Pub Date : 2019-09-01DOI: 10.1093/MED/9780190654818.003.0008
Swapnil Gupta, Rebecca Miller, J. Cahill
This chapter describes the specific considerations for decision-making surrounding the deprescribing of antidepressants. The chapter discusses how to arrive at a risk–benefit ratio that considers the pros and cons of deprescribing antidepressants, common clinical presentations of withdrawal symptoms and their management, and the possible steps that may be taken to prevent a recurrence of a depressive episode, including the use of nonpharmacological interventions. Antidepressants are among the most frequently prescribed psychotropic medications and are prescribed in an ongoing way that may be contrary to current guidelines. Commonly encountered decision points are discussed and illustrated with relevant case examples provided at the end of the chapter.
{"title":"Deprescribing Antidepressant Medications in Major Depressive Disorder","authors":"Swapnil Gupta, Rebecca Miller, J. Cahill","doi":"10.1093/MED/9780190654818.003.0008","DOIUrl":"https://doi.org/10.1093/MED/9780190654818.003.0008","url":null,"abstract":"This chapter describes the specific considerations for decision-making surrounding the deprescribing of antidepressants. The chapter discusses how to arrive at a risk–benefit ratio that considers the pros and cons of deprescribing antidepressants, common clinical presentations of withdrawal symptoms and their management, and the possible steps that may be taken to prevent a recurrence of a depressive episode, including the use of nonpharmacological interventions. Antidepressants are among the most frequently prescribed psychotropic medications and are prescribed in an ongoing way that may be contrary to current guidelines. Commonly encountered decision points are discussed and illustrated with relevant case examples provided at the end of the chapter.","PeriodicalId":296046,"journal":{"name":"Deprescribing in Psychiatry","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127049426","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}
Pub Date : 2019-09-01DOI: 10.1093/MED/9780190654818.003.0003
Swapnil Gupta, Rebecca Miller, J. Cahill
This chapter identifies the possible barriers to deprescribing, and presents suggestions for strategies to overcome them. Although deprescribing has the potential to streamline medication regimens, minimize side effects, cut costs, improve patient adherence, and strengthen the relationship between the patient and the prescribing professional, barriers may originate from the patient, physician, and/or the institution, both local and the larger medical institution. Barriers related to prescriber-related factors such as the physician’s illusion and fear of litigation, are discussed. Potential patient- and environment-related barriers are also discussed, including sociocultural factors which may emerge in the process of initiating a course of deprescribing. Included in this chapter is a discussion of the possibility of relapse, colloquially defined, and the patient’s and provider’s fears for rehospitalization. Possible strategies for overcoming each of these barriers are discussed.
{"title":"Barriers to Deprescribing","authors":"Swapnil Gupta, Rebecca Miller, J. Cahill","doi":"10.1093/MED/9780190654818.003.0003","DOIUrl":"https://doi.org/10.1093/MED/9780190654818.003.0003","url":null,"abstract":"This chapter identifies the possible barriers to deprescribing, and presents suggestions for strategies to overcome them. Although deprescribing has the potential to streamline medication regimens, minimize side effects, cut costs, improve patient adherence, and strengthen the relationship between the patient and the prescribing professional, barriers may originate from the patient, physician, and/or the institution, both local and the larger medical institution. Barriers related to prescriber-related factors such as the physician’s illusion and fear of litigation, are discussed. Potential patient- and environment-related barriers are also discussed, including sociocultural factors which may emerge in the process of initiating a course of deprescribing. Included in this chapter is a discussion of the possibility of relapse, colloquially defined, and the patient’s and provider’s fears for rehospitalization. Possible strategies for overcoming each of these barriers are discussed.","PeriodicalId":296046,"journal":{"name":"Deprescribing in Psychiatry","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130730308","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}
Pub Date : 2019-09-01DOI: 10.1093/MED/9780190654818.003.0009
Swapnil Gupta, Rebecca Miller, J. Cahill
This chapter discusses some of reasons for considering a deprescribing intervention with neuroleptic medications, including clear instances such as irrational antipsychotic polypharmacy and off-label use, as well as other situations driven by stakeholder pressures or medical comorbidity. The indefinite prescription of antipsychotic medications for psychotic disorders such as schizophrenia is commonly considered a recommended practice, although some uncertainty remains. The confidence of treatment recommendations also hinges on the accuracy of diagnoses—syndromes and classifications which typically evolve over time. This chapter describes a collaborative process of decision-making about the long-term use of antipsychotic medications as many patients wishing to attempt to decrease or discontinue these medications may do so without support of the prescriber, risking harm. The ability of current data to identify which patients may need long-term medication management versus those who may not is lacking. Considering the potential serious neurological and metabolic side effects of these medications, a patient’s preferences versus risks must be carefully weighed. Nonpharmacological interventions that may support the reduction of antipsychotic medications (but should not yet be presented as validated alternatives, alone) include psychoeducation, strategies for early identification and management of relapse, cognitive behavioral therapy for psychosis, and open dialogue are reviewed. The process is illustrated by case examples at the end of the chapter.
