Pub Date : 2021-07-01DOI: 10.30770/2572-1852-107.2.32
H. M. Koenig
{"title":"Editor's Note: Cognitive Screening for Physicians","authors":"H. M. Koenig","doi":"10.30770/2572-1852-107.2.32","DOIUrl":"https://doi.org/10.30770/2572-1852-107.2.32","url":null,"abstract":"","PeriodicalId":91752,"journal":{"name":"Journal of medical regulation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47118874","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 : 2021-07-01DOI: 10.30770/2572-1852-107.2.6
K. Simons
{"title":"Abiding in Our Mission, Despite a Difficult Environment","authors":"K. Simons","doi":"10.30770/2572-1852-107.2.6","DOIUrl":"https://doi.org/10.30770/2572-1852-107.2.6","url":null,"abstract":"","PeriodicalId":91752,"journal":{"name":"Journal of medical regulation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43876896","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 : 2021-07-01DOI: 10.30770/2572-1852-107.2.17
Ron Paterson
The regulation of sexual misconduct is a challenging area for medical boards. Complaints alleging sexual abuse should always sound alarm bells. They touch on deeply personal matters, the evidence is highly contested, patients are often traumatized, physicians are naturally defensive and boards know that their decisions may be contested and exposed to media scrutiny. Care, sensitivity and fairness in regulatory decision-making is essential.
{"title":"Physicians, Patients, Sex and Chaperones: Rethinking Medical Regulation","authors":"Ron Paterson","doi":"10.30770/2572-1852-107.2.17","DOIUrl":"https://doi.org/10.30770/2572-1852-107.2.17","url":null,"abstract":"The regulation of sexual misconduct is a challenging area for medical boards. Complaints alleging sexual abuse should always sound alarm bells. They touch on deeply personal matters, the evidence is highly contested, patients are often traumatized, physicians are naturally defensive and boards know that their decisions may be contested and exposed to media scrutiny. Care, sensitivity and fairness in regulatory decision-making is essential.","PeriodicalId":91752,"journal":{"name":"Journal of medical regulation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47844449","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 : 2021-07-01DOI: 10.30770/2572-1852-107.2.65
Bryan Carmody, Max Jordan Nguemeni Tiako
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Approximately 70% of the United States physician workforce consists of graduates of American MDgranting medical schools. The remainder is composed of osteopathic physicians and graduates of international medical schools.1 To medical regulators, all of these licensed physicians — regardless of their educational background — are created equal. Yet, to the general public and among their physician peers, status hierarchies often shape the way these doctors are viewed and the practice opportunities that they will receive. How does this social scale get established — and why does it persist?
{"title":"Doctors’ Orders: The Making of Status Hierarchies in an Elite Profession","authors":"Bryan Carmody, Max Jordan Nguemeni Tiako","doi":"10.30770/2572-1852-107.2.65","DOIUrl":"https://doi.org/10.30770/2572-1852-107.2.65","url":null,"abstract":". . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Approximately 70% of the United States physician workforce consists of graduates of American MDgranting medical schools. The remainder is composed of osteopathic physicians and graduates of international medical schools.1 To medical regulators, all of these licensed physicians — regardless of their educational background — are created equal. Yet, to the general public and among their physician peers, status hierarchies often shape the way these doctors are viewed and the practice opportunities that they will receive. How does this social scale get established — and why does it persist?","PeriodicalId":91752,"journal":{"name":"Journal of medical regulation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45833163","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 : 2021-07-01DOI: 10.30770/2572-1852-107.2.49
Mohammed Ahmed Rashid, Victoria Smith, Sean Tackett, Zakia Arfeen, Faraz Mughal
In 2010, the Educational Commission for Foreign Medical Graduates (ECFMG) announced that as of 2023, physicians applying to train and practice in the United States will be required to graduate from a medical school that has been accredited using criteria such as those developed by the World Federation for Medical Education. This study analyzed posts on the Student Doctor Network (SDN) online forum that refer to this accreditation requirement to investigate how it has been perceived and understood by current and prospective medical students. A keyword search of relevant terms was used to identify posts discussing the accreditation requirement on the SDN online forum, which were subjected to thematic analysis. There were a total of 83 posts from 49 distinct user accounts between May 2012 and January 2020. Seven themes were identified in total; four whose overall purpose was to seek or offer advice and three whose overall purpose was commentary. Themes relating to advice included applications and admissions, future career planning, personal circumstances, and countryspecific issues. Themes relating to commentary included the accreditation requirement policy itself, the potential implications of the requirement, and the educational quality of non-U.S. medical schools. Only half of web links on these posts were to the ECFMG website for official information about the requirement. Although a variety of different perspectives about the ECFMG accreditation requirement were expressed on an online forum for student doctors, the overall number of posts was low, which suggests that the requirement has not been a frequent topic of discussion on this platform. The insights gained from posts suggest personal opinions about the requirement and consequences for individual student application and career choices were the main areas of interest. Signposting to official information channels may help to raise awareness about the requirement and tackle areas of uncertainty and confusion about its implementation.
