Australasian Emergency Care最新文献

{"title":"Vital signs monitoring in Australasian emergency departments: Development of a consensus statement from ACEM and CENA","authors":"","doi":"10.1016/j.auec.2024.04.001","DOIUrl":"10.1016/j.auec.2024.04.001","url":null,"abstract":"<div><h3>Background</h3><p>Emergency Department (ED) care is provided for a diverse range of patients, clinical acuity and conditions. This diversity often calls for different vital signs monitoring requirements. Requirements often change depending on the circumstances that patients experience during episodes of ED care.</p></div><div><h3>Aim</h3><p>To describe expert consensus on vital signs monitoring during ED care in the Australasian setting to inform the content of a joint Australasian College for Emergency Medicine (ACEM) and College of Emergency Nursing Australasia (CENA) position statement on vital signs monitoring in the ED.</p></div><div><h3>Method</h3><p>A 4-hour online nominal group technique workshop with follow up surveys.</p></div><div><h3>Results</h3><p>Twelve expert ED nurses and doctors from adult, paediatric and mixed metropolitan and regional ED and research facilities spanning four Australian states participated in the workshop and follow up surveys. Consensus building generated 14 statements about vital signs monitoring in ED. Good consensus was reached on whether vital signs should be assessed for 15 of 19 circumstances that patients may experience.</p></div><div><h3>Conclusion</h3><p>This study informed the creation of a joint position statement on vital signs monitoring in the Australasian ED setting, endorsed by CENA and ACEM. Empirical evidence is needed for optimal, safe and achievable policy on this fundamental practice.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 3","pages":"Pages 207-217"},"PeriodicalIF":2.1,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2588994X24000228/pdfft?md5=67da3fa112be55f99e1df1c1253cea70&pid=1-s2.0-S2588994X24000228-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141077294","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":"The significance of paramedic communication during women’s birth experiences: A scoping review","authors":"","doi":"10.1016/j.auec.2024.04.002","DOIUrl":"10.1016/j.auec.2024.04.002","url":null,"abstract":"<div><h3>Background</h3><p>Internationally, over one-third of women experience birth trauma, leading to adverse mental health outcomes. Poor communication with healthcare professionals is a primary contributing factor. Paramedics attend various clinical presentations, including childbirth, yet their potential impact on women's birth experiences has been largely overlooked.</p></div><div><h3>Methods</h3><p>A systematic literature search was conducted following the Joanna Briggs Institute methodological framework. The search identified 1015 potentially suitable articles, and 5 articles met the inclusion criteria. Data was analysed using reflexive thematic analysis from a feminist standpoint.</p></div><div><h3>Results</h3><p>Three themes were generated: 1. <em>First Impressions Count:</em> paramedic demeanour impacted the woman's sense of safety and perception of paramedic clinical competence. 2. <em>Choice as a Pathway to Control:</em> when paramedics involved women in decision-making, it led to empowerment, while non-involvement led to women becoming passive participants. 3. <em>Exposed, Violated and Disempowered:</em> some paramedics disrespected and abused women, treating them solely as objects for the purpose of producing a baby.</p></div><div><h3>Conclusions</h3><p>This review highlights the influence of paramedic communication on women's birth experiences. While some paramedics communicated respectfully, other paramedics were the perpetrators of Obstetric Violence. Future research should inform paramedic education and improve outcomes for birthing women.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 3","pages":"Pages 218-226"},"PeriodicalIF":2.1,"publicationDate":"2024-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2588994X2400023X/pdfft?md5=db073b87497e7113f51febc56284a211&pid=1-s2.0-S2588994X2400023X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140909617","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":"Designing a standardised emergency nurse career pathway for use across rural, regional and metropolitan New South Wales, Australia: A consensus process","authors":"","doi":"10.1016/j.auec.2024.03.002","DOIUrl":"10.1016/j.auec.2024.03.002","url":null,"abstract":"<div><h3>Background</h3><p>Emergency nurses are the first clinicians to see patients in the ED; their practice is fundamental to patient safety. To reduce clinical variation and increase the safety and quality of emergency nursing care, we developed a standardised consensus-based emergency nurse career pathway for use across Australian rural, regional, and metropolitan New South Wales (NSW) emergency departments.</p></div><div><h3>Methods</h3><p>An analysis of career pathways from six health services, the College for Emergency Nursing Australasia, and NSW Ministry of Health was conducted. Using a consensus process, a 15-member expert panel developed the pathway and determined the education needs for pathway progression over six face-to-face meetings from May to August 2023.</p></div><div><h3>Results</h3><p>An eight-step pathway outlining nurse progression through models of care related to different ED clinical areas with a minimum 172 h protected face-to-face and 8 h online education is required to progress from novice to expert. Progression corresponds with increasing levels of complexity, decision making and clinical skills, aligned with Benner’s novice to expert theory.