{"title":"Deprescribing Antipsychotic Medications","authors":"Swapnil Gupta, Rebecca Miller, J. Cahill","doi":"10.1093/MED/9780190654818.003.0009","DOIUrl":"https://doi.org/10.1093/MED/9780190654818.003.0009","url":null,"abstract":"This chapter discusses some of reasons for considering a deprescribing intervention with neuroleptic medications, including clear instances such as irrational antipsychotic polypharmacy and off-label use, as well as other situations driven by stakeholder pressures or medical comorbidity. The indefinite prescription of antipsychotic medications for psychotic disorders such as schizophrenia is commonly considered a recommended practice, although some uncertainty remains. The confidence of treatment recommendations also hinges on the accuracy of diagnoses—syndromes and classifications which typically evolve over time. This chapter describes a collaborative process of decision-making about the long-term use of antipsychotic medications as many patients wishing to attempt to decrease or discontinue these medications may do so without support of the prescriber, risking harm. The ability of current data to identify which patients may need long-term medication management versus those who may not is lacking. Considering the potential serious neurological and metabolic side effects of these medications, a patient’s preferences versus risks must be carefully weighed. Nonpharmacological interventions that may support the reduction of antipsychotic medications (but should not yet be presented as validated alternatives, alone) include psychoeducation, strategies for early identification and management of relapse, cognitive behavioral therapy for psychosis, and open dialogue are reviewed. The process is illustrated by case examples at the end of the chapter.","PeriodicalId":296046,"journal":{"name":"Deprescribing in Psychiatry","volume":"102 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115745036","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}
Pub Date : 2019-09-01DOI: 10.1093/MED/9780190654818.003.0002
Swapnil Gupta, Rebecca Miller, J. Cahill
This chapter discusses a framework for psycho-pharmacological decision-making and its applications specifically in the context of deprescribing. It introduces concepts and considerations involved in implementing shared decision-making, including how to create a constructive environment for conversations, stages of shared decision-making, and factors to consider that may impact both the provider and the patient. These decisions are especially difficult when doctors and patients disagree, when values or preferences conflict with standard guidelines, or simply when no guidelines are available. Identifying possible bias against making changes in medication regimens is highlighted, as well as the importance of honoring cultural preferences in the decision-making process.
