{"title":"Career development committees: A guide for early- and mid-career faculty.","authors":"Samir S Shah","doi":"10.1002/jhm.13509","DOIUrl":"https://doi.org/10.1002/jhm.13509","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142247565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Lessons from patient safety to accelerate healthcare decarbonization","authors":"Hardeep Singh, Emily Senay, Jodi D. Sherman","doi":"10.1002/jhm.13493","DOIUrl":"https://doi.org/10.1002/jhm.13493","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142247611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Samir S. Shah, Gregory W. Ruhnke, Sanjay Mahant, Daniel J. Brotman, Farah A. Kaiksow, Charlie M. Wray
{"title":"Your service, our gratitude: A thank you to our peer reviewers","authors":"Samir S. Shah, Gregory W. Ruhnke, Sanjay Mahant, Daniel J. Brotman, Farah A. Kaiksow, Charlie M. Wray","doi":"10.1002/jhm.13457","DOIUrl":"https://doi.org/10.1002/jhm.13457","url":null,"abstract":"","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141570742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Matthew Kelleher MD, MEd, Benjamin Kinnear MD, MEd, Danielle E. Weber MD, MEd, Michelle I. Knopp MD, Daniel Schumacher MD, MEd, PhD, Eric Warm MD
<p>As hospitalists involved in internal medicine and pediatrics residency selection, each of us have read letters of recommendation (LORs) like the one in Box 1. As part of the process of selecting candidates for residency training, LORs hold significant implications for both applicants and programs and are tainted by deep-rooted flaws. These defects continue largely because of our collective failure to confront and address the glaring issues within the process. At best, LORs offer marginal benefit in selecting residents; at worst, they become overt channels for bias, inequity, inequality, and arbitrariness, often devolving into exercises of inanity, untruthfulness, obfuscation, and even propaganda. As such, they decrease the integrity and purpose of the residency selection process.</p><p>For example, gender bias in residency application LORs has been noted for Radiology, Orthopedic Surgery, Female Pelvic Medicine and Reconstructive Surgery, Cardiovascular Surgery, Emergency Medicine, Pediatrics, Anesthesiology, Radiation Oncology, Ophthalmology, Internal Medicine, and General Surgery, among others.<span><sup>1</sup></span> Women often find themselves described in these letters with communal traits, such as <i>helpful</i> and <i>caring</i>.<span><sup>2</sup></span> In contrast, men are more likely to be portrayed with agentic traits, including <i>leader</i> and <i>taking initiative</i>. LORs for women also tend to focus more on personal appearance (such as the misogynistic but real-life example about Ms. J. Smiths' figure in the above letter) and personal life. They also contain more doubt raisers (e.g., “it appears her health and personal life are stable”<span><sup>2</sup></span>), including hesitancy from the recommender, use of faint praise, potentially negative comments, unexplained comments, and irrelevancies.<span><sup>2</sup></span></p><p>Ethnic and racial biases are also prominent in residency LORs, where differences in language can subtly influence readers' perceptions of candidates.<span><sup>3</sup></span> As with gender, agentic and communal terms are used differently based on a candidate's ethnicity or race. Even apart from bias, LORs compound inequity. The process of obtaining LORs favors already advantaged groups who are more likely to have access to the most influential letter writers. Students often spend an inordinate amount of time searching for the “right” letter writer, often choosing those with titles or positions of power over those who know them best. LORs also tend to focus only on positive aspects of applicants, neglecting the comprehensive portrayal of a candidate's journey, struggles, and growth. This one-sided representation undermines the principle of holistic review (a balanced assessment of an applicant's experiences, attributes, and academic metrics<span><sup>4</sup></span>) by not fully acknowledging the resilience and perseverance shown in overcoming challenges, especially among disadvantaged applicants. Even wo
