.102362","url":null,"abstract":"<p><strong>Background: </strong>Medication errors are one of the most common types of errors in health care; however, similar data are limited to veterinary institutions. Pharmacists are not always present in veterinary hospitals. Therefore, all staff members actively engaged in the dispensation of medications must be aware of the high incidence of medication errors.</p><p><strong>Objectives: </strong>This study aimed to quantify the amount of and assess the types of medication errors that occur frequently within a veterinary teaching hospital (including both large and small animal patients), identify the specific medications that are most often involved in these errors, and determine whether the inclusion of pharmacist chart review decreases the number of medication error incident reports.</p><p><strong>Methods: </strong>Incident reports between July 2019 and March 2023 and pharmacist chart review documents between September 2022 and March 2023 were collected and reviewed. The total number of incidents was quantified and the incidents were categorized according to the type of error and medication involved. The number of incidents was compared for the period before and after the implementation of pharmacist chart review.</p><p><strong>Results: </strong>Between July 2019 and March 2023, medication errors accounted for 66% (n = 685) of all incident reports (n = 1031), and of those medication errors, 51% (n = 351 of n = 685) were errors caused by an incorrect dose. Gabapentin, methadone, and butorphanol were the most common medications cited in medication error incident reports. Incident reports containing medication errors reduced after the implementation of pharmacist chart review from 62% (n = 352) to 48% (n = 240) (P = 0.0504).</p><p><strong>Conclusion: </strong>Although not statistically significant, the results of this study indicated that the inclusion of daily pharmacist chart reviews may lead to a decrease in submitted medication error incident reports, warranting further study.</p>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":" ","pages":"102362"},"PeriodicalIF":2.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525189","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":"Assessing the Behavioral Health and Social Determinants of Health Training Needs of Pennsylvania Pharmacy Personnel.","authors":"Kelvin M Lu, Oluwatoyin Fadeyibi, Andrew M Peterson","doi":"10.1016/j.japh.2025.102363","DOIUrl":"https://doi.org/10.1016/j.japh.2025.102363","url":null,"abstract":"<p><strong>Background: </strong>Over ⅓ of Americans live in areas without access to mental health resources. Pharmacy personnel are a trusted and accessible resource in the community, allowing them to be a point of contact for individuals with behavioral health (BH) or social determinants of health (SDOH) needs. However, pharmacy personnel may not have the training or the confidence to provide that support.</p><p><strong>Objectives: </strong>The purpose of this study was to identify the BH/SDOH training gaps of Pennsylvania pharmacy personnel.</p><p><strong>Methods: </strong>An electronic needs survey was distributed to members of the Pennsylvania Pharmacists Association. Survey items elicited respondents' self-reported comfort in providing certain BH/SDOH services, self-reported access to related resources, and knowledge on true-false assessment questions. Demographic information (area of practice setting, type of community practice, job title, prior training) was selected a priori to determine if there were differences within the subcategories. Chi-squared tests were performed to determine statistical significance; α was set at 0.05.</p><p><strong>Results: </strong>140 respondents completed the survey, with 54% identifying as pharmacists and 52% practicing in a suburban setting. 41% of respondents reported feeling comfortable assessing an individual for risk of suicide or harm and 32% reported being able to refer patients to local homeless shelters. A minority of respondents answered all Mental Health First Aid-related assessment questions correctly (43%). A statistically significant higher percentage of pharmacists were comfortable providing information on BH compared to non-pharmacist personnel (64% vs 41%, p=0.01) but not for other services. There was no statistically significant difference in reported comfort by area of practice setting or by type of community practice.</p><p><strong>Conclusions: </strong>This study demonstrates that pharmacy personnel have some level of experience and comfort with providing BH/SDOH services, but gaps remain. We expect that with additional training, pharmacy personnel can become advocates to help care for patients with BH/SDOH needs.</p>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":" ","pages":"102363"},"PeriodicalIF":2.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525188","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, Patrick Gregory, Benjamin Smith, Brittney Champagne, Amit Patel, Holly Alvarado, Marie Tuft, Joshua Burrows, Alice Parish, Alaattin Erkanli","doi":"10.1016/j.japh.2025.102364","DOIUrl":"https://doi.org/10.1016/j.japh.2025.102364","url":null,"abstract":"<p><strong>Background: </strong>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 two interventions on patient no-show rates for CPP appointments and to identify barriers patients may face that lead to no-shows.