Journal of the American Geriatrics Society最新文献

{"title":"Deprescribing Benzodiazepine Receptor Agonists in Older Adults and People With Cognitive Impairment: A Systematic Review.","authors":"Aisling M McEvoy, Aili V Langford, Shin J Liau, Darshna Goordeen, Emily Reeve, Justin P Turner","doi":"10.1111/jgs.19512","DOIUrl":"https://doi.org/10.1111/jgs.19512","url":null,"abstract":"<p><strong>Background: </strong>Benzodiazepine receptor agonists (BZRAs) (benzodiazepines and z-drugs) may provide limited benefits in the management of insomnia when used short-term. However, they increase the risk of harms including falls, fractures, hospitalizations, and cognitive impairment. Deprescribing (cessation) of BZRAs may be beneficial for older adults and people living with cognitive impairment as they are at heightened risk of adverse events. This review investigated the effects of patient-directed, non-pharmacological interventions to support deprescribing of BZRAs used for insomnia in older adults and people living with cognitive impairment.</p><p><strong>Methods: </strong>Embase, CENTRAL, Scopus, and Medline were searched in January 2024 with no publication date restrictions. Screening, data extraction, and risk of bias assessments (ROB2 for randomized studies, ROBINS-I for non-randomized studies) were conducted independently by two authors. Outcomes of interest included the proportion of participants who ceased BZRAs, reduction in BZRAs, switching to another medication, sleep outcomes, and clinical outcomes. Studies were included if they investigated BZRA deprescribing in older adults (≥ 65 years) or people living with cognitive impairment.</p><p><strong>Results: </strong>Seventeen reports analyzing 16 studies in hospital, community, and aged care settings were included. BZRA cessation rates ranged between 23% to 72% for written education (n = 6); 14% to 57% for combined written and verbal education (n = 5); and 9% to 100% for multi-component interventions (n = 6). One report investigated a BZRA deprescribing educational intervention in people with cognitive impairment and found comparable effectiveness to participants without cognitive impairment. Most studies were at a high risk of bias.</p><p><strong>Conclusions: </strong>Patient-directed interventions led to BZRA cessation, although there was significant variability between studies. It is unknown if all interventions examined are similarly effective for people living with cognitive impairment. Further research investigating approaches to deprescribing BZRAs in older adults or people with cognitive impairment is required.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061368","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":"Editing Geriatric Medicine Journals: Perspectives From the Editors-in-Chief of Age and Ageing, European Geriatric Medicine and the Journal of the American Geriatrics Society.","authors":"Roy L Soiza, Alfonso J Cruz Jentoft, Joseph G Ouslander","doi":"10.1111/jgs.19429","DOIUrl":"https://doi.org/10.1111/jgs.19429","url":null,"abstract":"<p><p>This article has been simultaneously published in Journal of the American Geriatrics Society (published by Wiley Periodicals LLC on behalf of The American Geriatrics Society), Age and Ageing (published by Oxford University Press on behalf of British Geriatrics Society), and European Geriatric Medicine (published by Springer on behalf of European Geriatric Medicine Society). All rights reserved. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059015","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":"Waiting for the Other Shoe to Drop.","authors":"John R Burton","doi":"10.1111/jgs.19505","DOIUrl":"https://doi.org/10.1111/jgs.19505","url":null,"abstract":"","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065548","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":"Kinetics of SARS-CoV-2 Shedding in Nursing Home Residents and Staff.","authors":"Morgan J Katz, Majerle Reeves, Tiffany G Harris, Jazmin Duque, Scott K Fridkin, Paulina A Rebolledo, Jon P Furuno, Emily K Short, David H Canaday, Yasin Abul, Stefan Gravenstein, Sara E Cosgrove, Lona Mody, Jennifer Meddings, David A Nace, Steven Handler, Christopher J Crnich, Jennifer Meece, Richard J Webby, Tom P Fabrizio, Jennifer L Harcourt, Jessica M Healy, Marc Lipsitch, Joseph D Lutgring, Prabasaj Paul, Casey M Zipfel, Alfonso C Hernandez-Romieu, Sujan C Reddy, Rachel B Slayton","doi":"10.1111/jgs.19499","DOIUrl":"https://doi.org/10.1111/jgs.19499","url":null,"abstract":"<p><strong>Background: </strong>Nursing homes (NHs) were disproportionately affected by the COVID-19 pandemic. However, little is known regarding the kinetics of SARS-CoV-2 shedding in NH residents and staff, which could inform treatment and infection prevention.</p><p><strong>Methods: </strong>We enrolled NH residents and staff in eight US states from April to November 2023 and analyzed the kinetics of SARS-CoV-2 using serial antigen and molecular (RT-PCR) tests, whole genome sequencing, and viral culture (VC). Symptoms, vaccination, and treatment were collected via interviews and chart review. Viral load trajectories were modeled with gamma distribution functional forms. Antigen and VC test positivity over time were assessed using a Chi-squared test.