The Joint Commission journal on quality improvement最新文献

{"title":"Applying Quality Improvement Principles to Achieve Healthy Work Organizations","authors":"François Sainfort PhD (Professor),&nbsp;Ben-Tzion Karsh PhD (Assistant Professor),&nbsp;Bridget C. Booske PhD (Associate Scientist),&nbsp;Michael J. Smith PhD (Professor)","doi":"10.1016/S1070-3241(01)27041-2","DOIUrl":"10.1016/S1070-3241(01)27041-2","url":null,"abstract":"<div><h3>Background</h3><p>Health care has used total quality management (TQM)/quality improvement (QI) methods to improve quality of care and patient safety. Research on healthy work organizations (HWOs) shows that some of the same work organization factors that affect employee outcomes such as quality of life and safety can also affect organizational outcomes such as profits and performance. An HWO is an organization that has both financial success and a healthy workforce. For a health care organization to have financial success it must provide high-quality care with efficient use of scarce resources. To have a healthy workforce, the workplace must be safe, provide good ergonomic design, and provide working conditions that help to mitigate the stress of health care work.</p></div><div><h3>Integrating TQM/QI into the HWO paradigm</h3><p>If properly implemented and institutionalized, TQM/QI can serve as the mechanism by which to transform a health care organization into an HWO. To guide future research, a framework is proposed that links research on QI with research on HWOs in the belief that QI methods and interventions might be an effective means by which to create an HWO. Specific areas of research should focus on identifying the work organization, cultural, technological, and environmental factors that affect care processes; affect patient health, safety, and satisfaction; and indirectly affect patient health, safety, and satisfaction through their effects on staff and care process variables.</p></div><div><h3>Summary</h3><p>Integrating QI techniques within the paradigm of the HWO paradigm will make it possible to achieve greater improvements in the health of health care organizations and the populations they serve.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"27 9","pages":"Pages 469-483"},"PeriodicalIF":0.0,"publicationDate":"2001-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(01)27041-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56460911","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":"The Impact of Staffing and the Organization of Work on Patient Outcomes and Health Care Workers in Health Care Organizations","authors":"Christine Kovner PhD, RN (Professor and Senior Fellow)","doi":"10.1016/S1070-3241(01)27040-0","DOIUrl":"10.1016/S1070-3241(01)27040-0","url":null,"abstract":"<div><h3>Background</h3><p>Numerous reports in the popular press express concern about the restructuring or lowering of staffing levels in health care organizations and the impact on the quality of patient care. Overtime and other extended shifts also represent work stresses for health care workers. This article reviews the research literature on the relationships among staffing, organization of work, and patient outcomes, and it discusses research findings on the relationship between staffing and the health of health care workers.</p></div><div><h3>Research on staffing, organization, and patient outcomes/staff well-being</h3><p>Safe staffing level requirements have been identified for nursing homes, but only in extremely limited cases for hospitals, home care, or other health settings. There is little information about the impact of staffing levels and the organization of work on health personnel or on patient outcomes. There is almost no information about staffing and patient outcomes in home health and ambulatory care. Much of the research on staffing and quality has been discipline specific; future research should reflect the interdisciplinary nature of health care delivery rather than the impact of a particular occupation.</p></div><div><h3>Research use</h3><p>Research is conducted to increase the scientific base per se and to inform decision making. Who should decide staffing levels and the organization of work? Professionals, employers/owners, the government, and consumers all have significant interest in staffing levels and the organization of care. Improving health care quality requires research about the critical staffing and organization of work variables. This requires obtaining appropriate data, conducting the research, and widely disseminating the findings.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"27 9","pages":"Pages 458-468"},"PeriodicalIF":0.0,"publicationDate":"2001-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(01)27040-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56460897","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":"The Forgotten Component of the Quality Triad: Can We Still Learn Something from “Structure”?","authors":"Gregg S. Meyer MD, MSc (Director),&nbsp;Michael P. Massagli PhD (Formerly Research and Development Director)","doi":"10.1016/S1070-3241(01)27042-4","DOIUrl":"10.1016/S1070-3241(01)27042-4","url":null,"abstract":"<div><h3>Background</h3><p>Quality assessment was founded on structural measures, such as accreditation status of facilities, credentialling of providers, and type of provider. Recent efforts in measures development have focused on processes and outcomes because research has suggested that structural measures are not strong markers of the quality of care at the health plan or provider levels. Nevertheless, the literature on the quality of health care contains a number of examples illustrating the potential application of structural measures to the assessment of quality. The continued development of measures of structure—which would at least measure aspects of the physical environment, working conditions, organizational culture, and provider satisfaction—may be helpful because generalizing from studies of process and outcome requires specification of the conditions under which these linkages are found.