Journal of Medical Screening最新文献

{"title":"Impact of the COVID-19 pandemic on colorectal cancer screening in New York City.","authors":"Briton Lee,&nbsp;Sigrid Young,&nbsp;Renee Williams,&nbsp;Peter S Liang","doi":"10.1177/09691413221128666","DOIUrl":"https://doi.org/10.1177/09691413221128666","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic significantly impacted the delivery of cancer screening. The resulting decrease in outpatient visits and cancellations of non-urgent procedures have negatively affected colorectal cancer (CRC) screening. We aimed to determine the effect of the pandemic on CRC screening at a safety-net hospital and a private health system based in New York City.</p><p><strong>Methods: </strong>We identified individuals eligible for CRC screening aged 50 to 75 years presenting for outpatient care at a safety-net public hospital and private health system in April through September of 2019 and 2020. The primary outcome was the proportion of screening-eligible patients seen in primary care who underwent CRC screening.</p><p><strong>Results: </strong>The safety-net hospital had 516 (6.1% of screening-eligible individuals) and 269 (4.3%) screening tests completed in 2019 and 2020, respectively (p < 0.01). Fecal immunochemical tests (FIT) accounted for 69.6% of screening in 2019 and 88.1% in 2020. Colonoscopy accounted for 20.3% of screening in 2019 and 11.9% in 2020. The private health system had 39 (0.7%) and 21 (0.6%) screening tests completed in 2019 and 2020, respectively (p = 0.48). FIT accounted for 61.9% of screening in 2019 and 57.1% in 2020. Colonoscopy accounted for 38.1% of screening in 2019 and 42.9% in 2020.</p><p><strong>Conclusion: </strong>Absolute numbers of screening tests decreased for both institutions during the COVID-19 pandemic. We observed a decrease in screening uptake and increase in proportional FIT use in the safety-net hospital but no change in the private health system.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":"30 2","pages":"81-86"},"PeriodicalIF":2.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9513512/pdf/10.1177_09691413221128666.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9712666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating stage-specific sensitivity for cancer screening tests.","authors":"Paul Pinsky, Jane Lange, Ruth Etzioni","doi":"10.1177/09691413231154801","DOIUrl":"10.1177/09691413231154801","url":null,"abstract":"<p><strong>Objectives: </strong>When evaluating potential new cancer screening modalities, estimating sensitivity, especially for early-stage cases, is critical. There are methods to approximate stage-specific sensitivity in asymptomatic populations, both in the prospective (active screening) and retrospective (stored specimens) scenarios. We explored their validity via a simulation study.</p><p><strong>Methods: </strong>We fit natural history models to lung and ovarian cancer screening data that permitted estimation of stage-specific (early/late) true sensitivity, defined as the probability subjects screened in the given stage had positive tests. We then ran simulations, using the fitted models, of the prospective and retrospective scenarios. Prospective sensitivity by stage was estimated as screen-detected divided by screen-plus interval-detected cancers, where stage is defined as stage at detection. Retrospective sensitivity by stage was estimated based on cancers detected within specified windows before clinical diagnosis with stage defined as stage at clinical diagnosis.</p><p><strong>Results: </strong>Stage-specific true sensitivities estimated by the lung cancer natural history model were 47% (early) and 63% (late). Simulation results for the prospective setting gave estimated sensitivities of 81% (early) versus 62% (late). In the retrospective scenario, early/late sensitivity estimates were 35%/57% (1-year window) and 27%/49% (2-year window). In the prospective scenario, most subjects with negative early-stage screens presented as other than early-stage interval cases. Results were similar for ovarian cancer, with estimated prospective sensitivity much greater than true sensitivity for early stage, 84% versus 25%.</p><p><strong>Conclusions: </strong>Existing methods for approximating stage-specific sensitivity in both prospective and retrospective scenarios are unsatisfactory; improvements are needed before they can be considered to be reliable.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":"30 2","pages":"69-73"},"PeriodicalIF":2.6,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10245292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9712718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Couple screening for recessively inherited disorders.","authors":"Silvina Sisterna,&nbsp;Antoni Borrell","doi":"10.1177/09691413221137039","DOIUrl":"https://doi.org/10.1177/09691413221137039","url":null,"abstract":"<p><p>Couple screening aims to identify couples with an increased risk of having a child affected with an autosomal recessive or X-linked disorder, in order to facilitate informed reproductive decision making. Both expectant parents should be screened as a single entity, instead of individual testing. Carrier testing was typically performed for a few relatively common recessive disorders associated with significant morbidity, reduced life expectancy and often because of a considerably higher carrier frequency in a specific population for certain diseases. However, new genetic testing technologies enable the expansion of screening to multiple conditions, genes and sequence variants. There are multiple reproductive options for screening couples at risk, particularly when genetic traits are detected in the preconception period.