</p></div><div><h3>Conclusion</h3><p>A standardised career pathway with minimum 180 h would enable a consistent approach to emergency nursing training and enable nurses to work to their full scope of practice. This will facilitate transferability of emergency nursing skills across jurisdictions.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 3","pages":"Pages 198-206"},"PeriodicalIF":2.1,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2588994X24000216/pdfft?md5=e0c8d48c3b9fe6c4a23c2c615672ad6f&pid=1-s2.0-S2588994X24000216-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140308013","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":"Exploring clinicians' insertion experience with a new peripheral intravenous catheter in the emergency department","authors":"","doi":"10.1016/j.auec.2024.03.001","DOIUrl":"10.1016/j.auec.2024.03.001","url":null,"abstract":"<div><h3>Background</h3><p>Hospitals frequently introduce new medical devices. However, the process of clinicians adapting to these new vascular access devices has not been well explored. The study aims to explore clinicians’ experience with the insertion of a new guidewire peripheral intravenous catheter (PIVC) introduced in the emergency department (ED) setting.</p></div><div><h3>Methods</h3><p>The study was conducted at two EDs in Queensland, Australia, utilising a qualitative explorative approach. Interviews were conducted with guidewire PIVC inserters, including ED doctors and nurses, and field notes were recorded by research nurses during insertions. Data analysis was performed using inductive content analysis, from which themes emerged.</p></div><div><h3>Results</h3><p>The study compiled interviews from 10 participants and field notes from 191 observation episodes. Five key themes emerged, including <em>diverse experience, barriers related to the learning process, factors influencing insertion success, and recommendations to enhance clinicians’ acceptance</em>. These themes suggest that the key to successful adoption by clinicians lies in designing user-friendly devices that align with familiar insertion techniques, facilitating a smooth transfer of learning.</p></div><div><h3>Conclusion</h3><p>Clinician adaptation to new devices is vital for optimal patient care. Emergency nurses and doctors prefer simplicity, safety, and familiarity when it comes to new devices. Providing comprehensive device training with diverse training resources, hands-on sessions, and continuous expert support, is likely to enhance clinician acceptance and the successful adoption of new devices in ED settings.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 3","pages":"Pages 192-197"},"PeriodicalIF":2.1,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2588994X24000204/pdfft?md5=cde8ee19968cdda69f5abf2c22331e64&pid=1-s2.0-S2588994X24000204-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140137461","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":"Characteristics and outcomes of emergency department presentations brought in by police with and without an emergency examination authority: A state-wide cohort study","authors":"","doi":"10.1016/j.auec.2024.02.001","DOIUrl":"10.1016/j.auec.2024.02.001","url":null,"abstract":"<div><h3>Background</h3><p>The aim of this study was to describe and compare the demographic characteristics, clinical characteristics and patient and health service outcomes of emergency department (ED) presentations brought in by police with and without an emergency examination authority.</p></div><div><h3>Methods</h3><p>A retrospective cohort study of adult (≥ 18 years old) presentations brought in by police to EDs in Queensland, Australia from 01 January 2018 to 31 December 2020. Routinely collected ED data were used to describe and compare the demographic characteristics, clinical characteristics, and outcomes of people brought in by police with and without an emergency examination authority.</p></div><div><h3>Results</h3><p>A total of 42 502 adult ED presentations were brought in by police over the three-year period, of which 22 981 (44.7%) had an emergency examination authority. Compared with presentations brought in by police without an emergency examination authority, those brought in by police with an emergency examination authority had a higher proportion of presentations for mental health problems, were from major cities, and were allocated more urgent Australasian Triage Scale categories. Presentations brought in by police with an emergency examination authority were less likely to be seen within their Australasian Triage Scale timeframe and experienced a longer length of stay than those brought in by police without an emergency examination authority whether admitted (217 mins vs. 186 mins, p &lt; 0.001) or discharged (212 mins vs. 97 mins, p &lt; 0.001).</p></div><div><h3>Conclusions</h3><p>The characteristics and outcomes of people brought in by police with emergency examination authorities differed to those brought in by police without emergency examination authorities. Further research is required to enhance understanding of this relatively unexplored group of people and foster interagency collaborations.