BMJ quality improvement reports最新文献

{"title":"Improving door to CT scanner times for potential stroke thrombolysis candidates - The Emergency Department's role.","authors":"Victoria Barbour,&nbsp;Shobhan Thakore","doi":"10.1136/bmjquality.u211470.w4623","DOIUrl":"https://doi.org/10.1136/bmjquality.u211470.w4623","url":null,"abstract":"<p><p>Stroke thrombolysis is an important treatment in the management of acute strokes. Its' effectiveness is reliant on prompt administration after stroke onset. Disability free survival at 3-6 months increases by 10% when administered within 3 hours. There is also an economic benefit from early administration with reduced institutional care. New Scottish care standards have been introduced which suggest a target that 50% of suitable patients should receive thrombolysis within 30 minutes, and 80% within one hour 6. Processes in the Emergency Department play a key role in determining the time a patient waits between arrival and reaching the CT scanner. The project team looked at Ninewells Emergency Department times to CT scanner between May and August 2015 and found that only 20% of patients had their scan within 20 minutes, and 70% within 45 minutes. The team went on to conduct a quality improvement project. This involved initial patient mapping and short interviews with staff. A multi action approach was developed involving education in the form of emails, presentations and visual charts, and the final step was to simplify the paperwork involved. The project was conducted over 11 months and successfully reduced the times to CT, with 60% having had their CT scan within 20 minutes, and 100% within 45 minutes, with a very noticeable reduction in variation around the mean. It is hoped to take this approach forward and apply it to other processes in the department.</p>","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjquality.u211470.w4623","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35334142","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":"Reducing patient waiting time and length of stay in an Acute Care Pediatric Emergency Department.","authors":"Milfi Al-Onazi,&nbsp;Ahmed Al Hajri,&nbsp;Angela Caswell,&nbsp;Maria Leizl Hugo Villanueva,&nbsp;Zuhair Mohammed,&nbsp;Vania Esteves,&nbsp;Faith Vabasa,&nbsp;Khaled Al-Surimi","doi":"10.1136/bmjquality.u212356.w7916","DOIUrl":"https://doi.org/10.1136/bmjquality.u212356.w7916","url":null,"abstract":"<p><p>Prolonged waiting times and length of stay in Pediatric Emergency Department, are the two of the most challenging patient and clinical outcomes of healthcare institution. These emerged due to various reasons, namely: the use of triaging process and patient flow criteria that eventually lead to bottlenecks and overcrowding in the ED. After realizing the root causes of the prolonged waiting times and length of stay, the KASCH ED instigated a team to study the factors and thereby arrive at a considerable conclusion that will result in an improvement. The quality improvement project was initiated and steps were undertaken to improve the flow, reduce the waiting times, and reduce the overcrowding in Pediatric Emergency Acute Care Unit. The primary cause identified was inadequate team awareness and lack of the ED process flow, thus creating confusion as to where the type of patients based on the triage level will be assessed, managed and treated. Using the Canadian Triage and Acuity Scale (CTAS) as guide in triaging patients, a theory called Pediatric Rapid Assessment and Management (PRAM) was introduced in the Acute Care Unit. This certain model is basically aimed to rapidly assess and managed the patients who were triaged as Level III and Level IV within a period of 30 minutes. Several PDSA cycles were tested and implemented in order to assure that the process fit the criteria and the process flow will be improved. Following the completion of each cycle, significant improvements were noted, such as patients being assessed in Initial Assessment Room on average time less than the target of 15 minutes. In like manner, patients' length of stay on average less than 15 minutes in PRAM bed. The total time for assessment and plan of management is with a target time of less than 30 minutes. The team continuously drive th process and monitored the key performance indicators of the PRAM during the study period and subsequent improvement strategies were likewise implemented.</p>","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjquality.u212356.w7916","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35334141","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":"Acute kidney injury; improving the communication from secondary to primary care.","authors":"Clemency Nye,&nbsp;Suzanna Lake","doi":"10.1136/bmjquality.u211147.w6661","DOIUrl":"https://doi.org/10.1136/bmjquality.u211147.w6661","url":null,"abstract":"Acute kidney injury (AKI) is a common but preventable event in secondary care. It is known to be associated with poorer outcomes for the patient's future health. Patients therefore require specific after-care in the community following an AKI, both in the short and long term. However, information about an inpatient AKI is often not communicated to primary care at discharge. Only 11.0% of discharge summaries contained full information about an AKI (including stage of AKI, changes to medications and follow-up required) in August 2015. We aimed to improve communication about AKI on discharge summaries via implementation of a series of interventions between June 2015 and March 2016. A specific section was added to the discharge summary software