Journal of Genetic Counseling最新文献

{"title":"A guide to utilizing implementation science for genetic counseling","authors":"Alanna Kulchak Rahm,&nbsp;Deborah Cragun","doi":"10.1002/jgc4.70039","DOIUrl":"https://doi.org/10.1002/jgc4.70039","url":null,"abstract":"<p>Implementation Science (IS) is a growing field that provides tools to understand and facilitate the uptake of research and policies into healthcare delivery to improve quality and outcomes. Genetic counselors are uniquely positioned as the implementers of genomic medicine, with many seeking to learn about and incorporate IS into genetic counseling education and practice. We propose that genetic counselors can utilize IS in many areas of their practice and research, such as when applying new evidence or integrating guidelines into practice and when leading or assisting with quality improvement or research projects. Our goal with this paper is to provide a general overview of IS and to introduce the basics of theories, models, and frameworks, study designs and methods, and measuring IS outcomes. In addition, we briefly discuss IS tools useful for understanding and eliminating disparities and inequities, and how IS can assist genetic counselors with policy or clinical guideline implementation. It is our belief that incorporating IS tools into practice and teaching IS approaches will add to the value of genetic counselors. To that end, our hope is that this paper becomes a starting point for the integration of IS into the profession to improve the impact of our services in every context, demonstrate the value we add in the practice of genomic medicine, and contribute to the growth and evolution of our profession.</p>","PeriodicalId":54829,"journal":{"name":"Journal of Genetic Counseling","volume":"34 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgc4.70039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892962","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":"Balancing independence: Priorities, tensions, obstacles, and facilitators for independence among young adults with skeletal dysplasia and short stature","authors":"Sarah J. Ricks,&nbsp;Jodie Johnson,&nbsp;Kara B. Ayers,&nbsp;Loren D. M. Pena","doi":"10.1002/jgc4.70033","DOIUrl":"https://doi.org/10.1002/jgc4.70033","url":null,"abstract":"<p>Developing increased independence is a primary goal of the transition to adulthood. Individuals with disabilities may face additional challenges in developing and maintaining independence during this transition. While clinical presentations associated with many skeletal dysplasias have been documented, recent research investigating how skeletal dysplasia affects independence in young adulthood is limited. We sought to understand and describe how young adults with short stature and skeletal dysplasia define independence, the barriers they face in achieving and maintaining independence, and the resources they leverage to support their independence. We conducted virtual semi-structured qualitative interviews with 10 young adults (ages 18–28 years) with short stature and skeletal dysplasia. Interviews were transcribed and analyzed using a modified constructivist grounded theory methodology. Skeletal dysplasia diagnoses among the interviewed cohort include achondroplasia, osteogenesis imperfecta, spondyloepiphyseal dysplasia tarda, spondyloepimetaphyseal dysplasia, and acromicric/geleophysic dysplasia. Participants' experiences with independence are described through four major categories: prioritizing self-sufficiency, accommodating tension, identifying obstacles, and incorporating facilitators. Considering these categories, we propose that for young adults with short stature and skeletal dysplasia, independence is a balancing act between self-sufficiency and accepting needed assistance. Based on these results, providers can recognize independence as a balancing act between competing priorities, and investigate and support patients' individual priorities. Providers can also explore patients' coping strategies, provide anticipatory guidance, connect individuals to others with shared experiences, learn about available adaptive equipment, and evaluate their clinic environments for accessibility.</p>","PeriodicalId":54829,"journal":{"name":"Journal of Genetic Counseling","volume":"34 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgc4.70033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143893028","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":"Using mixed methods for genetic counseling research","authors":"Kennedy Borle,&nbsp;Jehannine (J9) Austin","doi":"10.1002/jgc4.70031","DOIUrl":"https://doi.org/10.1002/jgc4.70031","url":null,"abstract":"<p>Mixed methods research encompasses methodological approaches that involve the collection, analysis, and integration of qualitative and quantitative data. Mixed methods are useful for complex research questions, applied research settings, and when end users value multiple forms of evidence, which makes mixed methods suitable for many areas of genetic counseling research. High-quality rigorous research methods are required to generate useful knowledge that can advance the field of genetic counseling. The goal of this paper was to provide an introduction to mixed methods research and discuss the rationale, research paradigms, study designs, methodological considerations, opportunities, and challenges in genetic counseling research.