Health outcomes research in medicine最新文献

{"title":"The Burden of Fibromyalgia: Assessment of Health Status Using the EuroQol (EQ-5D) in Patients with Fibromyalgia Relative to Other Chronic Conditions","authors":"Xuemei Luo PhD ,&nbsp;Joseph C. Cappelleri PhD, MPH, MS ,&nbsp;Arthi Chandran MS, MPH","doi":"10.1016/j.ehrm.2011.08.002","DOIUrl":"10.1016/j.ehrm.2011.08.002","url":null,"abstract":"<div><h3>Objective</h3><p>To compare the health status of fibromyalgia patients assessed by EuroQol (EQ-5D) with healthy controls and patients with chronic conditions, and to identify modifiable clinical factors associated with the EQ-5D.</p></div><div><h3>Study Design</h3><p><span><span>EQ-5D scores were calculated using US preference weights for patients with fibromyalgia from a published patient survey. Scores were compared with healthy controls and individuals with chronic conditions (cancer, diabetes, asthma, headache, hypertension, myocardial infarction, coronary atherosclerosis, congestive heart failure, </span>osteoarthritis<span>, rheumatoid arthritis, and spondylopathies) from the Medical Expenditure Panel Survey. Demographic and clinical factors associated with the EQ-5D were identified using </span></span>regression analyses.</p></div><div><h3>Results</h3><p>Adjusted for age and sex, the mean (±SD) EQ-5D score was 0.56<!--> <!-->±<!--> <!-->0.18 among fibromyalgia patients; significantly lower, that is, worse (<em>P</em> &lt;.0001), than that of healthy controls (0.89<!--> <!-->±<!--> <!-->0.46) and other chronic conditions (<em>P</em><span> &lt;.0001). Differences in scores between fibromyalgia patients and comparators were ≥.074, indicating clinical significance. Patient self-reported fibromyalgia symptom severity was a significant factor associated with the EQ-5D. Compared with “very severe” patients, those with “moderate,” “mild,” and “very mild” symptoms had significantly (</span><em>P</em><span><span> &lt;.05) higher mean EQ-5D scores. Major depressive disorder also was a significant factor, but anxiety, </span>cognitive dysfunction<span>, and chronic fatigue syndrome were not; neither were fibromyalgia duration and number of tender points.</span></span></p></div><div><h3>Conclusions</h3><p>EQ-5D scores in fibromyalgia patients were significantly lower than healthy controls and individuals with other chronic conditions. Self-reported symptom severity was significantly associated with the EQ-5D. A substantial health burden for fibromyalgia has been highlighted and results suggest that effective symptom management is necessary to improve the health status of fibromyalgia patients.</p></div>","PeriodicalId":88882,"journal":{"name":"Health outcomes research in medicine","volume":"2 4","pages":"Pages e203-e214"},"PeriodicalIF":0.0,"publicationDate":"2011-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehrm.2011.08.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54245685","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":"Putting Research into Practice","authors":"Donald E. Stull Ph.D. (Editor-in-Chief)","doi":"10.1016/j.ehrm.2011.08.003","DOIUrl":"10.1016/j.ehrm.2011.08.003","url":null,"abstract":"","PeriodicalId":88882,"journal":{"name":"Health outcomes research in medicine","volume":"2 3","pages":"Page e129"},"PeriodicalIF":0.0,"publicationDate":"2011-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehrm.2011.08.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54245698","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":"Meeting Highlights on Mood Disorders: The 3rd Annual Chair Summit","authors":"Monique D. Johnson MD, CCMEP,&nbsp;Sandra Haas Binford MAEd,&nbsp;Christina J. Ansted MPH, CCMEP,&nbsp;Robert S. Kennedy MA","doi":"10.1016/j.ehrm.2011.07.007","DOIUrl":"10.1016/j.ehrm.2011.07.007","url":null,"abstract":"<div><p><span>Mood disorders are among the most common neuropsychiatric disorders. </span>Major depressive disorder<span> and bipolar disorder affect 14.8 million (6.7%) and 5.7 million (2.6%) adults in the United States aged 18 years and over in a given year, respectively; and these may be conservative estimates. In addition, these disorders are associated with significant disability and morbidity for the patient, and enormous societal costs. Regrettably, mortality is too common for patients affected; more than 90% of people who commit suicide have a diagnosable mental disorder, most commonly a depressive disorder.