Pub Date : 2024-08-27DOI: 10.1176/appi.ps.20240082
Deborah Scharf, Henry Chung, Joseph Parks
Measurement-informed care (MIC), also known as measurement-based care or patient-reported outcomes, for behavioral health conditions has had low uptake in the United States. To advance MIC in the near term, the authors reviewed nationally endorsed behavioral health measures and worked with national experts to recommend a core set of outpatient measures to prioritize for use. The resulting set of measures is for common behavioral and comorbid conditions and is outcomes based, low burden, and suitable for value-based payment. The panel of national experts also recommended developing a consensus on quality-of-life measures and functional measures for use across diagnostic categories of the core set.
{"title":"Advancing Measurement-Informed Care in Outpatient Community Behavioral Health.","authors":"Deborah Scharf, Henry Chung, Joseph Parks","doi":"10.1176/appi.ps.20240082","DOIUrl":"https://doi.org/10.1176/appi.ps.20240082","url":null,"abstract":"<p><p>Measurement-informed care (MIC), also known as measurement-based care or patient-reported outcomes, for behavioral health conditions has had low uptake in the United States. To advance MIC in the near term, the authors reviewed nationally endorsed behavioral health measures and worked with national experts to recommend a core set of outpatient measures to prioritize for use. The resulting set of measures is for common behavioral and comorbid conditions and is outcomes based, low burden, and suitable for value-based payment. The panel of national experts also recommended developing a consensus on quality-of-life measures and functional measures for use across diagnostic categories of the core set.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142073695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-27DOI: 10.1176/appi.ps.20230643
Jessica E Opie, An Vuong, Christopher Maylea, Hanan Khalil, Louis Brown, Alexandra Macafee, Blossom Ah Ket, Natalie Pearce, Nicola Guerin, Jennifer E McIntosh
Objective: Mental health lived experience organizations (LEOs) and their lived experience workforce are increasingly recognized as invaluable. However, a deeper understanding of the elements that enhance or inhibit LEOs' efficacy is required to learn how to sustain LEOs and support their workforce. Rapid international expansion has resulted in significant LEO growth and change, challenging many LEOs to adapt. With this rapid expansion, the field is evolving faster than many LEOs can keep pace with. This review, codesigned and coproduced in partnership with a LEO to draw on both lived experience and academic perspectives, aims for a deeper understanding of which elements within a LEO enhance or inhibit its efficacy, growth, and support for its lived experience workforce.
Methods: A systematic search of peer-reviewed and non-peer-reviewed literature, following the PRISMA-ScR guidelines and JBI methodology, identified 60 records published in English between 2000 and 2022.
Results: The results indicate general agreement regarding which LEO elements are important (e.g., culture, leadership, board composition, organizational structure, financial arrangements, and professionalization). However, considerable disagreements exist regarding the relative influence of several of these elements, especially funding arrangements, in which funder and LEO values often diverge; training for increased lived experience professionalization; and partnerships with medical model-focused mental health services.
Conclusions: Organizational disagreements relate to managing future LEO growth and advancing the lived experience workforce while preserving LEOs' unique characteristics that make them valued mental health services. Further research should examine community differences among LEOs, including hybrid LEOs within services and non-LEO mental health organizations.
