Journal of pain and symptom management最新文献

{"title":"Acute Intestinal Pseudo-Obstruction in an Infant with Hypoxic Ischemic Encephalopathy: A Palliative Approach with Neostigmine.","authors":"Sonia Brar, Katherine Boone","doi":"10.1016/j.jpainsymman.2025.04.019","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.04.019","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated with Cancer Patients' Preferences for Telemedicine or In-Person Palliative Care.","authors":"Min Ji Kim, Michael Tang, Terry Taylor, Minxing Chen, David Hui, Akhila Reddy, Santhosshi Narayanan, Eduardo Bruera","doi":"10.1016/j.jpainsymman.2025.05.002","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.05.002","url":null,"abstract":"<p><strong>Context: </strong>Prior studies demonstrate sociodemographic factors as barriers to telemedicine. Greater understanding of telemedicine preferences in cancer patients receiving palliative care and factors associated with their preferences could inform future care delivery in this vulnerable population.</p><p><strong>Objectives: </strong>This study aimed to identify cancer patients' preferences for in-person versus telemedicine palliative care visits in real-world clinical practice and associated patient-centric factors.</p><p><strong>Methods: </strong>This was a retrospective study involving chart review of in-person or telemedicine palliative care visits between September 2021 and October 2021, during which patients' preferences for telemedicine or in-person visits and perceived difficulty coming in-person were routinely asked. Their answers were collected from the electronic chart. Associations between visit preference and sociodemographic and clinical factors were identified.</p><p><strong>Results: </strong>Of 400 patients, mean age was 59 years. 217 (54%) were female. 285 (71%) were White. Most had advanced cancer (344; 86%). 83% (n=333) preferred telemedicine. 72% (n=288) cited difficulty coming in-person. On univariate analysis, female gender (p=0.03), college completion (p<0.01), and perceived difficulty coming in-person (p<0.01) were associated with preferring telemedicine. Positive Cut-Down, Annoyed, Guilty, Eye-Opener-Adapted to Include Drugs (CAGE-AID) score (p=0.02) was associated with in-person preference. On multivariate analyses, perceived difficulty coming in-person was associated with telemedicine preference (OR: 16.81; 95% CI: 7.91-35.28; p<0.01). A positive CAGE-AID score was associated with in-person preference (OR: 0.17; 95% CI: 0.05-0.59; p=0.01).</p><p><strong>Conclusion: </strong>Most patients having outpatient palliative care visits preferred telemedicine. Perceived difficulty coming in-person was associated with telemedicine preference. Patients with positive CAGE-AID scores were less likely to prefer telemedicine.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Manuscript Title: Defining and Characterizing Inappropriate Goals of Care Designation-A 10 year retrospective multicenter ICU cohort study.","authors":"Selena Au, Paloma Perepeluk, Andrea Soo, Jessica Simon","doi":"10.1016/j.jpainsymman.2025.04.015","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.04.015","url":null,"abstract":"<p><strong>Background: </strong>Goals of Care Designation (GCD) is a medical order used to describe and communicate the general aim of care. It includes a \"code status\" that guides the healthcare team on which interventions to offer during acute clinical deterioration. Inappropriate GCD occurs when there is lack of communication on the patient's wishes and values in the context of their health status, documentation of the conversation and plan, or agreement on medical effectiveness between patient, family and health care team stakeholders. The frequency of inappropriate GCD, the contributing factors, and their outcomes in ICUs are unknown.</p><p><strong>Methods: </strong>Using an existing quality assurance database, we conducted a retrospective multicenter cohort study of adult patients who died in the ICU between January 1, 2010 and December 31, 2019 to determine the frequency, etiology, and associated stakeholder and contextual features of patients flagged with goals of care concern by physician reviewers.</p><p><strong>Results: </strong>Of 4656 patients who died in the ICU and underwent a standardized morbidity and mortality review, 265 cases (5.7%) met criteria for inappropriate GCD for further analysis. Cases had one or more elements of suboptimal communication (n=119, 44.9%), documentation practices (n=77, 29.1%), or agreement of stakeholders (n = 115, 43.4%). Escalation in GCD to more intensive resuscitation orders occurred in 57 cases (21.5%) with common contextual features of crisis communication in the ER, or in preparation for a surgery or procedure.