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":"30 2","pages":"55-61"},"PeriodicalIF":2.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9650184","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":"\"It's cancer screening after all\". Barriers to cervical and colorectal cancer screening and attitudes to promotion of self-sampling kits upon attendance for breast cancer screening.","authors":"Pia Kirkegaard,&nbsp;Mette Bach Larsen,&nbsp;Berit Andersen","doi":"10.1177/09691413221137852","DOIUrl":"https://doi.org/10.1177/09691413221137852","url":null,"abstract":"Objectives To explore barriers to cervical and colorectal cancer screening and attitudes to promotion of self-sampling kits upon attendance for breast cancer screening. Methods Interview study with women who had not responded to one or more invitations to cervical or colorectal cancer screening. A semi-structured interview guide was used and interviews were audio recorded and transcribed verbatim. Concepts from Temporal Motivation Theory were used to structure and analyse the data. Results Twenty-two women were interviewed. Screening was highly valued but the women perceived screening for cervical cancer and colorectal cancer as more troublesome to participate in, compared with participation in breast cancer screening. The lack of a pre-booked appointment or a suggested deadline attenuated the perceived value of cervical and colorectal cancer screening and this further increased procrastination. Promotion of self-sampling kits for cervical and colorectal cancer screening upon attendance for breast cancer screening was considered a feasible way to increase salience of both types of screening. Conclusion A high number of micro steps and absence of a deadline in cervical and colorectal cancer screening diverted attention away from screening participation in cervical and colorectal cancer screening. The main facilitator could be reduction of micro actions, proposing a suggested deadline, and promotion of self-sampling kits when attending breast cancer screening to increase salience and a renewed attention to all three screening programmes.","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":"30 2","pages":"74-80"},"PeriodicalIF":2.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/36/ba/10.1177_09691413221137852.PMC10149879.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9712700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with women's supplemental screening intentions following dense breast notification in an online randomised experimental study.","authors":"Brooke Nickel,&nbsp;Hankiz Dolan,&nbsp;Nehmat Houssami,&nbsp;Erin Cvejic,&nbsp;Meagan Brennan,&nbsp;Jolyn Hersch,&nbsp;Melanie Dorrington,&nbsp;Angela Verde,&nbsp;Lisa Vaccaro,&nbsp;Kirsten McCaffery","doi":"10.1177/09691413221125320","DOIUrl":"https://doi.org/10.1177/09691413221125320","url":null,"abstract":"<p><p>Controversy surrounding recommendations for supplemental screening (ultrasound and magnetic resonance screening) in women with dense breasts exists, as the long-term benefits from these additional modalities may not outweigh the harms. This study aimed to examine factors associated with supplemental screening intentions following a hypothetical breast density notification in a population of women who have not been routinely notified. Australian women of breast screening age participated in an online randomised experimental study where they were presented with one of two breast density notifications (with or without health literacy-sensitive information) and asked their screening intentions. After adjusting for covariates in multivariable analyses, women in both groups (n = 940) who indicated higher levels of breast cancer worry, had private health insurance, had a family history of breast cancer, and had a greater number of times previously attending mammography screening had higher intentions for supplemental screening. Understanding women's supplemental screening intentions following notification of dense breasts has important implications for health systems with breast screening considering the impacts of widespread notification. Personal, clinical and psychological factors should be considered when discussing both the benefits and harms of supplemental screening with women with dense breasts.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":"30 2","pages":"92-95"},"PeriodicalIF":2.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9656202","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":"Interval cancer audit and disclosure in breast screening programmes: An international survey.","authors":"Patricia Fitzpatrick,&nbsp;Helen Byrne,&nbsp;Fidelma Flanagan,&nbsp;Ann O'Doherty,&nbsp;Alissa Connors,&nbsp;Aideen Larke,&nbsp;Risteard O'Laoide,&nbsp;Yvonne Williams,&nbsp;Therese Mooney","doi":"10.1177/09691413221122014","DOIUrl":"https://doi.org/10.1177/09691413221122014","url":null,"abstract":"<p><strong>Objective and setting: </strong>Accurate monitoring of interval cancers is important both for quality improvement and education and is a key parameter of breast screening quality assurance. Issues in relation to communication regarding interval cervical cancer in the Irish cervical screening programme were found, prompting interval cancer process review in all cancer screening programmes. An international survey to examine international consensus on interval breast cancer audit processes was conducted to inform Irish processes.