Palliative medicine reports最新文献

{"title":"Rosalind Franklin Society Proudly Announces the 2022 Award Recipient for Palliative Medicine Reports","authors":"N. Torres-Blasco","doi":"10.1089/pmr.2023.29002.rfs2022","DOIUrl":"https://doi.org/10.1089/pmr.2023.29002.rfs2022","url":null,"abstract":"","PeriodicalId":74394,"journal":{"name":"Palliative medicine reports","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44763695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advance Care Planning and Health-Related Quality of Life in Huntington Disease: Results from a Multicenter National Study.","authors":"Leonard L Sokol, Jonathan P Troost, Danny Bega, Benzi M Kluger, Holly G Prigerson, Martha Nance, Samuel Frank, Joel S Perlmutter, Praveen Dayalu, David Cella, Noelle E Carlozzi","doi":"10.1089/pmr.2022.0034","DOIUrl":"10.1089/pmr.2022.0034","url":null,"abstract":"<p><strong>Objective: </strong>With Huntington disease (HD), a fatal neurodegenerative disease where the prevalence of suicidal thoughts and behavior (STB) remains elevated as compared to other neurological disorders, it is unknown whether STB and health-related quality of life (HRQoL) affect plans for the end of life or more broadly, advance care planning (ACP). Conversely, it is unknown whether ACP would provoke future changes to STB and HRQoL. Therefore, we sought to evaluate whether STB and HRQoL patient-reported outcomes (PROs) contribute to ACP and whether ACP relates to changes in STB and HRQoL at 24 months.</p><p><strong>Methods: </strong>HD-validated clinician- and patient-assessments (i.e., HRQoL PROs) were obtained at baseline enrollment, 12 and 24 months through our multi-center study (HDQLIFE™) throughout the United States among people with premanifest, early-stage, and late-stage manifest HD. We used linear mixed-effects models to determine the relationships between STB and HRQoL at baseline and HDQLIFE End of Life Planning at follow-up. Separate linear mixed-effects models were used to assess the relationship between HDQLIFE End of Life Planning at baseline, and HRQoL and STB at 12 and 24 months. False discovery rate adjustments were used to account for multiple comparisons.</p><p><strong>Results: </strong>At baseline enrollment, STB and HRQoL were not related to HDQLIFE End of Life Planning at 12 or 24 months. Similarly, at baseline, HDQLIFE End of Life Planning demonstrated no association with STB or HRQoL at 12 or 24 months.</p><p><strong>Interpretation: </strong>STB and HRQoL PROs do not significantly affect patient engagement with ACP. Most importantly, engaging in ACP does not cause untoward effects on HRQoL or STB for this rare neurodegenerative disease where the lifetime prevalence of STB approaches 30%.</p>","PeriodicalId":74394,"journal":{"name":"Palliative medicine reports","volume":"4 1","pages":"79-88"},"PeriodicalIF":1.1,"publicationDate":"2023-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10036076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9193638","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":"Physicians' Knowledge, Attitudes, and Perception Toward Pediatric Palliative Care in Saudi Arabia: A National Exploratory Survey.","authors":"Saadiya Khan,&nbsp;Kim Sadler,&nbsp;Khawar Sidiqui,&nbsp;Hamad AlYami,&nbsp;Malak AlGarni,&nbsp;Amani Al-Kofide,&nbsp;Antonello Podda","doi":"10.1089/pmr.2023.0010","DOIUrl":"https://doi.org/10.1089/pmr.2023.0010","url":null,"abstract":"<p><strong>Background: </strong>Pediatric palliative care (PPC) helps maintain the quality of life for both children and their families. It has been identified as an important goal within the global health agenda. In Saudi Arabia, the discipline remains in its infancy, as illustrated by the absence of PPC programs in academic and health care institutions.</p><p><strong>Aim: </strong>The aim was to conduct a pilot study assessing physicians' knowledge, attitudes, and perceptions toward PPC.</p><p><strong>Method: </strong>Data were gathered through a self-administered questionnaire sent to physicians working in Saudi Arabia.</p><p><strong>Results: </strong>One hundred twelve completed the survey (male 54.2%, <i>n</i> = 50). A total of 40.8% (<i>n</i> = 42) had 20 years or more of experience, 42.9% (<i>n</i> = 48) were from the hematology-oncology specialty, and 68.5% (<i>n</i> = 74) received no training in PPC. Half suggested that children should be informed of their condition but mostly when reaching 12 or 15 years of age. Various physicians reported that the most appropriate time to discuss a transition to palliative care goals is when diagnosing an incurable condition or when despite all efforts, a condition continues to progress and death is expected.</p><p><strong>Conclusion: </strong>Multiple gaps were identified. PPC basic concepts should be included in the formal medical curriculum (e.g., pain management, communication, and ethical considerations at the end of life). There is also a significant need to develop further both primary and specialized palliative care.