Journal of multimorbidity and comorbidity最新文献

{"title":"A critical appraisal of professional competency frameworks: What guidance is provided for stroke rehabilitation clinicians managing 'complexity'?","authors":"Alyssa Indar, Michelle Nelson, Whitney Berta, Maria Mylopoulos","doi":"10.1177/26335565231215671","DOIUrl":"https://doi.org/10.1177/26335565231215671","url":null,"abstract":"<p><strong>Background: </strong>Given current health system trends, clinicians increasingly care for patients with complex care needs. There is a recognized lack of evidence to support clinician decision-making in these situations, as complex or multimorbid patients have been historically excluded from the types of research that inform clinical practice guidelines. However, expert clinicians at sites of excellence (e.g., Stroke Distinction sites) provide measurably excellent care. We sought to review profession-specific competency frameworks to locate information that may be supporting the development of clinician expertise when managing the care of patients with complex care needs.</p><p><strong>Methods: </strong>We conducted a review of the professional competency frameworks for core members of the inpatient stroke rehabilitation team, to determine the degree of guidance and/or preparation for the management of patients with complex care needs. We developed and applied an assessment rubric to locate references to patient complexity, multimorbidity and complexity theory.</p><p><strong>Results: </strong>Across the professional competency frameworks, there are some references to complexity at patient- and team-levels; there are fewer references to system-level complexity. We noted a lack of clear guidance for clinicians regarding the management of patients with complex care needs.</p><p><strong>Conclusion: </strong>Further research is needed to explore how clinicians develop expertise in the management of patients with complex care needs, as we noted minimal guidance in the professional competency frameworks. However, we suggest that integrating complexity-related language into professional competency frameworks could better prime novice clinicians for new learning in the workplace and ease their transition into working in a complex context.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565231215671"},"PeriodicalIF":0.0,"publicationDate":"2023-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10657527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138464842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlations between comorbidities in trials and the community: An individual-level participant data meta-analysis.","authors":"Jamie Crowther, Elaine W Butterly, Laurie J Hannigan, Bruce Guthrie, Sarah H Wild, Frances S Mair, Peter Hanlon, Fergus J Chadwick, David A McAllister","doi":"10.1177/26335565231213571","DOIUrl":"10.1177/26335565231213571","url":null,"abstract":"<p><strong>Background: </strong>People with comorbidities are under-represented in randomised controlled trials, and it is unknown whether patterns of comorbidity are similar in trials and the community.</p><p><strong>Methods: </strong>Individual-level participant data were obtained for 83 clinical trials (54,688 participants) for 16 index conditions from two trial repositories: Yale University Open Data Access (YODA) and the Centre for Global Clinical Research Data (Vivli). Community data (860,177 individuals) were extracted from the Secure Anonymised Information Linkage (SAIL) databank for the same index conditions. Comorbidities were defined using concomitant medications. For each index condition, we estimated correlations between comorbidities separately in trials and community data. For the six commonest comorbidities we estimated all pairwise correlations using Bayesian multivariate probit models, conditioning on age and sex. Correlation estimates from trials with the same index condition were combined into a single estimate. We then compared the trial and community estimates for each index condition.</p><p><strong>Results: </strong>Despite a higher prevalence of comorbidities in the community than in trials, the correlations between comorbidities were mostly similar in both settings. On comparing correlations between the community and trials, 21% of correlations were stronger in the community, 10% were stronger in the trials and 68% were similar in both. In the community, 5% of correlations were negative, 21% were null, 56% were weakly positive and 18% were strongly positive. Equivalent results for the trials were 11%, 33%, 45% and 10% respectively.</p><p><strong>Conclusions: </strong>Comorbidity correlations are generally similar in both the trials and community, providing some evidence for the reporting of comorbidity-specific findings from clinical trials.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565231213571"},"PeriodicalIF":0.0,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10637135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89720981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing stroke rehabilitation inpatients and clinical trials eligibility criteria: A secondary chart review analysis revealing that most patients could have been excluded from rehabilitation trials based on comorbidity status.","authors":"Michelle LA Nelson,&nbsp;Hardeep Singh,&nbsp;Jason Nie,&nbsp;Shannon MacDonald,&nbsp;Mark Bayley,&nbsp;Christian Fortin,&nbsp;Ross Upshur","doi":"10.1177/26335565231211668","DOIUrl":"https://doi.org/10.1177/26335565231211668","url":null,"abstract":"<p><strong>Background: </strong>The generalizability of treatments examined in rehabilitation randomized controls trials (RCTs) partly depend on the similarity between trial subjects and a stroke rehabilitation inpatient population. The aim of this study was to determine the proportion of stroke rehabilitation inpatients that would have been eligible or ineligible to participate in published stroke RCTs.