</p><p><strong>Conclusion: </strong>We validated one definition of inappropriate GCD through a large retrospective cohort that can be used as a baseline incidence for future QI endeavors. Through this cohort analysis, a breadth of system opportunities to reduce inappropriate care through optimization of communication, documentation, and stakeholder decision-making processes is described.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain Management in Frail Hip Fracture Patients Receiving Palliative Care: A Descriptive Study.","authors":"Alexandra Tremblay, Stéphane Pelet, Étienne Belzile, Chantal Morency, Norbert Dion, Sandrine Linsotan, Diane Tapp, Axel Benhamed, Marc-Aurèle Gagnon, Fabian Severino, Mélanie Bérubé","doi":"10.1016/j.jpainsymman.2025.04.012","DOIUrl":"10.1016/j.jpainsymman.2025.04.012","url":null,"abstract":"<p><strong>Context: </strong>Adequate pain management in frail hip fracture patients receiving nonoperative treatment has been identified as an important issue. Palliative care could be an option to consider to ensure a comfortable end of life for these patients.</p><p><strong>Objectives: </strong>This study aimed to describe pain relief in frail patients admitted to palliative care following a hip fracture, and the pain management strategies used among them.</p><p><strong>Methods: </strong>This descriptive monocentric observational study included a retrospective phase, based on a review of medical records, and a prospective phase, by direct observation of patients. Data collection took place within the first five days following admission to palliative care. Pain was assessed with the ALGOPLUS scale. Data on pharmacological and nonpharmacological pain management strategies were collected from medical records.</p><p><strong>Results: </strong>A total of 61 patients with a mean age of 87 years (±7) and severe frailty were included. The proportion of patients with pain at rest ranged from 30% on day 1 to 10% on day 5, and from 71% to 32% during mobilization. The mean oral morphine equivalent daily dose administered ranged from 13.1 mg (±10.7) to 21.9 mg (±16.2). On average, 75% of patients received co-analgesics, and nonpharmacological strategies were applied in 33% of them over the five-day of data collection period.</p><p><strong>Conclusion: </strong>Pain remains an issue in frail patients with a nonoperated hip fracture, despite the provision of palliative care. Optimizing pain management, particularly ahead of mobilization, remains a crucial and underexplored area to address for this population.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing Palliative Care Development in Mexico through the WHO Actionable Indicators Model.","authors":"Jorge Alberto Ramos-Guerrero, Gregorio Zuniga-Villanueva, Beatriz Dorsey-Rivera, Leticia Ascencio-Huertas, Silvia Allende-Perez, Guillermo Aréchiga-Ornelas, Alfredo Covarrubias-Gómez, Elena Espín-Paredes, Uria Guevara-López, Luis Miguel Hernández-Flores, Adriana Templos-Esteban, Monica Osio-Saldaña, Livier Ortiz-Coronado, Bernardo Villa-Cornejo","doi":"10.1016/j.jpainsymman.2025.04.013","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.04.013","url":null,"abstract":"<p><strong>Context: </strong>Assessing the development of palliative care (PC) is essential to advancing PC delivery worldwide. The World Health Organization (WHO) offers a new conceptual model for assessing PC development that focuses on identifying gaps in service provision, which helps define priorities and guide decisions. Previous reports ranked Mexico at a high level of PC development, described as an early integration stage in the health system. However, this updated framework offers a more profound and holistic analysis by providing previously unavailable data.</p><p><strong>Objectives: </strong>To document the current state of PC development in Mexico through the WHO actionable indicators model.</p><p><strong>Methods: </strong>Six components were measured: a) PC provision; b) use of essential medicines; c) education and training; d) research; e) health policies; and f) empowerment of people and communities. Fourteen indicators were individually ranked into four levels of development: 1) emerging, 2) intermediate, 3) established, and 4) advanced.