</p></div><div><h3>A road map for measures development</h3><p>The Leapfrog Group of large purchasers has promoted the application of three patient safety “leaps” that are, in essence, structural measures: the use of computerized physician order entry, the selective referral of patients to high-volume providers for certain procedures, and the availability of board-certified critical care specialists in intensive care units. Structural measures, like process and outcomes measures, face the same challenges of standardization, reliability, validity, and portability. Field testing of potential measures will be required to examine the feasibility and added value of these measures in real-world settings.</p></div><div><h3>Conclusion</h3><p>Research to date suggests that a new cadre of structural measures of health care quality, which have largely been overlooked in the recent measures development boom, have the potential to fill in important gaps in our ability to assess quality.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"27 9","pages":"Pages 484-493"},"PeriodicalIF":0.0,"publicationDate":"2001-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(01)27042-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56460926","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":"Identifying and Using Tools for Reducing Risks to Patients and Health Care Workers: A Nursing Perspective","authors":"Mary E. Foley MS, RN (President),&nbsp;David Keepnews JD, MPH, RN (Formerly Assistant Professor),&nbsp;Karen Worthington MS, RN (Occupational Safety and Health Specialist)","doi":"10.1016/S1070-3241(01)27043-6","DOIUrl":"10.1016/S1070-3241(01)27043-6","url":null,"abstract":"<div><h3>Background</h3><p>Research efforts and policy initiatives in health care errors and injury to health care workers have attracted increasing attention in recent years. An emerging theme in both these areas is the importance of organizational and other systems factors in the occurrence of medical error and health care worker injury. These commonalities call for the identification of common research efforts and, when appropriate, policy efforts.</p></div><div><h3>Moving from hypothesis to conclusion</h3><p>The proposition that health care error and worker injury are linked to the same organizational variables requires further research and deserves the same type of human factors approach that has characterized much of the investigative efforts that have occurred in the patient safety arena during the past decade. Serious problems exist with respect to access to data on staffing levels, skill mix, consecutive work hours, and other information that is crucial to examining the link between practice conditions, health care error, and health care worker injury.</p></div><div><h3>Human factors</h3><p>One important resource in identifying effective approaches to prevent error and health care worker injury is the field of human factors, the discipline concerned with the design of tools, machines, and systems that takes into account human capabilities, limitations, and characteristics.</p></div><div><h3>Conclusion</h3><p>The potential benefits of linking patient safety and health care worker safety efforts are significant. The research, experience, and successful practices from multiple disciplines must be utilized in identifying areas of common interest and concern in advancing work in both of these important areas.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"27 9","pages":"Pages 494-499"},"PeriodicalIF":0.0,"publicationDate":"2001-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(01)27043-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56460955","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":"Designing an Intervention to Improve the Management of Helicobacter pylori Infection","authors":"Sumit R. Majumdar MD MPH,&nbsp;Stephen B. Soumerai ScD (Professor),&nbsp;Marianne Lee PharmD (Clinical Pharmacist),&nbsp;Dennis Ross-Degnan ScD (Associate Professor)","doi":"10.1016/S1070-3241(01)27035-7","DOIUrl":"10.1016/S1070-3241(01)27035-7","url":null,"abstract":"<div><h3>Background</h3><p>An intervention to improve the testing and treatment of <em>Helicobacter pylori</em> (HP) in patients receiving chronic acid suppression (AS) therapy was developed at Harvard Pilgrim Health Care (HPHC), a mixed-model not-for-profit health maintenance organization.</p></div><div><h3>Methods</h3><p>Ten full-time primary care physicians (4 staff model and 6 group practice) were interviewed in 1999 about their knowledge, attitudes, and practice regarding dyspepsia, the use of chronic AS drugs, and approaches to HP infection, as well as about the feasibility and acceptability of various potential interventions that might be used in a quality improvement program.</p></div><div><h3>Results</h3><p>Self-reported practice regarding dyspepsia and HP infection were relatively uniform, and physicians were generally aware of current recommendations. Three common misperceptions acted as barriers to optimal HP management: Untreated HP was not considered an important problem; patients who used drugs for chronic AS rarely had HP infection; and chronic use of AS drugs was considered effective and without adverse consequence. All physicians wanted brief educational materials with explicit guidelines, preferably locally adapted and endorsed by local experts. All informants agreed that the main barrier to successful QI interventions was the requirement for any extra time or effort, particularly when directed at populations of patients who do not have symptomatic complaints.