</p><p><strong>Methods: </strong>This was a secondary analysis of chart review data collected as part of an independent quality improvement initiative. Data pertaining to the characteristics of stroke rehabilitation inpatients (e.g. age, cognitive impairment, previous stroke, comorbidities) were extracted from the medical charts of patients consecutively admitted to an inpatient stroke rehabilitation unit at a large urban rehabilitation hospital in Canada. Using the exclusion criteria categories of stroke RCTs identified from a systematic scoping review of 428 RCTs, we identified how many stroke rehabilitation inpatients would have been eligible or ineligible to participate in stroke RCTs based on their age, cognitive impairment, previous stroke and presence of comorbidities.</p><p><strong>Results: </strong>In total, 110 stroke rehabilitation inpatients were included. Twenty-four percent of patients were 80 years of age or older, 84.5% had queries or concerns regarding patient cognitive abilities, 28.0% had a previous stroke, and 31.8% had a severe stroke. Stroke rehabilitation inpatients had six comorbidities on average. Based on these factors, most stroke rehabilitation inpatients could have been excluded from stroke RCTs, with cognitive impairment the most common RCT exclusion criteria.</p><p><strong>Conclusions: </strong>Changes to the design of RCTs would support the development of clinical practice guidelines that reflect stroke rehabilitation inpatient characteristics, enhancing equity, diversity, and inclusion within samples and the generalizability of results.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565231211668"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10624005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71489703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring comorbidity and pharmacological treatment patterns in psoriasis - a retrospective population-based cross-sectional study.","authors":"Nelly Hamgård, Albert Duvetorp, Anna Hägg, Sandra Jerkovic Gullin, Oliver Seifert","doi":"10.1177/26335565231212336","DOIUrl":"10.1177/26335565231212336","url":null,"abstract":"<p><strong>Background: </strong>Individuals with psoriasis face an increased risk of suffering from various comorbid conditions. However, there haven´t been any studies conducted in Sweden to examine the frequency of comorbidities and the corresponding treatment for these conditions among psoriasis patients.</p><p><strong>Methods: </strong>The Cosmic electronic medical record represents a comprehensive repository of medical information including all residents of Region Jönköping. To conduct a population-based retrospective cross-sectional study, all individuals diagnosed with psoriasis between April 9, 2008 and July 1, 2016, were identified via the electronic medical records using ICD-10 codes. Data on comorbidity and dispensation of prescribed drugs against these comorbid conditions were analyzed.</p><p><strong>Results: </strong>During the study period, 1.7% of the population (4,587 individuals) were diagnosed with psoriasis, with 74.3% of cases classified as mild to moderate psoriasis and 25.7% as severe. The remaining 268,949 individuals did not receive a psoriasis diagnosis. The study showed that psoriasis patients had higher odds of experiencing the majority of the comorbid conditions examined. Arthritis other than psoriasis arthritis was found to be the most prevalent comorbid diagnosis among psoriasis patients (adjusted OR 7.2, CI 95% 6.4-8.2, p < 0.001), followed by obesity (OR 2.4, CI 95% 1.9-3.1, p < 0,001). There was no significant difference in drug prescription for comorbid diseases between patients with psoriasis and patients without psoriasis except for arthritis and smoking cessation treatment.</p><p><strong>Conclusions: </strong>Individuals with psoriasis are more susceptible to experiencing multiple comorbid conditions compared to the general population, particularly those with severe psoriasis. There is no evidence of undertreatment of comorbidity except for arthritis among psoriasis patients.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565231212336"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10617277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71429929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between social care expenditure and multiple-long term conditions: A population-based area-level analysis.","authors":"Emeka Chukwusa,&nbsp;Paulino Font-Gilabert,&nbsp;Jill Manthorpe,&nbsp;Andrew Healey","doi":"10.1177/26335565231208994","DOIUrl":"https://doi.org/10.1177/26335565231208994","url":null,"abstract":"<p><strong>Background: </strong>Multiple long-term health conditions (MLTCs) are common and increasing among older people, yet there is limited understanding of their prevalence and association with social care expenditure.