</p>","PeriodicalId":74394,"journal":{"name":"Palliative medicine reports","volume":"4 1","pages":"185-192"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10366288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9879705","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":"Identification of Factors Contributing to Methadone-Induced Daytime Sleepiness in Cancer Patients and Proposal of the Conversion Ratio from Other Opioids to Oral Methadone: A Retrospective Cohort Study.","authors":"Miho Takemura,&nbsp;Kazuyuki Niki,&nbsp;Yoshiaki Okamoto,&nbsp;Yoshinobu Matsuda,&nbsp;Makie Kohno,&nbsp;Mikiko Ueda","doi":"10.1089/pmr.2023.0007","DOIUrl":"https://doi.org/10.1089/pmr.2023.0007","url":null,"abstract":"<p><strong>Background: </strong>When methadone is used to treat cancer pain, the Japanese health insurance system recommends to determine the starting dose according to the equivalency conversion table based on the morphine-equivalent daily dose (MEDD) of prior opioids proposed by the National Comprehensive Cancer Network. Owing to the wide range in variability of the conversion table, methadone increases the incidence of daytime sleepiness.</p><p><strong>Objective: </strong>To identify the factors associated with daytime sleepiness and propose a conversion ratio from pretreatment MEDD to oral methadone that decreases the risk of daytime sleepiness.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting/subjects: </strong>One hundred patients who started oral methadone to relieve cancer pain at Ashiya Municipal Hospital (Hyogo, Japan) from January 1, 2013, to August 31, 2022, were enrolled.</p><p><strong>Measurements: </strong>The primary endpoint, the conversion ratio from pretreatment MEDD to oral methadone without daytime sleepiness, was determined using receiver operator characteristic (ROC) curve analysis.</p><p><strong>Results: </strong>The incidence of daytime sleepiness within seven days of methadone initiation was 40.0%. The factors identified as contributing to daytime sleepiness were pretreatment MEDD (odds ratio [OR]: 0.941, 95% confidence interval [CI]: 0.916-0.966, <i>p</i> <0.001) and methadone dose (OR: 1.395, 95% CI: 1.178-1.652, <i>p</i> <0.001). The conversion ratio from pretreatment MEDD to oral methadone was 0.24, with an area under the ROC curve of 0.909 (<i>p</i> <0.001).</p><p><strong>Conclusions: </strong>Daytime sleepiness developed when methadone dose is high relative to pretreatment MEDD. To the best of our knowledge, this is the first study to suggest the conversion ratio from pretreatment MEDD to oral methadone without causing daytime sleepiness.</p>","PeriodicalId":74394,"journal":{"name":"Palliative medicine reports","volume":"4 1","pages":"194-201"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10389252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9917082","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":"Kusankha Pamodzi: Health Care Decision-Making Preferences Among Patients with Cancer in Malawi.","authors":"Alyssa E Tilly,&nbsp;April Evans,&nbsp;Jane S Chen,&nbsp;Agness Manda,&nbsp;Ande Salima,&nbsp;Samuel Bingo,&nbsp;Maria Chikasema,&nbsp;Katherine D Westmoreland","doi":"10.1089/pmr.2023.0002","DOIUrl":"https://doi.org/10.1089/pmr.2023.0002","url":null,"abstract":"<p><strong>Background: </strong>Oncology teams are encouraged to include patient preferences and goals of care in determining appropriate treatment courses. There are no existing data from Malawi exploring decision-making preferences among cancer patients.</p><p><strong>Methods: </strong>In the oncology clinic in Lilongwe, Malawi, 50 patients were surveyed for decision making.</p><p><strong>Results: </strong>Most participants (70%, <i>n</i> = 35) preferred to engage in shared decision making regarding cancer treatment. About half (52%, <i>n</i> = 24) did not feel that their medical team involved them in decision making and 64% (<i>n</i> = 32) felt that they were never or only sometimes listened to by the medical team. Nearly all (94%, <i>n</i> = 47) preferred to have their medical team inform them how likely treatments are to lead to cure.</p><p><strong>Conclusions: </strong>Shared decision making was the preferred mode of treatment decision making by the majority of the surveyed cancer patients in Malawi. Cancer patients in Malawi may have similar preferences to cancer patients in other low-resource settings regarding decision making and communication.</p>","PeriodicalId":74394,"journal":{"name":"Palliative medicine reports","volume":"4 1","pages":"127-132"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10150710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9762992","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":"Feasibility and Preliminary Effectiveness of Behavioral Activation for Patients with Cancer and Depression in Japan.","authors":"Takatoshi Hirayama,&nbsp;Yuko Ogawa,&nbsp;Yuko Yanai,&nbsp;Akie Shindo,&nbsp;Moeko Tanaka,&nbsp;Shin-Ichi Suzuki","doi":"10.1089/pmr.2023.0020","DOIUrl":"https://doi.org/10.1089/pmr.2023.0020","url":null,"abstract":"<p><strong>Background: </strong>Though the effectiveness of behavioral activation (BA) for patients with cancer and depression were reported, there is no evidence in Japan.</p><p><strong>Objectives: </strong>This study aimed at examining the feasibility and preliminary effectiveness of BA for patients with cancer and depression in Japan.