</p>","PeriodicalId":54829,"journal":{"name":"Journal of Genetic Counseling","volume":"34 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgc4.70031","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143893008","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":"Addressing language barriers in access to genetic testing under the United States 21st Century Cures Act","authors":"Lucas Pereira,&nbsp;Philip D. Connors,&nbsp;Maggie Ruderman,&nbsp;Claire M. Barton,&nbsp;Gauri Anand,&nbsp;Kimberly Zayhowski","doi":"10.1002/jgc4.70037","DOIUrl":"https://doi.org/10.1002/jgc4.70037","url":null,"abstract":"<p>The Final Rule of the 21st Century Cures Act (“Cures”) in the United States, which healthcare professionals (HCPs) were required to comply with starting in 2021, transformed clinical care by providing patients with immediate electronic access to their medical records. This often included the option to view their genetic testing results before discussing them with HCPs. “Cures” overarching goal was to enhance healthcare access and empower patients. However, a crucial limitation within the implementation of this legislation is the absence of language concordance in the dissemination of test results. While immediate access to test results may be a significant advancement, these results are predominantly offered in English, creating a formidable barrier for patients with limited English proficiency (LEP), exacerbating healthcare inequities. Consequently, this has the potential for misinterpretations, misdiagnoses, and inappropriate medical interventions. There is an urgent need to provide accessible, culturally sensitive, and language concordant genetic testing and counseling services, especially as results may also carry a direct impact on family members' medical management. This paper underscores the importance of recognizing that the issue extends beyond the availability of genetic testing results; it exemplifies a broader systemic challenge that disenfranchises patients with LEP, limiting their ability to comprehend and engage effectively with their healthcare. This paper advocates for the role of genetic counselors in developing and implementing solutions that bridge the language gap and promote equitable access to genetic healthcare. By leveraging our advocacy skills, genetic counselors can contribute to positive changes that benefit patients with LEP, ensuring that the promise of “Cures” is realized for patients of all linguistic backgrounds.</p>","PeriodicalId":54829,"journal":{"name":"Journal of Genetic Counseling","volume":"34 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143893011","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":"Perceived cancer risk and genetic counseling: A biopsychological perspective","authors":"Eleonora Cilli,&nbsp;Francesco Brancati,&nbsp;Dina Di Giacomo","doi":"10.1002/jgc4.70032","DOIUrl":"https://doi.org/10.1002/jgc4.70032","url":null,"abstract":"<p>In Italy, genetic testing is becoming a regular part of clinical practice in public healthcare. The clinical implications are that probands' educational level and relatives' ages for cascade genetic screening should be considered during counseling. The study aimed to investigate the role of cancer worry in the psychological dimensions of patients undergoing genetic testing and to analyze its moderating effect thereon. We conducted an observational study based on a sample of 55 patients aged between 19 years and 73 years. The sample was classified into two groups based on genetic-testing indications: oncological diagnosis eligible for hereditary breast and ovarian cancer (HBOC) genetic testing and patients eligible for family cascade testing by known genetic mutation in HBOC. A psychological battery was applied after the first scheduled genetic counseling. Our findings highlighted the relevance of cancer worry in the management of genetic counseling. The influence of cancer worry on dysphoria traits is that patients/relatives undergoing genetic testing feel vulnerable. Genomic medicine oriented to the biopsychosocial (BPS) approach in the counseling process could be the driving force for efficient and integrated genomic-risk assessment.</p>","PeriodicalId":54829,"journal":{"name":"Journal of Genetic Counseling","volume":"34 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgc4.70032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892920","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":"Impacts of student debt on the professional and personal lives of genetic counselors: A 10-year perspective","authors":"Holly L. Greer,&nbsp;Elizabeth M. Petty,&nbsp;Michael R. Lasarev,&nbsp;Ashley Kuhl","doi":"10.1002/jgc4.70013","DOIUrl":"https://doi.org/10.1002/jgc4.70013","url":null,"abstract":"<p>The financial landscape for those entering the genetic counseling profession has shifted significantly regarding salaries and educational costs since the 2014 study by Kuhl et al. Limited information is available regarding whether and how educational costs and student debt impacts have changed over time for genetic counselors. An updated web-based survey of 317 recent genetic counseling program graduates was conducted to address this gap. Overall, educational costs, total debt, and salaries showed increases from the prior study, and many factors measuring the impact of genetic counseling graduate student debt showed little to no change. Ninety-six percent (<i>n</i> = 222/232) of respondents still reported feeling burdened by their student debt, and 45% (<i>n</i> = 105/232) reported experiencing more hardship than anticipated, though most respondents were once again satisfied with their genetic counseling education. Student debt influenced many lifestyle choices to a strikingly similar degree, and a large majority still said that this debt did not change their career path post-graduation. Several factors did not significantly impact reported hardship, including having received financial help from family members or financial counseling before starting a genetic counseling program. Total debt and starting salaries had medians of $50,000 to $75,000 and $70,000 to $75,000, respectively, again exceeding expert recommendations that student debt payments do not surpass 10% of the borrower's projected gross monthly income. These results suggest ongoing burden and hardship caused by student debt and similar impacts on professional and personal life choices compared to a decade ago. In response to these ongoing issues, we suggest ways to alleviate this burden and increase financial transparency and access to the profession for future cohorts.