</span></p><p><em>The 3^rd<span><span> Annual Chair Summit, The Master Class for Neuroscience </span>Professional Development</span></em><span><span>, held in Chicago, Illinois (August 2010), a comprehensive continuing medical education<span> (CME) conference on neuroscience targeted to psychiatry and </span></span>neurology<span><span> clinicians and featuring relevant department chairs as faculty, included numerous educational sessions on unipolar and bipolar mood disorders. Notable topics in depression were management of subtypes (psychotic and anxious), onset in late life, available evidence regarding use of complementary and alternative medicine, and the impact </span>of depression treatment<span> on cardiovascular disease. Bipolar disorder sessions focused on patients with childhood onset of illness and those who require systematic therapy trials in order to arrive at the optimal, individualized treatment plan. Additionally, a forward-looking session was held on innovations, both diagnostic and therapeutic, on the horizon for improving care of bipolar disorder. This 2nd article of 5 in a CME-certified companion series presents highlights of these sessions with summary points connecting research to clinical practice for each topic.</span></span></span></p></div>","PeriodicalId":88882,"journal":{"name":"Health outcomes research in medicine","volume":"2 3","pages":"Pages e141-e155"},"PeriodicalIF":0.0,"publicationDate":"2011-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehrm.2011.07.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54246155","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":"Continuing Professional Development in Psychiatry and Neurology: The 3rd Annual Chair Summit","authors":"Christina J. Ansted MPH, CCMEP,&nbsp;Monique D. Johnson MD, CCMEP,&nbsp;Sandra Haas Binford MAEd,&nbsp;Robert S. Kennedy MA","doi":"10.1016/j.ehrm.2011.07.006","DOIUrl":"10.1016/j.ehrm.2011.07.006","url":null,"abstract":"<div><p><span><span>The continuing professional development (CPD) of clinicians is a critical process in protecting one of the United States’ most precious human resources. The American Medical Association considers CPD as a system in which physicians, with the help of educational experts, consistently enhance their own clinical practice to provide optimal patient care. CPD calls for clinicians to be motivated, self-directed, lifelong learners who are focused on patient outcomes. </span>Continuing medical education<span> (CME) is a powerful strategic asset to the CPD of clinicians, which aims to improve the lives of patients by translating research and evidence into clinical practice. The Institute of Medicine report </span></span><span><em>Redesigning Continuing Education in the Health </em><em>Professions</em></span> (2010) calls for CME to align learning with health professionals’ needs. To meet that goal, <span><span><em>The 3rd Annual Chair Summit, The Master Class for </em><em>Neuroscience</em><em> </em></span><em>Professional Development</em></span><span><span><span>, held in Chicago, Illinois (August 2010), brought together chairpersons in psychiatry and </span>neurology<span> to act as expert peer teachers for frontline clinician learners. Faculty and learners collaboratively evaluated evidence, shared ideas and clinical practice challenges, developed individualized clinical strategies, explored the role of the multidisciplinary team, discussed health-system issues, and translated the neuroscience discoveries into patient-centered practice improvements. This introduction introduces 4 companion, CME-certified articles of 2010 Chair Summit highlights, addressing the gap between evidence and practice in multiple sclerosis<span>, traumatic brain injury<span>, sleep-wake disorders, Alzheimer disease, genetic research into psychosis, schizophrenia, treatment-resistant depression, </span></span></span></span>bipolar disorder<span><span>, anxiety, posttraumatic stress disorder, </span>attention deficit hyperactivity disorder<span>, physician addiction, suicide, and technology-based treatment.</span></span></span></p></div>","PeriodicalId":88882,"journal":{"name":"Health outcomes research in medicine","volume":"2 3","pages":"Pages e133-e140"},"PeriodicalIF":0.0,"publicationDate":"2011-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehrm.2011.07.