目的:心理健康生活体验组织(LEOs)及其生活体验工作团队的价值日益得到认可。然而,要了解如何维持 LEO 和支持他们的工作队伍,就需要对提高或抑制 LEO 效率的因素有更深入的了解。迅速的国际扩张带来了 LEO 的显著增长和变化,对许多 LEO 的适应能力提出了挑战。随着这种快速扩张,该领域的发展速度超过了许多 LEO 的发展速度。本综述是与一家 LEO 合作设计和共同制作的,借鉴了生活经验和学术观点,旨在更深入地了解 LEO 中的哪些因素会提高或抑制其效率、发展以及对其生活经验工作团队的支持:方法:根据PRISMA-ScR指南和JBI方法,对同行评议和非同行评议文献进行了系统检索,发现了2000年至2022年间发表的60篇英文文献:结果表明,对于哪些 LEO 要素(如文化、领导力、董事会组成、组织结构、财务安排和专业化)是重要的,人们普遍达成了一致。然而,在其中几个要素的相对影响方面存在着相当大的分歧,尤其是资金安排,因为资金提供者和 LEO 的价值观往往不一致;为提高生活经验专业化程度而进行的培训;以及与以医疗模式为重点的心理健康服务机构的合作关系:组织上的分歧涉及到如何管理 LEO 的未来发展,以及如何在保持 LEO 独特性的同时促进生活体验工作队伍的发展,这些独特性使 LEO 成为有价值的心理健康服务机构。进一步的研究应该考察 LEO 之间的社区差异,包括服务机构中的混合 LEO 和非 LEO 心理健康组织。
{"title":"Understanding Lived Experience Organizations: A Systematic Scoping Review of Organizational Elements and Characteristics.","authors":"Jessica E Opie, An Vuong, Christopher Maylea, Hanan Khalil, Louis Brown, Alexandra Macafee, Blossom Ah Ket, Natalie Pearce, Nicola Guerin, Jennifer E McIntosh","doi":"10.1176/appi.ps.20230643","DOIUrl":"https://doi.org/10.1176/appi.ps.20230643","url":null,"abstract":"<p><strong>Objective: </strong>Mental health lived experience organizations (LEOs) and their lived experience workforce are increasingly recognized as invaluable. However, a deeper understanding of the elements that enhance or inhibit LEOs' efficacy is required to learn how to sustain LEOs and support their workforce. Rapid international expansion has resulted in significant LEO growth and change, challenging many LEOs to adapt. With this rapid expansion, the field is evolving faster than many LEOs can keep pace with. This review, codesigned and coproduced in partnership with a LEO to draw on both lived experience and academic perspectives, aims for a deeper understanding of which elements within a LEO enhance or inhibit its efficacy, growth, and support for its lived experience workforce.</p><p><strong>Methods: </strong>A systematic search of peer-reviewed and non-peer-reviewed literature, following the PRISMA-ScR guidelines and JBI methodology, identified 60 records published in English between 2000 and 2022.</p><p><strong>Results: </strong>The results indicate general agreement regarding which LEO elements are important (e.g., culture, leadership, board composition, organizational structure, financial arrangements, and professionalization). However, considerable disagreements exist regarding the relative influence of several of these elements, especially funding arrangements, in which funder and LEO values often diverge; training for increased lived experience professionalization; and partnerships with medical model-focused mental health services.</p><p><strong>Conclusions: </strong>Organizational disagreements relate to managing future LEO growth and advancing the lived experience workforce while preserving LEOs' unique characteristics that make them valued mental health services. Further research should examine community differences among LEOs, including hybrid LEOs within services and non-LEO mental health organizations.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142073697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-27DOI: 10.1176/appi.ps.20240027
Tina Marshall, Alden Farrar, Melissa Wilson, Jeffrey Taylor, Preethy George, Sushmita Shoma Ghose, John Cosgrove, Nikhil A Patel
Objective: Mindfulness-based interventions are increasingly being used in schools to improve students' mental, emotional, and behavioral development. Although many mindfulness programs exist, the types of programs that are effective for specific age groups remain unclear. In this systematic review, the authors used established rating criteria to describe the level of evidence for school-based mindfulness interventions.
Methods: A search of major databases, gray literature, and evidence base registries was conducted to identify studies published between 2008 and 2022 that focused on mindfulness interventions within school settings. The authors rated mindfulness interventions as having high, moderate, or low levels of evidence based on the number and rigor of studies with positive outcomes.
Results: Of the 24 interventions identified across 41 studies, three interventions-Learning to BREATHE, Mindfulness in School Project, and mindfulness-based stress reduction (MBSR)-received a rating of high level of evidence. Three interventions-Gaia Program, MindUP, and a blended version of MBSR and mindfulness-based cognitive therapy-received a rating of moderate level of evidence. The interventions rated as having a high level of evidence were conducted with middle or high school students, and interventions with moderate evidence were also conducted with elementary students, demonstrating effectiveness of mindfulness across a range of age groups. Few studies examined outcomes for underserved populations.
