Journal of the American Board of Family Medicine最新文献

{"title":"Factors Influencing Changing Scopes of Practice Among Contemporary Graduates of the Nation's Largest Family Medicine Residency.","authors":"Nicholas LeFevre, Richard A Young","doi":"10.3122/jabfm.2024.240172R1","DOIUrl":"10.3122/jabfm.2024.240172R1","url":null,"abstract":"<p><strong>Background: </strong>John Peter Smith (JPS) Hospital Family Medicine Residency participated in both the P4 (Preparing the Personal Physician for Practice) and LOT (Length of Training) projects, and is known for its emphasis on preparing physicians for full-scope practice. Scope of practice outcomes among graduates of these programs are previously described, but how and why the scope of practice of these physicians change in their early career merits further exploration.</p><p><strong>Methods: </strong>A structured questionnaire was sent to all JPS graduates who matriculated as interns in the years 2007 to 2016 with information on cognitive and procedural scope of practice. Graduates were asked about their scope of practice both in their initial jobs out of residency and their current jobs. They were also asked about the forces affecting their scope of practice with both structured and open-ended questions. Responses were analyzed quantitatively and through qualitative thematic analysis.</p><p><strong>Results: </strong>A total 184 graduates provided information about practice scope. Graduates stopped providing inpatient care for children (9.2%), prenatal care (8.8%), long-acting reversible contraception (7.8%), ICU care of adults (7.8%), joint injections (7.4%), and inpatient care of adults (6.9%) at the highest rates between initial and current jobs. Scope of practice changes over time found to be statistically significant included inpatient care of children, ICU care of adults, inpatient care of adults, nursing home, substance use disorder including medication assisted therapy, and obstetric deliveries. The most common reasons for change were personal preference and work-life balance, rather than institutional and related systematic barriers.</p><p><strong>Conclusion: </strong>In the graduates of one institution, it is common for the scope of practice to change over time, both by discontinuing and adding services. Changes seem most driven by choice and work-life balance, rather than outside pressures or a feeling of inadequate preparation for practice.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 1","pages":"133-138"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992757","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":"Integrating Adverse Childhood Experiences and Social Risks Screening in Adult Primary Care.","authors":"India Gill, Ariana Thompson-Lastad, Denise Ruvalcaba, Laura M Gottlieb, Danielle Hessler Jones","doi":"10.3122/jabfm.2024.240170R1","DOIUrl":"10.3122/jabfm.2024.240170R1","url":null,"abstract":"<p><strong>Background: </strong>In 2020, the state of California started financially incentivizing primary care practices to screen for adverse childhood events (ACEs). In its current Medicaid 1115 waiver, the state also has encouraged health care teams to screen for social risks (SR) - (eg, food, housing, and transportation insecurity). In this qualitative study, we explore community health center (CHC) staff and patient perspectives about opportunities and barriers to integrating adult screening for ACEs and SR.</p><p><strong>Methods: </strong>We identified eligible California CHCs through Medicaid claims data on ACEs screening and/or participation in ACEs or SR-related learning collaboratives. Staff and/or patients in 12 clinics participated in semistructured interviews exploring opportunities and barriers to integrated ACEs and SR screening. Interviews were analyzed using a rapid qualitative data analysis approach.</p><p><strong>Results: </strong>Thirty-nine clinic staff (including clinic leaders, allied health professionals, licensed clinicians) and 10 patients participated. While staff and patients often conceptually endorsed integrated ACEs and SR screening, they identified substantial practical barriers to integration. Barriers primarily related to different screening frequencies and workflows. Other barriers reflected broader primary care time constraints and workforce shortages. Participants shared multiple recommendations to improve screening programs, including strategies for combining ACEs and SR screening.</p><p><strong>Discussion: </strong>California CHC staff and patients described several conceptual benefits of integrating ACEs and SR screening, but longstanding primary care challenges make it complicated to integrate these activities. Standardizing the integration of ACEs and SR screening will require institutional and structural shifts to overcome common barriers to providing whole person care.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"15-27"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789403","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":"Patient Perspectives on Delayed Specialty Follow-Up After a Primary Care Visit.","authors":"Leonor Fernández, Dru Ricci, Amie Pollack, Maelys J Amat, Meghan Drielak, Talya Salant, Gordon D Schiff, Umber Shafiq, Scot B Sternberg, James Benneyan, Mark Aronson, Erin Sullivan, Russell S Phillips","doi":"10.3122/jabfm.2024.240063R3","DOIUrl":"10.3122/jabfm.2024.240063R3","url":null,"abstract":"<p><strong>Background: </strong>Patients are often referred for important diagnostic tests or consultations after a concerning symptom or finding is identified at a primary care visit, but many referrals are delayed or not completed.