Telemedicine journal and e-health : the official journal of the American Telemedicine Association最新文献

{"title":"Economic Impact of an Employer-Sponsored Integrated Digital Intervention Targeting Substance Use Disorders: Return on Investment Analysis.","authors":"Suzette Glasner, Alfonso Ang, Darcy Michero","doi":"10.1089/tmj.2025.0102","DOIUrl":"10.1089/tmj.2025.0102","url":null,"abstract":"<p><p><b>Background:</b> In light of the limited accessibility of evidence-based treatments for substance use disorders (SUD), coupled with the excess health care costs associated with untreated SUD, digital health has the potential to be transformative in addressing substance use and related chronic co-occurring conditions. This research aimed to evaluate the economic impact of Pelago (PEL), an integrated digital intervention combining psychosocial and pharmacological treatment targeting alcohol, tobacco, and opioid use disorders in a commercially insured adult population (N = 7,586). The model provided telehealth services using a smartphone application, from which clinician-facilitated videoconferencing and asynchronous messaging were delivered, along with digital, evidence-based therapy content and pharmacotherapy. <b>Methods:</b> Using a longitudinal model, a return on investment (ROI) analysis was undertaken to evaluate the impact of PEL on all-cause medical plan utilization costs 12 months before and after treatment initiation, relative to a matched control group. <b>Results:</b> In the 12 months following PEL registration, the intent-to-treat cohort who received the digital intervention evidenced an average all-cause medical plan utilization cost savings of $6,758 or 33% less per participant (4.5 ROI; p = 0.001). Among 1,172 participants who received PEL, a total savings of $7,920,376, relative to total program costs of $1,747,452 yielded a 4.5:1 ROI. <b>Conclusions:</b> Evidence-based treatment for SUD delivered via telehealth is associated with a significant positive ROI. Employers and payers willing to offer access to digital SUD care can mitigate morbidity and mortality while concurrently reducing medical costs and service utilization.</p>","PeriodicalId":520784,"journal":{"name":"Telemedicine journal and e-health : the official journal of the American Telemedicine Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shared Decision Making in Telehealth Versus In-Person Pediatric Primary Care.","authors":"Ellen A Lipstein, Sandy Lee, Chelsey Anderson, Andrew F Beck, William B Brinkman, Maria T Britto, Ruby Hyland-Brown, Chunyan Liu, Ken Tegtmeyer, Nanhua Zhang, Kristin N Ray","doi":"10.1089/tmj.2025.0139","DOIUrl":"https://doi.org/10.1089/tmj.2025.0139","url":null,"abstract":"<p><p><b>Background</b>: Expansion of telehealth in pediatrics has occurred without evaluation of how communication, such as shared decision making (SDM), is impacted. <b>Methods</b>: We recorded telehealth and in-person pediatric primary care visits and then scored them using an adaptation of the Informed Decisions Measure (IDM). We compared the total score for telehealth versus in-person through mixed effect models with random intercept for clinicians. <b>Results</b>: We observed 88 visits (46 telehealth and 42 in-person). The mean parent IDM score for telehealth was 5.43 ± 3.34 and for in-person was 5.19 ± 3.39. For adolescent patients, the mean IDM score for telehealth was 4.00 ± 3.26 and for in-person was 5.43 ± 3.8. There was no statistical difference between in-person visits and telehealth visits for parents or adolescents. <b>Conclusions</b>: The lack of difference in SDM between telehealth and in-person pediatric care provides an opportunity to develop training approaches that would work for either modality.</p>","PeriodicalId":520784,"journal":{"name":"Telemedicine journal and e-health : the official journal of the American Telemedicine Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Systematic Review of the Concepts of Efficacy, Effectiveness, and Efficiency as Applied and Measured for Virtual Health Care Delivery in Correctional Facilities.","authors":"Caroline Nyongesa, Tazeen Majeed, Marc Remond, Amy Lewandowski, Xenia Dolja-Gore, Leigh Haysom, Elizabeth Sullivan","doi":"10.1089/tmj.2024.0554","DOIUrl":"https://doi.org/10.1089/tmj.2024.0554","url":null,"abstract":"<p><p><b>Background:</b> The use of virtual care interventions in correctional facilities has increased in recent years owing to the impacts of the COVID-19 pandemic. However, the literature shows variability in the application and measurement of efficacy, effectiveness, and efficiency of virtual care interventions. This systematic review addresses this gap in evidence and provides an overview and appraisal of the methods and measures used to evaluate these aspects of virtual care interventions in correctional facilities, using a modified conceptual framework by the World Health Organization (WHO). <b>Methods:</b> We conducted a systematic review using a narrative synthesis approach. Comprehensive searches were performed in PubMed, Scopus, and Web of Science for peer-reviewed studies published in English between 2014 and 2024. The Joanna Briggs Institute Meta-Analysis of Statistical Assessment and Review Instrument was used to assess the methodological quality of included studies. <b>Results:</b> Twenty-one studies were included, and most were conducted in the United States and focused on synchronous modality for adult males. None of the studies explicitly defined the efficacy, effectiveness, and efficiency of virtual care interventions. The concept of effectiveness was the most frequently explored, and aligned best with WHO's conceptual framework, whereas efficiency was the least explored. The most common evaluation measures were clinical effectiveness, user satisfaction, and interexaminer agreement. <b>Conclusions:</b> This review highlights the need for adopting a unified framework for evaluating virtual care in correctional facilities that can standardize evaluation metrics and improve resource allocation, ultimately enhancing patient outcomes by ensuring that virtual care interventions are efficacious, effective, and efficient.