Journal of the American Board of Family Medicine最新文献

{"title":"Intervention to Improve Psychosocial Care for People with Type 2 Diabetes.","authors":"Deborah J Cohen, Shannon M Sweeney, Rachel Springer, Bijal A Balasubramanian, LeAnn Michaels, Miguel Marino, Danielle Hessler, Andrea Baron, Johanna Nesse","doi":"10.3122/jabfm.2024.240265R1","DOIUrl":"10.3122/jabfm.2024.240265R1","url":null,"abstract":"<p><strong>Background: </strong>This proof-of-concept study tested the feasibility and acceptability of INTEGRATE-D, an implementation support intervention for primary care clinics to improve the psychosocial care of patients with type 2 diabetes.</p><p><strong>Methods: </strong>Cluster randomized controlled pragmatic trial, with a parallel, convergent mixed methods design. Two Intervention Clinics (ICs) were offered tailored training on American Diabetes Association (ADA)-recommended psychosocial care and facilitation to identify and support clinical change. Two Control Clinics (CCs) received no intervention.</p><p><strong>Primary outcomes: </strong>intervention acceptability, appropriateness and feasibility.</p><p><strong>Secondary outcomes: </strong>process-of-care metrics (eg, depression screening, diabetes management) and clinical outcomes measures (PHQ-9 and A1C). Qualitative data were collected to assess implementation and experience with the intervention.</p><p><strong>Results: </strong>ICs were offered training and received 15-months of facilitation. To accommodate COVID-19-related safety restrictions, the intervention was changed to be delivered virtually (eg, remote facilitation and training sessions). Despite an adapted delivery and COVID-19 and staffing stressors, clinics exposed to INTEGRATE-D found it to be acceptable, well-aligned with clinics' needs, and feasible. Qualitative data suggest COVID-19 stressors tempered feasibility. The effect of INTEGRATE-D on process and clinical outcome measures were mixed. Several factors, including differences in ICs and CCs not addressed in randomization and delivery of a less intensive intervention due to the pandemic, may help explain these results.</p><p><strong>Conclusions: </strong>Given the growing number of people with type 2 diabetes and the importance of psychosocial care for these patients, INTEGRATE-D warrants further pilot-testing with a larger sample of clinics and patients, and under conditions where in-person facilitation and expanded training is possible.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 2","pages":"253-274"},"PeriodicalIF":2.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated with Documenting Social Determinants of Health in Electronic Health Records.","authors":"Jeongyoung Park, Yalda Jabbarpour, Robert L Phillips, Andrew W Bazemore, Nathaniel Hendrix","doi":"10.3122/jabfm.2024.240279R1","DOIUrl":"https://doi.org/10.3122/jabfm.2024.240279R1","url":null,"abstract":"<p><strong>Introduction: </strong>Social determinants of health (SDOH) significantly impact health outcomes, yet their integration into clinical decision making is inconsistent. We examined how family physicians document SDOH in electronic health records (EHRs) and identified factors influencing this practice.</p><p><strong>Methods: </strong>We performed a cross-sectional analysis of 2,089 family physicians completing the 2022 American Board of Family Medicine Continuous Certification Questionnaire. The outcome was physicians' self-reported SDOH documentation by checking a box within the EHR, writing it in a note, or entering it as a diagnosis. Physician, practice, and community characteristics associated with SDOH documentation were assessed, using logistic regression.</p><p><strong>Results: </strong>We found that 61% of family physicians documented SDOH in notes, with fewer using checkboxes (46%) or diagnosis codes (35%). Across models, factors persistently positively associated with documenting SDOH included participating in value-based programs, having more resources for social needs, collaborating with neighborhood organizations, and working in a more disadvantaged area (higher Social Deprivation Index [SDI] score). For example, family physicians who worked in areas with the third quartile of SDI (OR = 1.366, 95% CI = 1.037 - 1.799) and the fourth quartile of SDI (OR = 1.364, 95% CI = 1.032 - 1.804) were more likely to enter SDOH as a diagnosis, compared with those in the least disadvantaged areas.</p><p><strong>Discussion: </strong>Socioeconomic aspects of the communities and a practice-level capacity to address SDOH were the biggest predictors of documenting SDOH, rather than the physicians' own characteristics. These findings affirm the necessity of financial incentives and well-resourced care teams to successfully achieve integrated SDOH in primary care practice.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 2","pages":"290-301"},"PeriodicalIF":2.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of COVID-19 on Cervical Cancer Screening in Primary Care.","authors":"Omer Atac, Lars E Peterson, Teresa M Waters","doi":"10.3122/jabfm.2024.240243R1","DOIUrl":"https://doi.org/10.3122/jabfm.2024.240243R1","url":null,"abstract":"<p><strong>Introduction: </strong>The COVID-19 pandemic has reduced the number of elective in-person visits to primary care practices. This study examined how the pandemic may have affected cervical cancer (CC) screening rates in primary care settings across the United States.