Conclusions: With greater use and more research, mindfulness interventions have the potential to promote student well-being and prevent mental health conditions.
目的:学校越来越多地采用正念干预措施来改善学生的心理、情绪和行为发展。虽然存在许多正念计划,但对特定年龄组有效的计划类型仍不明确。在这篇系统性综述中,作者使用既定的评级标准来描述基于学校的正念干预措施的证据水平:方法:作者对主要数据库、灰色文献和证据基础登记处进行了检索,以确定 2008 年至 2022 年间发表的有关学校环境中正念干预的研究。作者根据取得积极成果的研究数量和严谨性,将正念干预措施的证据水平分为高、中、低三个等级:在 41 项研究中确定的 24 项干预措施中,三项干预措施--"学会呼吸"(Learning to BREATHE)、"正念在学校项目"(Mindfulness in School Project)和 "正念减压"(MBSR)--被评为高证据等级。三项干预--Gaia 计划、MindUP 以及 MBSR 和正念认知疗法的混合版本--被评为中等证据水平。被评为高证据等级的干预措施是针对初中生或高中生进行的,而中等证据等级的干预措施也是针对小学生进行的,这表明正念疗法在不同年龄段的人群中都很有效。很少有研究对服务不足人群的结果进行了调查:结论:随着正念干预的更广泛使用和更多研究的开展,正念干预有可能促进学生的身心健康并预防心理健康问题。
{"title":"Mindfulness-Based Interventions in Schools: Assessing the Evidence Base.","authors":"Tina Marshall, Alden Farrar, Melissa Wilson, Jeffrey Taylor, Preethy George, Sushmita Shoma Ghose, John Cosgrove, Nikhil A Patel","doi":"10.1176/appi.ps.20240027","DOIUrl":"https://doi.org/10.1176/appi.ps.20240027","url":null,"abstract":"<p><strong>Objective: </strong>Mindfulness-based interventions are increasingly being used in schools to improve students' mental, emotional, and behavioral development. Although many mindfulness programs exist, the types of programs that are effective for specific age groups remain unclear. In this systematic review, the authors used established rating criteria to describe the level of evidence for school-based mindfulness interventions.</p><p><strong>Methods: </strong>A search of major databases, gray literature, and evidence base registries was conducted to identify studies published between 2008 and 2022 that focused on mindfulness interventions within school settings. The authors rated mindfulness interventions as having high, moderate, or low levels of evidence based on the number and rigor of studies with positive outcomes.</p><p><strong>Results: </strong>Of the 24 interventions identified across 41 studies, three interventions-Learning to BREATHE, Mindfulness in School Project, and mindfulness-based stress reduction (MBSR)-received a rating of high level of evidence. Three interventions-Gaia Program, MindUP, and a blended version of MBSR and mindfulness-based cognitive therapy-received a rating of moderate level of evidence. The interventions rated as having a high level of evidence were conducted with middle or high school students, and interventions with moderate evidence were also conducted with elementary students, demonstrating effectiveness of mindfulness across a range of age groups. Few studies examined outcomes for underserved populations.</p><p><strong>Conclusions: </strong>With greater use and more research, mindfulness interventions have the potential to promote student well-being and prevent mental health conditions.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142073696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-20DOI: 10.1176/appi.ps.20240115
Kenneth Minkoff
{"title":"Civil Commitment for People With Substance Use Disorders: Balancing Benefits and Harms.","authors":"Kenneth Minkoff","doi":"10.1176/appi.ps.20240115","DOIUrl":"https://doi.org/10.1176/appi.ps.20240115","url":null,"abstract":"","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-20DOI: 10.1176/appi.ps.20230416
Rocksheng Zhong, Tobias Wasser
{"title":"Ending Involuntary Commitment for People With Treatment-Resistant Mental Illness and Grave Disability.","authors":"Rocksheng Zhong, Tobias Wasser","doi":"10.1176/appi.ps.20230416","DOIUrl":"https://doi.org/10.1176/appi.ps.20230416","url":null,"abstract":"","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-14DOI: 10.1176/appi.ps.20240152
Amanda I Mauri, Saba Rouhani, Jonathan Purtle
Objective: The authors aimed to examine how certified community behavioral health clinics (CCBHCs) fulfill crisis service requirements and whether clinics added crisis services after becoming a CCBHC.
