Journal of Hand Therapy最新文献

{"title":"Exploring the barriers and enablers to the standardized and routine use of patient-rated outcomes for clients presenting with hand injuries at an Australian public hospital.","authors":"Laura Cowling, Dave Parsons, Cleo Bigwood, Sally Foster, Andrea Pinto, Yu Xuan Kong","doi":"10.1016/j.jht.2024.08.006","DOIUrl":"https://doi.org/10.1016/j.jht.2024.08.006","url":null,"abstract":"<p><strong>Background: </strong>The utilization of standardized patient-rated outcome measures (PROMs) by hand therapists is essential to evaluate treatment and clinical outcomes and underpins evidence-based and patient-centered practice. However, research indicates that the routine use of PROMs is inconsistent in clinical practice.</p><p><strong>Purpose: </strong>To explore the barriers and enablers experienced by hand therapists in the routine use of standardized and valid PROMs. Additionally, it aimed to describe appropriate strategies, based on the barriers and enablers identified, to improve the administration of PROMs in hand therapy practice.</p><p><strong>Study design: </strong>Qualitative.</p><p><strong>Methods: </strong>Semistructured interviews were used to explore the experiences of hand therapists in routinely using PROMs in clinical practice at two Australian tertiary public hospital hand clinics. Qualitative data were analyzed for themes using reflexive thematic analysis described by Braun and Clarke.</p><p><strong>Results: </strong>Ten participants were interviewed. Interview findings generated three core themes-Culture is King, It's All Too Hard and When I do it, I value it. The core themes-Culture is King and It's All Too Hard reflected the cultural and institutional factors that present as barriers to the routine uptake of standardized PROMs, such as lack of infrastructure to support data collection and a lack of knowledge of PROMs. The third core theme, \"When I do it, I value it\" reflects the value and importance of completing PROMs to facilitate evidence-based practice and benefits in tracking treatment progress and providing feedback regarding their progression. Suggested strategies for addressing barriers included using appropriate and standardized methods of collecting and storing PROM data, improving accessibility to PROMs in clinical practice and forming peer education groups and training opportunities.</p><p><strong>Conclusions: </strong>Hand therapists identify the value and importance of completing PROMs in daily practice; however, culture in the workplace and organizational infrastructure adversely influence the routine use of standardized PROMs by hand therapists.</p>","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025354","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 2021 American Hand Therapy Foundation research priorities survey.","authors":"April C Cowan, Marsha B Lawrence, Elaine E Fess, Caroline W Stegink-Jansen","doi":"10.1016/j.jht.2024.11.007","DOIUrl":"https://doi.org/10.1016/j.jht.2024.11.007","url":null,"abstract":"<p><strong>Background: </strong>In 1998, the American Hand Therapy Foundation (AHTF) surveyed Certified Hand Therapists and active Charter Members of the American Society of Hand Therapists to identify hand rehabilitation research priorities, guide grant awards, and confirm alignment with the foundation's mission.</p><p><strong>Purpose: </strong>The American Hand Therapy Foundation repeated the survey in 2021 to confirm that its award funding was consistent with hand therapists' research priorities.</p><p><strong>Study design: </strong>Convergent parallel mixed method study design.</p><p><strong>Methods: </strong>The survey was sent to 7093 hand therapists from the United States and overseas. Respondents' demographic information was captured using quantitative questions analyzed with descriptive statistics and weighted means. Research priorities and interests were captured using qualitative questions, Grounded Theory analysis, and Constant Comparative Methods.</p><p><strong>Results: </strong>A total of 397 surveys were returned and analyzed (5.6% return rate, 95% confidence level, 5% margin of error). Participants' top research priorities were outcome studies and research grants. Tendon injuries and lateral epicondylitis were the highest prioritized diagnoses for further research. Intervention study priorities included hand rehabilitation management strategies and use of orthoses. Responses presented a need for funded outcomes research validating hand rehabilitation interventions. Level of interest in research participation was in data collection and as coauthor. Top barriers to participation in research activities were time constraints and lack of proficiency. Research education for clinicians and mentorship programs were identified as specific needs.</p><p><strong>Conclusions: </strong>American Hand Therapy Foundation research award funding was consistent with practice and reported research concerns. Participants identified their top concerns for diagnostic and outcomes research and prioritized continuing Foundation involvement in funding clinical research.