</p><p><strong>Methods: </strong>We conducted a retrospective cross-sectional study using data from the PRIME Registry of the American Board of Family Medicine from March 15, 2017, to March 14, 2022. We included 2,207,355 women aged 21 to 65 years who had visited a clinician (n = 1,052) from any of 472 primary care practices. We compared CC screening rates among eligible women during in-person visits over the 3 prepandemic years with those during the 2 years of the pandemic.</p><p><strong>Results: </strong>Screening rates (per 100 eligible patients with in-person visits) decreased from 1.85 to 1.12 in the first quarter of the first year and remained lower throughout both years of the pandemic compared with prepandemic year, had not returned to prepandemic levels by the end of the second year. Hispanic or Latino (odds ratio [OR] = 1.96) and Black or African American (OR = 1.37) women were more likely to be screened, whereas those receiving care from male clinicians (OR = 0.34) were less likely to be screened.</p><p><strong>Conclusions: </strong>CC screening rates remained below prepandemic levels throughout the 2 years of the pandemic. Policy makers and health care professionals should strategize approaches to enhance CC screening rates, including the exploration of alternative methods, such as home-based CC screening. New screening approaches are needed to ensure preparedness for future health crises.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 2","pages":"209-222"},"PeriodicalIF":2.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shared Decision-Making and Discontinuation of Opioid Therapy for Chronic Pain.","authors":"John C Licciardone, Michaela Digilio, Subhash Aryal","doi":"10.3122/jabfm.2024.240290R1","DOIUrl":"https://doi.org/10.3122/jabfm.2024.240290R1","url":null,"abstract":"<p><strong>Background: </strong>Research is needed to measure the effects of shared decision-making (SDM) on discontinuation of opioid therapy for chronic pain.</p><p><strong>Design: </strong>Target trial emulation.</p><p><strong>Setting: </strong>National pain research registry from September 2016 to January 2024.</p><p><strong>Participants: </strong>A total of 328 patients currently using opioid therapy for chronic low back pain at baseline, including 164 patients each in greater and lesser SDM groups matched on propensity scores.</p><p><strong>Measurements: </strong>SDM was measured with the Communication Behavior Questionnaire. Primary outcomes involving discontinuation of opioid therapy and opioid prescribing frequency and secondary outcomes of pain, function, and health-related quality of life were measured over 12 months.</p><p><strong>Results: </strong>The mean (SD) age of patients was 56.1 (SD, 11.1) years and 239 (72.9%) were female. During 1178 quarterly encounters, greater SDM was associated with less frequent discontinuation of opioid therapy 3 months postbaseline (RR, 0.56; 95% CI, 0.37-0.86; <i>P</i> = .006) and more frequent opioid prescribing 3 to 12 months postbaseline (RR, 1.24; 95% CI, 1.11-1.38: <i>P</i> < .001). Although greater SDM was associated with worse physical function, and opioid therapy was associated with greater back-related disability and worse physical function, these results were not clinically important. SDM x opioid therapy interaction effects were not observed, indicating that more frequent use of opioid therapy with SDM did not yield better outcomes.</p><p><strong>Conclusions: </strong>SDM was associated with less frequent short-term discontinuation of opioid therapy and more frequent long-term opioid prescribing that was not associated with better outcomes. Thus, SDM is necessary but insufficient to improve opioid prescribing for patients with chronic pain.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 2","pages":"275-289"},"PeriodicalIF":2.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustainable Family Medicine Obstetrics as a Safety Net for Marginalized Low Resource Communities 2005-2022: The Impact of Expanded Training and Office Redesign.","authors":"Wm MacMillan Rodney, Kelly Rodney Arnold, John Rocco M Rodney, Nicholas Behymer, Caleb Fox, Mohammad Albitawi","doi":"10.3122/jabfm.2024.240161R2","DOIUrl":"https://doi.org/10.3122/jabfm.2024.240161R2","url":null,"abstract":"<p><strong>Background: </strong>This prospective study of all pregnancies explored the impact of infrastructure changes reducing health care disparities over 18 years. Office redesign, hospital privileges, and expanded point of care services allowed family physicians to sustain comprehensive family care including obstetrics.