</p><p><strong>Results: </strong>Mexico's PC development has focused on specialization streams for physicians, increased awareness through scientific conferences, publications, and community organizations, and the inclusion of PC in the national basic health package and national and local laws. In contrast, PC development is halted by insufficient PC services, a lack of a national PC authority, association, or plan, limited access to essential medications, and scarce undergraduate education.</p><p><strong>Conclusions: </strong>This study shows a regression in the level of PC development in Mexico through an updated analysis, highlighting the gaps that need to be urgently addressed. These findings help continue PC advocacy, growth, and implementation in the region.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Content and comprehensiveness of goals-of-care documentation in pediatric patients.","authors":"Hannah Riedy, Kiira Lyons, David J Casarett, Megan Jordan, Bryan S Monroe, Erin Eckert, Jessica E Ma","doi":"10.1016/j.jpainsymman.2025.04.014","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.04.014","url":null,"abstract":"<p><strong>Context: </strong>Documented goals-of-care (GOC) conversations promote goal-concordant care; few studies have evaluated the comprehensiveness of this documentation within pediatrics.</p><p><strong>Objective: </strong>To evaluate the content of pediatric GOC documentation within a health system.</p><p><strong>Methods: </strong>GOC notes were written between 7/8/2016 and 9/8/2023 for patients ≤18 years old at one academic health system. Notes were identified by related GOC-specific 'text markers' in the electronic health record. A pediatric GOC codebook was adapted from existing frameworks. Notes were evaluated for the presence of each of seven components from the codebook. Misfiled GOC notes were excluded from analysis.</p><p><strong>Results: </strong>A total of 429 notes were written in the inpatient or outpatient setting across pediatric specialties. Most notes were written by the palliative care service (77.9%) and by attending physicians (77.4%). Most patients were <1 (41.0%) or 1 to 6 years old (23.4%), non-Hispanic (82.9%), and spoke English (90.2%). Of the 91 patients (44.4%) who died before 9/8/2023, the median number of days between their first GOC note and death was 10.3 days (interquartile range (IQR) 1.6-49.0). The median number of GOC components per note was 5.0 out of 7 possible (IQR 4.0-5.5). Frequently documented GOC components were discussion participants (98.1%), goals/fears/priorities (87.6%), and treatment decisions (85.3%). Infrequent components were end-of-life care planning (33.3%) and information preferences (9.8%).</p><p><strong>Conclusion: </strong>Pediatric GOC notes included most GOC components; however, number of components may not reflect the quality and depth of actual discussions. Future research should assess GOC documentation for pediatric patients from diverse backgrounds.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presence.","authors":"Matthew T McEvoy","doi":"10.1016/j.jpainsymman.2025.04.017","DOIUrl":"10.1016/j.jpainsymman.2025.04.017","url":null,"abstract":"","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Olanzapine for Managing Side Effects From Antiangiogenic Tyrosine-Kinase Inhibitors.","authors":"Regina M Koch, Miguel Muniz, Candy S Peskey, Aminah Jatoi, Kathryn J Ruddy, Jacob J Orme, Lance C Pagliaro, Fernando Quevedo, Brian A Costello, Megan T Spychalla, Elisabeth I Heath, Yousef Zakharia, Parminder Singh, Oliver Sartor, Irbaz B Riaz, Elizabeth J Cathcart-Rake, Stacy D D'Andre, Charles L Loprinzi, Daniel S Childs","doi":"10.1016/j.jpainsymman.2025.04.016","DOIUrl":"10.1016/j.jpainsymman.2025.04.016","url":null,"abstract":"<p><strong>Context: </strong>Side effects from tyrosine kinase inhibitors (TKIs) are common and burdensome. Olanzapine is useful for managing symptoms from conventional chemotherapy, but its role in treating TKI-related side effects is unclear.</p><p><strong>Objectives: </strong>Examine the efficacy of olanzapine for TKI-induced nausea, vomiting, anorexia, weight loss, and insomnia.</p><p><strong>Methods: </strong>All patients prescribed olanzapine with lenvatinib, cabozantinib, axitinib, or tivozanib at Mayo Clinic between January 2018 and June 2024 were assessed for inclusion. For baseline assessment, clinical notes documenting symptoms and indication(s) for starting olanzapine were reviewed. Notes and portal messages from the first three months after starting olanzapine were then evaluated for qualitative descriptions of change in symptom burden. Data were categorized as \"improved,\" \"worsened,\" \"stable,\" or \"missing data,\" with each symptom domain analyzed independently, when olanzapine was prescribed for multiple interrelated symptoms.