{"title":"What Will It Mean for Me? Perceptions of the ECFMG 2023 Accreditation Requirement from an Online Forum.","authors":"Mohammed Ahmed Rashid, Victoria Smith, Sean Tackett, Zakia Arfeen, Faraz Mughal","doi":"10.30770/2572-1852-107.2.49","DOIUrl":"https://doi.org/10.30770/2572-1852-107.2.49","url":null,"abstract":"<p><p>In 2010, the Educational Commission for Foreign Medical Graduates (ECFMG) announced that as of 2023, physicians applying to train and practice in the United States will be required to graduate from a medical school that has been accredited using criteria such as those developed by the World Federation for Medical Education. This study analyzed posts on the Student Doctor Network (SDN) online forum that refer to this accreditation requirement to investigate how it has been perceived and understood by current and prospective medical students. A keyword search of relevant terms was used to identify posts discussing the accreditation requirement on the SDN online forum, which were subjected to thematic analysis. There were a total of 83 posts from 49 distinct user accounts between May 2012 and January 2020. Seven themes were identified in total; four whose overall purpose was to seek or offer advice and three whose overall purpose was commentary. Themes relating to advice included applications and admissions, future career planning, personal circumstances, and countryspecific issues. Themes relating to commentary included the accreditation requirement policy itself, the potential implications of the requirement, and the educational quality of non-U.S. medical schools. Only half of web links on these posts were to the ECFMG website for official information about the requirement. Although a variety of different perspectives about the ECFMG accreditation requirement were expressed on an online forum for student doctors, the overall number of posts was low, which suggests that the requirement has not been a frequent topic of discussion on this platform. The insights gained from posts suggest personal opinions about the requirement and consequences for individual student application and career choices were the main areas of interest. Signposting to official information channels may help to raise awareness about the requirement and tackle areas of uncertainty and confusion about its implementation.</p>","PeriodicalId":91752,"journal":{"name":"Journal of medical regulation","volume":"107 2","pages":"49-56"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7611736/pdf/EMS135387.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39471114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.30770/2572-1852-107.2.41
C. Bundy, B. Williams
Senior physicians are an invaluable community asset that comprise an increasing proportion of the physician workforce. An increase in demand for health care services, with demand exceeding the supply of physicians, has contributed to discussions of the potential benefit of delaying physician retirement to help preserve physician supply. The probable increase in the number of senior physicians has been associated with concerns about their competent practice. Central to this issue are the changes that occur as part of normal aging, how such changes might impact medical practice and what steps need to be taken to ensure the competency of senior physicians. We propose that while age may be an important risk factor for performance issues, it is not the only factor and may not even be the most important. Data on cognitive performance among physicians referred for behavioral and performance concerns reveal that cognitive impairment afflicts physicians across the career span. If the overarching goal is to prevent patient harm through early detection, older physicians may be too narrow a target. Approaches focusing on health screening and promotion across the career span will ultimately be more effective in promoting workforce sustainability and patient safety than age-based solutions.
