Rebecca Weeks, K. Sawasky, Adam Perry, Michael Malone
{"title":"Navigating Care Transitions for Older Adults in the Emergency Department When a Social Worker is Unavailable","authors":"Rebecca Weeks, K. Sawasky, Adam Perry, Michael Malone","doi":"10.17294/2694-4715.1023","DOIUrl":"https://doi.org/10.17294/2694-4715.1023","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47973382","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}
Delirium is an acute fluctuating condition characterized by an alteration in the level of consciousness associated with inattention and disorganized thinking. Delirium is known to cause increased morbidity and mortality in older adults. It has been associated with prolonged hospitalizations,1 functional decline,2 and cognitive decline.3 Delirium can either be present on arrival to the ED, early during the ED course (prevalent delirium), or develop during hospitalization in a patient who was initially not delirious in the ED (incident delirium). Delirium is missed in >50% of cases when screening is not performed.4-5 In addition, approximately 25% of older adults with delirium are discharged from the ED.6 Therefore, delirium screening, as well as mitigation of ED risk factors, are imperative to patient care. For this installment of the Geriatric Emergency Medicine Fellowship Journal Club, we reviewed two articles related to delirium risk to understand which patients are at risk of developing delirium after arriving in the ED and what strategies could be considered in the ED to prevent the development of incident delirium.
{"title":"Geriatric Emergency Medicine Fellowship Journal Club: Operational Changes for Recognizing Prevalent Delirium and Preventing Incident Delirium","authors":"N. M. Elder","doi":"10.17294/2694-4715.1032","DOIUrl":"https://doi.org/10.17294/2694-4715.1032","url":null,"abstract":"Delirium is an acute fluctuating condition characterized by an alteration in the level of consciousness associated with inattention and disorganized thinking. Delirium is known to cause increased morbidity and mortality in older adults. It has been associated with prolonged hospitalizations,1 functional decline,2 and cognitive decline.3 Delirium can either be present on arrival to the ED, early during the ED course (prevalent delirium), or develop during hospitalization in a patient who was initially not delirious in the ED (incident delirium). Delirium is missed in >50% of cases when screening is not performed.4-5 In addition, approximately 25% of older adults with delirium are discharged from the ED.6 Therefore, delirium screening, as well as mitigation of ED risk factors, are imperative to patient care. For this installment of the Geriatric Emergency Medicine Fellowship Journal Club, we reviewed two articles related to delirium risk to understand which patients are at risk of developing delirium after arriving in the ED and what strategies could be considered in the ED to prevent the development of incident delirium.","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42338409","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}
Kelvin H Kramp, Rutger de Hond, Mirwais Mehrab, Martijn A A van Hooft, R. Hessels
Background The average age of patients admitted to the emergency department (ED) continues to rise. Many face difficult discussions about cardiopulmonary resuscitation (CPR) and end-of-life decisions. Objectives This study aimed to determine which healthcare professionals that elderly patients admitted via the ED preferred to discuss their CPR directive with and their opinion about the ED as a setting for discussing their CPR directive. Methods A mixed-methods study with an explanatory sequential design was conducted. A questionnaire was administered to 100 patients >65 years of age admitted to nursing wards via the ED that had a CPR-directive conversation during admission 24-48 hours earlier. Patients who indicated that they preferred to discuss their CPR-directive conversation with a physician working in the ED were invited for follow-up semi-structured interviews. Results General practitioners (GP) were the most preferred healthcare professionals for a conversation about CPR directives (64%). However, physicians working in the ED were the second most preferred medical professionals (51%) along with medical specialists (51%). Only 6% of patients did not consider a physician in the ED as a suitable option for these conversations. Interviewed patients saw a physician consultation in the ED as an opportunity to: 1) check and update their CPR directive, 2) get information about the content and consequences of CPR considering their current health status, and 3) prevent the use of undesired medical treatment during admission. Conclusions Although GPs were the most preferred healthcare professionals with whom to discuss CPR preferences, an unexpectedly large proportion of the investigated population preferred to discuss their choices with a physician working in the ED. These considered these discussions of In conclusion, this study demonstrates that elderly patients admitted to a hospital ward via the ED identified their GP as the most preferred health professional with which to discuss their CPR preferences. However, a significant part of the study population answered in our questionnaire that they also prefer to discuss this topic at the time of admission with a physician in the ED. Interviews showed that a conversation with a physician in the ED was primarily considered suitable based on their decline in health before admission and the expected level of expertise in acute care of the physician in the ED. The results suggest that the topic is on average less repulsive for elderly patients than healthcare providers might think and that, for a significant part of elderly patients, engaging in these conversations is a key aspect of patient-centered healthcare.