</p><p><strong>Results: </strong>Of the 587 enrolled participants, 86 tested positive and 73 underwent testing for ≥ 10 days; most residents (78%) and staff (87%) had ≥ 3 COVID-19 vaccine doses. The modeled SARS-CoV-2 proliferation period (period prior to reaching peak viral load) had ended for 48% (14/29) of residents and 56% (9/16) of staff when they took the initial RT-PCR test. Both antigen and VC showed higher positivity rates early in the course of disease (Days 0-5 vs. Days ≥ 6) (antigen: p < 0·001, VC: p < 0·001). VC positivity was 15% after Day 5 (14/96); two participants were VC positive after Day 10.</p><p><strong>Conclusions: </strong>Peak viral load occurs early in the disease, suggesting asymptomatic and presymptomatic transmission may be a significant driver of transmission. Only two participants had a positive VC after Day 10, supporting current isolation and return to work recommendations.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065544","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":"Undocumented Dementia Diagnosis During Skilled Home Health Care: Prevalence and Associated Factors.","authors":"Julia G Burgdorf, Halima Amjad, Yolanda Barrón, Miriam Ryvicker","doi":"10.1111/jgs.19491","DOIUrl":"https://doi.org/10.1111/jgs.19491","url":null,"abstract":"<p><strong>Background: </strong>Skilled home health (HH) is a critical source of clinical care for community-living older adults. One-third of HH patients have dementia, but poor information transfer may limit HH providers' awareness of dementia diagnosis. We determined the prevalence of undocumented dementia diagnosis among HH patients and associated care delivery patterns and clinical outcomes.</p><p><strong>Methods: </strong>Among a 2018 national sample of Medicare HH patients, we compared those (1) without diagnosed dementia, (2) with dementia documented during HH, (3) with dementia undocumented during HH. Dementia diagnosis was determined from the Medicare Beneficiary Summary File claims-based indicator and documentation was determined via HH clinical assessments (OASIS). We measured HH care delivery and outcomes from claims and assessment data. We fit multivariable negative binomial and logistic regression models to estimate associations of dementia status and documentation with outcomes, while adjusting for patient- and HH agency-level characteristics and clustering at the HH agency level.</p><p><strong>Results: </strong>Among 1,372,570 HH patients, 30% had diagnosed dementia. Among those with diagnosed dementia, most (69%) had this diagnosis go undocumented during HH. Compared to those with documented dementia, those with undocumented dementia had longer lengths of stay (+3.1 days; 95% CI: 6.4-7.1) and were more likely to receive physical therapy (aOR: 1.19; 95% CI: 1.16-1.22) and less likely to receive social work (aOR: 0.82; 95% CI: 0.80-0.84). Compared to those with documented dementia, those with undocumented dementia had higher odds of hospitalization (aOR: 1.20; 95% CI: 1.17-1.24) and Emergency Department use (aOR: 1.14; 95% CI: 1.11-1.17) and lower odds of discharge to self-care (aOR: 0.88; 95% CI: 0.86-0.90). Findings were robust to sensitivity analyses stratifying by cognitive symptom severity, functional impairment, clinical severity, and referral source.</p><p><strong>Conclusions: </strong>Results suggest that HH providers often lack pertinent information regarding patients' dementia status, and patients with undocumented dementia more often experience acute care utilization.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065546","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":"Around the EQUATOR With Clin-STAR: Systematic Reviews of Intervention Effectiveness; Challenges and Opportunities.","authors":"Thomas F Crocker, Oliver Todd, Andrew Clegg","doi":"10.1111/jgs.19498","DOIUrl":"https://doi.org/10.1111/jgs.19498","url":null,"abstract":"<p><p>Systematic reviews offer clarity about the effectiveness of interventions based on the best available evidence. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 statement updated previous guidance to ensure transparency in the reporting of systematic reviews of intervention effectiveness. To adhere to the 27 items of PRISMA 2020, aging-focused researchers must specify the choice of age-based criteria for the review, comprehensively identify studies, select the most important outcomes that will therefore be collected, define the effect measures (e.g., odds ratio), describe investigations of the causes of heterogeneity (e.g., different settings), assess and report the risk of bias including blinding of participants and missing outcome data for results that contribute to each meta-analysis, and discuss the implications of the findings for practice, which will often include some uncertainty. This article provides guidance on overcoming the specific challenges faced by aging-focused researchers in transparently reporting a systematic review.