</p><p><strong>Methods: </strong>This pre-post study without a control group was conducted in patients with cancer and depression in Japan. The program completion rate was compared with those of previous studies to examine feasibility. To examine the preliminary effectiveness, outcomes were evaluated four times: before and immediately after the program, and two weeks and three months after the program ended. The primary outcome was the remission rate of depression using the 17-item version of the GRID Hamilton Rating Scale for Depression (HAMD₁₇). Secondary outcomes were self-reported depression, anxiety, quality of life, changes in behavior, values, and perceived reward of activity and environmental factors. Pre- and post-program data were compared using paired-samples <i>t</i>-tests, and data obtained at four time points were analyzed using one-way repeated-measures analysis of variance.</p><p><strong>Results: </strong>Of the 68 patients recruited from February 2018 to January 2022, 32 were registered. The completion rate was 75% (24/32), which was similar to previous studies. The total HAMD₁₇ score significantly improved after the program. The remission rate of depression was 62.5% (20/32), which was above the defined threshold value (30%). All but two secondary outcomes significantly improved after the program (<i>p</i> < 0.05).</p><p><strong>Conclusions: </strong>The feasibility and preliminary effectiveness of BA for patients with cancer and depression in Japan were suggested.</p><p><p>The Clinical Trial Registration number: UMIN 000036104.</p>","PeriodicalId":74394,"journal":{"name":"Palliative medicine reports","volume":"4 1","pages":"150-160"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10345282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9816656","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":"Comparison of the Burden Evolution of the Family Caregivers for Patients With Cancer and Nononcological Diseases Who Need Palliative Care: A Prospective Longitudinal Study.","authors":"Rodica Sorina Pop,&nbsp;Daniela Viorica Mosoiu,&nbsp;Aida Puia,&nbsp;Diana Tint","doi":"10.1089/pmr.2022.0067","DOIUrl":"https://doi.org/10.1089/pmr.2022.0067","url":null,"abstract":"<p><strong>Background: </strong>The family caregiver (FCG) is with the patient from diagnosis till the end of life. The accumulated burden has a negative impact on the caregiver's quality of life and on his physical and emotional well-being.</p><p><strong>Objective: </strong>To quantify the burden of care for a patient with palliative needs, and to compare the burden experienced by caregivers for nononcological patients with those for cancer patients.</p><p><strong>Design: </strong>Prospective longitudinal study.</p><p><strong>Setting/participants: </strong>One hundred forty patient-primary caregiver pairs participated in the study, which were separated into two groups: those who cared for patients with nononcological diseases (<i>n</i> = 63) and those who cared for patients with cancer (<i>n</i> = 77).</p><p><strong>Measurements: </strong>The burden measurement was assessed with Burden Scale for FCGs.</p><p><strong>Results: </strong>The average score of the FCG's burden was significantly higher in the nononcological group (45 ± 14.45 vs. 36.52 ± 15.05; <i>p</i> = 0.001). In the case of caregivers for cancer patients it is noticed that the caregivers' burden decreases after the intervention of the specialized team (45.58 ± 14.11 at T1 vs. 36.65 ± 16.10 at T2; <i>p</i> = 0.001). The burden values for caring for patients with nononcological diseases remained in the plateau, indicating incremental caregiver adaptation, although the rising trend is still present toward the end of the term (47.43 ± 13.32 vs. 56.69 ± 15.44; <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>The burden dynamics are different depending on the patient's disease, duration of care, degree of dependence, number of comorbidities, and on the intervention of the palliative care team that ensures the support of the caregiver for the palliative patient.</p>","PeriodicalId":74394,"journal":{"name":"Palliative medicine reports","volume":"4 1","pages":"161-168"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10357105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9860931","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":"Quality Versus Quantity of Life: Beyond the Dichotomy.","authors":"Ariel Dempsey,&nbsp;John Mulder","doi":"10.1089/pmr.2022.0058","DOIUrl":"https://doi.org/10.1089/pmr.2022.0058","url":null,"abstract":"<p><p>A restrictive and dichotomous question has become the primary approach in many goals of care discussions. Is the primary goal of care <i>quantity</i> of life through aggressive therapy or <i>quality</i> of life through comfort care and hospice? Even though many health care providers recognize that quality vs quantity of life (QvQ) is a false dichotomy, in practice QvQ underlies many goals of care discussions and can negatively impact patient care. This article offers strategies for assessing patients at the end of life, presenting a first-line conversation process that can support a range of treatment options as well as a diversity of dynamic patient values. Based on decades of experience in palliative care and a review of relevant literature, we recommend four practical questions to serve as values \"vital signs,\" monitoring dynamic notions of quality of life and harmonizing patient values with treatment options.