{"title":"CPR-Directive Conversations in the Emergency Department: The Opinion of Elderly Patients","authors":"Kelvin H Kramp, Rutger de Hond, Mirwais Mehrab, Martijn A A van Hooft, R. Hessels","doi":"10.17294/2694-4715.1028","DOIUrl":"https://doi.org/10.17294/2694-4715.1028","url":null,"abstract":"Background The average age of patients admitted to the emergency department (ED) continues to rise. Many face difficult discussions about cardiopulmonary resuscitation (CPR) and end-of-life decisions. Objectives This study aimed to determine which healthcare professionals that elderly patients admitted via the ED preferred to discuss their CPR directive with and their opinion about the ED as a setting for discussing their CPR directive. Methods A mixed-methods study with an explanatory sequential design was conducted. A questionnaire was administered to 100 patients >65 years of age admitted to nursing wards via the ED that had a CPR-directive conversation during admission 24-48 hours earlier. Patients who indicated that they preferred to discuss their CPR-directive conversation with a physician working in the ED were invited for follow-up semi-structured interviews. Results General practitioners (GP) were the most preferred healthcare professionals for a conversation about CPR directives (64%). However, physicians working in the ED were the second most preferred medical professionals (51%) along with medical specialists (51%). Only 6% of patients did not consider a physician in the ED as a suitable option for these conversations. Interviewed patients saw a physician consultation in the ED as an opportunity to: 1) check and update their CPR directive, 2) get information about the content and consequences of CPR considering their current health status, and 3) prevent the use of undesired medical treatment during admission. Conclusions Although GPs were the most preferred healthcare professionals with whom to discuss CPR preferences, an unexpectedly large proportion of the investigated population preferred to discuss their choices with a physician working in the ED. These considered these discussions of In conclusion, this study demonstrates that elderly patients admitted to a hospital ward via the ED identified their GP as the most preferred health professional with which to discuss their CPR preferences. However, a significant part of the study population answered in our questionnaire that they also prefer to discuss this topic at the time of admission with a physician in the ED. Interviews showed that a conversation with a physician in the ED was primarily considered suitable based on their decline in health before admission and the expected level of expertise in acute care of the physician in the ED. The results suggest that the topic is on average less repulsive for elderly patients than healthcare providers might think and that, for a significant part of elderly patients, engaging in these conversations is a key aspect of patient-centered healthcare.","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41383358","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":"Call to Action: Improving the Care of Older Patients in Emergency Departments. A much-needed Collaboration between Emergency Medicine Physicians and Geriatricians.","authors":"S. Saxena","doi":"10.17294/2694-4715.1027","DOIUrl":"https://doi.org/10.17294/2694-4715.1027","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42959277","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}
L. Berrin, Phraewa Thatphet, A. Chary, Surriya Ahmad, D. Melady, Shan W Liu
dissemination methods of the RAMS listserv and Twitter still do not include all EM residents and interested medical students, so some part of the population was likely missed. In addition, this survey was announced at the AGEM annual meeting, as part of SAEM, so there is likely some selectivity bias in recruiting trainees who have already expressed an interest in GEM. This may explain the number of trainees who responded positively to questions regarding interest and importance of GEM and a career in GEM, the lower numbers for those who said that they are not interested in GEM. This study also focused only on emergency medicine residents and medical students who self-identified as interested in EM, so the results are less generalizable to the general population of medical trainees not interested in EM. This survey examined self-reported comfort with core geriatric competencies, rather than objective knowledge and skills, which is a direction for future research. This study is an initial step toward exploring the level of comfort EM residents and medical students interested in EM have in evaluating and managing older patients, as measured with the geriatric core competencies, as well as exploring trainees’ exposure to GEM. More work is needed in this area to understand trainee comfort with the geriatric core competencies and working with this complex population. Greater geriatrics exposure in preclinical and clinical training can increase competency and interest, which may be best accomplished earlier in medical training. EM trainees are aware of the need for and importance of additional GEM education, and educators should find ways to teach trainees creatively and engagingly about caring for older patients. Increasing GEM exposure and training will be important in creating a future EM physician workforce that is comfortable in the required competencies for caring for this complex and important patient population.