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004336","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":"Gaps in Primary Care Follow-Up After Hospital Discharge Among Medicare Beneficiaries.","authors":"Timothy S Anderson, John Z Ayanian, Shoshana J Herzig, Jeffrey Souza, Bruce E Landon","doi":"10.1111/jgs.19496","DOIUrl":"https://doi.org/10.1111/jgs.19496","url":null,"abstract":"<p><strong>Background: </strong>Timely primary care follow-up after hospitalization is recommended to monitor recovery and coordinate care. Whether follow-up differs for vulnerable populations, such as those with frailty and those discharged to skilled nursing facilities (SNF) prior to returning home, is not known.</p><p><strong>Methods: </strong>Retrospective cohort study using a 100% sample of traditional Medicare beneficiaries discharged from hospital to home or from hospital to SNF and then home, between 2010 and 2022. The primary outcome was the receipt of a primary care visit within 30 days of return to home, measured overall and stratified by disposition (discharged home vs. to SNF then home) and by frailty (defined by a claims-based frailty index). Multivariable logistic regression models were used to estimate changes in outcomes over time, overall and stratified by disposition and frailty.</p><p><strong>Results: </strong>The cohort included 94,248,326 discharges (80.1% age ≥ 65 years, 55.1% female, 36.7% frail) of which 21.5% were discharged to SNF and then home. Between 2010 and 2022, primary care follow-up increased from 51.5% to 57.5% for patients discharged directly home and from 24.3% to 28.4% for patients discharged to SNF then home. In adjusted analyses, compared to those discharged directly home, patients discharged to SNF and then home had an 8.2% point (pp) (95% CI, -8.5 to -7.9) lower predicted probability of ambulatory follow-up in 2022. Among patients discharged directly home, no difference was evident in follow-up between frail and non-frail patients (54.6% vs. 54.1%); difference 0.4 pp (95% CI, -0.1 to 1.0). In contrast, among patients discharged to SNF then home, frail patients had a lower predicted probability of follow-up (42.8% vs. 48.9%); difference - 6.1 pp (95% CI, -7.0 to -5.2).</p><p><strong>Conclusions: </strong>Frail patients and patients requiring a short-term SNF stay after hospitalization are less likely to receive timely follow-up upon return to home than other patient groups.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004338","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":"Assessing the Content of Goals of Care Documentation for Hospitalized Patients With Alzheimer's Disease and Related Dementias.","authors":"Gina Piscitello, Jennifer Lingler, Katherine Ramos, Yael Schenker, Robert M Arnold, Jane Schell","doi":"10.1111/jgs.19502","DOIUrl":"https://doi.org/10.1111/jgs.19502","url":null,"abstract":"<p><strong>Background: </strong>Goals of care (GOC) conversations are an evidence-based practice that help clarify and align patient values and preferences for medical care with treatment options. Little is known about how clinicians document the content of GOC conversations for patients with Alzheimer's disease and related dementias (AD/ADRD) in the electronic health record (EHR) and whether this may differ across hospitals. We aimed to assess the content of GOC documentation for hospitalized patients with and without AD/ADRD.</p><p><strong>Methods: </strong>We performed a retrospective cross-sectional study to assess documented content within a standardized GOC note written for seriously ill hospitalized adult patients admitted to 21 hospitals between 2021 and 2023. Seriously ill patients had a predicted 90-day mortality greater than 30% as determined by an artificial intelligence mortality prediction score. Patients with AD/ADRD were identified using diagnostic codes placed by clinicians in the EHR.</p><p><strong>Results: </strong>Our review of GOC documentation across 21 hospitals identified 5475 patients with GOC notes. The study sample had a median age of 76 years and was 52% male, 13% nonwhite, 81% with Medicare insurance, and 14% with AD/ADRD. Compared to patients without AD/ADRD, patients with AD/ADRD were more likely to have documentation of family presence at the GOC conversation (93% vs. 76%, p = < 0.001), a surrogate decision-maker (60% vs. 54%, p = 0.003), and patient prognosis (84% vs. 78%, p = < 0.001). Patients with AD/ADRD were less likely to have documentation of patient presence at the GOC conversation (28% vs. 64%, p = < 0.001) and patient values and preferences for medical care (65% vs. 69%, p = < 0.05).</p><p><strong>Conclusions: </strong>Hospitalized patients with AD/ADRD are infrequently present in GOC conversations and less likely to have their values and preferences for medical care documented within a GOC note. Further research is needed to explore the reasons for these findings.