</p>","PeriodicalId":74394,"journal":{"name":"Palliative medicine reports","volume":"4 1","pages":"17-23"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9892925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9190008","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":"Integration of the Verbatim Exercise into a Hospice and Palliative Medicine Fellowship.","authors":"Christopher R Powers,&nbsp;Garrett E Snipes,&nbsp;Katie Boykin Harbin,&nbsp;Andrew Fischer,&nbsp;Nancy Anderson,&nbsp;Kevin Cheng,&nbsp;Kristi Ford-Scales,&nbsp;Bryan C Siefert","doi":"10.1089/pmr.2022.0025","DOIUrl":"https://doi.org/10.1089/pmr.2022.0025","url":null,"abstract":"<p><p>One of the more challenging aspects of specialty level training in any medical fellowship is learning to communicate mindfully and effectively with patients and families in the face of serious illness. For the past five years, our accredited Hospice and Palliative Medicine (HPM) fellowship program has been integrating the \"verbatim\"-an exercise with a long and integral history in the training of health care chaplains. Verbatims are word-for-word accounts of a clinician's encounter with a patient and/or the patient's family. The verbatim serves as a formative educational exercise offering a method to hone one's clinical skills and competencies, while providing a unique space to practice self-awareness and self-reflection. Although sometimes difficult and intense for the fellow, we have found this to be a helpful exercise in improving the fellow's ability to make meaningful connections with patients and leading to improved outcomes of communication episodes. This potential growth in self-awareness supports both resiliency and mindfulness, which are essential skills for longevity and reduction of burnout risk in the field of HPM. The verbatim invites all participants to reflect on their own participation in facilitating whole person care to patients and families. Out of the six HPM milestone metrics for fellowship training, the verbatim exercise supports achievement in at least three of the milestones. We present survey data over the past five years of our fellowship in support of the utility of this exercise and for consideration to include this exercise in a palliative medicine fellowship. We offer additional suggestions for further study of this formative tool. This article delineates the verbatim technique and its specific integration into our accredited ACGME Hospice and Palliative Medicine fellowship training program.</p>","PeriodicalId":74394,"journal":{"name":"Palliative medicine reports","volume":"4 1","pages":"133-138"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10171960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9469371","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":"Associations in Perceived Health and Persistent Breathlessness: A Cross-Sectional Study.","authors":"Slavica Kochovska,&nbsp;Sungwon Chang,&nbsp;Max Olsson,&nbsp;Magnus Ekström,&nbsp;David C Currow","doi":"10.1089/pmr.2022.0071","DOIUrl":"https://doi.org/10.1089/pmr.2022.0071","url":null,"abstract":"<p><strong>Background: </strong>Persistent breathlessness is debilitating and increases in prevalence with advanced age and at end of life. This study aimed to evaluate any relationship between self-reported global impressions of change (GIC) in perceived health and breathlessness in older men.</p><p><strong>Design: </strong>Cross-sectional study of 73-year-old Swedish men in the VAScular and Chronic Obstructive Lung disease study. A postal survey included items on perceived changes in health and breathlessness (GIC scales) and breathlessness (assessed using the modified Medical Research Council [mMRC] breathlessness scale, Dyspnea-12 and Multidimensional Dyspnea Scale) since age 65.</p><p><strong>Results: </strong>Of 801 respondents, breathlessness (mMRC ≥2) was reported by 17.9%, worsening breathlessness by 29.1%, and worsening perceived health by 51.3%. Worsening breathlessness was strongly correlated with worsening perceived health (Pearson's correlation coefficient of 0.68 [<i>p</i> < 0.001] and Kendall's τ of 0.56 [<i>p</i> < 0.001]) and associated with more limited function (47.2% vs. 29.7%; <i>p</i> < 0.0001) and increased rates of anxiety/depression.</p><p><strong>Conclusion: </strong>The strong correlation between perceived changes in health and persistent breathlessness helps delineate a more comprehensive picture of the challenges faced by older adults living with this disabling symptom.</p>","PeriodicalId":74394,"journal":{"name":"Palliative medicine reports","volume":"4 1","pages":"120-126"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10122221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9759189","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}