to prompt inclusion of information regarding AKI. An automatic warning message was added later as an additional prompt. A programme of education was provided for the junior doctors. A ward-based campaign was rolled out using the animated character ‘Ned the Nephron,’ using posters, emails and screen savers. We also introduced an AKI warning sticker for drug charts, which reminds the discharging doctor that the patient has had an AKI during the admission. Our primary outcome was the percentage of discharge summaries that had the AKI section completed, as this contained all the desired information, including stage of AKI and frequency of follow up blood tests in primary care. Monthly data collections showed that this gradually increased from 4.7% in September 2015 to 35.0% in January 2016. We expect further increases with the recent introduction of the drug chart sticker.","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjquality.u211147.w6661","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35139252","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 patient blood management in obstetrics: snapshots of a practice improvement partnership.","authors":"Cindy J Flores, Farah Sethna, Ben Stephens, Ben Saxon, Frank S Hong, Trish Roberts, Tracey Spigiel, Maria Burgess, Belinda Connors, Philip Crispin","doi":"10.1136/bmjquality-2017-000009","DOIUrl":"10.1136/bmjquality-2017-000009","url":null,"abstract":"<p><p>Iron deficiency and anaemia are common in pregnancy. Audit data from our tertiary obstetrics unit demonstrated 22% of maternity patients experiencing a postpartum haemorrhage received a transfusion; a third of whom were anaemic on admission intrapartum. Australian Patient Blood Management (PBM) Module 5 Obstetrics guidelines focuses on maximising red cell mass at the time of delivery and reducing the reliance on transfusion as a salvage therapy to treat blood loss. A clinical practice improvement partnership began in February 2015 and completed in April 2016; which aimed to implement systems to improve antenatal identification and management of iron deficiency, and improve postpartum anaemia management. In order to develop change strategies, reasons for poor detection and correction of iron deficiency in the antenatal period were identified following a quality improvement methodology. Education was delivered to maternity healthcare providers. Standardised algorithms and an oral iron prescription handout were developed and piloted. Follow-up audit, staff and patient feedback, and other hospital data were collected to measure outcomes. The rate of anaemia on admission intrapartum fell from 12.2% in 2013 to 3.6% in 2016 following the introduction of unselective ferritin screening and other antenatal interventions. Sixty to 70% of maternity patients screened each month had iron deficiency. The algorithms aided staff to become confident in blood test interpretation and management of iron deficiency and anaemia. Patients found the oral iron prescription handout helpful. Additionally, single unit transfusions significantly increased from 35.4% to 50% (p=0.037) over the project timeframe. This project demonstrated the potential to improve patient blood management in obstetrics, reduce anaemia and transfusions by active antenatal interventions.</p>","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"6 1","pages":"e000009"},"PeriodicalIF":0.0,"publicationDate":"2017-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6d/b5/bmjquality.2017.000009.PMC5492477.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35334143","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":"Reducing the number of unnecessary liver function tests requested on the Paediatric Intensive Care Unit.","authors":"Lynn Sinitsky, Joe Brierley","doi":"10.1136/bmjquality.u214071.w5561","DOIUrl":"10.1136/bmjquality.u214071.w5561","url":null,"abstract":"<p><p>Between January and October 2014, Great Ormond Street Hospital Paediatric Intensive Care Unit (PICU) was spending an average £23,392 on blood tests per month. Blood tests should be requested based on previous results and the patient's clinical condition, medication and nutritional status. However, more blood tests were being ordered than clinically indicated: an audit in October 2014 showed liver function tests (LFTs) were requested daily on most patients, even with previous normal results. A driver diagram identified three primary drivers for blood test requesting: decision-making, situational awareness and computer-based ordering. Decision-making for routine blood tests was the responsibility of the bedside nurses on each night shift. The communication between the nurses and doctors was an identified secondary driver. The project's primary aim was to reduce unnecessary LFTs requests on PICU over 6 months by implementing a blood test request form, a table of common investigations to facilitate and document discussion between the nursing and medical teams. The secondary aims were to reduce other unnecessary blood test requests, including full blood counts (FBC), coagulation screens and CRP. This project was conducted in three phases: construction, testing and implementation of the blood test form. PDSA cycles were used within each phase. Two PICU nurse champions were engaged to provide bedside support, education and feedback. In the 8-month period following implementation, there was a significant sustained reduction in LFTs requests. A similar pattern of sustained reduction also occurred for FBC, coagulation screens and CRP requests. This sustained reduction in blood tests requested equated to a saving in excess of £36,000. This project was successful: the reduction in the number of inappropriate blood tests had clear financial benefit for PICU and reduced blood loss for patients. Early engagement and support from key stakeholders avoided conflict, guaranteed data sharing and aided engagement of bedside nurses.