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54246144","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 3rd Annual Chair Summit, The Master Class for Neuroscience Professional Development: Introduction to Meeting Highlights","authors":"Christina J. Ansted MPH, CCMEP,&nbsp;Sandra Haas Binford MAEd,&nbsp;Monique D. Johnson MD, CCMEP,&nbsp;Robert S. Kennedy MA","doi":"10.1016/j.ehrm.2011.05.001","DOIUrl":"https://doi.org/10.1016/j.ehrm.2011.05.001","url":null,"abstract":"","PeriodicalId":88882,"journal":{"name":"Health outcomes research in medicine","volume":"2 3","pages":"Pages e131-e132"},"PeriodicalIF":0.0,"publicationDate":"2011-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehrm.2011.05.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92079112","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":"Meeting Highlights on Psychiatric Treatment Perspectives in Neurology: The 3rd Annual Chair Summit","authors":"Christina J. Ansted MPH, CCMEP,&nbsp;Robert S. Kennedy MA,&nbsp;Monique D. Johnson MD, CCMEP,&nbsp;Sandra Haas Binford MAEd","doi":"10.1016/j.ehrm.2011.07.008","DOIUrl":"10.1016/j.ehrm.2011.07.008","url":null,"abstract":"<div><p>The Institute of Medicine report entitled <span><em>Redesigning Continuing Education in the Health </em><em>Professions</em></span><span> (2010) calls for continuing medical education (CME) to align learning with health professionals’ needs. To meet that goal, </span><em>The 3^rd Annual Chair Summit,</em> <span><span><em>The Master Class for </em><em>Neuroscience</em><em> </em></span><em>Professional Development</em></span><span><span>, held in Chicago, Illinois (August 2010), brought together chairpersons in psychiatry and </span>neurology to act as expert peer teachers for frontline, clinician learners. Faculty and learners collaboratively evaluated evidence, shared ideas and clinical practice challenges, developed individualized clinical strategies, explored the role of the multidisciplinary team, discussed health-system issues, and translated the neuroscience discoveries into patient-centered practice improvements. This 5</span>^th and final article in the companion series, “<em>Meeting Highlights of the 3^rd Annual Chair Summit, The Master Class for Neuroscience Professional Development, 2010</em><span><span><span><span>” will summarize psychiatric perspectives on neurological illnesses and injuries: multiple sclerosis; </span>traumatic brain injury; sleep-wake disorders, including </span>obstructive sleep apnea; Alzheimer’s disease management; and </span>psychiatric care<span> of older persons, including a case from one chart review session. Highlights of current and emerging developments related to psychiatric treatment perspectives for the management of neurological illness are discussed. Summary points connecting research to clinical practice for each topic are also presented.</span></span></p></div>","PeriodicalId":88882,"journal":{"name":"Health outcomes research in medicine","volume":"2 3","pages":"Pages e183-e194"},"PeriodicalIF":0.0,"publicationDate":"2011-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehrm.2011.07.008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54245666","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":"Meeting Highlights on Psychiatric Clinical Challenges and Advancing the Science of Treatment: The 3rd Annual Chair Summit","authors":"Monique D. Johnson MD, CCMEP,&nbsp;Robert S. Kennedy MA,&nbsp;Sandra Haas Binford MAEd,&nbsp;Christina J. Ansted MPH, CCMEP","doi":"10.1016/j.ehrm.2011.07.004","DOIUrl":"10.1016/j.ehrm.2011.07.004","url":null,"abstract":"<div><p><span><span><span>Health care providers encounter many patients who have a typical, bread-and-butter symptom presentation and illness course, and for whom developing a treatment<span> plan is relatively straightforward. However, some patients have cases that are challenging because 1) their illnesses are atypical, severe, or treatment-refractory in nature; 2) their conditions are less frequently encountered in the clinical setting; or 3) optimal treatment has not yet been well-studied and clearly defined. In the neurosciences, such challenges often seem to be the rule more than the exception. </span></span>Continuing medical education<span> (CME) can