</p><p><strong>Research design: </strong>Family physicians leased office space in a chronically underserved urban area, with clinical revenue as the primary funding source. The office was redesigned to focus on providing bilingual services in a low resource community. Practicing physicians met weekly to improve policies for the care of uninsured and poorly insured patients. Independence from hospital and university control was essential for the changes that led to a self-sustaining medical group. The office was open access 7 days a week. A call group of family physicians with hospital privileges for higher risk obstetric care was formed to cover deliveries 24/7 365. This was prospectively designed as a longitudinal study 2005 to 2022. Data on family care and obstetrics were collected.All physicians followed the American College of Obstetrics and Gynecology (ACOG) guidelines and were subject to hospital peer review. A subset of consecutive patients from the index group, 2019 to 2022, provided detailed data describing office visits, high-risk patients, office ultrasound, nursery services, and subsequent well-child family care. Coding and collections analysis tabulated revenue associated with these deliveries. External audits measured quality and cost.</p><p><strong>Results: </strong>Data from 13,926 consecutive family medicine deliveries over eighteen years underscore sustainability. A subset of 2,335 deliveries from Medicos 2019 to 2022 validated quality outcomes of high-risk obstetrics and repeat cesarean sections by family physicians. Expanded point of care services data included the first prenatal visit through postpartum, nursery, and early childcare.</p><p><strong>Conclusion: </strong>This model provides a framework for retaining obstetric services in low-resource, marginalized communities. Independence from hospital control allowed expansion of service which increased access and quality at lower cost.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 2","pages":"199-208"},"PeriodicalIF":2.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virtual Preconception Risk Assessment and Counseling In Primary Health Care.","authors":"Anne L Dunlop, Susana Alfonso, Nora Hansen, Dionne Williams, Victoria Anderson","doi":"10.3122/jabfm.2024.240143R1","DOIUrl":"https://doi.org/10.3122/jabfm.2024.240143R1","url":null,"abstract":"<p><strong>Background: </strong>Professional association recommendations call for integrating preconception health promotion with primary care, yet there are scarce tools and implementation research to support practices in doing so.</p><p><strong>Purpose: </strong>To evaluate the feasibility of integrating a preconception health digital risk assessment and virtual coaching into women's primary care encounters.</p><p><strong>Methods: </strong>In the Emory Family Medicine Clinic, female patients 21 to 40 years of age with a well-woman or chronic condition encounter scheduled between 9/1/2022 and 5/1/2023 were invited to participate. Consenting patients were provided the <i>Frame Your Future</i> weblink to complete the digital risk assessment followed by virtual counseling, and their family physicians were provided with a PDF summary to discuss during the primary care encounter. Demographic and clinical information was collected via medical record abstraction and patient and physician experiences via survey.</p><p><strong>Results: </strong>Of 46 enrolled patients, 44 (96%) made a FRAME™ account, 38 (86%) completed the risk assessment, 34 (89%) completed virtual coaching, and 24 (71%) had a physician discuss their preconception health assessment during the primary care encounter. Nearly 80% of patients reported an increase in confidence in discussing fertility with their physician, and 50% reported they would not otherwise have brought up fertility and preconception health during the encounter. Both patients and physicians were satisfied with the process and viewed it as helping motivate positive changes in patient health and health behaviors.</p><p><strong>Conclusion: </strong>The completion of preconception digital risk assessment and virtual counseling facilitates discussion of preconception health during primary care encounters and shows promise for improving women's health.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 2","pages":"223-238"},"PeriodicalIF":2.4,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional Variation in Scope of Practice by Family Physicians.","authors":"Alyssa Lambert, Sarah E Fleischer, Omer Atac, Andrew Bazemore, Lars E Peterson","doi":"10.3122/jabfm.2024.240201R1","DOIUrl":"10.3122/jabfm.2024.240201R1","url":null,"abstract":"<p><strong>Introduction: </strong>Geographic variation in physician scope of practice (SOP) has been documented but the causes remain unknown. We examined whether geographic variation in family physician (FP) SOP is explained by differences in the characteristics of the FPs, their practices, practice environment, or health care market.</p><p><strong>Methods: </strong>We utilized 2 datasets from the American Board of Family Medicine (ABFM) from 2017 to 2022. The National Graduate Survey captures early career FPs while the Continuous Certification Questionnaire is administered to mid to late career FPs. We used a SOP score that ranges from 0 to 30 with a larger score reflecting a broader SOP. Bivariate analyses assessed for differences by Census division in clinician, practice, community, and health care market characteristics. A series of multilevel linear regression analyses tested if geographic differences in SOP were attenuated by the aforementioned characteristics.</p><p><strong>Results: </strong>Our analytic included 9,378 early career FPs and 28,832 mid to late career FPs in the unadjusted regression model. We found significant differences in clinician characteristics by division and cohort. In unadjusted results, SOP score differed by division and career stage within division (range 11.49 to 14.95 for later career FPs and 15.22 to 17.51 for early career FPs). Adjusting for clinician, practice, community, and health care market characteristics did not attenuate divisional variation in SOP.