这不正是《要点》作者所要求的有效性证据吗？事实上，在有效性证据的基础上，一项决策研究表明，通过阅读四份 SLORs，可以可靠地区分不同的申请人。30 这一点至关重要，因为住院医师培训项目需要完成对所有申请者的最终排名。目前还没有证据表明任何信息都能预测住院医师培训的成功与否，但利用 SLORs 似乎是改进住院医师培训选择、减少偏差并为项目提供其所需数据的一种方法。然而，一项又一项的研究表明，在整个住院医师遴选过程中，没有任何一项数据似乎可以预测未来的表现。14, 31 LORs 一直被认为是有价值的，具有促进公平的潜力，但同时又与住院医师遴选过程中的其他指标一样存在缺陷。取消口头推荐信破坏了整体审查的理念；我们认为，从挂毯（即住院医师遴选）中抽出一根线（即口头推荐信）有可能弊大于利。选择先删除 LOR 并不是武断的。相反，这是一个战略性举措，旨在解决住院医师遴选过程中一个典型的正常化偏差案例。正常化偏差是指偏差做法在一个组织内逐渐被接受为正常的现象，往往会导致道德和绩效标准的降低32 。就住院医师遴选而言，LORs 就是这种偏差的一个突出例子。尽管这些做法存在固有的缺陷，而且缺乏公平性，但它们已成为整个过程的常规部分。结束常态化偏差的第一步是承认并使问题显性化。取消 LOR 可以立即做到这一点。一旦迈出了这一步，重点就可以转移到住院医师申请和遴选程序的其他方面。我们的目标是建立一个公平、公正、准确、有效和有价值的系统，不仅要纠正单一方面的缺陷，还要挑战长期以来已被接受的正常化偏差模式。这种方法不仅仅是要消除单一的问题因素，而是要站在更高的诚信和有效性的立场上。CBME 的叙述性评估与广泛的利益相关者共享，包括学员、能力委员会、专业医师和院校，确保了透明度和集体监督。相比之下，LORs 的可见度仍然有限，只有作者和少数评审者可以查阅。就其目前的形式而言，它们是对 CBME 的诅咒：基于有限数据和低质量有效性证据的孤立的高风险评估。因此，所有的偏见、不准确和不公平都会加剧。医学教育者仍在学习如何利用 CBME 来明确界定并帮助医学生达到毕业的基本标准。33 一旦毕业生达到了这些标准，医学院就可以在具体的有效性证据支持下，自信地宣称他们已经做好了实习的准备。这样就不再需要LOR了。我们不需要为此等待。现在，LORs 正在造成危害，我们应该停止撰写和阅读用于住院医师遴选的 LORs。
{"title":"Point/counterpoint: Should we stop writing and reading letters of recommendation for residency selection?","authors":"Matthew Kelleher MD, MEd, Benjamin Kinnear MD, MEd, Danielle E. Weber MD, MEd, Michelle I. Knopp MD, Daniel Schumacher MD, MEd, PhD, Eric Warm MD","doi":"10.1002/jhm.13440","DOIUrl":"10.1002/jhm.13440","url":null,"abstract":"<p>As hospitalists involved in internal medicine and pediatrics residency selection, each of us have read letters of recommendation (LORs) like the one in Box 1. As part of the process of selecting candidates for residency training, LORs hold significant implications for both applicants and programs and are tainted by deep-rooted flaws. These defects continue largely because of our collective failure to confront and address the glaring issues within the process. At best, LORs offer marginal benefit in selecting residents; at worst, they become overt channels for bias, inequity, inequality, and arbitrariness, often devolving into exercises of inanity, untruthfulness, obfuscation, and even propaganda. As such, they decrease the integrity and purpose of the residency selection process.</p><p>For example, gender bias in residency application LORs has been noted for Radiology, Orthopedic Surgery, Female Pelvic Medicine and Reconstructive Surgery, Cardiovascular Surgery, Emergency Medicine, Pediatrics, Anesthesiology, Radiation Oncology, Ophthalmology, Internal Medicine, and General Surgery, among others.<span><sup>1</sup></span> Women often find themselves described in these letters with communal traits, such as <i>helpful</i> and <i>caring</i>.<span><sup>2</sup></span> In contrast, men are more likely to be portrayed with agentic traits, including <i>leader</i> and <i>taking initiative</i>. LORs for women also tend to focus more on personal appearance (such as the misogynistic but real-life example about Ms. J. Smiths' figure in the above letter) and personal life. They also contain more doubt raisers (e.g., “it appears her health and personal life are stable”<span><sup>2</sup></span>), including hesitancy from the recommender, use of faint praise, potentially negative comments, unexplained comments, and irrelevancies.<span><sup>2</sup></span></p><p>Ethnic and racial biases are also prominent in residency LORs, where differences in language can subtly influence readers' perceptions of candidates.<span><sup>3</sup></span> As with gender, agentic and communal terms are used differently based on a candidate's ethnicity or race. Even apart from bias, LORs compound inequity. The process of obtaining LORs favors already advantaged groups who are more likely to have access to the most influential letter writers. Students often spend an inordinate amount of time searching for the “right” letter writer, often choosing those with titles or positions of power over those who know them best. LORs also tend to focus only on positive aspects of applicants, neglecting the comprehensive portrayal of a candidate's journey, struggles, and growth. This one-sided representation undermines the principle of holistic review (a balanced assessment of an applicant's experiences, attributes, and academic metrics<span><sup>4</sup></span>) by not fully acknowledging the resilience and perseverance shown in overcoming challenges, especially among disadvantaged applicants. Even wo","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13440","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141461462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sara D. Turbow MD, MPH, Jennifer Lom MD, Mohammed K. Ali MD, MSc, MBA