help clinicians address these challenges and promote clinical competence<span> regarding innovations in neuroscience technologies. In August 2010, psychiatry and </span></span></span>neurology health care providers participated in a comprehensive neuroscience CME conference—</span><em>The 3^rd Annual Chair Summit, The Master Class for Neuroscience Professional Development—</em>that featured faculty chairpersons of psychiatry and neurology departments. This 4^th<span><span> article of 5 in a CME-certified companion series presents meeting highlights on managing the complexities of neuropsychiatric care and on scientific advances, especially technology-based innovations. Specifically, clinical topics focus on recognizing attention deficit hyperactivity disorder that persists into adulthood; differential diagnosis of rage and aggression; treating borderline personality disorder; preventing suicide; and implementing care strategies for physician addiction. Rounding out this attention to difficult cases, technology highlights pertained to advanced diagnostic innovations in functional magnetic resonance imaging and to </span>brain stimulation<span><span> treatment strategies (ie, electroconvulsive therapy, deep brain stimulation, </span>repetitive transcranial magnetic stimulation, and vagus nerve stimulation). This article contains several patient cases and summary points connecting research to clinical practice.</span></span></p></div>","PeriodicalId":88882,"journal":{"name":"Health outcomes research in medicine","volume":"2 3","pages":"Pages e169-e182"},"PeriodicalIF":0.0,"publicationDate":"2011-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehrm.2011.07.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54246116","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":"Meeting Highlights on Psychosis and Schizophrenia: The 3rd Annual Chair Summit","authors":"Robert S. Kennedy MA,&nbsp;Sandra Haas Binford MAEd,&nbsp;Christina J. Ansted MPH, CCMEP,&nbsp;Monique D. Johnson MD, CCMEP","doi":"10.1016/j.ehrm.2011.07.005","DOIUrl":"10.1016/j.ehrm.2011.07.005","url":null,"abstract":"<div><p>The Institute of Medicine report <span><em>Redesigning Continuing Education in the Health </em><em>Professions</em></span><span> (2010) calls for CME to align learning with health professionals’ needs. To meet that goal, </span><span><em>The 3rd Annual Chair Summit, The Master Class for </em><em>Neuroscience</em><span><em> </em><em>Professional Development</em></span></span><span><span>, held in Chicago, Illinois (August 2010), brought together chairpersons in psychiatry and </span>neurology to act as expert peer teachers for frontline clinician learners. Faculty and learners collaboratively evaluated evidence, shared ideas and clinical practice challenges, developed individualized clinical strategies, explored the role of the multidisciplinary team, discussed health-system issues, and translated the neuroscience discoveries into patient-centered practice improvements. This third article in the CME-certified companion series, “</span><em>Meeting Highlights of the 3^rd Annual Chair Summit, The Master Class for Neuroscience Professional Development, 2010</em><span><span>,” will analyze plenary and breakout educational sessions on psychosis and schizophrenia genetic research, </span>clinical research<span>, and patient care. Highlights of the important issues related to management of psychosis and extreme or violent situations are discussed. Two clinical case challenges help cement previous learning and encourage readers to consider management options and sketch out patient-centered, tailored treatment plans. Summary points connecting research to clinical practice for each topic are also presented.</span></span></p></div>","PeriodicalId":88882,"journal":{"name":"Health outcomes research in medicine","volume":"2 3","pages":"Pages e157-e168"},"PeriodicalIF":0.0,"publicationDate":"2011-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehrm.2011.07.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54246126","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":"Accuracy of Claims-Based Measures of Severity of Childhood Illnesses","authors":"Farrokh Alemi PhD,&nbsp;Maria Uriyo PhD","doi":"10.1016/j.ehrm.2011.07.002","DOIUrl":"10.1016/j.ehrm.2011.07.002","url":null,"abstract":"<div><h3>Background</h3><p>The use of electronic health records to conduct comparative effectiveness studies requires accurate measure of severity of patients’ illness.