{"title":"Cognitive Screening for Senior Physicians: Are We Minding the Gap?","authors":"C. Bundy, B. Williams","doi":"10.30770/2572-1852-107.2.41","DOIUrl":"https://doi.org/10.30770/2572-1852-107.2.41","url":null,"abstract":"\u0000 Senior physicians are an invaluable community asset that comprise an increasing proportion of the physician workforce. An increase in demand for health care services, with demand exceeding the supply of physicians, has contributed to discussions of the potential benefit of delaying physician retirement to help preserve physician supply. The probable increase in the number of senior physicians has been associated with concerns about their competent practice. Central to this issue are the changes that occur as part of normal aging, how such changes might impact medical practice and what steps need to be taken to ensure the competency of senior physicians. We propose that while age may be an important risk factor for performance issues, it is not the only factor and may not even be the most important. Data on cognitive performance among physicians referred for behavioral and performance concerns reveal that cognitive impairment afflicts physicians across the career span. If the overarching goal is to prevent patient harm through early detection, older physicians may be too narrow a target. Approaches focusing on health screening and promotion across the career span will ultimately be more effective in promoting workforce sustainability and patient safety than age-based solutions.","PeriodicalId":91752,"journal":{"name":"Journal of medical regulation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44891924","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 : 2021-07-01DOI: 10.30770/2572-1852-107.2.8
S. Achar, Nikhil Sinha, W. Norcross
The electronic prescribing of controlled substances (EPCS) is now becoming implemented in most health care practices and pharmacies in the United States. This review aims to detail the steps needed for EPCS adoption and synthesize the most current literature on the benefits and challenges associated with its adoption. Our systematic review of seven published studies from 1990 to 2020 notes the benefits of EPCS in the reduction of errors, fraud, overprescribing, cost and efficiency improvements. There is limited published evidence of challenges, such as the cost of implementation and prescriber burden. With EPCS becoming a nationwide process, further research needs to be conducted to maximize the effectiveness of EPCS and explore additional benefits and challenges. We used a modified version of the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) system for systematic reviews highlighted in the “Cochrane Handbook for Systematic Reviews of Interventions” to assess the quality of the primary studies reviewed.1 Each author was tasked with determining the quality of each primary study reviewed and assigning a quality score of either high, moderate or low quality. Evidence stemming from randomized controlled trials starts as high quality while evidence from observational studies starts as low quality. Quality can be lowered by five factors: risk of bias, imprecision, inconsistency, indirectness, and publication bias and can be raised by a large magnitude of effect and a clear dose-response gradient. We extracted data from the text, tables and graphs of the original publications. Appendix A illustrates the quality of the studies. Databases reviewed included PubMed, Google Scholar, Cochrane and SCOPUS. The search was started in 1990, with the first wave of the opioid epidemic and the first published studies of e-prescribing, and continued to the year of 2020. The key phrases “electronic prescribing of controlled substances,” “e-prescribing of controlled substances,” “fraudulent prescribing of controlled substances,” “EPCS with PDMP,” and “drug interactions with e-prescribing of controlled drugs” were used as an inclusion criterion to search online scholarly databases for articles. Only primary and secondary data from reports, reviews and research studies written in English were included. The Centers for Disease Control (CDC), National Institute on Drug Abuse (NIDA), Drug Enforcement Administration (DEA), Substance Abuse and Mental Health Services Administration (SAMHSA), American Academy of Family Medicine (AAFP), and nationally represented health information networks were used to obtain updated statistics regarding EPCS.