</p><p><strong>Methods: </strong>In this qualitative study, we reviewed electronic health record data to identify patients who did not have timely completion of a recommended referral at an academic primary care hospital-based practice and an affiliated community health center. Using semistructured interview guides, we interviewed 15 patients who did not complete a cardiac stress test within 28 days of a primary care visit associated with a diagnosis of chest pain, and 15 patients who did not complete a dermatology referral within 90 days of identification of a concerning skin lesion.</p><p><strong>Results: </strong>Thematic analysis highlighted 3 areas: 1) Patients desired clear communication to inform, equip and empower them, 2) Clinician-patient communication regarding a referral's rationale and value is key, and 3) Referral appointment processes were often challenging and/or delayed. Patients wished to understand why they were being referred, the specific value and reason for the referral, and what to expect. We developed a conceptual model describing how the initial clinician-patient communication may influence referral completion.</p><p><strong>Conclusions: </strong>Failure to close diagnostic loops may be more likely when a patient is not given sufficient meaningful information, particularly if there is health system \"friction\" that reduces the patient's ability and ease to obtain a timely diagnostic referral appointment. Clinicians should use accessible language to communicate why a diagnostic referral is useful and important for the patient's health, and include a specific optimal time frame. The initial communication and the ease of the subsequent appointment booking both matter, and may compound or mitigate each other's effect. To reduce diagnostic referral failures and delays. clinicians should advocate for consistent appointment booking processes that systematically inform, equip, and empower patients with clear and meaningful referral information and timely appointments.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 1","pages":"139-153"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995979","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":"Use of AI in Family Medicine Publications: A Joint Editorial from Journal Editors.","authors":"Sarina Schrager, Dean A Seehusen, Sumi Sexton, Caroline Richardson, Jon Neher, Christopher Pimlott, Marjorie Bowman, Jose Rodriguez, Christopher P Morley, Li Li, James Dom Dera","doi":"10.3122/jabfm.2024.240397R0","DOIUrl":"10.3122/jabfm.2024.240397R0","url":null,"abstract":"","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"4-8"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015126","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":"Perceptions and Preferences for Defining Biosimilar Products in Prescription Drug Promotion.","authors":"Mihaela Johnson, Jessica E Thompson, Avery A Tilley, Amie C O'Donoghue, Kathryn J Aikin","doi":"10.3122/jabfm.2024.240151R1","DOIUrl":"10.3122/jabfm.2024.240151R1","url":null,"abstract":"<p><strong>Background: </strong>Prescription biosimilars are highly similar to and have no clinically meaningful differences from existing FDA-approved reference products. Despite increased availability in the marketplace, consumers and clinician lack awareness of these products. Our study experimentally tested understanding of and preference for brief descriptions of biosimilars in the form of disclosure statements in a fictitious prescription drug advertisement.</p><p><strong>Methods: </strong>Consumers (n = 379) and HCPs (n = 368) viewed a mock advertisement and responded to an online survey. Study participants were randomized to 1 of 7 biosimilar disclosure definitions or a control. Disclosure conditions varied with regard to 1) identifying the product as a biosimilar; 2) information provided in the definition; and 3) naming the reference product. We tested the effects of disclosure conditions on comprehension, perceptions, attitudes, intentions, and preferences.</p><p><strong>Results: </strong>Overall, comprehension of information in the biosimilar disclosure was less than optimal (48.5%-62.0% and 68.4%-88.4% for consumers and HCPs, respectively), even when provided with a definition. Perceptions of benefit, comparative efficacy, and safety were neutral. Content of the biosimilar definition generally did not influence outcomes, except that HCPs reported more positive attitudes toward the biosimilar and stronger intentions to prescribe when provided with expanded definitions. Both groups preferred the expanded definitions, and HCPs preferred seeing a named reference product. HCPs generally agreed with a statement that biosimilars could be used \"interchangeably\" with the reference product.