</p><p><strong>Methods: </strong>A survey of 24 international population-based breast screening programmes was done to determine which undertook audit of interval breast cancer; if yes, they were asked (1) how they undertake audit, (2) if they obtain individual consent for audit and inform women of audit results, and (3) if disclosure of audit results occurs.</p><p><strong>Results: </strong>Response was 71% (17/24). Of these, 71% (12/17) have a programmatic audit process to calculate the interval cancer rate (ICR). Of these, ten also carry out radiological reviews, three using a blinded review. Two inform patients that audit is taking place; two provide choice to be in the audit; nine state that routine screening consent covers audit. For two of the five that have an open disclosure policy for medical incidents, this policy applies to screening interval cancers. One other country/region has an open disclosure policy for category 3 interval cancers only. Five have legal protection for interval cancers arising in the screened population.</p><p><strong>Conclusion: </strong>While consistency in providing aggregate programmatic audits exists, there is no consistent approach to individual interval cancer reviews or results disclosure.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":"30 1","pages":"36-41"},"PeriodicalIF":2.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/79/a7/10.1177_09691413221122014.PMC9925906.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9299735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thanks to reviewers.","authors":"","doi":"10.1177/09691413231154697","DOIUrl":"https://doi.org/10.1177/09691413231154697","url":null,"abstract":"","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":"30 1","pages":"51"},"PeriodicalIF":2.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9229648","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":"The impact of the COVID-19 pandemic on breast cancer screening and diagnosis in a Brazilian metropolitan area.","authors":"Erika Marina Solla Negrao,&nbsp;Cesar Cabello,&nbsp;Livia Conz,&nbsp;Edmundo Carvalho Mauad,&nbsp;Luiz Carlos Zeferino,&nbsp;Diama Bhadra Vale","doi":"10.1177/09691413221122055","DOIUrl":"https://doi.org/10.1177/09691413221122055","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the performance of breast cancer screening and early diagnosis during the pandemic, compared to the pre-pandemic period.<b>Setting:</b> The public referral centre for screening in Campinas, São Paulo State, Brazil.</p><p><strong>Methods: </strong>This is an audit study of performance screening and diagnostic indicators. Two periods were analysed: 2019, the pre-COVID period, and 2020, the COVID period. All women who underwent mammography in these periods were included. Indicators were compared between periods, and the US Breast Cancer Surveillance Consortium benchmarks were used as a reference.</p><p><strong>Results: </strong>A comparison between the periods shows a reduction of 57.4% in screening and 4.4% in diagnosis using mammography. Cancer detection rate per 1000 screening mammograms dropped from 4.62 to 2.83 (p  =  0.031), while it increased from 84.43 to 89.36 in diagnosis mammograms (p  =  0.701), higher than the reference (34.4, p < 0.001). With regard to diagnosis, the proportion of minimal cancers was reduced (p  =  0.005) and was lower than the reference (40.0%, p < 0.001), along with the proportion of node-negative invasive cancers (p < 0.001). The mean size of invasive tumours was similar in the two periods (32.50 mm and 33.40 mm, p  =  0.808) but larger than the reference value (16.50 mm, p < 0.001). Recall rate was lower in the COVID period (22.55% vs. 27.37%, p  =  0.015).</p><p><strong>Conclusion: </strong>The COVID pandemic caused an overall decrease in breast screening and detection of breast cancer cases, although the reduction in number of diagnosis mammograms performed was minimal. Tumour mean size was large in both periods, the pandemic highlighting a previous profile of detection at an advanced stage.</p>","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":"30 1","pages":"42-46"},"PeriodicalIF":2.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9922643/pdf/10.1177_09691413221122055.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10814865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age at breast cancer screening in women with intellectual disability.","authors":"Daniel Satgé,&nbsp;Motoi Nishi","doi":"10.1177/09691413221132674","DOIUrl":"https://doi.org/10.1177/09691413221132674","url":null,"abstract":"Dear Editors, Current guidelines for breast cancer screening in women with intellectual disability (WIDs) do not differ from those for women in the general population. However, research suggests that WIDs are younger and have more advanced disease at breast cancer diagnosis than women in the general population. Three studies conducted in France showed breast cancer appearing earlier (Table 1). A hospital survey in central France included 11 breast cancer cases in WIDs discovered at a mean age of 55.6 years, 7 years earlier than in the control cohort (62.4 years). Five of the 11 malignancies (45%) were discovered in women before the age of 50. The cases in WIDs however were at a more advanced stage than in the control cohort (American Joint Committee on Cancer: AJCC1, OR=3.2, p=0.010). A study including 1519 randomly selected institutions dedicated to disabled adults across the whole of France identified 13 breast cancer cases in WIDs (with age known). These were diagnosed at a mean age of 47.8 years, 15 years earlier than in the French population during the corresponding period, and