{"title":"Decision-Making in Deprescribing","authors":"Swapnil Gupta, Rebecca Miller, J. Cahill","doi":"10.1093/MED/9780190654818.003.0002","DOIUrl":"https://doi.org/10.1093/MED/9780190654818.003.0002","url":null,"abstract":"This chapter discusses a framework for psycho-pharmacological decision-making and its applications specifically in the context of deprescribing. It introduces concepts and considerations involved in implementing shared decision-making, including how to create a constructive environment for conversations, stages of shared decision-making, and factors to consider that may impact both the provider and the patient. These decisions are especially difficult when doctors and patients disagree, when values or preferences conflict with standard guidelines, or simply when no guidelines are available. Identifying possible bias against making changes in medication regimens is highlighted, as well as the importance of honoring cultural preferences in the decision-making process.","PeriodicalId":296046,"journal":{"name":"Deprescribing in Psychiatry","volume":"1083 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133240568","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}
Pub Date : 2019-09-01DOI: 10.1093/MED/9780190654818.003.0007
Swapnil Gupta, Rebecca Miller, J. Cahill
Deprescribing of psychotropic medications introduces additional complexities related to the specific context of psychiatric disorders and their cultural meaning. This chapter expands on the process of deprescribing as it relates specifically to psychiatry, taking the five essential steps of deprescribing in general medicine and elaborating on them for use in psychiatry. These include a detailed decision-making process, psychoeducation of both the patient and friends or family, and close monitoring and adaptation during medication reduction. Given the current absence of guidelines in this area, documentation is a key element of the process and is discussed in this chapter. Included are suggested templates to support accurate documentation, including the decision-making process, the patient’s response to medication changes, medication lists with their indications, and the appearance and management of withdrawal symptoms and/or relapse.
{"title":"The Process of Deprescribing","authors":"Swapnil Gupta, Rebecca Miller, J. Cahill","doi":"10.1093/MED/9780190654818.003.0007","DOIUrl":"https://doi.org/10.1093/MED/9780190654818.003.0007","url":null,"abstract":"Deprescribing of psychotropic medications introduces additional complexities related to the specific context of psychiatric disorders and their cultural meaning. This chapter expands on the process of deprescribing as it relates specifically to psychiatry, taking the five essential steps of deprescribing in general medicine and elaborating on them for use in psychiatry. These include a detailed decision-making process, psychoeducation of both the patient and friends or family, and close monitoring and adaptation during medication reduction. Given the current absence of guidelines in this area, documentation is a key element of the process and is discussed in this chapter. Included are suggested templates to support accurate documentation, including the decision-making process, the patient’s response to medication changes, medication lists with their indications, and the appearance and management of withdrawal symptoms and/or relapse.","PeriodicalId":296046,"journal":{"name":"Deprescribing in Psychiatry","volume":"128 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133584652","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}
Pub Date : 2019-09-01DOI: 10.1093/MED/9780190654818.003.0010
Swapnil Gupta, Rebecca Miller, J. Cahill
This chapter reviews the literature on lithium withdrawal and provides strategies on how to reduce the risk of relapse through such measures as slow tapers. Combinations of mood stabilizers such as lithium, divalproex, carbamazepine, and lamotrigine are used frequently and recommended even with the approval of several second-generation antipsychotic medications as mood stabilizers. As patients grow older, the potential nephrotoxicity and hepatotoxicity of these medications can become a significant consideration. The question of misdiagnosis of mood instability and off-label use occurring in personality disorders and substance abuse is also addressed. Psychotherapeutic interventions such as psychoeducation, family therapy, and cognitive behavioral therapy that support the treatment of bipolar disorder are described as a part of the deprescribing process and illustrated by case examples.