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 3","pages":"Pages 185-191"},"PeriodicalIF":2.1,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2588994X24000198/pdfft?md5=39ae159359cc04058606980029e0be31&pid=1-s2.0-S2588994X24000198-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140095219","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":"Providing end of life care in the emergency department: A hermeneutic phenomenological study","authors":"","doi":"10.1016/j.auec.2024.01.002","DOIUrl":"10.1016/j.auec.2024.01.002","url":null,"abstract":"<div><h3>Background</h3><p>Registered nurses report the experience of delivering end of life care in emergency departments as challenging. The study aim was to understand what it is like to be a registered nurse providing end of life care to an older person in the emergency department.</p></div><div><h3>Methods</h3><p>A hermeneutic phenomenological study was conducted in 2021, using semi-structured interviews with seven registered nurses across two hospital emergency departments in Queensland, Australia. Thematic analysis of participants’ narratives was undertaken.</p></div><div><h3>Findings</h3><p>Seven registered nurses were interviewed; six of whom were women. Participant’s experience working in the emergency department setting ranged from 2.5–20 years. Two themes were developed through analysis: (i) Presenting the patient as a dying person; and (ii) Mentalising death in the context of the emergency department.</p></div><div><h3>Conclusions</h3><p>Nurses providing end of life care in the emergency department draw upon their personal and aesthetic knowing to present the dying patient as a person. The way death is mentalised suggests the need to develop empirical knowing about ageing and supportive medical care and ethical knowing to assist with the transition from resuscitation to end of life care. Shared clinical reflection on death in the emergency department, facilitated by experts in ageing and end of life care is recommended.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 3","pages":"Pages 161-166"},"PeriodicalIF":2.1,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2588994X24000022/pdfft?md5=232c2a40be81379115e2c51c5de6b8b0&pid=1-s2.0-S2588994X24000022-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139663843","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":"The experiences of trans (binary and non-binary) patients accessing care in the emergency department: An integrative review","authors":"","doi":"10.1016/j.auec.2024.01.003","DOIUrl":"10.1016/j.auec.2024.01.003","url":null,"abstract":"<div><p>Accessing care in the Emergency Department is often fraught with stress and heightened emotions due to illness or injury, and the complexity of navigating an often busy and overwhelming healthcare setting. For people who identify as trans (binary and non-binary), accessing Emergency Department care is often associated with additional stress or avoided due to fears of discrimination, or previous negative experiences (1). The aim of this integrative review was to identify and review the literature relating to the experiences of trans (binary and non-binary) people accessing Emergency Department care, to guide practice and future research. A structured search process was used to identify 11 articles published between January 2013 and November 2023. These articles were appraised using the mixed methods appraisal tool (MMAT) (2) and included in this review. Utilising the methodology outlined by Whittemore &amp; Knafl (3), a constant comparison analytic approach identified five key themes; <em>1. emergency department context; 2. interactions with staff and language; 3. health professional knowledge; 4. advocacy;</em> and <em>5. disclosing trans status.</em> This review identified a perceived lack of competence for healthcare providers to deliver gender affirming healthcare in the Emergency Department due to perceptions of inadequate healthcare provider knowledge, and structural barriers founded on cisgender processes.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 3","pages":"Pages 167-176"},"PeriodicalIF":2.1,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2588994X24000046/pdfft?md5=24bd4e5fc294d367baec4c210dd38ae4&pid=1-s2.0-S2588994X24000046-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139656402","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":"Examining emergency departments practices on advance care directives and medical treatment decision making using the victorian emergency minimum dataset","authors":"","doi":"10.1016/j.auec.2024.01.001","DOIUrl":"10.1016/j.auec.2024.01.001","url":null,"abstract":"<div><h3>Introduction</h3><p>Existence of Advance Care Planning<span><span> (ACP) documents including contact details of Medical Treatment Decision Makers (MTDM), are essential patient care records that support </span>Emergency Department (ED) clinicians in implementing treatment concordant with patients’ expressed wishes. Based upon previous findings, we conducted a statewide study to evaluate the performance of Victorian public hospital emergency departments on reporting of availability of records for ACP.</span></p></div><div><h3>Method</h3><p>The study is a quantitative retrospective observational comparative design based upon ED tier levels as defined by the Australasian College for Emergency Medicine (ACEM) for the calendar year 2021.</p></div><div><h3>Results</h3><p>Of 1.8 million total Victorian ED attendances, 15,222 patients had an ACP alert status recorded. Of these, 7296 were aged ≥ 65 years (study group). Of the thirty-one public EDs that submitted data, 65 % were accredited and assigned a level of service tier. The presence of ACP alerts positively correlated to location, tier level, age and gender (MANOVA wilk’s; p &lt; 0.001, value=.981, F = (12, 15,300), partial ƞ² = .006, observed power = 1.0 = 95.919).</p></div><div><h3>Conclusion</h3><p>The identified rate of ACP reporting is low. Strategies to improve the result include synchronising ACP (generated at different points) electronically, staff education, training and further validation of the data at the sending and receiving agencies.