</p>","PeriodicalId":520784,"journal":{"name":"Telemedicine journal and e-health : the official journal of the American Telemedicine Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decreased Health Care Utilization in Complex Care Pediatrics After 1 Year with a Remote Examination Device.","authors":"Anna Jane Sibilia, Scott R Callahan, Kathleen Pulda, Lindsey M Schiferl, James D Odum, Marie A Pfarr, Ken Tegtmeyer","doi":"10.1089/tmj.2025.0105","DOIUrl":"https://doi.org/10.1089/tmj.2025.0105","url":null,"abstract":"<p><p><b>Background:</b> Children with medical complexity are a growing population of pediatric patients with high health care utilization. Telemedicine could provide timely and reliable access to care that mitigates the associated burden of transportation and cost of expensive emergency room visits or hospitalizations. This study evaluated the health care utilization of patients in a complex care center (CCC) after a year with a remote examination telehealth device. <b>Methods:</b> A single-center, nonrandomized retrospective observational study was performed. The health care utilization of 273 patients with the device (cases) was evaluated 1 year after device acquisition and compared with health care utilization 2 years and 1 year prior to device acquisition. The health care utilization of 204 patients without the device (controls) was compared with cases over the same time period. Demographic differences between cases and controls were also evaluated. <b>Results:</b> Cases had significantly less health care utilization compared with controls in the year after device acquisition and compared with the time prior to device acquisition (<i>p</i> < 0.001). Cases were more likely to reside in communities with high socioeconomic status, were more likely to be white, and more likely to speak English than nonusers. <b>Conclusions:</b> A telemedicine remote examination device was shown to be associated with decreased health care utilization in patients in a CCC. However, significant socioeconomic and demographic differences existed between the groups, which may have contributed to these findings.</p>","PeriodicalId":520784,"journal":{"name":"Telemedicine journal and e-health : the official journal of the American Telemedicine Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge, Attitudes, and Practices of Teleconsultation in France Among General Population and Physicians: A National Survey.","authors":"Robin Ohannessian, Dorothée Lamarche, Solange Brugnaux, Sarah Ghazarian, Jamel Cheniour, Paul Martin Gousset, Jean-Pascal Piermé, Julie Salomon","doi":"10.1089/tmj.2025.0079","DOIUrl":"https://doi.org/10.1089/tmj.2025.0079","url":null,"abstract":"<p><p><b>Introduction:</b> The utilization of teleconsultation (TC) via synchronous video calls has surged globally and in France since the onset of the COVID-19 pandemic in 2020. The objective was to describe the knowledge, attitudes, and practices regarding TC among the general population and physicians in France. <b>Methods:</b> We conducted two national voluntary anonymous online surveys for the general population and for physicians. The sample size, calculated for a 95% confidence level and a 5% margin of error, was determined to be 2,001 participants for the general population and was estimated with the quota method to ensure representativeness. The survey for physicians was sent from April 27 to June 2, 2023. <b>Results:</b> Among the population, 32% were TC users primarily conducted for themselves (83%) or their children (28%), as a replacement for a physical consultation (75%) and not with their treating physician (56%), while considering the physician location as not relevant (68%). The satisfaction among TC users was 88%. They experienced quicker access to care (54%) and similar or better experience (74%), and 84% agreed that TC improved access to care. If TC had not been available, 28% would have gone to the emergency department (ED). The main reasons cited for consulting remotely were to obtain a medical opinion related to new symptoms (38%) and to acquire a medical certificate or sick leave (35%). Among non-TC users, 53% were considering using it. Among physicians, 83.6% used TC for 1-4 years (68%), with 32% practicing for at least 3 years. <b>Discussion:</b> Thirty-two percent of the French population practiced TCs in France in 2023 with a very high satisfaction rate of 88%. Almost one-third of patients would visit the ED if they could not do a TC.