</p><p><strong>Objectives: </strong>Determine if the interventions were associated with a change in the no-show rate for embedded DPC CPP appointments.</p><p><strong>Methods: </strong>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 to 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 five minutes late. The intervention groups were compared to a control group from one year prior. A chi-square test was used to compare no-show rates.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>The two 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.</p>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":" ","pages":"102364"},"PeriodicalIF":2.5,"publicationDate":"2025-02-24","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":"Cannabis at a Crossroads: Pharmacist care considerations in the context of a changing cannabis regulatory landscape.","authors":"Shreni Sheth, Megan Maroney, Mary Barna Bridgeman","doi":"10.1016/j.japh.2025.102361","DOIUrl":"10.1016/j.japh.2025.102361","url":null,"abstract":"<p><p>The debate over whether cannabis should be handled as a vilified substance or potential therapeutic entity has persisted over the past 50 years, coupled with or supported by a changing state-level regulatory landscape in the United States. Pharmacists must be aware of potential health implications and keep abreast of regulatory implications likely to result from potential state and national regulation changes. In this commentary, we highlight key considerations for pharmacists in the evolving cannabis regulatory landscape, including historical perspectives, current regulations, and future implications. Special attention to vulnerable populations is outlined, given the potential health consequences that must be considered if cannabis is rescheduled. The substantive public health implications associated with adult cannabis use (e.g., substance use/misuse, driving, lung health) are outside the scope of this commentary.</p>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":" ","pages":"102361"},"PeriodicalIF":2.5,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517140","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":"Implementation of a multidose ophthalmic medication policy change at a large health system.","authors":"Gregory Mak, Cecilia Cece Speck, Indrani Kar, Douglas J Rhee","doi":"10.1016/j.japh.2025.102356","DOIUrl":"10.1016/j.japh.2025.102356","url":null,"abstract":"<p><strong>Background: </strong>In response to a multidose ophthalmic medication (topical eye drop) shortage, the health system had to evaluate the current policy for multidose medications and propose changes to the policy to provide patient care while managing the drug shortage. The use of multidose eye drops on multiple patients is accepted in ophthalmology care per the Centers for Medicare and Medicaid Services updated guidance for ambulatory surgical centers. Before this, the use of multidose eye drops on multiple patients had not been in practice at our health system owing to contamination risk from repeated use in the preoperative setting. Given the ambiguity of the current policy with regard to multidose ophthalmic drop usage and the available literature, an updated policy was developed.</p><p><strong>Objectives: </strong>This report aimed to describe the evaluation, assessment, and implementation of a policy change supporting the use of multidose ophthalmic medications on multiple patients.</p><p><strong>Methods: </strong>Key stakeholders met and assessed the impact of the shortage and potential policy needs. After the evaluation of available literature and regulatory guidance, the proposed change was brought through the necessary formulary, safety, and policy channels for review.</p><p><strong>Results: </strong>After a review of the available literature, a determination was made that there is sufficient support for the practice of using multidose eye drops in multiple patients provided that there are appropriate infection control guidelines. The policy edits were approved by the appropriate committees and subsequently the organization's policy oversight committee.</p><p><strong>Conclusions: </strong>Our organization was able to make a substantial policy change through a collaborative, interdisciplinary review of literature and best practices to address a critical patient care need resulting from a medication shortage.</p>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":" ","pages":"102356"},"PeriodicalIF":2.5,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434210","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, Timothy C Hutcherson, Elizabeth M Bradley, John Rizk, Nicholas D Steele","doi":"10.1016/j.japh.2025.102360","DOIUrl":"10.1016/j.japh.2025.102360","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":" ","pages":"102360"},"PeriodicalIF":2.5,"publicationDate":"2025-02-15","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":"Implementing a pharmacist collaborative practice agreement to improve a Medicare quality measure: Statin Use in Persons with Diabetes.","authors":"Anna Sandalidis, Christina M Polomoff, Sean M Jeffery","doi":"10.1016/j.japh.2025.102347","DOIUrl":"10.1016/j.japh.2025.102347","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":" ","pages":"102347"},"PeriodicalIF":2.5,"publicationDate":"2025-02-14","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}