</p></div><div><h3>Discussion</h3><p>The interviews revealed the many barriers to improving the management of HP infection and to targeting educational messages and tailoring different methods for facilitating practice change across different managed care settings. Evidence-based components of the intervention program include physician education, a notification/reminder system, and practice-based tools to facilitate change and minimize workload.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"27 8","pages":"Pages 405-414"},"PeriodicalIF":0.0,"publicationDate":"2001-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(01)27035-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56460835","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":"The Search for Good Antimicrobial Stewardship","authors":"Dale N. Gerding MD","doi":"10.1016/S1070-3241(01)27034-5","DOIUrl":"10.1016/S1070-3241(01)27034-5","url":null,"abstract":"","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"27 8","pages":"Pages 403-404"},"PeriodicalIF":0.0,"publicationDate":"2001-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(01)27034-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56460813","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":"Measuring and Improving Patients’ and Families’ Perceptions of Care in a System of Pediatric Hospitals","authors":"Alice Lanford RN, MSN, CNAA (Director of Nursing and Patient Care Services),&nbsp;Rhonda Clausen RN (Corporate Director of Performance Improvement),&nbsp;Janet Mulligan RN, MSN (Director of Nursing and Patient Care Services),&nbsp;Cheri Hollenback RNC, MN (Director of Nursing and Patient Care Services),&nbsp;Suzanne Nelson RHIA (Director of Support Services),&nbsp;Vicki Smith RN, CPHQ (Director of Performance Improvement)","doi":"10.1016/S1070-3241(01)27036-9","DOIUrl":"10.1016/S1070-3241(01)27036-9","url":null,"abstract":"<div><h3>Background</h3><p>Shriners Hospitals for Children (SHC) is a network of 22 pediatric specialty hospitals that provide medical care free of charge to children up to 18 years of age and that serve as referral centers for children with complex orthopedic and burn problems. In 1998 the SHC system began using The Picker Institute’s Patient and Family Perception of Care inpatient survey throughout its hospitals.</p></div><div><h3>Systemwide implementation</h3><p>A broad-based implementation plan was developed to promote acceptance of the perception of care topic and provide education on performance improvement. In 1999 a work group was formed to prioritize areas for improvement, survey benchmark hospitals, and identify best practices in benchmark hospitals. This work group first focused on the dimensions of Partnership Between Families and Clinicians and Information and Education to the Child. In May 1999 the work group began the task of identifying best practices in these two priority dimensions from the SHC benchmark hospitals. Surveys were submitted to those hospitals, asking what they perceived as being the reasons they scored well in those areas. The results of these surveys were used to identify key practices in these benchmark hospitals that are of significant importance in patient and family perceptions of quality care.</p></div><div><h3>Next steps</h3><p>The challenge is to facilitate cross-facility interactions to understand and adopt best practices. Focus groups will be conducted to further delineate the dimensions with higher problem scores. The SHC system plans to expand the patient surveys to outpatients, to allow for the evaluation of the full complement of hospital patients.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"27 8","pages":"Pages 415-429"},"PeriodicalIF":0.0,"publicationDate":"2001-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(01)27036-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56460850","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":"Promoting Patient Safety: Is Technology the Solution?","authors":"Deborah M. Nadzam PhD (Director),&nbsp;Roger M. Macklis MD (Chairman)","doi":"10.1016/S1070-3241(01)27037-0","DOIUrl":"10.1016/S1070-3241(01)27037-0","url":null,"abstract":"<div><h3>Background</h3><p>On April 30, 2001, the Cleveland Clinic Foundation and Cleveland Clinic Health System Quality Institute sponsored a 1-day conference focused on technology in patient safety.</p></div><div><h3>Patient safety–A call to action</h3><p>Kenneth W. Kizer focused on ten high-priority patient safety strategies identified by the National Quality Forum—including implementing recognized “safe practices,” recognizing and dealing with professional misconduct, and supporting efforts to create a nonpunitive environment for health care error reporting.</p></div><div><h3>Cultural implications of introducing new technology</h3><p>Randolph A. Miller described a computerized clinician order-entry system used to provide decision support, reduce excess test ordering, introduce cost savings, and meet regulations for inpatient radiology and cardiology tests.</p></div><div><h3>Using bar codes to eliminate medication errors</h3><p>Jeff Ramirez reported on the Veterans Health Administration’s use of bar coding technology for point-of-care validation of medication administration, which has resulted in improvements in response time; the efficiency of the dispensing, delivery, and administration process; and patient care.</p></div><div><h3>How to make computers team players</h3><p>The knowledge base exists to design computers as team players that expand human expertise and help health care practitioners better create safety. Yet David D. Woods challenged the audience to anticipate the changing shape of iatrogenic risk as a result of increasing dependence on automation in health care.