</p><p><strong>Aim: </strong>To estimate the prevalence of MTLCs and association with English social care expenditure.</p><p><strong>Methods: </strong>Our study population included those aged ≥ 65 who died in England in the year 2018 with any of the following long-term conditions recorded on their death certificate: diabetes; cardiovascular diseases (CVDs) including hypertension; dementia; stroke; respiratory; and chronic kidney diseases (CKDs). Prevalence was based on the proportion of death reported for older people with MTLCs (≥ 2) in each of the 152 English Local Authorities (LAs). Ordinary least square regression (OLS) was used to assess the relationship between prevalence of MTLCs and adult social care expenditure, adjusting for LA characteristics.</p><p><strong>Results: </strong>Of the 409551 deaths reported, 19.9% (n = 81395) had ≥ 2 MTLCs, of which the combination of CVDs-diabetes was the most prevalent. Hospitals were the leading place of death for those with MTLCs. Results from the OLS regression model showed that an increased prevalence of MLTCs is associated with higher LA social care expenditure. A percentage point increase in prevalence of MLTCs is associated with an increase of about £8.13 in per capita LA social care expenditure.</p><p><strong>Conclusion: </strong>Our findings suggest that the increased prevalence of MTLCs is associated with increased LA social care expenditure. It is important for future studies to further explore the mechanisms or link between LA social care expenditure and the prevalence of MTLCs.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565231208994"},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10612455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71415811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving person-centered care for people with multimorbidity: the potential of participatory learning and action research.","authors":"Anne MacFarlane,&nbsp;Marianne McCallum,&nbsp;Moira Stewart","doi":"10.1177/26335565231207075","DOIUrl":"https://doi.org/10.1177/26335565231207075","url":null,"abstract":"","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565231207075"},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10605676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71415810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-concept in Adolescents with Physical-Mental Comorbidity.","authors":"Mark A Ferro,&nbsp;Megan Dol,&nbsp;Karen A Patte,&nbsp;Scott T Leatherdale,&nbsp;Lilly Shanahan","doi":"10.1177/26335565231211475","DOIUrl":"10.1177/26335565231211475","url":null,"abstract":"<p><strong>Objective: </strong>Little is known about self-concept in adolescents with physical-mental comorbidity. This study investigated whether physical-mental comorbidity was associated with self-concept in adolescents and examined if adolescent age or sex moderated the association between physical-mental comorbidity and self-concept.</p><p><strong>Methods: </strong>Study data were obtained from the Multimorbidity in Youth across the Life-course (MY LIFE), an ongoing Canadian study of adolescents with chronic physical illness who were recruited from outpatient clinics at a pediatric hospital. A total of 116 adolescents aged ≥ 10 years provided self-reports on key measures.</p><p><strong>Results: </strong>Adolescents with comorbidity (n = 48) had lower self-concept scores on the Self-Determination Questionnaire (SDQ; d = 0.62) and Self-Perception Profile for Children (SPPC; d = 0.53) vs. adolescents without comorbidity (n = 68). An age × comorbidity status interaction was found and age-stratified models were computed to investigate this moderating effect of age. Amongst older adolescents, comorbidity was associated with lower SDQ (B = -2.55, p < .001), but this association was not found among younger adolescents (B = -0.29, p = .680). A similar effect was found for SPPC among older (B = -0.48, p = .001) and younger adolescents (B = 0.03, p = .842). Adolescent sex was not found to be a moderator.</p><p><strong>Conclusions: </strong>Physical-mental comorbidity in adolescence was associated with lower self-concept and this association was moderated by age-differences between adolescents with vs. without comorbidity were greater for older adolescents and were clinically relevant. Opportunities to support positive self-perceptions for adolescents with comorbidity are warranted, especially when planning the transition from pediatric to adult health services.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565231211475"},"PeriodicalIF":0.0,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1d/5f/10.1177_26335565231211475.PMC10594959.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50164023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-regulatory coping among community dwelling older adults with multiple chronic conditions.","authors":"Ayomide Okanlawon Bankole, Sara L Gill, Jenny McSharry, Carole L White, Chidinma Aniemeke, Sherrie Flynt Wallington, Dorothy Ewurabena Addo-Mensah, Carrie Jo Braden","doi":"10.1177/26335565231207538","DOIUrl":"10.1177/26335565231207538","url":null,"abstract":"<p><strong>Objectives: </strong>Many older adults with multiple chronic conditions (MCC) frequently experience hospitalizations, functional limitations, and poor quality of life. Outcomes may be improved by promoting self-regulation, which may individuals respond to health threats and manage their health conditions. The aim of this study was to describe self-regulatory coping among older adults with MCC.