{"title":"The Adoption and Increased Use of Electronic Prescribing of Controlled Substances","authors":"S. Achar, Nikhil Sinha, W. Norcross","doi":"10.30770/2572-1852-107.2.8","DOIUrl":"https://doi.org/10.30770/2572-1852-107.2.8","url":null,"abstract":"\u0000 The electronic prescribing of controlled substances (EPCS) is now becoming implemented in most health care practices and pharmacies in the United States. This review aims to detail the steps needed for EPCS adoption and synthesize the most current literature on the benefits and challenges associated with its adoption. Our systematic review of seven published studies from 1990 to 2020 notes the benefits of EPCS in the reduction of errors, fraud, overprescribing, cost and efficiency improvements. There is limited published evidence of challenges, such as the cost of implementation and prescriber burden. With EPCS becoming a nationwide process, further research needs to be conducted to maximize the effectiveness of EPCS and explore additional benefits and challenges. We used a modified version of the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) system for systematic reviews highlighted in the “Cochrane Handbook for Systematic Reviews of Interventions” to assess the quality of the primary studies reviewed.1 Each author was tasked with determining the quality of each primary study reviewed and assigning a quality score of either high, moderate or low quality. Evidence stemming from randomized controlled trials starts as high quality while evidence from observational studies starts as low quality. Quality can be lowered by five factors: risk of bias, imprecision, inconsistency, indirectness, and publication bias and can be raised by a large magnitude of effect and a clear dose-response gradient. We extracted data from the text, tables and graphs of the original publications. Appendix A illustrates the quality of the studies. Databases reviewed included PubMed, Google Scholar, Cochrane and SCOPUS. The search was started in 1990, with the first wave of the opioid epidemic and the first published studies of e-prescribing, and continued to the year of 2020. The key phrases “electronic prescribing of controlled substances,” “e-prescribing of controlled substances,” “fraudulent prescribing of controlled substances,” “EPCS with PDMP,” and “drug interactions with e-prescribing of controlled drugs” were used as an inclusion criterion to search online scholarly databases for articles. Only primary and secondary data from reports, reviews and research studies written in English were included. The Centers for Disease Control (CDC), National Institute on Drug Abuse (NIDA), Drug Enforcement Administration (DEA), Substance Abuse and Mental Health Services Administration (SAMHSA), American Academy of Family Medicine (AAFP), and nationally represented health information networks were used to obtain updated statistics regarding EPCS.","PeriodicalId":91752,"journal":{"name":"Journal of medical regulation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45000006","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 : 2021-04-01DOI: 10.30770/2572-1852-107.1.7
Derek J Jorgenson, D. Alazawi, J. Bareham, Nicole Bootsman
Overdoses of prescription medications continue to be a significant concern for health systems around the world. Medical regulators in several jurisdictions have started generating personalized prescribing profiles for individual physicians as an audit and feedback tool to reduce the sub-optimal prescribing of high-risk drugs such as opioids, benzodiazepines and stimulants. However, little is known about how to most effectively communicate the data in these prescriber profiles to the intended recipients. The aim of this study was to collect the opinions of physicians in Saskatchewan, Canada, regarding their personalized prescriber profiles. One-on-one semi-structured interviews were completed in January 2019 with 17 physicians who were given access to personalized profiles containing their prescribing information on opioids, benzodiazepines, stimulants and gabapentin. Interviews were recorded and data was analyzed using thematic analysis. Respondents thought the profiles were a useful tool that had significant potential to improve their prescribing practices. However, many physicians also thought the profiles were confusing and difficult to interpret. Several recommendations were made to improve the prescriber profiles, which may be applicable to other jurisdictions currently using, or planning to develop, similar quality improvement tools. These recommendations include: limiting the use of abbreviations and acronyms; being explicit regarding the intent of the profiles; ensuring comparator data is relevant to the individual recipient; using a combination of numbers and visuals to display data; and providing detailed context regarding what the data means.