</p>","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016606","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 case of a woman with bilateral Dupuytren's contractures who developed CRPS-1 after fasciectomy with no relapse on subsequent collagenase clostridium histolyticum injection and manipulation of the other hand: Considerations for implementing a Budapest criteria checklist and assessing vasomotor instability by measuring differences in skin temperature.","authors":"Julianne W Howell","doi":"10.1016/j.jht.2024.09.002","DOIUrl":"https://doi.org/10.1016/j.jht.2024.09.002","url":null,"abstract":"<p><strong>Background: </strong>For patients who experience atypical neurogenic pain thought to be complex regional pain syndrome (CRPS) after Dupuytren's fasciectomy early recognition has been reported to improve outcomes. Furthermore, given the progressive nature of Dupuytren's, individuals with a history of CRPS have been \"at risk\" for further surgical intervention.</p><p><strong>Purpose: </strong>To familiarize therapists with a Budapest criteria (BC) checklist for early diagnosis of CRPS, describe how tracking sudomotor/vasomotor signs alongside differences in skin temperature were used to monitor vasomotor instability and intervention effectiveness for a patient with atypical pain after fasciectomy and to detail management of the same patient with a CRPS history who had collagenase clostridium histolyticum (CCH) injection of her other hand without exacerbating CRPS.</p><p><strong>Study design: </strong>Case report.</p><p><strong>Methods: </strong>Medical record review was done by the author. Part 1- patient-reported symptoms and therapist-observed signs were mined and scored against the BC. Part 2- vasomotor/sudomotor signs and differences in skin temperatures (>1˚C) were used to interpret response to therapy and medical interventions. Part3- description and pictures of the process this patient underwent for CCH and manipulation.</p><p><strong>Results: </strong>Part 1- therapist documentation failed to satisfy the BC. Part 2- vasomotor/sudomotor signs and skin temperature differences of >1˚C reflected the patient's incomplete response to therapy and medication, thus strengthening need for percutaneous stellate ganglion sympathetic nerve blocks. Part 3- CRPS was not exacerbated with CCH procedure.</p><p><strong>Conclusions: </strong>Use of a BC checklist may guide documentation, speed recognition for an earlier diagnosis of CRPS in patients with Dupuytren's and an atypical post-fasciectomy response. Once identified, observed signs and measures of skin temperature could be used to monitor response to therapy and medical interventions. The positive outcome for this woman with Dupuytren's and CRPS-I after CCH injection are encouraging.</p>","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016612","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":"A collaborative interdisciplinary approach for trigger finger management.","authors":"Emma Yanko, Chris Thomson, Richard Bourassa, Curtis Gasmo, Thuy Le, Katie Crockett","doi":"10.1016/j.jht.2024.12.003","DOIUrl":"https://doi.org/10.1016/j.jht.2024.12.003","url":null,"abstract":"<p><strong>Background: </strong>Stenosing tenosynovitis, or trigger finger, is a common cause of hand disability. This study outlines a trigger finger management protocol that redirects referrals for surgical consultations to conservative management first.</p><p><strong>Purpose: </strong>The primary outcome variable was the protocol endpoint based on the resolution of trigger finger symptoms (i.e. pain and triggering). Secondary outcome measures were to identify which patient characteristics were associated with an increased need for (i) surgical management and (ii) corticosteroid injections.</p><p><strong>Study design: </strong>Retrospective chart review.</p><p><strong>Methods: </strong>The study sample included all patients referred for surgical consultation for trigger finger who were redirected to physical therapy first between the dates of August 2018 and January 2023 (n = 72). Participants initially received a physical therapy assessment and three treatment sessions. Further management was determined based on patient presentation following our protocol. Descriptive analysis involved frequency calculations of studied variables. Comparison of patient characteristics and treatment modalities across different sub-groups was examined as well as associations between various patient characteristics and increased need for (i) surgical management and (ii) corticosteroid injection.</p><p><strong>Results: </strong>Seventy-two patients were included in the study, and 60 patients completed the protocol. Of these patients, 22% (n = 16) resolved with physical therapy (PT) alone, 48.5% (n = 35) resolved with 1-2 corticosteroid injections following initial PT management and 12.5% (n = 9) were referred back for surgical consult. Sub-group comparisons revealed no significant differences in patient characteristics and treatment modalities across patients who resolved with physical therapy alone, physical therapy plus 1-2 injections, or in cases referred back for surgical consults.</p><p><strong>Conclusion: </strong>The interdisciplinary care protocol in this study demonstrated that conservative management was successful in a majority of cases; facilitating timely access to evidence-based care, including corticosteroid injections and surgical management if necessary. Physical therapy treatment provides self-management and education strategies to those requiring further interventions, potentially reducing recurrence rates.