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065540","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":"Pulling Back the Curtain on Hospital Dementia Detection: Validation of the Informant-Based Clinical Dementia Rating.","authors":"Márlon Juliano Romero Aliberti, Thiago Junqueira Avelino-Silva, Kenneth E Covinsky, Laiss Bertola, Regina Miksian Magaldi, Cynthia M Boyd, Christopher R Carpenter, Mônica Sanches Yasuda, Claudia Kimie Suemoto","doi":"10.1111/jgs.19494","DOIUrl":"https://doi.org/10.1111/jgs.19494","url":null,"abstract":"<p><strong>Background: </strong>Dementia often goes undetected in hospital settings, where cognitive assessments are challenging due to illness severity and delirium. This study aimed to (1) evaluate the accuracy of the Clinical Dementia Rating (CDR), based solely on knowledgeable informant reports, for detecting preexisting dementia and cognitive impairment in hospitalized patients compared to a gold-standard diagnosis, (2) and compare its performance to the 16-item Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE-16).</p><p><strong>Methods: </strong>This cross-sectional study assessed consecutive patients aged ≥ 65 admitted to inpatient units from five hospitals in Brazil. The informant-based CDR was administered to knowledgeable informants within 48 h of admission, capturing patients' cognitive status 3 months before hospitalization to avoid the influence of acute cognitive impairments. Blinded experts provided a gold standard clinical diagnosis of dementia or cognitive impairment no dementia (CIND) based on a 90-min comprehensive assessment, including a standardized neuropsychology battery. Areas under the curve (AUC) examined diagnostic accuracy.</p><p><strong>Results: </strong>Of 65 participants (mean age = 79.4 years; women = 54%), 34% had dementia and 32% had CIND. Compared to the gold standard, the informant-based CDR showed excellent diagnostic accuracy for detecting dementia (AUC = 0.92; 95% confidence interval [CI] = 0.86-0.98) and cognitive impairment (AUC = 0.93; 95% CI = 0.88-0.98), with a cutoff of ≥ 1 showing 98% specificity for dementia and a cutoff of ≥ 0.5 showing 98% sensitivity for cognitive impairment. Compared to the IQCODE-16, the informant-based CDR had similar performance in detecting dementia and a nonsignificant slight advantage in identifying cognitive impairment (AUC = 0.93 vs. 0.84, p = 0.069), reducing unrecognized cognitive impairment based on medical record documentation from 70% to 2%.</p><p><strong>Conclusions: </strong>Informant-based CDR is a valid and efficient tool for detecting dementia and cognitive impairment in hospitalized older adults, supporting early diagnosis and guiding multidisciplinary interventions in acute care. Its use in routine hospitals may help clinicians reduce undetected cognitive impairment, enhance decision making, and improve patient care.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013353","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":"Insights From Seven Communities Improving Eldercare for Their Populations.","authors":"Joanne Lynn, Nils Franco","doi":"10.1111/jgs.19481","DOIUrl":"https://doi.org/10.1111/jgs.19481","url":null,"abstract":"<p><strong>Background: </strong>Older adults' experiences when living with disabilities largely depend upon fragmented, uncoordinated arrangements for medical and supportive services in their community. Many separate organizations provide these services in the U.S., but no overarching entity is responsible for assessing quality, equity, continuity, supply or cost - or for addressing shortcomings.</p><p><strong>Methods: </strong>We initially aimed to aggregate data from care plans across local provider organizations; but inadequate care planning and digital documentation, and non-existent interoperability of records across providers, made this impossible. We proceeded to partner with seven communities to test improving eldercare community-wide through collaborative efforts guided by data. We provided a readiness assessment, technical assistance, and eventually insights from Medicare administrative data and other national datasets.</p><p><strong>Results: </strong>Descriptive narrative data elucidated overarching themes, lessons learned, challenges, and areas for future research. From 57 applicants, seven selected organizations developed local collaborations and improved some aspect of eldercare. Organizations faced challenges in finding useful whole-population data and faced uncertain authority and limited sustainability of their coalitions and interventions. We ultimately developed geographic eldercare metrics from Medicare data and other sources to support these communities and future efforts.</p><p><strong>Conclusions: </strong>Implementing eldercare improvement for geographically defined populations is possible. Future demonstrations should test this approach more broadly, and those demonstrations should facilitate data access to guide interventions and should establish the authority of a respected entity, broadly representative of stakeholders, to take responsibility for the performance of local arrangements.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059066","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}