Methods: National survey data on CCBHC crisis services were paired with data on clinic features and the demographic and socioeconomic characteristics of the counties within a CCBHC service area. The dependent variables were whether CCBHCs provided the three categories of CCBHC crisis services (i.e., crisis call lines, mobile crisis response, and crisis stabilization) directly or through another organization and whether these services were added after becoming a CCBHC. Descriptive statistics and multivariable logistic regression analyses were performed with data about clinics and the counties they served. In total, 449 CCBHCs were surveyed in the summer of 2022, with a response rate of 56%. The final sample comprised 247 clinics.
Results: The number of CCBHC employees per 1,000 people within a CCBHC service area was significantly and positively associated with clinics providing some crisis services directly (mobile crisis response: adjusted OR [AOR]=1.46, 95% CI=1.08-1.98; crisis stabilization services: AOR=1.60, 95% CI=1.17-2.19). Compared with clinics that did not receive a CCBHC Medicaid bundled payment, clinics that received this payment had higher odds of adding mobile crisis response (AOR=2.52, 95% CI=1.28-4.97) and crisis stabilization services (AOR=3.19, 95% CI=1.51-6.72) after becoming a CCBHC.
Conclusions: CCBHC initiatives, particularly CCBHC Medicaid bundled payments, may provide opportunities to increase the availability of behavioral health crisis services, but the sufficiency of this increase for meeting crisis care needs remains unknown.
{"title":"Characterizing Crisis Services Offered by Certified Community Behavioral Health Clinics: Results From a National Survey.","authors":"Amanda I Mauri, Saba Rouhani, Jonathan Purtle","doi":"10.1176/appi.ps.20240152","DOIUrl":"https://doi.org/10.1176/appi.ps.20240152","url":null,"abstract":"<p><strong>Objective: </strong>The authors aimed to examine how certified community behavioral health clinics (CCBHCs) fulfill crisis service requirements and whether clinics added crisis services after becoming a CCBHC.</p><p><strong>Methods: </strong>National survey data on CCBHC crisis services were paired with data on clinic features and the demographic and socioeconomic characteristics of the counties within a CCBHC service area. The dependent variables were whether CCBHCs provided the three categories of CCBHC crisis services (i.e., crisis call lines, mobile crisis response, and crisis stabilization) directly or through another organization and whether these services were added after becoming a CCBHC. Descriptive statistics and multivariable logistic regression analyses were performed with data about clinics and the counties they served. In total, 449 CCBHCs were surveyed in the summer of 2022, with a response rate of 56%. The final sample comprised 247 clinics.</p><p><strong>Results: </strong>The number of CCBHC employees per 1,000 people within a CCBHC service area was significantly and positively associated with clinics providing some crisis services directly (mobile crisis response: adjusted OR [AOR]=1.46, 95% CI=1.08-1.98; crisis stabilization services: AOR=1.60, 95% CI=1.17-2.19). Compared with clinics that did not receive a CCBHC Medicaid bundled payment, clinics that received this payment had higher odds of adding mobile crisis response (AOR=2.52, 95% CI=1.28-4.97) and crisis stabilization services (AOR=3.19, 95% CI=1.51-6.72) after becoming a CCBHC.</p><p><strong>Conclusions: </strong>CCBHC initiatives, particularly CCBHC Medicaid bundled payments, may provide opportunities to increase the availability of behavioral health crisis services, but the sufficiency of this increase for meeting crisis care needs remains unknown.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-14DOI: 10.1176/appi.ps.20240156
Patrick W Corrigan
Program development and evaluation that promote health equity are driven by community-based participatory research and led by people from select communities to adhere to the principles of diversity, equity, inclusion, and accessibility (DEIA). This process is enriched when these communities represent intersections within DEIA, such as, for example, Korean American women with depression. Research shows that culture-specific adaptations of services are significantly more effective for these communities than is the standard of care for the broader population. However, cultural specificity decreases generalizability of findings and scalability of interventions. Decisions about intersectionality are affected by implications for science as well as real-world benefits for individuals participating in this process.