</p>","PeriodicalId":520784,"journal":{"name":"Telemedicine journal and e-health : the official journal of the American Telemedicine Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144289750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Assessment on the Impact of Virtual Backgrounds on Patient Perceptions in Telemedicine.","authors":"Bree Holtz, Mengyan Ma","doi":"10.1089/tmj.2025.0140","DOIUrl":"https://doi.org/10.1089/tmj.2025.0140","url":null,"abstract":"<p><p><b>Introduction:</b> Telemedicine is widely used, yet nonverbal cues such as virtual backgrounds remain understudied despite their potential influence on patient perceptions of provider credibility. <b>Methods:</b> This study used a randomized experimental design to examine the impact of three telemedicine background conditions, clinical, home office, and plain white, on patient ratings of provider expertness, competence, and ethicality. Participants (N = 136) were recruited from a large Midwestern university and completed a postvideo survey. <b>Results:</b> Analysis of variance results showed significant effects of background type on all three credibility measures. Providers in the white background condition were consistently rated lower in expertness, competence, and ethicality compared with the clinical and home office backgrounds. <b>Conclusions:</b> Findings suggest virtual backgrounds convey meaningful professional cues. Clinical and home office settings enhanced perceptions of provider credibility, while plain backgrounds diminished them. Background choice in telemedicine influences patient trust, underscoring the need for visual professionalism guidelines in virtual care settings.</p>","PeriodicalId":520784,"journal":{"name":"Telemedicine journal and e-health : the official journal of the American Telemedicine Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Satisfaction with Lung Transplant Telemedicine: Lessons from the COVID-19 Pandemic.","authors":"June Kim, Ester Villalonga-Olives, George Doumat, Roumen M Vesselinov, Julio A Huapaya, Hatoon M N Abbas, Vaidehi Kaza, Srinivas Bollineni, Nicholas Ladikos, Adrian Lawrence, Manish R Mohanka, Juan Deleija-Lujano, Adnan Khan, Joseph Crossno, Fernando Torres, Vipul Patel, Anu Varghese, Aldo T Iacono, Bartley P Griffith, Michael L Terrin, Irina Timofte","doi":"10.1089/tmj.2025.0090","DOIUrl":"https://doi.org/10.1089/tmj.2025.0090","url":null,"abstract":"<p><p><b>Background:</b> Telemedicine has become essential for maintaining post-transplant care while reducing exposure risks during the SARS-CoV-2 pandemic. Lung transplant recipients require frequent monitoring due to chronic immunosuppression and comorbidities. This study evaluates patient satisfaction and the feasibility of a lung transplant telemedicine program using a multidimensional, patient-centered survey. <b>Methods:</b> We conducted an observational study at the University of Maryland Lung Transplant Center between March and November 2020. A customized telemedicine satisfaction survey, developed with expert and patient input, was distributed via e-mail to lung transplant recipients, with a follow-up 6 months later. Key domains included quality of care, technology usability, cost burden, and overall experience. <b>Results:</b> Of 148 patients surveyed, 106 responded, with 53 completing the follow-up survey. In the initial and follow-up surveys, 94% and 89% rated telemedicine care as \"very good\" or \"excellent.\" Technology usability was high, with 96% and 94% reporting good understanding. Most patients (90% initially, 84% at follow-up) noted decreased travel costs. However, while patients appreciated these benefits, preference for in-person visits increased from 45% initially to 65% at follow-up. <b>Conclusion:</b> Lung transplant patients reported high satisfaction with telemedicine, benefiting from reduced costs and COVID-19 exposure risk. The survey captured the complexities of post-transplant care while addressing technological barriers. Future research should validate telemedicine satisfaction tools across multiple centers and assess its impact on clinical outcomes in transplant populations.</p>","PeriodicalId":520784,"journal":{"name":"Telemedicine journal and e-health : the official journal of the American Telemedicine Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telehealth Competencies to Ensure Health Care Access, Quality, and Equity for Older Adults: A Scoping Review.","authors":"Melanie T Gentry, Allison H Beito, Donald M Hilty","doi":"10.1089/tmj.2025.0080","DOIUrl":"https://doi.org/10.1089/tmj.2025.0080","url":null,"abstract":"<p><p><b>Background:</b> During the COVID-19 pandemic, increased use of telehealth expanded access to health care for older adults. Many clinicians and health systems adjusted workflows and realized that certain competencies are needed to fully engage older adults in telehealth services. This scoping review evaluates the approaches needed to educate clinicians about providing telehealth services to older adults. <b>Methods:</b> We conducted a review of studies published from January 2000 through February 2024 by using the 6-stage scoping review process. Searches of PubMed/MEDLINE and five other databases included the concept areas of competencies, telehealth delivery of mental health services, and older adults. <b>Results:</b> We initially identified 813 articles, of which 89 were eligible for full-text review and 15 met our inclusion criteria. Most studies included training participants about the use of telehealth but without formal curricular interventions or evaluations and lacked details about topics, materials, methods, or outcomes. Telehealth training was general and focused primarily on the use of technology and telepresence, although not specifically for older adults. Three themes were identified from the studies: the role of teams and interprofessional education, the importance of training for clinicians and older patients, and adaptations to improve telehealth delivery for older adults. <b>Conclusions:</b> Individual and institutional competencies are needed to guide educational goals and outcome measures related to telehealth services for older adults. The use of telehealth specifically for older adults may require adaptation to clinical practice and delivery, adjustments to workflow, development of clinician skills, and promotion of interprofessional teamwork.