Despite the recent closure of several high-profile metropolitan hospitals, investigations into risk factors for metropolitan hospital closures have been limited. The goal of this study was to describe metropolitan hospitals that closed and compare them to metropolitan hospitals that remain open and micropolitan and rural hospitals that closed using American Hospital Association Annual Survey Data from 2010 to 2021. We independently verified hospitals reported as closed in the Annual Survey and examined the hospital characteristics associated with closure using bivariate statistics and logistic regression. We found that metropolitan hospitals that closed (n = 142) were more likely to be for-profit (66.9% vs. 29.7%, p < .0001; adjusted odds ratio [AOR]: 3.05, 95% confidence interval [CI]: 1.93, 4.81) and to come from a state that did not expand Medicaid (45.1% vs. 29.4%, p < .0001; AOR: 1.66, 95% CI: 1.16, 2.38). Policies tailored to metropolitan hospitals should be developed to identify at-risk hospitals and mitigate the effect of closures on patients, clinicians, and other stakeholders.
尽管最近有几家备受瞩目的大都市医院关闭，但对大都市医院关闭风险因素的调查却很有限。本研究的目的是利用美国医院协会 2010 年至 2021 年的年度调查数据，对关闭的大都市医院进行描述，并将其与仍在营业的大都市医院以及关闭的微型和乡村医院进行比较。我们对年度调查中报告为关闭的医院进行了独立核实，并使用二元统计和逻辑回归检验了与关闭相关的医院特征。我们发现，关闭的大都市医院（n = 142）更有可能是营利性医院（66.9% vs. 29.7%，p＜0.05）。
{"title":"Where and what separates rural from urban hospital closures?","authors":"Sara D. Turbow MD, MPH, Jennifer Lom MD, Mohammed K. Ali MD, MSc, MBA","doi":"10.1002/jhm.13438","DOIUrl":"10.1002/jhm.13438","url":null,"abstract":"<p>Despite the recent closure of several high-profile metropolitan hospitals, investigations into risk factors for metropolitan hospital closures have been limited. The goal of this study was to describe metropolitan hospitals that closed and compare them to metropolitan hospitals that remain open and micropolitan and rural hospitals that closed using American Hospital Association Annual Survey Data from 2010 to 2021. We independently verified hospitals reported as closed in the Annual Survey and examined the hospital characteristics associated with closure using bivariate statistics and logistic regression. We found that metropolitan hospitals that closed (<i>n</i> = 142) were more likely to be for-profit (66.9% vs. 29.7%, <i>p</i> < .0001; adjusted odds ratio [AOR]: 3.05, 95% confidence interval [CI]: 1.93, 4.81) and to come from a state that did not expand Medicaid (45.1% vs. 29.4%, <i>p</i> < .0001; AOR: 1.66, 95% CI: 1.16, 2.38). Policies tailored to metropolitan hospitals should be developed to identify at-risk hospitals and mitigate the effect of closures on patients, clinicians, and other stakeholders.</p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13438","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141422219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Beyond “Who is your mentor?”","authors":"Samir S. Shah MD, MSCE, MHM","doi":"10.1002/jhm.13435","DOIUrl":"10.1002/jhm.13435","url":null,"abstract":"<p>\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13435","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141319379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shannon K. Martin MD, MS, Venkatesan R. Krishnamoorthi MD, MPH
{"title":"Leadership & professional development: Prevent poster paresis: Pushing through to publish","authors":"Shannon K. Martin MD, MS, Venkatesan R. Krishnamoorthi MD, MPH","doi":"10.1002/jhm.13430","DOIUrl":"10.1002/jhm.13430","url":null,"abstract":"<p>\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141302317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Don't forget your Skittles","authors":"Samir S. Shah MD, MSCE, MHM","doi":"10.1002/jhm.13419","DOIUrl":"10.1002/jhm.13419","url":null,"abstract":"<p>\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13419","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141159344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Derek J. Williams MD, MPH, Hui Nian PhD, Srinivasan Suresh MD, MBA, Jason Slagle PhD, Stephen Gradwohl MD, MSACI, Jakobi Johnson BS, Justine Stassun MS, Carrie Reale RN, MSN, Shari L. Just RN, MSN, Nancy S. Rixe MD, Russ Beebe BA, Donald H. Arnold MD, MPH, Robert W. Turer MD, James W. Antoon MD, PhD, Laura F. Sartori MD, MPH, Robert E. Freundlich MD, MSCI, Carlos G. Grijalva MD, MPH, Joshua C. Smith PhD, Asli O. Weitkamp PhD, MSACI, Matthew B. Weinger MD, MS, Yuwei Zhu MD, MS, Judith M. Martin MD
Background
Hospitalization rates for childhood pneumonia vary widely. Risk-based clinical decision support (CDS) interventions may reduce unwarranted variation.