</p><p><strong>Conclusions: </strong>Our findings signal some knowledge gaps and uncertainty regarding biosimilars among consumers and HCPs. Further education is warranted around these products, and communications for both groups require careful testing to ensure that the information is understood and does not result in a negative perception of the product.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 1","pages":"94-106"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047809","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":"Re: Physician and Advanced Practice Clinician Burnout in Rural and Urban Settings.","authors":"Cody J Klinker","doi":"10.3122/jabfm.2024.240300R0","DOIUrl":"10.3122/jabfm.2024.240300R0","url":null,"abstract":"","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 1","pages":"192-193"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029869","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":"Evaluating Pragmatism of Lung Cancer Screening Randomized Trials with the PRECIS-2 Tool.","authors":"Erin A Hirsch, Jamie L Studts, Susan Zane, Marina McCreight, Amy G Huebschmann","doi":"10.3122/jabfm.2024.240142R1","DOIUrl":"10.3122/jabfm.2024.240142R1","url":null,"abstract":"<p><strong>Objective: </strong>Lung cancer screening (LCS) implementation has been challenging for community and rural primary care settings. One contributing factor may be that the randomized clinical trials (RCTs) that form the evidence base are guided by explanatory methods not reflective of primary care settings. This study applied the <b>PR</b>agmatic <b>E</b>xplanatory <b>C</b>ontinuum <b>I</b>ndicator <b>S</b>ummary (PRECIS - 2) tool to determine the pragmatism of LCS RCTs envisioned through a decentralized, primary care lens.</p><p><strong>Methods: </strong>LCS RCTs were identified from efficacy meta-analyses, and the VA Demonstration Project was chosen as a nonrandomized multi-center comparator case. Two independent raters evaluated PRECIS-2 domains for each trial. Ratings were completed on a 5-point scale, where 1 indicated completely explanatory and 5 indicated completely pragmatic. Mean PRECIS-2 scores were calculated for each study and each domain. Descriptive information from raters' comments was used to describe differences between the most pragmatic and most explanatory RCTs.</p><p><strong>Results: </strong>Eleven RCTs and the VA Demonstration Project were evaluated. Mean PRECIS-2 scores for each study ranged from 2.12 to 3.33, with the DLSCT rated the most explanatory and the Lung Screening Study and ITALUNG studies rated the most pragmatic. Six domains had a mean score <3, indicating more explanatory (eligibility, recruitment, setting, organization, staff flexibility, follow-up). The remaining 3 domains had mean scores >3, indicating more pragmatic (adherence, outcome, analysis).</p><p><strong>Discussion: </strong>This approach of evaluating each study from a primary care lens demonstrated that LCS RCTs trended toward a more explanatory nature, incorporating considerable support and infrastructure that extend beyond the capacity of typical primary care settings in the US.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 1","pages":"56-83"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050033","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":"Association of Social Needs with Diabetes Outcomes in an Older Population.","authors":"David M Mosen, Stephanie L Fitzpatrick, Erin M Keast, John F Dickerson, Briar L Ertz-Berger, Matthew P Banegas","doi":"10.3122/jabfm.2024.240139R2","DOIUrl":"10.3122/jabfm.2024.240139R2","url":null,"abstract":"<p><strong>Background: </strong>Identifying and addressing social needs is important to improve health for older adults with type 2 diabetes mellitus (T2DM). However, few studies have examined the association between social needs and T2DM-related outcomes among older populations within integrated health care systems. This study examined the association between social needs and DM-related outcomes among older adults with T2DM receiving care at Kaiser Permanente Northwest.</p><p><strong>Methods: </strong>From a cohort of 1954 Medicare members ages 65 and older who completed a social needs questionnaire, we examined the association between 5 dichotomous (yes vs no) social needs measures (financial strain, food insecurity, housing instability, social isolation, and transportation needs) and 3 DM-specific outcomes in the 12 months after assessment: 1) good glycemic control (HbA1c < 8%); 2) any DM-specific emergency department (ED) utilization; and 3) any DM-specific hospital admissions.</p><p><strong>Results: </strong>About 40% of the study population reported 1 or more social needs. Financial strain (OR = 0.56, 95% CI = 0.36-0.85), food insecurity (OR = 0.47, 95% CI = 0.28-0.81) and housing instability (OR = 0.50, 95% CI = 0.25-0.99) were associated with lower odds of good glycemic control. All 5 social needs were associated with higher ED utilization (financial strain: OR = 1.65, 95% CI = 1.17-2.33; food insecurity: OR = 1.62, 95% CI = 1.02-2.57; housing instability: OR = 2.14, 95% CI = 1.23-3.75; social isolation: OR = 1.36, 95% CI = 1.06-1.74; transportation needs: OR = 1.83, 95% CI = 1.23-2.71). Financial strain was also associated with higher hospital admissions (OR = 1.77, 95% CI = 1.17-2.68).