{"title":"Saskatchewan Physicians’ Opinions of Their Personalized Prescribing Profiles Related to Opioids, Benzodiazepines, Stimulants, and Gabapentin","authors":"Derek J Jorgenson, D. Alazawi, J. Bareham, Nicole Bootsman","doi":"10.30770/2572-1852-107.1.7","DOIUrl":"https://doi.org/10.30770/2572-1852-107.1.7","url":null,"abstract":"\u0000 Overdoses of prescription medications continue to be a significant concern for health systems around the world. Medical regulators in several jurisdictions have started generating personalized prescribing profiles for individual physicians as an audit and feedback tool to reduce the sub-optimal prescribing of high-risk drugs such as opioids, benzodiazepines and stimulants. However, little is known about how to most effectively communicate the data in these prescriber profiles to the intended recipients. The aim of this study was to collect the opinions of physicians in Saskatchewan, Canada, regarding their personalized prescriber profiles. One-on-one semi-structured interviews were completed in January 2019 with 17 physicians who were given access to personalized profiles containing their prescribing information on opioids, benzodiazepines, stimulants and gabapentin. Interviews were recorded and data was analyzed using thematic analysis. Respondents thought the profiles were a useful tool that had significant potential to improve their prescribing practices. However, many physicians also thought the profiles were confusing and difficult to interpret. Several recommendations were made to improve the prescriber profiles, which may be applicable to other jurisdictions currently using, or planning to develop, similar quality improvement tools. These recommendations include: limiting the use of abbreviations and acronyms; being explicit regarding the intent of the profiles; ensuring comparator data is relevant to the individual recipient; using a combination of numbers and visuals to display data; and providing detailed context regarding what the data means.","PeriodicalId":91752,"journal":{"name":"Journal of medical regulation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44216603","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 : 2021-04-01DOI: 10.30770/2572-1852-107.1.17
Lisa Qiu, Jennifer M. Zech, K. Brigham, T. Gallagher
Current models governing how boards of medicine regulate the practice of medicine rely heavily on concepts from the past. Changes in our understanding of how medical errors occur, as well as in the organization and delivery of health care, have created challenges for boards when addressing medical errors. We conducted a qualitative study to explore the principles that boards use to respond to medical errors and to identify opportunities for improvement. Twenty key informant interviews were conducted with board members and staff, followed by two focus group discussions with 16 participants who actively participate in the process of medical regulation. Our results show that the major principles guiding boards of medicine in regulation around medical errors include fairness, consistency, efficiency and transparency. Implementation of these principles proved difficult, partly because of boards’ lack of authority over health care institutions. We recommend the development of a broader array of tools for boards to use in response to medical errors. Increased efforts are also needed to strengthen communication and collaboration among boards, physicians and health care organizations. Additionally, we suggest that boards implement and report performance metrics to promote public engagement and enhance trust in them.
{"title":"Strategies to Enhance Boards of Medicine Responses to Medical Error","authors":"Lisa Qiu, Jennifer M. Zech, K. Brigham, T. Gallagher","doi":"10.30770/2572-1852-107.1.17","DOIUrl":"https://doi.org/10.30770/2572-1852-107.1.17","url":null,"abstract":"\u0000 Current models governing how boards of medicine regulate the practice of medicine rely heavily on concepts from the past. Changes in our understanding of how medical errors occur, as well as in the organization and delivery of health care, have created challenges for boards when addressing medical errors. We conducted a qualitative study to explore the principles that boards use to respond to medical errors and to identify opportunities for improvement. Twenty key informant interviews were conducted with board members and staff, followed by two focus group discussions with 16 participants who actively participate in the process of medical regulation. Our results show that the major principles guiding boards of medicine in regulation around medical errors include fairness, consistency, efficiency and transparency. Implementation of these principles proved difficult, partly because of boards’ lack of authority over health care institutions. We recommend the development of a broader array of tools for boards to use in response to medical errors. Increased efforts are also needed to strengthen communication and collaboration among boards, physicians and health care organizations. Additionally, we suggest that boards implement and report performance metrics to promote public engagement and enhance trust in them.","PeriodicalId":91752,"journal":{"name":"Journal of medical regulation","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44527084","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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