</p>","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016588","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":"Applying grip during isokinetic testing significantly impacts the concentric and eccentric strength of the wrist flexors.","authors":"Smadar Peleg, Eitan Shemy, Takashi Okada, Michal Arnon, Zeevi Dvir","doi":"10.1016/j.jht.2024.12.019","DOIUrl":"https://doi.org/10.1016/j.jht.2024.12.019","url":null,"abstract":"","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016593","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 intermetacarpal distance method for assessment of active thumb radial abduction has excellent test-retest agreement, reliability, and precision in persons with non-operative thumb carpometacarpal osteoarthritis.","authors":"Halil Ibrahim Ergen, Karl Dischinger, Corey McGee","doi":"10.1016/j.jht.2024.12.002","DOIUrl":"https://doi.org/10.1016/j.jht.2024.12.002","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Limitations in thumb radial abduction (i.e., carpometacarpal extension) are commonly experienced by persons with thumb carpometacarpal osteoarthritis. Restoring this deficit is often a focus of surgical and rehabilitative interventions. Because of this, clinical measures of radial abduction are needed. The ''gold-standard'' assessment of thumb radial abduction is goniometry however it has modest reliability in persons with thumb carpometacarpal osteoarthritis. Conversely, the intermetacarpal distance (IMD) method of assessing radial abduction has promising reliability in healthy persons and excellent inter-rater reliability in those with thumb carpometacarpal osteoarthritis. However, to date, there has been no exploration of its test-retest reliability and precision in persons with thumb carpometacarpal osteoarthritis. Further, while multiple trials are often performed in various hand therapy assessments, it is common practice to take a single measurement of hand joint range of motion. Yet, we do not know if multiple trials might enhance the reliability of these range of motion measurements.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The current study aimed to (1) assess the test-retest agreement, reliability, and precision of the IMD method when measuring thumb radial abduction and (2) compare these psychometric properties when reporting one trial, the mean of two trials, and the mean of three trials of the IMD method in people with thumb carpometacarpal (CMC1) osteoarthritis (OA).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Prospective Cohort study of test-retest reliability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Purposive sampling was used to recruit adults with radiographically confirmed CMC1 OA. Participants' radial abduction was assessed using the IMD method to measure radial abduction of the affected hand on two separate occasions approximately two weeks apart. Three trials of the assessment were administered at each visit. The Bland Altman method was uses to assess agreement, the intraclass correlation coefficient (ICC&lt;sub&gt;2,3&lt;/sub&gt;) was calculated to examine the reliability, and the standard error of the measurement (SEM), minimum detectable change (MDC) and MDC percentage were calculated to determine the precision of the IMD method for one trial, the mean of two trials, and the mean of three. Descriptive data on demographics and IMD values of the sample were presented.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Forty persons with CMC1 OA participated. The mean difference between trials ranged from 0.21 to 0.30 mm, no significant fixed biases (p≥0.48) or proportional biases (p≥0.41) existed between mean test and retest scores, and 38/40 (95%) of test-retest differences fell within the 95% limits of agreement. The Intraclass Correlation Coefficient (ICC&lt;sub&gt;2,3&lt;/sub&gt;) values were 0.942 (0.893-0.968), 0.970 (0.943-0.984), and 0.970 (0.942-0.984) for 1 trial, the mean of two trials, and then mean of three trials respectively. The ICC value of ","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016619","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":"Positive clinical tests for medial epicondylalgia are more common than tests for lateral epicondylalgia in recreational pickleball players: A cross-sectional study.","authors":"Betsy A Myers, June Hanks","doi":"10.1016/j.jht.2024.12.013","DOIUrl":"https://doi.org/10.1016/j.jht.2024.12.013","url":null,"abstract":"<p><strong>Background: </strong>Epicondylalgia is a common overuse injury in tennis. However, little is known regarding epicondylalgia in pickleball.</p><p><strong>Purpose: </strong>This study examined the prevalence of positive epicondylalgia tests in recreational pickleball players and the relationship between positive tests and player characteristics.</p><p><strong>Study design: </strong>Cross-sectional study.</p><p><strong>Methods: </strong>Clinical tests for epicondylalgia were performed courtside on the dominant arm of 129 recreational pickleball players. Participants completed a survey with questions related to demographics and play characteristics. Descriptive data were reported for epicondylalgia testing and survey performance. Chi-squared analysis and Fisher's exact test were used to determine associations between testing and survey responses. Relative risk estimates for positive tests for epicondylalgia were calculated based on pickleball playing characteristics.