</p>","PeriodicalId":54829,"journal":{"name":"Journal of Genetic Counseling","volume":"34 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgc4.70013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892809","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":"Call to action for genetic counseling research in hereditary cancer: Considerations from the evidence-based guidelines development process","authors":"Brooke Levin,&nbsp;Erin Salo-Mullen,&nbsp;Julie O. Culver,&nbsp;Raluca N. Kurz,&nbsp;Pamela Brock,&nbsp;Rochelle Demsky,&nbsp;Stacy Lloyd,&nbsp;Ghecemy Lopez,&nbsp;Phuong L. Mai,&nbsp;Kami Wolfe Schneider","doi":"10.1002/jgc4.70026","DOIUrl":"https://doi.org/10.1002/jgc4.70026","url":null,"abstract":"<p>The National Society of Genetic Counselors (NSGC) planned to develop an evidence-based guideline on the outcomes of genetic counseling for individuals at risk for hereditary cancer. The practice guideline workgroup used Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology including ranking the importance of outcomes of genetic counseling for individuals at risk for hereditary cancer. However, due to evidence gaps in the literature, particularly the limited availability of high quality and well-designed studies for many important outcomes of genetic counseling, the NSGC identified a need for additional research prior to guideline development. Herein, we describe a “call to action” for future research, particularly for health services-related outcomes of genetic counseling in diverse populations. Identified research priorities include conducting high-quality studies that separate the outcomes of genetic counseling from genetic testing, assessing outcomes associated with pre- and/or post-test genetic counseling, measuring patient-reported and health system-reported outcomes, comparing genetic counseling by certified genetic counselors versus non-genetics-trained providers, differentiating need in various hereditary cancer indications, and identifying barriers to genetic counseling in historically excluded patient communities.</p>","PeriodicalId":54829,"journal":{"name":"Journal of Genetic Counseling","volume":"34 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgc4.70026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892814","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":"2024 National Society of Genetic Counselors presidential address: The path we take","authors":"Colleen A. Campbell","doi":"10.1002/jgc4.70024","DOIUrl":"https://doi.org/10.1002/jgc4.70024","url":null,"abstract":"&lt;p&gt;Good afternoon. I'm humbled and honored to be standing before you today as your NSGC President-Elect. As I thought about this address, I kept thinking about the path that brought me to this moment. My family loves to hike, and it turns out paths have been a recurring theme throughout my life. In high school, I had written a Ralph Waldo Emerson quote on a piece of paper and stuck it on the bulletin board in my bedroom. It reads “Do Not Go Where The Path May Lead, Go Instead Where There Is No Path And Leave A Trail” (Emerson, &lt;span&gt;n.d.&lt;/span&gt;). Over time, everything else on the bulletin board was thrown out or packed away, yet the quote remained. After I received my genetic counseling degree I returned to graduate school to study molecular genetics. This was before exome sequencing was available and few people understood why I would want to take a path that combined the two careers. When I had to select a quote for my thesis, it was a no brainer what the quote would be. When I started thinking about what I would say today, I realized I had photographs of paths in both my office and my home. We've all taken different paths to get here today, and we are all still traveling our paths and will continue to do so throughout our careers. Though each path is unique, we share the fact that we are all genetic counselors.&lt;/p&gt;&lt;p&gt;As I think about the path our profession has taken, it is truly remarkable how far we have come in the relatively short time since the first graduate program began in 1969. In preparing for today, I have been reflecting on the 20 years since I graduated from Sarah Lawrence College and my first experience with NSGC at the annual education conference in Phoenix, Arizona. Like many others in this room, my path has been one with many twists, turns, and surprises along the way.