</p><p><strong>Discussion: </strong>Significant geographic variation in FP SOP was not explainable by adjustment for clinician, practice, community, and health care market characteristics. This suggests that health care variation is multifactorial and will require more multifaceted interventions to ameliorate.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"28-45"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying and Addressing Social Determinants of Health with an Electronic Health Record.","authors":"Oluwatomi Ajibola, Rehab Tabchi, Karen Hepworth, Alycia Walty, Auguste Niyibizi","doi":"10.3122/jabfm.2024.240167R1","DOIUrl":"10.3122/jabfm.2024.240167R1","url":null,"abstract":"<p><strong>Objective: </strong>The benefits of Social Determinants of Health (SDoH) is well documented but several studies highlight the complexity of collecting and standardizing SDoH data in a way that makes it relevant to the standard clinical interaction. The purpose of this study is to examine how leveraging an Electronic Health Record (EHR) system can facilitate SDoH screening and its integration into Primary Care encounters, while also using the data collected to meet the identified needs.</p><p><strong>Methods: </strong>This is an observational study design. EHR and SDoH screening data from 2020 to 2023 at 3 primary care sites were gathered. The study was implemented in 3 phases to streamline and establish the screening and referral processes.</p><p><strong>Results: </strong>SDoH screening increased by 95% from 2020 to 2022 with a consequent increase in social work referrals and the allocation of resources to a targeted patient population.</p><p><strong>Conclusion: </strong>Identifying SDoH unique to a community or population can be strategically used to deliver relevant and timely services to patients. This fosters a multidisciplinary, collaborative and integrated approach to patient care.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 1","pages":"9-14"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternity Care Deserts: Key Drivers of the National Maternal Health Crisis.","authors":"Eli Y Adashi, Daniel P O'Mahony, I Glenn Cohen","doi":"10.3122/jabfm.2024.240198R1","DOIUrl":"10.3122/jabfm.2024.240198R1","url":null,"abstract":"<p><p>Maternal care deserts, defined as counties where there are no hospitals offering obstetric services or birth centers and no obstetricians, gynecologists, or certified nurse midwives, have a significant adverse effect on the quality of maternity care afforded women in the United States, especially Black women and women in rural areas. The maternal mortality rate for Black women in 2022 was 2.6 times higher than the rate for White women. The rate in the most rural counties is 1.6 times higher than the rate in large metropolitan counties. Across the nation, 36% of all US counties qualify as maternal care deserts, contributing to the country's poor placement globally among high-income nations. A recent report by the March of Dimes draws attention to the crisis in maternal health care. A number of interventions have been proposed by federal government entities to address the persistent problem. Family physicians in particular have a potential role in improving the situation as they represent the broadest geographic coverage of all maternity care providers.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 1","pages":"165-167"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Empowering Family Physicians in Medical Staff Leadership to Foster Physician Well-Being.","authors":"Megan R Mahoney, Edward Damrose, Tait Shanafelt","doi":"10.3122/jabfm.2024.240136R1","DOIUrl":"10.3122/jabfm.2024.240136R1","url":null,"abstract":"<p><p>In the evolving landscape of health care, marked by increasing physician distress, the role of family physicians in leadership positions emerges as crucial for driving systemic improvements. Drawing from 9 years of collective experience as chiefs of staff, this commentary outlines a framework for family physicians serving in the Chief of Staff, Medical Staff President role or other physician executive positions aimed at improving physician well-being. Recognizing the comprehensive scope of practice and team-based orientation of family medicine, we highlight the unique capabilities of family physicians to foster organizational changes that address the root causes of physician burnout. The proposed framework emphasizes the importance of effective communication channels to ensure the medical staff's voices are heard and valued. It advocates for physician-centered approaches to credentialing and privileging processes, equitable incident reporting systems, and supportive measures for physicians facing professional challenges. By implementing a wellness-oriented framework, healthcare organizations can safeguard the future of the medical profession and create a healthcare system that prioritizes the well-being of both patients and clinicians.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 1","pages":"168-171"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}