</p>","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d7/f1/bmjqir.u214071.w5561.PMC5483531.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35139251","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":"Reducing DNA Rates and Increasing Positive Contacts in an Outpatient Chronic Fatigue Service.","authors":"Tumseela Masoud,&nbsp;Amar Shah,&nbsp;Shameem Joomun,&nbsp;Amar Shah","doi":"10.1136/bmjquality.u212876.w5262","DOIUrl":"https://doi.org/10.1136/bmjquality.u212876.w5262","url":null,"abstract":"<p><p>The Chronic Fatigue Service at East London NHS Foundation Trust recognised and coalesced around its major issue of engaging its service users. Using the systematic approach of quality improvement, and the infrastructure provided within East London NHS FT's quality improvement programme, it tested a number of change ideas which saw a significant reduction in non-attendance at appointments, an increase in patient cancellations when they could not attend, and an increase in positive contacts with the service. All these improvements surpassed the initial aims set within the project, and have been sustained over the course of 18 months.</p>","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5a/d8/bmjqir.u212876.w5262.PMC5483529.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35139799","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 use of a validated pre-discharge questionnaire to improve the quality of patient experience of orthopaedic care.","authors":"Paul Baker,&nbsp;Beverley Tytler,&nbsp;Angela Artley,&nbsp;Khalid Hamid,&nbsp;Rajat Paul,&nbsp;William Eardley","doi":"10.1136/bmjqir.w7046","DOIUrl":"https://doi.org/10.1136/bmjqir.w7046","url":null,"abstract":"<p><p>Patient experience is central to the delivery of excellent healthcare. As such it is enshrined within the 2015 NHS outcomes framework, a set of indicators against which quality in healthcare is measured. A variety of tools are available to quantify patient experience across clinical settings. When combined with a framework for continued data collection and suitable mechanisms for analysis, feedback, and intervention, these tools allow improvements in patient care and clinical services to be realised. In response to an increasing number of patient complaints and friends and family scores below the trust average within our orthopaedic department we instituted an improvement programme in March 2015. The programme was based around the Picker Patient Experience 15 questionnaire and aimed to improve friends and family test scores, reduce complaints and improve patient experience scores over an 18-month period. An improvement model including baseline measurement and 2 improvement cycles over an 18-month period was used. Initial benchmarks for practice were created by referencing national data allowing problem areas of care to be identified and interventions to address these developed. This process identified areas for improvement including improving staff awareness and engagement with patient experience, improving staff and patient communication and ensuring patients were aware and involved in plans for their own care. Actions to address these issues resulted in a 38% decrease in patient complaints, a >10% increase in patient experience, and improvements in patient satisfaction and friends and family scores.</p>","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d6/40/bmjqir.u216326.w7046.PMC5522972.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35334140","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":"Experiences with Lean Six Sigma as improvement strategy to reduce parenteral medication administration errors and associated potential risk of harm.","authors":"Afke van de Plas,&nbsp;Mariëlle Slikkerveer,&nbsp;Saskia Hoen,&nbsp;Rick Schrijnemakers,&nbsp;Johanna Driessen,&nbsp;Frank de Vries,&nbsp;Patricia van den Bemt","doi":"10.1136/bmjquality.u215011.w5936","DOIUrl":"https://doi.org/10.1136/bmjquality.u215011.w5936","url":null,"abstract":"<p><p>In this controlled before-after study the effect of improvements, derived from Lean Six Sigma strategy, on parenteral medication administration errors and the potential risk of harm was determined. During baseline measurement, on control versus intervention ward, at least one administration error occurred in 14 (74%) and 6 (46%) administrations with potential risk of harm in 6 (32%) and 1 (8%) administrations. Most administration errors with high potential risk of harm occurred in bolus injections: 8 (57%) versus 2 (67%) bolus injections were injected too fast with a potential risk of harm in 6 (43%) and 1 (33%) bolus injections on control and intervention ward. Implemented improvement strategies, based on major causes of too fast administration of bolus injections, were: Substitution of bolus injections by infusions, education, availability of administration information and drug round tabards. Post intervention, on the control ward in 76 (76%) administrations at least one error was made (RR 1.03; CI95:0.77-1.38), with a potential risk of harm in 14 (14%) administrations (RR 0.45; CI95:0.20-1.02). In 40 (68%) administrations on the intervention ward at least one error occurred (RR 1.47; CI95:0.80-2.71) but no administrations were associated with a potential risk of harm. A shift in wrong duration administration errors from bolus injections to infusions, with a reduction of potential risk of harm, seems to have occurred on the intervention ward. Although data are insufficient to prove an effect, Lean Six Sigma was experienced as a suitable strategy to select tailored improvements. Further studies are required to prove the effect of the strategy on parenteral medication administration errors.