{"title":"Level of Comfort in Evaluating Older Patients Amongst Medical Students and Emergency Medicine Residents","authors":"L. Berrin, Phraewa Thatphet, A. Chary, Surriya Ahmad, D. Melady, Shan W Liu","doi":"10.17294/2694-4715.1024","DOIUrl":"https://doi.org/10.17294/2694-4715.1024","url":null,"abstract":"dissemination methods of the RAMS listserv and Twitter still do not include all EM residents and interested medical students, so some part of the population was likely missed. In addition, this survey was announced at the AGEM annual meeting, as part of SAEM, so there is likely some selectivity bias in recruiting trainees who have already expressed an interest in GEM. This may explain the number of trainees who responded positively to questions regarding interest and importance of GEM and a career in GEM, the lower numbers for those who said that they are not interested in GEM. This study also focused only on emergency medicine residents and medical students who self-identified as interested in EM, so the results are less generalizable to the general population of medical trainees not interested in EM. This survey examined self-reported comfort with core geriatric competencies, rather than objective knowledge and skills, which is a direction for future research. This study is an initial step toward exploring the level of comfort EM residents and medical students interested in EM have in evaluating and managing older patients, as measured with the geriatric core competencies, as well as exploring trainees’ exposure to GEM. More work is needed in this area to understand trainee comfort with the geriatric core competencies and working with this complex population. Greater geriatrics exposure in preclinical and clinical training can increase competency and interest, which may be best accomplished earlier in medical training. EM trainees are aware of the need for and importance of additional GEM education, and educators should find ways to teach trainees creatively and engagingly about caring for older patients. Increasing GEM exposure and training will be important in creating a future EM physician workforce that is comfortable in the required competencies for caring for this complex and important patient population.","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47883617","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}
Head injury is an increasingly common presenting complaint for older adults in the Emergency Department (ED). From 2007 to 2013, the number of traumatic brain injury (TBI)-related ED visits in adults 65 years and older increased from approximately 220 000 to 485 000 cases in the United States.1 Most of these injuries were fall-related. Fall-associated intracranial hemorrhages (ICH) in older adults are also increasing.2 The mortality rate associated with traumatic ICH is 15% and ICH accounts for onehalf of all fall-associated deaths in older adults.3,4 Clinical evaluation of geriatric trauma patients is complicated by frailty, polymorbidity, polypharmacy, anatomic and physiologic changes, and medication effects.5 Practice variation exists among emergency clinicians around when to obtain neuroimaging in older adults with falls, in part due to multiple clinical decision rules and misconceptions exist around their use. This article is a summary of the Journal Club on this topic held by the Geriatric EM Fellowship Journal Club series held on November 4, 2021, presented by the three authors. We review three articles that address the risk factors for ICH in older adults and that use clinical decision rules for guiding imaging in this population.