</p><p><strong>Results: </strong>The prevalence of positive tests was 7% for medial epicondylalgia, 5.4% for lateral epicondylalgia, and 2.3% for both medial epicondylalgia and lateral epicondylalgia. Ninety-two participants (71.3%) completed the survey. Those who participated in tournaments were less likely to have a positive test for medial epicondylalgia (Fisher's exact test, p = 0.017). The relative risk of having a positive epicondylalgia test was lower for those who have played for at least 4 years (medial = 0.875 [CI 0.81-0.95] and lateral 0.913 [CI 0.866-0.979]). Epicondylalgia testing was not associated with age, sex, hand dominance, level of play, location of play, warm-up performance, frequency of play, or length of play.</p><p><strong>Conclusions: </strong>Among pickleball players, there was a lower prevalence of positive tests for lateral epicondylalgia than for medial epicondylalgia. Compared to tennis, lateral epicondylalgia may be less common due to a lower elbow torque, while medial epicondylalgia may be more common due to methods to impart spin. Given the differences among sports, clinicians may need to utilize different prevention and intervention strategies when working with pickleball players.</p>","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016603","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":"Effects of high-intensity laser therapy in patients with De Quervain's tenosynovitis: A systematic review and meta-analysis.","authors":"Hernán Andrés de la Barra Ortiz, Nivaldo Antonio Parizotto, Claudio Chamorro Lange, Richard Eloin Liebano","doi":"10.1016/j.jht.2024.10.001","DOIUrl":"https://doi.org/10.1016/j.jht.2024.10.001","url":null,"abstract":"<p><strong>Background: </strong>De Quervain's tenosynovitis (QT) is common among individuals performing repetitive manual tasks and significantly affects daily activities due to pain. While traditional treatments often provide limited relief, high-intensity laser therapy (HILT) shows as a potential analgesic resource.</p><p><strong>Purpose: </strong>This systematic review aimed to evaluate the analgesic effects of HILT in patients with QT.</p><p><strong>Study design: </strong>This study is a systematic review with meta-analysis with an observational, retrospective, and secondary design.</p><p><strong>Methods: </strong>The search was conducted in PubMed, Web of Science, Scopus, EBSCOhost, Embase, Cochrane Library, Physiotherapy Evidence Database (PEDro), and Google Scholar (last updated September 17, 2024) to identify clinical trials comparing HILT with other treatments for QT. Pain intensity, measured with a Visual Analog Scale (VAS), was the main outcome. Disability and handgrip strength, measured with the quick disabilities of the arm, shoulder and hand (Q-DASH) and patient-rated wrist and hand evaluation (PRWE) questionnaires and dynamometry, were the secondary outcomes. Study quality was assessed using the Cochrane Risk of Bias Tool 2 (RoB2), and a meta-analysis was performed using mean difference (MD) or standardized mean difference (SMD). The GRADE approach guided evidence-based recommendations for statistically significant outcomes.</p><p><strong>Results: </strong>Three studies were included, demonstrating an overall low bias (66%), with outcome measurements being the principal sources of bias. The meta-analysis did not reveal statistically significant advantages for HILT in terms of pain intensity and disability (VAS MD=0.21 cm; 95% CI: -1.43,1.86) (SMD=-0.31; 95% CI: -0.75,0.13). Despite individual studies reporting significant differences favoring HILT, the meta-analysis lacks statistical significance, preventing definitive recommendations.</p><p><strong>Conclusions: </strong>Despite the potential benefits of HILT in managing QT, the current evidence does not support its superiority over conventional treatments like splinting or splinting combined with exercise. Further clinical trials are necessary to confirm HILT's efficacy and refine treatment guidelines in line with the dosage proposed by the included studies.</p>","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016598","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":"A valid and reliable 3D-printed electronic grip strength assessment tool.","authors":"Amelia Sorensen, Lily Brosnan, Yong Hao Pua, Julian Thumboo, Yee Sien Ng, Laura Tay Bee Gek, Ross Clark","doi":"10.1016/j.jht.2024.11.010","DOIUrl":"https://doi.org/10.1016/j.jht.2024.11.010","url":null,"abstract":"","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016590","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":"Is it prudent to interpret findings from nonblinded RCTs relying solely on patient-reported outcome measures for outcome assessment?","authors":"Manigandan Chockalingam, Laura Pearson, Orla Daly","doi":"10.1016/j.jht.2024.09.001","DOIUrl":"https://doi.org/10.1016/j.jht.2024.09.001","url":null,"abstract":"","PeriodicalId":54814,"journal":{"name":"Journal of Hand Therapy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016602","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}