eight (61%) were in women under 50 years at diagnosis. The third was a population-based study conducted in the south of France which analyzed breast cancers in 21 WIDs. The mean age at diagnosis was 7 years earlier (54.7 years vs 61.8 years) than for controls in the regional Cancer Registry. Seven tumors (33%) were diagnosed before 50 years of age. There was also a trend to greater tumor volume (more advanced T stage) (Jacot et al., article submitted). A literature search conducted by one of us (MN) on Japanese publication sources, using “Japan Medical Abstract Society” (ICHUSHI) which includes medical conference reports, with key words “breast cancer” and “intellectual disability” yielded five articles and abstracts published 2003–2018.Thefive Japanesewomen concerned were aged 38–61 (mean 46.6). According to the data of “Cancer Statistics”, Cancer Information Service, National Cancer Center, Japan (National Cancer Registry, Ministry of Health, Labor and Welfare)” in recent years (2016–2018), the mean age at diagnosis of female breast cancer in Japan is 62.4 years. Three of the five WIDs were younger than 50 years at diagnosis. In a US nationwide study of data collected during 2010, 384 breast cancers among 602 reproductive cancers in WIDs were treated almost seven years earlier, at a mean age of 61, compared to 67.8 years for women without intellectual disability. Mass screening is a precious opportunity to treat breast cancer early in WIDs. First, breast cancer which has a similar incidence compared to women in the general population is the most frequent malignancy in WIDs. Second, WIDs have greater risk factors such as being more frequently overweight or obese, less involved in physical exercise, more frequently nulliparous and rarely breast feeding. Third, many WIDs do not practice breast self-palpation and have difficulties expressing their pain and symptoms. Fou","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":"30 1","pages":"47-48"},"PeriodicalIF":2.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10718106","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":"Public health perspective on prostate-specific antigen screening: Implications of overdiagnosis and differences in health insurance systems across countries.","authors":"Takeshi Takahashi","doi":"10.1177/09691413221139960","DOIUrl":"https://doi.org/10.1177/09691413221139960","url":null,"abstract":"Of the guidelines (for men at average and high risk) listed in their table, the US Preventive Services Task Force (USPSTF) recommendations are made solely by public health physicians, while others are made mainly by urologists. In the US, the 2012 USPSTF’s Grade D recommendation (not recommended) was strongly opposed by the American Urological Association (AUA), claiming that PSA screening reduces cancer mortality. After being upgraded to Grade C in 2018, the AUA endorsed it and other guidelines have been adapted accordingly. However, in practice, information provided by hospitals to patients tends to have nuances in favor of PSA screening. In Europe, the European Association of Urology (EAU) recommends PSA screening, arguing that it reduces cancer mortality and that the risk-adapted strategy has solved the problem. Since prostate cancer is a cancer of the elderly, the risk of death from other causes is overwhelmingly higher than that from cancer. Improvements in cancer-specific mortality have no benefit unless overall survival (OS) changes. If only the cause of death changes and the length of life remains the same, there is no need for early detection and treatment. In the UK, attempts to encourage PSA screening of high-risk populations, such as men of Black race, have been criticized. The prostate cancer mortality rate of 5.4 per 10,000 may become 10.8 in the high-risk group, but we don’t know how the screening group mortality rate would change, from 4.3 per 10,000 (according to USPSTF summary), and there would be no change in the OS. Higher risk does not necessarily mean greater benefit from screening. In addition, it is known that the mortality rate of prostate cancer is extremely low in Asians. Screening is less and less relevant, and the benefit, if any, will be even smaller. Urologists do not adequately understand the recommendations of public health physicians. One of the reasons why there is no PSA screening program in the UK is that the National Health Service, made up of many public health physicians, respects the fact that there is insufficient evidence of its efficacy and cost-effectiveness. The USPSTF does not recommend publically funded screening. Grade C recommendations are for private insurance coverage. In other words, in the US, you should be well informed, be convinced, pay, and take responsibility for the consequences yourself. The UK and Canada have public medical insurance and no PSA screening. In Japan, a group of public health physicians published a guideline in 2009 that is nearly identical to the 2018 USPSTF statement. Urologists were initially members of the group and involved in the development of the guideline, but they resigned because they were unhappy with the content and have since developed their own, recommending PSA screening for all age groups and almost identical to the 2012 AUA comments. Even after the AUA approved the USPSTF statement in 2018, it has yet to be revised. The prostate cancer mortality among J","PeriodicalId":51089,"journal":{"name":"Journal of Medical Screening","volume":"30 1","pages":"49-50"},"PeriodicalIF":2.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10718646","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}