</p>","PeriodicalId":520784,"journal":{"name":"Telemedicine journal and e-health : the official journal of the American Telemedicine Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telenursing Demands Among Older Adults with Disability in Saudi Arabia.","authors":"Khalid Abdullah Aljohani","doi":"10.1089/tmj.2025.0033","DOIUrl":"https://doi.org/10.1089/tmj.2025.0033","url":null,"abstract":"<p><p><b>Introduction:</b> Telenursing leverages information technology and telecommunications to provide nursing services remotely, which offers distinct advantages to patients, caregivers, and nurses. This study explored the demand for and factors influencing long-term telenursing care among older adults with disabilities in Saudi Arabia. <b>Methods:</b> Participants included individuals aged 60 or older with physical disabilities, or their caregivers with at least three months of caregiving experience. Data were collected using a three-part questionnaire distributed through multiple channels, including nursing facilities. Descriptive statistics, single-factor analysis, and multivariate linear regression were conducted using SPSS v25, with significance set at p < 0.05. <b>Results:</b> A total of 188 responses were analyzed. Among the telenursing services assessed, online appointments had the highest demand (M = 4.18 ± 0.78), followed by visual calls (M = 4.04 ± 0.83) and telenursing consultations (M = 3.88 ± 0.88). Online reminders for important dates were least in demand (M = 3.41 ± 1.12). Demand varied significantly by gender, marital status, number of chronic illnesses, and self-perceived health. Women and widowed individuals showed the highest demand (M = 91.8 ± 16.9; M = 99.4 ± 13.6, respectively). Similarly, participants with poor self-perceived health or multiple chronic conditions reported greater interest in telenursing (M = 106.9 ± 26.4; M = 98.5 ± 16.5, respectively). <b>Conclusions:</b> Strong interest was observed for online appointments, visual calls, and consultations, among older adults with disabilities. Key influencing factors include marital status, chronic illness, health perception, and socioeconomic status. Further research is needed to develop targeted, patient-centered telenursing strategies.</p>","PeriodicalId":520784,"journal":{"name":"Telemedicine journal and e-health : the official journal of the American Telemedicine Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lessons Learned from a Vitreoretinal Virtual Service in a Tertiary Referral Center.","authors":"Bence Tasnadi, Anthony Gigon, Huda Al-Hayouti, Shohista Saidkasimova","doi":"10.1089/tmj.2025.0042","DOIUrl":"https://doi.org/10.1089/tmj.2025.0042","url":null,"abstract":"<p><p><b>Background:</b> We present our experience in telemedicine in a tertiary referral hospital covering the west of Scotland, from November 29, 2021, to June 27, 2022. We piloted vitreoretinal virtual clinics where patients were directly referred by community optometrists or by general ophthalmologists. Most patients were referred with an accompanying Optical Coherence Tomography (OCT) scan. A consultant vitreoretinal surgeon reviewed the scans with any accompanying-colored pictures and conducted a telephone consultation with the patients. This study aimed to analyze the efficacy of this virtual service to improve delivery of future care. <b>Methods</b>: This was a retrospective audit study. All patients booked into the virtual telephone clinics for one consultant were identified through the electronic referral pathway and health care records. The total number of patients booked into these virtual clinics was 284, of which 258 attended. Each patient's referral letter and clinic letter were reviewed. Patients were also sent a questionnaire to assess their experience accessing the virtual clinic. <b>Results</b>: Of the 258 patients who attended the virtual clinic, 55 patients were listed for surgical intervention, 6 were sent for outpatient treatment, 38 were invited for a face-to-face consultation, 10 were offered surgery but declined, and 149 were discharged from the clinic. Our patient questionnaire found that 86% of attendees were satisfied with the accessibility of the appointment and 63% were confident in the quality of care provided. <b>Conclusions</b>: The combination of patients requiring no further treatment and those declining treatment demonstrated a 62% reduction in the number of face-to-face hospital appointments required. We believe the use of imaging such as OCT and wide-field colored fundus photography proves to be an excellent tool for assessment of patients in combination with a telephone discussion of symptomatology and management plans. This approach can also prove cost-effective for both the health care systems and the patients.</p>","PeriodicalId":520784,"journal":{"name":"Telemedicine journal and e-health : the official journal of the American Telemedicine Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}