{"title":"Geriatric Emergency Medicine Fellowship Journal Club: To CT or Not","authors":"M. Lanoue, K. Gossack-Keenan, D. Melady","doi":"10.17294/2694-4715.1025","DOIUrl":"https://doi.org/10.17294/2694-4715.1025","url":null,"abstract":"Head injury is an increasingly common presenting complaint for older adults in the Emergency Department (ED). From 2007 to 2013, the number of traumatic brain injury (TBI)-related ED visits in adults 65 years and older increased from approximately 220 000 to 485 000 cases in the United States.1 Most of these injuries were fall-related. Fall-associated intracranial hemorrhages (ICH) in older adults are also increasing.2 The mortality rate associated with traumatic ICH is 15% and ICH accounts for onehalf of all fall-associated deaths in older adults.3,4 Clinical evaluation of geriatric trauma patients is complicated by frailty, polymorbidity, polypharmacy, anatomic and physiologic changes, and medication effects.5 Practice variation exists among emergency clinicians around when to obtain neuroimaging in older adults with falls, in part due to multiple clinical decision rules and misconceptions exist around their use. This article is a summary of the Journal Club on this topic held by the Geriatric EM Fellowship Journal Club series held on November 4, 2021, presented by the three authors. We review three articles that address the risk factors for ICH in older adults and that use clinical decision rules for guiding imaging in this population.","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43963071","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}
M. Malone, T. Hogan, A. Bonner, K. Biese, P. Pagel, K. Unroe
OVID-19 has posed a considerable threat to all aspects of older Americans ’ lives. The pandemic generated acute illness, emergency department (ED) visits, hospitalization, respiratory failure, and death. Pandemic-associated social isolation and loneliness further endangered older adults. Recovery from COVID-19 illness has commonly been followed by chronic symptoms, which may also precipitate ED visits. While vaccination has mitigated risks of serious illness requiring hospitalization, a booster dose is required to sustain protection. New treatments and therapies, including monoclonal antibodies and antiviral agents, have shown efficacy for older adults who are at risk of hospitalization. Older adults remain vulnerable in 2022, after two years of the COVID-19 pandemic. Emergency care for older patients is now challenged with health system staffing shortages and diminished access to care in community programs & skilled nursing facilities. This article attempts to synthesize the avalanche of discovery and innovation into a narrative review focused on the emergency and immediate post ED care of the aging adult patients both during and as a result of the COVID-19 pandemic . of Another showed that one-third of hypoxic on did Cochrane review determined that of very low certainty.
{"title":"COVID-19 in Older Adults- A Practical Review for Emergency Providers in 2022","authors":"M. Malone, T. Hogan, A. Bonner, K. Biese, P. Pagel, K. Unroe","doi":"10.17294/2694-4715.1026","DOIUrl":"https://doi.org/10.17294/2694-4715.1026","url":null,"abstract":"OVID-19 has posed a considerable threat to all aspects of older Americans ’ lives. The pandemic generated acute illness, emergency department (ED) visits, hospitalization, respiratory failure, and death. Pandemic-associated social isolation and loneliness further endangered older adults. Recovery from COVID-19 illness has commonly been followed by chronic symptoms, which may also precipitate ED visits. While vaccination has mitigated risks of serious illness requiring hospitalization, a booster dose is required to sustain protection. New treatments and therapies, including monoclonal antibodies and antiviral agents, have shown efficacy for older adults who are at risk of hospitalization. Older adults remain vulnerable in 2022, after two years of the COVID-19 pandemic. Emergency care for older patients is now challenged with health system staffing shortages and diminished access to care in community programs & skilled nursing facilities. This article attempts to synthesize the avalanche of discovery and innovation into a narrative review focused on the emergency and immediate post ED care of the aging adult patients both during and as a result of the COVID-19 pandemic . of Another showed that one-third of hypoxic on did Cochrane review determined that of very low certainty.","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45911574","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":"Pitfalls of Delirium Screening in Older Adults","authors":"D. Khoujah, D. Eagles","doi":"10.17294/2694-4715.1022","DOIUrl":"https://doi.org/10.17294/2694-4715.1022","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43949100","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}