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 3","pages":"Pages 155-160"},"PeriodicalIF":2.1,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139543555","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":"“Mind the gap”: An exploratory qualitative study of paramedics’ experiences attending older adults who fall in Western Australia","authors":"","doi":"10.1016/j.auec.2024.01.004","DOIUrl":"10.1016/j.auec.2024.01.004","url":null,"abstract":"<div><h3>Purpose</h3><p>To explore paramedics’ experiences and perspectives about attending and managing older adults who had fallen.</p></div><div><h3>Procedures</h3><p>This qualitative, exploratory study used a purposive sample of paramedics in Western Australia. Participants had at least one year of clinical experience. Semi-structured interviews were undertaken. Data were analysed via an inductive thematic approach.</p></div><div><h3>Findings</h3><p>Fourteen paramedics were interviewed (Median age: 38 years, n = 5 females). The main theme identified that experiences were positive when attending patients with high-acuity medical problems or injuries following falls because binary decision-making (transport vs non-transport) was appropriate. Themes highlighted that decision-making for low-acuity falls attendances was a complex balance between 1) patient context, 2) risk management, 3) paramedic reactions, and 4) the lack of alternate referral pathways available. Experiences could be stressful and frustrating when attending falls call-outs for older adults with no injuries or medical problems. Participants concurred that when transport to hospital was not required there were no available, alternative pathways to refer onwards for appropriate health or social care.</p></div><div><h3>Conclusion</h3><p>Attending low-acuity call-outs for falls was often frustrating and required complex decision-making, with gaps in services identified. Further exploration of alternative referral pathways for health care for pre-hospital management of adults who fall is required.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 3","pages":"Pages 177-184"},"PeriodicalIF":2.1,"publicationDate":"2024-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2588994X24000034/pdfft?md5=a7631145220a3c41550719a31ffb1641&pid=1-s2.0-S2588994X24000034-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139483015","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":"Informing Utstein-style reporting guidelines for prehospital thrombolysis: A scoping review","authors":"Louis Jenkins ,&nbsp;Tania Johnston ,&nbsp;Richard Armour ,&nbsp;Sonja Maria","doi":"10.1016/j.auec.2023.12.001","DOIUrl":"10.1016/j.auec.2023.12.001","url":null,"abstract":"<div><h3>Background</h3><p>Rural Australians with acute myocardial infarction (AMI) face higher mortality rates due to limited access to specialised cardiac services. Paramedic-administered prehospital thrombolysis (PHT) has emerged as an alternative to primary percutaneous intervention (pPCI) for patients facing barriers or delays to cardiac care. There is variability in PHT practices among Australian ambulance services, lacking standardised definitions and outcome measures. The aim of this scoping review was to identify quality indicators and influencing factors associated with outcomes for patients receiving PHT.</p></div><div><h3>Methods</h3><p>A systematic search of literature in SCOPUS and Academic Search Complete, CINAHL and Health Source: Nursing/Academic Edition databases via EBSCO (Health) was conducted following the Joanna Briggs Institute methodology. Peer-reviewed studies from the past decade were screened using search criteria relevant to prehospital thrombolysis and quality indicators. Data extraction was performed and themed using five domains from the Utstein-style template commonly known for standardised prehospital cardiac arrest reporting.</p></div><div><h3>Results</h3><p>After removing duplicates, the search yielded 3596 articles with 28 empirical studies meeting inclusion criteria for the review. These were primarily retrospective cohort studies performed in Australia, Canada and the United States. The scoping review identified 24 clinical quality indicators and factors related to Emergency Medical Service (EMS) systems, AMI recognition and ambulance dispatch, patient variables, PHT processes and patient outcomes. These findings correlate to the Donabedian structure-process-outcome quality of care model and have utility to inform future PHT reporting guidelines for jurisdictional ambulance services.</p></div><div><h3>Conclusions</h3><p>Given the variability in prehospital practice across Australian ambulance services, standardised reporting on quality indicators for PHT is needed. The Utstein-style template used to report data on pre-hospital cardiac arrest, trauma and airway management could be used for quality improvement in PHT. This review presents 24 quality indicators representing system, recognition and response, patient, process, and outcomes related to PHT. These results could be used to inform a future Delphi study and Utstein-like reporting guideline for prehospital thrombolysis.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 2","pages":"Pages 148-154"},"PeriodicalIF":1.8,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2588994X23000908/pdfft?md5=0fbf3c20128a488efae8450a1ff424c2&pid=1-s2.0-S2588994X23000908-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139483100","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}