{"title":"Deprescribing Mood Stabilizers","authors":"Swapnil Gupta, Rebecca Miller, J. Cahill","doi":"10.1093/MED/9780190654818.003.0010","DOIUrl":"https://doi.org/10.1093/MED/9780190654818.003.0010","url":null,"abstract":"This chapter reviews the literature on lithium withdrawal and provides strategies on how to reduce the risk of relapse through such measures as slow tapers. Combinations of mood stabilizers such as lithium, divalproex, carbamazepine, and lamotrigine are used frequently and recommended even with the approval of several second-generation antipsychotic medications as mood stabilizers. As patients grow older, the potential nephrotoxicity and hepatotoxicity of these medications can become a significant consideration. The question of misdiagnosis of mood instability and off-label use occurring in personality disorders and substance abuse is also addressed. Psychotherapeutic interventions such as psychoeducation, family therapy, and cognitive behavioral therapy that support the treatment of bipolar disorder are described as a part of the deprescribing process and illustrated by case examples.","PeriodicalId":296046,"journal":{"name":"Deprescribing in Psychiatry","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134280880","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}
Pub Date : 2019-09-01DOI: 10.1093/MED/9780190654818.003.0004
Swapnil Gupta, Rebecca Miller, J. Cahill
This chapter discusses the possible psychological and social impacts of deprescribing that may emerge when initiating a course of deprescribing. These may include anticipated reactions from family members, treaters, and systems, each of which deserves addressing in the context of the intervention in order to best facilitate deprescribing. These reactions may include real and imagined consequences for a patient, family and friends, treater, and systems (such as altered access to resources/entitlements). By understanding and considering these nonpharmacological aspects of the intervention, prescribers may better anticipate otherwise unforeseen pitfalls in the process. Strategies for eliciting and addressing these concerns are discussed.
{"title":"Nonpharmacological Aspects of Deprescribing","authors":"Swapnil Gupta, Rebecca Miller, J. Cahill","doi":"10.1093/MED/9780190654818.003.0004","DOIUrl":"https://doi.org/10.1093/MED/9780190654818.003.0004","url":null,"abstract":"This chapter discusses the possible psychological and social impacts of deprescribing that may emerge when initiating a course of deprescribing. These may include anticipated reactions from family members, treaters, and systems, each of which deserves addressing in the context of the intervention in order to best facilitate deprescribing. These reactions may include real and imagined consequences for a patient, family and friends, treater, and systems (such as altered access to resources/entitlements). By understanding and considering these nonpharmacological aspects of the intervention, prescribers may better anticipate otherwise unforeseen pitfalls in the process. Strategies for eliciting and addressing these concerns are discussed.","PeriodicalId":296046,"journal":{"name":"Deprescribing in Psychiatry","volume":"94 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123613190","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}
Pub Date : 2019-09-01DOI: 10.1093/MED/9780190654818.003.0011
Swapnil Gupta, Rebecca Miller, J. Cahill
This chapter addresses the considerations particular to deprescribing benzodiazepines and stimulant medications. Included are considerations around deprescribing those medications that a patient may be invested in taking either because the medications provide immediate relief or because they can improve occupational functioning in the short-term. Addiction and problem use (due to rewarding effects) of psychotropic medications are beyond the scope of this book and are amply addressed elsewhere. Addressed are psychoeducation needs, the acknowledgment of how much relief the medications bring, and the recognition of how severe and prolonged withdrawal symptoms can be. Accounts from patients experiencing prolonged withdrawal are included as well as suggestions around tapering speed and flexibility adapted to the patient’s response and supported by other measures such as cognitive behavioral therapy (CBT) for anxiety, CBT for insomnia, and connection with support groups.