</p>","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjquality.u215011.w5936","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35139798","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":"Introducing a post-operative proforma for elective lower limb arthroplasty patients - improving patient care and junior doctor confidence.","authors":"James Olivier,&nbsp;Michael Stoddart,&nbsp;Katie Miller,&nbsp;Robbie McLintock,&nbsp;Mark Dahill","doi":"10.1136/bmjquality-2017-000043","DOIUrl":"https://doi.org/10.1136/bmjquality-2017-000043","url":null,"abstract":"<p><p>The assessment of post-operative patients is vital to identify early complications and ensure patient safety. Good clinical record keeping is essential for effective continuity of care and patient safety in the post-operative period. A group of foundation year 2 (FY2) doctors noted a disparity in levels of confidence and ability in performing this assessment. The aim of the project was to improve documentation and understanding of day one lower limb arthroplasty reviews by FY2 doctors. The Plan-Do-Study-Act model for continuous improvement was adopted from September 2015 to July 2016. A composite score comprising the twelve most important review parameters for documentation was used to score the quality of documentation on an ongoing basis. An electronic survey was completed by every FY2 rotating through the department. Interventions included registrar-led teaching sessions and an integrated review form placed in the medical notes. Further iterations of the proforma and further interventions were coordinated with the ward clerks, sisters, physiotherapists and senior clinicians. The baseline mean composite score was 6.3/12. Following implementation of a standardised proforma this score improved to 10.5 in those who had used the proforma, but 5.7 in those who hadn't. Electronic survey responses showed the proforma and teaching were effective in improving knowledge and understanding of post-operative reviews. The use of an integrated proforma in the medical notes and teaching it's use at induction, improves the documentation and understanding of day one post-operative reviews. Coordinating ward-based change across a cohort of FY2s, with involvement from the multidisciplinary team and management, affects sustained improvements in patient reviews.</p>","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"6 1","pages":"e000043"},"PeriodicalIF":0.0,"publicationDate":"2017-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjquality-2017-000043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35285016","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 medicines reconciliation rates at Ashford and St. Peter's Hospitals NHS Foundation Trust.","authors":"Reshmee Doolub","doi":"10.1136/bmjquality-2017-000064","DOIUrl":"https://doi.org/10.1136/bmjquality-2017-000064","url":null,"abstract":"<p><p>Medicines reconciliation is integral to patient safety, symptom control and reducing patient anxiety. During a 3-month period on the respiratory ward at St. Peter's Hospital, 54% of drug charts were not reconciled with pre-admission medicines at the point of discharge for admissions up to 17 days. Only 18% were reconciled within 24 hours of admission. 50% of drug charts were missing 0-2 pre-admission medicines and 50% were missing 3-5 pre-admission medicines. The most common medicines that were not reconciled included topical applications which included eye, ear, nasal and skin applications (14%); vitamins i.e. vitamin B12 and thiamine, analgesia, PRN inhalers (11% individually); antidepressants and lipid regulators (6% individually); amongst a range of other medications including antiplatelets, calcium channel blockers, ACE inhibitors and diuretics. Two interventions were carried out to improve the rate of medicines reconciliation onto hospital drug charts with pre-admission medicines. These were: 1) a green sticker placed in the medical notes by the pharmacist when drug charts were incomplete, which required a date and signature from the doctor when the drug chart had been reconciled 2) the placing of the loose medicines reconciliation record (a list of pre-admission medicines retrieved from a reliable source usually by the pharmacist) to the front of the drug chart. These measures were designed to alert the doctors that the drug chart was incomplete. After 2 PDSA cycles, the results showed positive outcomes. In 75% of the cases where the interventions were used, medicines reconciliation was complete at the point of discharge with 34% of drug charts reconciled within 24 hours of admission. Of the 25% of drug charts that were not reconciled despite the use of the interventions, 100% of them were missing 0-2 medicines however 0% were missing 3-5 medicines. This highlights that the interventions were effective in improving the rates of medicines reconciliation.</p>","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"6 1","pages":"e000064"},"PeriodicalIF":0.0,"publicationDate":"2017-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjquality-2017-000064","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35285017","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}