</p></div><div><h3>Technology and medication systems</h3><p>Mark Neuenschwander spoke about automating various steps within the medication use system, through computerized prescriber order entry and bedside scanning.</p></div><div><h3>Future technological possibilities</h3><p>Charles Denham suggested how technology may aid health care professionals in their care of patients, such as in using predictive modeling to identify the risks of therapeutic intervention.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"27 8","pages":"Pages 430-436"},"PeriodicalIF":0.0,"publicationDate":"2001-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(01)27037-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56460859","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":"Improving Inpatient Antibiotic Prescribing: Insights from Participation in a National Collaborative","authors":"Gordon D. Schiff MD,&nbsp;Mary Wisniewski RN, MSN,&nbsp;Judilynn Bult PharmD (Pharmacy Manager),&nbsp;Jorge P. Parada MD, MPH,&nbsp;Hem Aggarwal MBBS,&nbsp;David N. Schwartz MD","doi":"10.1016/S1070-3241(01)27033-3","DOIUrl":"10.1016/S1070-3241(01)27033-3","url":null,"abstract":"<div><h3>Background</h3><p>Increasing rates of antimicrobial resistance and the role antibiotic overuse plays in contributing to this problem have been widely documented and have prompted appeals to change prescribing practices. How to actually achieve such changes represents a major challenge. As part of the Institute for Healthcare Improvement (IHI) Breakthrough Series project Improving Prescribing Practices (IPP), in 1997–1998, Cook County Hospital (Chicago) worked with other institutions that chose antibiotics as their focus in this national collaborative.</p></div><div><h3>Practical suggestions</h3><p>Practical suggestions are offered within six categories–adopting a general approach to improving antibiotic prescribing (marshaling credible evidence, addressing physician concerns and skepticism, and removing barriers to make it easier for prescribers to change); rethinking guidelines (providing syndrome-based guidance, revising national guidelines for local use, defining scenarios in which drug(s) can be safely withheld, offering alternatives, prospectively resolving conflicts over drug of choice and empiric regimens, and defining situations in which immediate treatment is and is not critical); getting the message out and changes implemented (using antibiotic order forms, computer order entry, and infectious disease specialist consultation); building viable linkages to leverage change (bridging disciplines); improving measurement; and promoting nondrug strategies and patients’ roles in treating and preventing infection.</p></div><div><h3>Conclusion</h3><p>Antimicrobials are unique, being the only class of drug therapy that affects not only the patient to whom it is prescribed but other current and future patients as well. Institutions therefore have a special responsibility to ensure their efficient and judicious use. It is often easier to prescribe antibiotics than to exercise restraint.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"27 8","pages":"Pages 387-402"},"PeriodicalIF":0.0,"publicationDate":"2001-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(01)27033-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56460792","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":"Patient Satisfaction Measurement Strategies: A Comparison of Phone and Mail Methods","authors":"Thomas E. Burroughs PhD,&nbsp;Brian M. Waterman MPH (Performance Measurement Research Analyst),&nbsp;Jane C. Cira (Manager, Customer Satisfaction Research),&nbsp;Radhika Desikan PhD (Research Scientist),&nbsp;William Claiborne Dunagan MD (Vice President)","doi":"10.1016/S1070-3241(01)27030-8","DOIUrl":"10.1016/S1070-3241(01)27030-8","url":null,"abstract":"<div><h3>Background</h3><p>In 1998 the BJC Health System (St Louis) made the decision to migrate its patient satisfaction measurement system from a mail-out/mail-back method to a phone interview method. Out of concern that results obtained by phone would not be comparable with the 4 years of mail-based data, a controlled study was undertaken to directly compare mail and phone responses and to evaluate response rates, patient sample demographics, and patient satisfaction ratings.</p></div><div><h3>Methods</h3><p>Mail and phone responses obtained from parallel random samples selected from inpatient, outpatient test/treatment, outpatient surgery, and emergency service patient populations were compared. Patients were randomly selected to receive a standardized satisfaction survey by either phone or mail 10 to 14 days postdischarge.</p></div><div><h3>Results</h3><p>Significantly higher response rates were obtained by telephone then via the mail-based method for all four samples. After adjusting for demographic differences, numerous significant differences in mean scores as well as percentages of excellent and fair or poor responses were observed, and more positive ratings were obtained by phone.</p></div><div><h3>Discussion</h3><p>Crude comparisons of satisfaction scores between organizations using phone and mail-based responses may lead to erroneous conclusions about consumer-perceived quality. Organizations that use mixed-mode surveys should conduct careful side-by-side studies of the methods used on the survey of interest and then establish a correction formula to adjust the results for the measurement biases.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"27 7","pages":"Pages 349-361"},"PeriodicalIF":0.0,"publicationDate":"2001-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(01)27030-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56461228","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}