{"title":"Benefits and Challenges of Addressing Cultural Intersectionality for Program Development and Evaluation.","authors":"Patrick W Corrigan","doi":"10.1176/appi.ps.20240156","DOIUrl":"https://doi.org/10.1176/appi.ps.20240156","url":null,"abstract":"<p><p>Program development and evaluation that promote health equity are driven by community-based participatory research and led by people from select communities to adhere to the principles of diversity, equity, inclusion, and accessibility (DEIA). This process is enriched when these communities represent intersections within DEIA, such as, for example, Korean American women with depression. Research shows that culture-specific adaptations of services are significantly more effective for these communities than is the standard of care for the broader population. However, cultural specificity decreases generalizability of findings and scalability of interventions. Decisions about intersectionality are affected by implications for science as well as real-world benefits for individuals participating in this process.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-14DOI: 10.1176/appi.ps.20240113
Yueh-Yi Chiang, Alejandro Amill-Rosario, Phuong Tran, Susan dosReis
Objective: This study evaluated psychotropic polypharmacy frequency and patterns of use among Medicaid-enrolled youths.
Methods: A cross-sectional study of a state Medicaid claims database (2015-2020) focused on youths (≤17 years old) with at least one psychotropic medication claim and ≥90 continuous days of Medicaid enrollment. Psychotropic polypharmacy (claims for three or more therapeutic classes of psychotropics for ≥90 consecutive days) was analyzed as average annual days and annual prevalence of class combinations. Multivariable negative binomial regression models assessed changes in annual psychotropic polypharmacy days.
Results: A total of 126,972 unique youths were identified. Almost all youths with psychotropic polypharmacy had three-class combinations, the most common of which included attention-deficit hyperactivity disorder medications, antipsychotics, and antidepressants. The number of polypharmacy days increased from a mean±SD of 227.8±90.3 in 2015 to 235.7±97.5 in 2020. Polypharmacy days significantly increased year over year (rate ratio=1.01, 95% CI=1.00-1.01).
Conclusions: Psychotropic polypharmacy regimens reflect chronic use that is increasing over time.
{"title":"Psychotropic Polypharmacy Combinations and Duration of Polypharmacy Among Medicaid-Enrolled Youths.","authors":"Yueh-Yi Chiang, Alejandro Amill-Rosario, Phuong Tran, Susan dosReis","doi":"10.1176/appi.ps.20240113","DOIUrl":"https://doi.org/10.1176/appi.ps.20240113","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluated psychotropic polypharmacy frequency and patterns of use among Medicaid-enrolled youths.</p><p><strong>Methods: </strong>A cross-sectional study of a state Medicaid claims database (2015-2020) focused on youths (≤17 years old) with at least one psychotropic medication claim and ≥90 continuous days of Medicaid enrollment. Psychotropic polypharmacy (claims for three or more therapeutic classes of psychotropics for ≥90 consecutive days) was analyzed as average annual days and annual prevalence of class combinations. Multivariable negative binomial regression models assessed changes in annual psychotropic polypharmacy days.</p><p><strong>Results: </strong>A total of 126,972 unique youths were identified. Almost all youths with psychotropic polypharmacy had three-class combinations, the most common of which included attention-deficit hyperactivity disorder medications, antipsychotics, and antidepressants. The number of polypharmacy days increased from a mean±SD of 227.8±90.3 in 2015 to 235.7±97.5 in 2020. Polypharmacy days significantly increased year over year (rate ratio=1.01, 95% CI=1.00-1.01).</p><p><strong>Conclusions: </strong>Psychotropic polypharmacy regimens reflect chronic use that is increasing over time.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}