</p><p><strong>Methods: </strong>A qualitative descriptive study using semi-structured interviews and content analysis and guided by the Common-Sense Self-Regulation Model. Seventeen community-dwelling older adults with two or more chronic conditions participated in our study.</p><p><strong>Results: </strong>Three themes were developed from the analysis: (1) <i>\"I don't think about it unless something happens\":</i> coping in the absence of a health event, (2) <i>\"doing what I am supposed to do\"</i>: coping during a health event, and (3) <i>\"How do I know if what I did works?\":</i> appraisal of coping success.</p><p><strong>Discussion: </strong>Self-regulatory coping was influenced by individual beliefs and experiences (<i>illness representations</i>), context, self-efficacy and availability of support and resources to cope with MCC. These findings suggest implications for clinical practice and future self-regulation interventions for older adults with MCC.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565231207538"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/73/fa/10.1177_26335565231207538.PMC10588418.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49694884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimorbidity and the need to rethink Medical Education.","authors":"Cara Bezzina,&nbsp;Lindsey Pope","doi":"10.1177/26335565231207811","DOIUrl":"10.1177/26335565231207811","url":null,"abstract":"The prevalence of patients experiencing multimorbidity is increasing year on year, accompanied by an expanding knowledge base in this field. Perhaps once considered the domain of geriatricians and general practitioners, all healthcare professionals are now likely to encounter, assess and manage patients living with multimorbidity as part of their daily practice. Despite our recognition and understanding of this changing profile of our patients, the evidence on how best to educate our healthcare workforce to meet the population’s needs lags behind.We propose that all healthcare education and training must give due consideration to the positioning of multimorbidity in their curricula and assessments. Furthermore, expertise from both educationalists and multimorbidity researchers will be required to inform key decisions.","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565231207811"},"PeriodicalIF":0.0,"publicationDate":"2023-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10578062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41241826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geospatial assessment of the convergence of communicable and non-communicable diseases in South Africa.","authors":"Diego F Cuadros, Claudia M Moreno, Andrew Tomita, Urisha Singh, Stephen Olivier, Alison Castle, Yumna Moosa, Johnathan A Edwards, Hae-Young Kim, Mark J Siedner, Emily B Wong, Frank Tanser","doi":"10.1177/26335565231204119","DOIUrl":"10.1177/26335565231204119","url":null,"abstract":"<p><strong>Introduction: </strong>Several low-and middle-income countries are undergoing rapid epidemiological transition with a rising burden of non-communicable diseases (NCDs). South Africa (SA) is a country with one of the largest HIV epidemics worldwide and a growing burden of NCDs where the collision of these epidemics poses a major public health challenge.</p><p><strong>Methods: </strong>Using data from a large nationally representative survey, the South Africa Demographic and Health Survey (SADHS 2016), we conducted a geospatial analysis of several diseases including HIV, tuberculosis (TB), cardiovascular, respiratory, and metabolic diseases to identify areas with a high burden of co-morbidity within the country. We explored the spatial structure of each disease and associations between diseases using different spatial and visual data methodologies. We also assessed the individual level co-occurrence of HIV and the other diseases included in the analysis.</p><p><strong>Results: </strong>The spatial distribution for HIV prevalence showed that this epidemic is most intense in the eastern region of the country, mostly within the Gauteng, Mpumalanga, and Kwazulu-Natal provinces. In contrast, chronic diseases had their highest prevalence rates the southern region of the country, particularly in the Eastern and Western Cape provinces. Individual-level analyses were consistent with the spatial correlations and found no statistically significant associations between HIV infection and the presence of any NCDs.</p><p><strong>Conclusions: </strong>We found no evidence of geospatial overlap between the HIV epidemic and NCDs in SA. These results evidence the complex epidemiological landscape of the country, characterized by geographically distinct areas exhibiting different health burdens. The detailed description of the heterogenous prevalence of HIV and NCDs in SA reported in this study could be a useful tool to inform and direct policies to enhance targeted health service delivery according to the local health needs of each community.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565231204119"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ed/5e/10.1177_26335565231204119.PMC10540575.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41175027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}