Methods
We conducted a pragmatic randomized trial in two US pediatric emergency departments (EDs) comparing electronic health record (EHR)-integrated prognostic CDS versus usual care for promoting appropriate ED disposition in children (<18 years) with pneumonia. Encounters were randomized 1:1 to usual care versus custom CDS featuring a validated pneumonia severity score predicting risk for severe in-hospital outcomes. Clinicians retained full decision-making authority. The primary outcome was inappropriate ED disposition, defined as early transition to lower- or higher-level care. Safety and implementation outcomes were also evaluated.
Results
The study enrolled 536 encounters (269 usual care and 267 CDS). Baseline characteristics were similar across arms. Inappropriate disposition occurred in 3% of usual care encounters and 2% of CDS encounters (adjusted odds ratio: 0.99, 95% confidence interval: [0.32, 2.95]). Length of stay was also similar and adverse safety outcomes were uncommon in both arms. The tool's custom user interface and content were viewed as strengths by surveyed clinicians (>70% satisfied). Implementation barriers include intrinsic (e.g., reaching the right person at the right time) and extrinsic factors (i.e., global pandemic).
Conclusions
EHR-based prognostic CDS did not improve ED disposition decisions for children with pneumonia. Although the intervention's content was favorably received, low subject accrual and workflow integration problems likely limited effectiveness. Clinical Trials Registration: NCT06033079.
{"title":"Prognostic clinical decision support for pneumonia in the emergency department: A randomized trial","authors":"Derek J. Williams MD, MPH, Hui Nian PhD, Srinivasan Suresh MD, MBA, Jason Slagle PhD, Stephen Gradwohl MD, MSACI, Jakobi Johnson BS, Justine Stassun MS, Carrie Reale RN, MSN, Shari L. Just RN, MSN, Nancy S. Rixe MD, Russ Beebe BA, Donald H. Arnold MD, MPH, Robert W. Turer MD, James W. Antoon MD, PhD, Laura F. Sartori MD, MPH, Robert E. Freundlich MD, MSCI, Carlos G. Grijalva MD, MPH, Joshua C. Smith PhD, Asli O. Weitkamp PhD, MSACI, Matthew B. Weinger MD, MS, Yuwei Zhu MD, MS, Judith M. Martin MD","doi":"10.1002/jhm.13391","DOIUrl":"10.1002/jhm.13391","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hospitalization rates for childhood pneumonia vary widely. Risk-based clinical decision support (CDS) interventions may reduce unwarranted variation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a pragmatic randomized trial in two US pediatric emergency departments (EDs) comparing electronic health record (EHR)-integrated prognostic CDS versus usual care for promoting appropriate ED disposition in children (<18 years) with pneumonia. Encounters were randomized 1:1 to usual care versus custom CDS featuring a validated pneumonia severity score predicting risk for severe in-hospital outcomes. Clinicians retained full decision-making authority. The primary outcome was inappropriate ED disposition, defined as early transition to lower- or higher-level care. Safety and implementation outcomes were also evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study enrolled 536 encounters (269 usual care and 267 CDS). Baseline characteristics were similar across arms. Inappropriate disposition occurred in 3% of usual care encounters and 2% of CDS encounters (adjusted odds ratio: 0.99, 95% confidence interval: [0.32, 2.95]). Length of stay was also similar and adverse safety outcomes were uncommon in both arms. The tool's custom user interface and content were viewed as strengths by surveyed clinicians (>70% satisfied). Implementation barriers include intrinsic (e.g., reaching the right person at the right time) and extrinsic factors (i.e., global pandemic).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>EHR-based prognostic CDS did not improve ED disposition decisions for children with pneumonia. Although the intervention's content was favorably received, low subject accrual and workflow integration problems likely limited effectiveness. Clinical Trials Registration: NCT06033079.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141155466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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