</p></div><div><h3>Objectives</h3><p>This brief report provides data on relative accuracy of claims-based severity indices for childhood diseases.</p></div><div><h3>Measures</h3><p>We compared the accuracy of All Patient Refined Diagnosis-Related Groups (APR-DRG), All Payer Severity-adjusted Diagnosis-Related Groups (APS-DRG), Alemi and Walters Severity across Episodes of Illness, and count of diagnoses.</p></div><div><h3>Methods</h3><p>The accuracy of each measure was calculated using the percent of deviance explained in mortality and percent of variation explained in length of stay (a surrogate measure of resource utilization).</p></div><div><h3>Subjects</h3><p>Data were obtained from the 2006 Kid’s Inpatient Database of the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality. We examined data on 3.1 million patients across 38 states.</p></div><div><h3>Results</h3><p>Alemi and Walters’ formula-based severity score explained 34% of variation in length of stay and 32% of variation in mortality. This index was more accurate than other indices, especially in predicting mortality, where it was 5-fold more accurate than APS-DRG and 3-fold more accurate than APR-DRG. The difference in accuracy was not only statistically significant but also large enough that it could change conclusions of comparative effectiveness studies.</p></div>","PeriodicalId":88882,"journal":{"name":"Health outcomes research in medicine","volume":"2 2","pages":"Pages e71-e78"},"PeriodicalIF":0.0,"publicationDate":"2011-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehrm.2011.07.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54246090","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":"Translating Research into Clinical Practice: Functional Recovery Post Total Hip Arthroplasty Using Outcomes Gathered in the Usual Physical Therapy Practice Setting","authors":"Carmen S. Kirkness PT, MSc ,&nbsp;Julie M. Fritz PT, PhD","doi":"10.1016/j.ehrm.2011.04.001","DOIUrl":"10.1016/j.ehrm.2011.04.001","url":null,"abstract":"<div><h3>Purpose</h3><p>The purpose of this study is to determine the pattern of functional change after total hip arthroplasty (THA) in patients attending physical therapy (PT) in a usual care setting and to explore the effect of sex and time from surgery to the first physical therapy visit as potential prognostic factors influencing postoperative THA recovery.</p></div><div><h3>Study Design</h3><p>Adults with THA were retrospectively identified in an electronic medical record PT database (October 1, 2004-April 30, 2010). Hierarchical linear modeling was used to evaluate growth curves and individual variations in function using the Lower Extremity Function Scale (LEFS). Investigated predictors were: sex, age, start time, and PT visit.</p></div><div><h3>Results</h3><p>A total of 147 (81 female, 66 male) postoperative THA patients were included in the study; mean age was 62.7 years (SD 10.6, range 45-91 years). The majority (79%) of patients initiated PT &lt;9 weeks postsurgery; predominately lower-functioning women started at ≥9 weeks. For patients initiating treatment at &lt;9 weeks, the curvilinear slopes of recovery were similar between sexes, although the predicted levels of functional status were lower for females than for males (<em>P</em> = .041).</p></div><div><h3>Conclusions</h3><p>This study of usual physical therapy practice supports the findings from controlled studies that post-THA women enter and are discharged from outpatient PT with lower functional status than men. New findings suggest that functional status for early start patients steadily improves over 26 weeks postsurgery. Modeling change in clinical practice using outcomes measures acquired through usual practice can feasibly and adequately serve to guide decisions in the management of THA rehabilitation.</p></div>","PeriodicalId":88882,"journal":{"name":"Health outcomes research in medicine","volume":"2 2","pages":"Pages e119-e127"},"PeriodicalIF":0.0,"publicationDate":"2011-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehrm.2011.04.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37832146","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}