&lt;/p&gt;&lt;p&gt;One of the unexpected turns on my path was becoming an advocate for growing our profession. This began in 2013 when the University of Iowa Health Care Vice President, Dr. Jean Robillard, asked me to start a genetic counseling graduate program. At the time, there were only five board-certified genetic counselors in the state of Iowa, and none specialized in either cancer or prenatal, so I did not think we would get accredited. He instructed me to write a business proposal on how to revamp genetic counseling in Iowa. I spent a year talking to as many people as I could, and ultimately, the proposal to set up University of Iowa Hospitals &amp; Clinics (UIHC) Genetic Counseling was funded. Bolstered by the success of this effort, I set to work to build a great genetic counseling team locally. At this point, my path took another unexpected turn into public policy by advocating for licensure of genetic counselors in the state of Iowa. These efforts did lead to substantial growth, and now 24 of the 40 genetic counselors in Iowa work at the University of Iowa (and we are hiring!). A few years later, I embarked on yet another unexpected turn in my path. I received a ","PeriodicalId":54829,"journal":{"name":"Journal of Genetic Counseling","volume":"34 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgc4.70024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143875586","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":"Evaluation of prenatal genetic counselors' abortion education and training as variables associated with self-efficacy","authors":"Brianna J. Gentile,&nbsp;Rebecca LeShay Araujo,&nbsp;Jessica Kianmahd Shamshoni,&nbsp;Carole H. Browner,&nbsp;Christina G. S. Palmer","doi":"10.1002/jgc4.2019","DOIUrl":"https://doi.org/10.1002/jgc4.2019","url":null,"abstract":"<p>Prenatal genetic counselors in many states have modified their practices, considering new state-level abortion restrictions enacted after the 2022 US Supreme Court Dobbs decision. Therefore, genetic counselors' preparedness to counsel patients under these restrictions warrants new attention. Using a cross-sectional design, we assessed prenatal genetic counselors' self-efficacy given their exposures to abortion education during and after their graduate training and other variables potentially associated with self-efficacy. Participants were board-certified or eligible prenatal genetic counselors practicing in the United States. They completed an anonymous online survey, which assessed demographics, exposures to abortion topics, and the six-factor Genetic Counseling Self-Efficacy Scale (GCSES; subscale range 0 (low)-100 (high)), answered using context from a hypothetical prenatal case scenario. Kruskal–Wallis and Wilcoxon rank sum tests compared median GCSES factor scores for each demographic and curricular variable. Chi-square and Fisher's exact tests compared coverage of abortion topics according to location of graduate program (restrictive vs. protective state, per Guttmacher Institute). We analyzed 94 surveys (93% female, 53% aged &lt;25–34, 66% restrictive states). GCSES scores skewed high (65.00–100.00). Higher scores on complex skills, communication, genetic testing, and basic psychosocial skills were associated with older age (<i>p</i>'s &lt; 0.01), more years since graduation (<i>p</i>'s &lt; 0.01), and more years' experience practicing as a prenatal genetic counselor (<i>p</i>'s &lt; 0.01); graduate program exposure to counseling about pregnancy termination option was associated with higher scores on complex skills, communication, and genetic testing (<i>p</i>'s &lt; 0.05). Participants reported high self-efficacy to address the prenatal scenario regardless of location of graduate program or current practice. Still, if graduate programs wish to increase their coverage of abortion topics, our results indicate that exposures to counseling the option of pregnancy termination through practical experiences, such as clinical rotations or role plays, are the most effective didactic tools for promoting self-efficacy in prenatal sessions.</p>","PeriodicalId":54829,"journal":{"name":"Journal of Genetic Counseling","volume":"34 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgc4.2019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778217","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":"Uptake rates for non-invasive prenatal screening for single-gene disorders associated with advanced paternal age","authors":"Kylie Katz,&nbsp;Justin S. Brandt,&nbsp;Gary Heiman,&nbsp;Laurie Simone,&nbsp;Shama Khan,&nbsp;Pranali Shingala,&nbsp;Elena Ashkinadze","doi":"10.1002/jgc4.2025","DOIUrl":"https://doi.org/10.1002/jgc4.2025","url":null,"abstract":"<p>This study sought to quantify uptake rates of non-invasive prenatal screening for de novo single-gene disorders (NIPS-SGD) in pregnant subjects whose reproductive partner is of advanced paternal age (APA) and to determine individual parameters associated with higher test uptake rates. A cross-sectional study was performed of pregnant subjects who received prenatal genetic counseling at a mid-size tertiary care center and were offered NIPS-SGD for APA (defined as 45 or older at delivery) between June 1, 2017 and April 13, 2021. We included non-anomalous, singleton gestations who conceived without donor egg/sperm. The outcome was measured as subjects who elected to do NIPS-SGD versus subjects who declined. Multivariable logistic regression was used to develop a model to discriminate between those who opted for testing and those who did not. 186 subjects were offered NIPS-SGD and met inclusion criteria. 70 had testing and 116 declined. Overall uptake rate was 38%. Several individual parameters were associated with higher test uptake including utilization of other screenings such as NIPS for aneuploidy (OR 3.4), carrier screening (OR 7.0) and invasive diagnostic testing (OR 8.4), presence of reproductive partner (OR 4.3), medicaid insurance (OR 2.6), and counseling at an offsite location (OR 2.0). AUC for the final regression model predicting NIPS-SGD uptake was 0.79. Based on this study, subjects who are information seekers and who opt for other prenatal screenings are more likely to pursue NIPS-SGD for de novo conditions associated with APA.</p>","PeriodicalId":54829,"journal":{"name":"Journal of Genetic Counseling","volume":"34 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgc4.2025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778218","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}