in nature. However, one study showed that of older adults admitted to the hospital with the admitting diagnosis of “failure to thrive,” 88% of these patients ultimately had an acute medical problem, the most common of which were infectious, followed by cardiac and neurologic 3 . Patients with failure to thrive had longer and more complex hospital stays than patients who were admitted for long-term care placement only. 4 Additionally, over half of the patients presenting with “nonspecific complaints” developed a serious condition within 30 days . 5 These studies suggest that nonspecific symptoms grouped as failure to thrive may instead indicate a high probability of serious underlying, acute, medical etiology. Acute medical causes that may present as weakness, confusion, poor appetite and can be masked if categorized as failure to thrive include, but are not limited to, cardiac ischemia, valvular disease, stroke, electrolyte imbalance, infections, neurologic disease, and anemia. Medication reactions and interactions should also be considered, particularly if temporally related to the onset of symptoms. Higher-risk medications include steroids, statins, antihypertensives, and any centrally-acting medications. Furthermore, clinicians should determine if the clinical presentation generalized as failure to thrive more accurately represents hypoactive delirium when assessing a patient. Hypoactive delirium is the most common form of delirium and is characterized by increased somnolence, Failure to thrive is a progressively outdated way to describe older adults with vague symptoms without an immediately apparent etiology. The associated bias that there is no acute medical condition or that it is a surrogate for inability to cope at home may result in missing a serious underlying condition and further highlights the need to move away from this phrase and instead to depict patients more precisely in terms of their symptoms. Conversely, frailty is a geriatric syndrome that the ED should strive to recognize more frequently in order to accurately risk-stratify older adults, assist in medical decision-making, and pro-actively connect patients and families to the most appropriate resources.
{"title":"What’s in a Name? Understanding Failure to Thrive and Frailty in the Emergency Department","authors":"Katherine Selman, C. Shenvi","doi":"10.17294/2694-4715.1021","DOIUrl":"https://doi.org/10.17294/2694-4715.1021","url":null,"abstract":"in nature. However, one study showed that of older adults admitted to the hospital with the admitting diagnosis of “failure to thrive,” 88% of these patients ultimately had an acute medical problem, the most common of which were infectious, followed by cardiac and neurologic 3 . Patients with failure to thrive had longer and more complex hospital stays than patients who were admitted for long-term care placement only. 4 Additionally, over half of the patients presenting with “nonspecific complaints” developed a serious condition within 30 days . 5 These studies suggest that nonspecific symptoms grouped as failure to thrive may instead indicate a high probability of serious underlying, acute, medical etiology. Acute medical causes that may present as weakness, confusion, poor appetite and can be masked if categorized as failure to thrive include, but are not limited to, cardiac ischemia, valvular disease, stroke, electrolyte imbalance, infections, neurologic disease, and anemia. Medication reactions and interactions should also be considered, particularly if temporally related to the onset of symptoms. Higher-risk medications include steroids, statins, antihypertensives, and any centrally-acting medications. Furthermore, clinicians should determine if the clinical presentation generalized as failure to thrive more accurately represents hypoactive delirium when assessing a patient. Hypoactive delirium is the most common form of delirium and is characterized by increased somnolence, Failure to thrive is a progressively outdated way to describe older adults with vague symptoms without an immediately apparent etiology. The associated bias that there is no acute medical condition or that it is a surrogate for inability to cope at home may result in missing a serious underlying condition and further highlights the need to move away from this phrase and instead to depict patients more precisely in terms of their symptoms. Conversely, frailty is a geriatric syndrome that the ED should strive to recognize more frequently in order to accurately risk-stratify older adults, assist in medical decision-making, and pro-actively connect patients and families to the most appropriate resources.","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45694139","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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