{"title":"Deprescribing Benzodiazepines, Z-Drugs, and Stimulants","authors":"Swapnil Gupta, Rebecca Miller, J. Cahill","doi":"10.1093/MED/9780190654818.003.0011","DOIUrl":"https://doi.org/10.1093/MED/9780190654818.003.0011","url":null,"abstract":"This chapter addresses the considerations particular to deprescribing benzodiazepines and stimulant medications. Included are considerations around deprescribing those medications that a patient may be invested in taking either because the medications provide immediate relief or because they can improve occupational functioning in the short-term. Addiction and problem use (due to rewarding effects) of psychotropic medications are beyond the scope of this book and are amply addressed elsewhere. Addressed are psychoeducation needs, the acknowledgment of how much relief the medications bring, and the recognition of how severe and prolonged withdrawal symptoms can be. Accounts from patients experiencing prolonged withdrawal are included as well as suggestions around tapering speed and flexibility adapted to the patient’s response and supported by other measures such as cognitive behavioral therapy (CBT) for anxiety, CBT for insomnia, and connection with support groups.","PeriodicalId":296046,"journal":{"name":"Deprescribing in Psychiatry","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121802070","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}
Pub Date : 2019-09-01DOI: 10.1093/MED/9780190654818.003.0006
Swapnil Gupta, Rebecca Miller, J. Cahill
When considering deprescribing for a patient, in addition to personal, self-determined strategies, it is essential to evaluate the person’s interest in and potential benefit from specific modalities of psychotherapy, symptom support, and other clinical interventions—without necessarily implying that these alone are sufficient alternatives to the deprescribed treatment. This chapter further explores these adjunctive strategies for supporting people in the process of deprescribing; specifically those strategies typically housed in clinical settings, such as psychotherapy, peer support, and cognitive behavioral therapy. Particular attention is paid to the importance of sleep management in the deprescribing process and how to add supports in that area. In addition, briefly discussed are emerging, progressive and albeit controversial approaches such as open dialogue.
{"title":"Wellness Approaches II","authors":"Swapnil Gupta, Rebecca Miller, J. Cahill","doi":"10.1093/MED/9780190654818.003.0006","DOIUrl":"https://doi.org/10.1093/MED/9780190654818.003.0006","url":null,"abstract":"When considering deprescribing for a patient, in addition to personal, self-determined strategies, it is essential to evaluate the person’s interest in and potential benefit from specific modalities of psychotherapy, symptom support, and other clinical interventions—without necessarily implying that these alone are sufficient alternatives to the deprescribed treatment. This chapter further explores these adjunctive strategies for supporting people in the process of deprescribing; specifically those strategies typically housed in clinical settings, such as psychotherapy, peer support, and cognitive behavioral therapy. Particular attention is paid to the importance of sleep management in the deprescribing process and how to add supports in that area. In addition, briefly discussed are emerging, progressive and albeit controversial approaches such as open dialogue.","PeriodicalId":296046,"journal":{"name":"Deprescribing in Psychiatry","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130814231","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}
Pub Date : 2019-09-01DOI: 10.1093/MED/9780190654818.003.0005
Swapnil Gupta, Rebecca Miller, J. Cahill
Some patients and their support systems may interpret an attempt at deprescribing as a withdrawal of treatment or care. The prescriber must work to counter this perception by acknowledging the problem and by bolstering existing strategies or introducing and developing, along with the patient, new strategies for maintaining wellness. Deprescribing prompts an excellent opportunity for an individual to expand supports and wellness strategies. This chapter discusses those strategies initiated by the person in order to maintain wellness and manage any symptoms that emerge during the process. These include using a preplanning tool such as a Wellness Recovery Action Plan (WRAP) or others to develop and articulate needed supports and preferences in case of crisis. Exercise, family support, and finding meaning and purpose are also discussed in this chapter.
{"title":"Wellness Approaches I","authors":"Swapnil Gupta, Rebecca Miller, J. Cahill","doi":"10.1093/MED/9780190654818.003.0005","DOIUrl":"https://doi.org/10.1093/MED/9780190654818.003.0005","url":null,"abstract":"Some patients and their support systems may interpret an attempt at deprescribing as a withdrawal of treatment or care. The prescriber must work to counter this perception by acknowledging the problem and by bolstering existing strategies or introducing and developing, along with the patient, new strategies for maintaining wellness.\u0000 Deprescribing prompts an excellent opportunity for an individual to expand supports and wellness strategies. This chapter discusses those strategies initiated by the person in order to maintain wellness and manage any symptoms that emerge during the process. These include using a preplanning tool such as a Wellness Recovery Action Plan (WRAP) or others to develop and articulate needed supports and preferences in case of crisis. Exercise, family support, and finding meaning and purpose are also discussed in this chapter.","PeriodicalId":296046,"journal":{"name":"Deprescribing in Psychiatry","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133411372","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}
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