</p><p><strong>Discussion: </strong>Associations between social needs and DM-specific outcomes demonstrate the need to develop programs to address social needs in the clinical setting and test whether such interventions improve DM-related outcomes.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 1","pages":"125-132"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050070","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":"Successful Implementation of Integrated Behavioral Health.","authors":"W Perry Dickinson, Mark Gritz, Kyle E Knierim, Stephanie Kirchner, Douglas H Fernald, Allyson Gottsman, Kimberly Wiggins, L Miriam Dickinson","doi":"10.3122/jabfm.2024.240081R1","DOIUrl":"10.3122/jabfm.2024.240081R1","url":null,"abstract":"<p><strong>Introduction: </strong>The Colorado State Innovation Model (SIM) initiative aimed to support primary care practices in implementing behavioral health integration and other aspects of advanced primary care. This project evaluated implementation of behavioral health integration and the Building Blocks of High Performing Primary Care in primary care practices.</p><p><strong>Methods: </strong>A total of 334 practices participated in SIM in 3 cohorts for 1 year (cohort 3) or 2 years (cohorts 1 and 2). Practice transformation support for implementation of advanced primary care and behavioral health integration was provided. Measures included 1) Comprehensive Primary Care Practice Monitor, completed at baseline, 12, and 24 months to assess implementation of the building blocks of primary care and behavioral integration, and 2) Behavioral health clinical quality measures, reported quarterly.</p><p><strong>Results: </strong>Practices improved on implementation of all building blocks, including leadership, data driven improvement, empanelment, team-based care, patient-team partnerships, population management, continuity of care access to care, care coordination, resource utilization, behavioral health integration, and general behavioral health improvement (all <i>P</i> < .0001). Onsite behavioral health integration was implemented by 78% of practices by the end of the intervention. Practices improved on depression screening and monitoring (<i>P</i> < .0001) and maternal depression screening (<i>P</i> < .001). Implementation of several building blocks mediated improvement in depression screening and monitoring and maternal depression screening (<i>P</i> < .05).</p><p><strong>Discussion: </strong>Practices in the SIM initiative successfully implemented behavioral health integration and the building blocks of high performing primary care, yielding improved behavioral clinical quality measures. Implementation of the building blocks mediated improvements in clinical quality measures.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":"38 1","pages":"107-118"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990439","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":"Associations Between Modifiable Preconception Care Indicators and Pregnancy Outcomes.","authors":"Ashwini Kamath Mulki, Melanie B Johnson, Nicole M Burgess, Kyle Shaak, Katie Nisbett, Katarzyna Jabbour, Roya Hamadani, Beth Careyva","doi":"10.3122/jabfm.2024.240133R1","DOIUrl":"10.3122/jabfm.2024.240133R1","url":null,"abstract":"<p><strong>Purpose: </strong>This study explored gaps and opportunities in preconception care with a focus on determining whether modifiable preconception care indicators are associated with preterm births.</p><p><strong>Methods: </strong>This retrospective case-control study explored prepregnancy data of patients ≥18 years old who delivered preterm (cases) versus full term (controls) between June 1, 2018, and May 31, 2019, at a health care network in Pennsylvania. Cases were matched 1:2 with controls based on age, parity, and history of preterm delivery. A literature review yielded 11 key indicators of quality preconception care. Documentation of counseling on these indicators were extracted from patient charts from their most recent primary care visit before pregnancy (preconception care) and their pregnancy intake visit (prenatal care). Bivariate analyses were used to assess whether any of the 11 preconception indicators were associated with preterm birth. All analyses were conducted using SPSS statistical software.</p><p><strong>Results: </strong>Our sample included 663 patient charts: 221 preterm births and 442 term births. Elevated blood pressure (>120/80) in the preconception period (Odds Ratio [OR] = 1.84) and at the prenatal intake visit (OR = 1.68) was significantly associated with preterm birth. In addition, patients with Body Mass Index (BMI) ≤18 or ≥30 at their prenatal visit were nearly twice as likely (OR = 1.85) to have pregnancies resulting in preterm birth.</p><p><strong>Conclusions: </strong>Our study highlights BMI and Blood Pressure (BP) as key focus points for preconception counseling. Additional studies are needed to determine whether pregnancy outcomes other than preterm birth may be influenced by these and other preconception care indicators.</p>","PeriodicalId":50018,"journal":{"name":"Journal of the American Board of Family Medicine","volume":" ","pages":"84-93"},"PeriodicalIF":2.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789400","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}