</p><p><strong>Results: </strong>Sixty patients received olanzapine, most commonly 5 mg (n = 37, 61.7%) or 2.5 mg (n = 16, 26.6%). Indications included nausea without vomiting (n = 35), anorexia (n = 25), nausea with vomiting (n = 16), weight loss (n = 16), and insomnia (n = 11). It was given for multiple symptoms in 32 patients. Within the first 3 months, 85% of patients had improvement in nausea without vomiting, 93% in nausea with vomiting, 74% in appetite, and 85% in sleep. Among 34 patients with weight loss prior to olanzapine, 50% gained weight (median: 6.1 kg), 26% stabilized (±1 kg), and 24% continued to lose weight. Only 4 patients discontinued olanzapine due to side effects.</p><p><strong>Conclusion: </strong>Olanzapine appears effective in treating TKI-induced nausea, vomiting, anorexia, insomnia, and weight loss, warranting further investigation in prospective studies.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Loneliness in Advanced Life-Threatening Illness: An Integrative Review.","authors":"Carolyn Blair, Tracey McConnell, Natasha Bradley, Anne Finucane, Briony Hudson, Angela McCullagh, Austin Orr, Sharon Paradine, Katarzyna Patynowska, Joanne Reid","doi":"10.1016/j.jpainsymman.2025.04.008","DOIUrl":"10.1016/j.jpainsymman.2025.04.008","url":null,"abstract":"<p><strong>Context: </strong>To inform supportive interventions, experiences of loneliness must be understood specifically from the perspective of those with advanced life-threatening illness and their caregivers.</p><p><strong>Objectives: </strong>To identify the causes, experiences, and impacts of loneliness among adults with advanced life-threatening illnesses and caregivers, and which modifiable factors might mitigate loneliness.</p><p><strong>Methods: </strong>Systematic searching of six databases (CINHAL, Web of science, Cochrane central, Medline, HMIC and Proquest) was supplemented by backward citation searching from Jan 2014-Jan2024. This was followed by screening and selection based on the PRISMA extension for scoping reviews (PRISMA-ScR) guidelines. Studies were imported into NVivo version 1.6 for data management. An inductive approach was used to facilitate the synthesis. Quality assessment with diverse studies (QuADS) was used. The review protocol was registered with Prospero, ID: CRD42023493999.</p><p><strong>Results: </strong>Ninteen observational studies and 6 intervention studies were included in this review. Evidence confirms that the causes, impacts and outcomes of loneliness are multifaceted and interact dynamically. Risk factors on a micro level include psychological and existential factors such as emotional distress and fear of death; potentially modifiable factors include efforts to enhance communication and befriending programs. On meso level physical and social factors are risk factors such as symptom burden and social withdrawal, potentially modifiable factors include utilizing technology to make home an accessible place to maintain social connections. On a macro level environmental and societal risk factors include mobility restrictions and stigma; potentially modifiable factors include increasing societal engagement through community programs CONCLUSION: This integrative review will help healthcare providers, policymakers and the public understand the causes, experiences and impact of loneliness in adults with advanced life-threatening illnesses and their caregivers. The evidence suggests that an integrated approach that combines personal, social, and systemic efforts is needed which includes enhanced communication, targeted interventions, robust support systems, and community engagement. Rigorous research studies are required which include patient and public involvement from inception to completion to ensure that the study designs and methodologies are purposeful for those they intend to serve.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuation of Potentially Inappropriate Life-Sustaining Therapies: Provider Perspectives.","authors":"Rebekka DePew, Kemberlee Bonnet, David Schlundt, Jessica Turnbull, Rebecca Propper","doi":"10.1016/j.jpainsymman.2025.04.011","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.04.011","url":null,"abstract":"<p><strong>Background: </strong>Prior work examines provider perspectives on withholding potentially inappropriate life-sustaining treatments over family objections; however, data are limited regarding how physicians approach situations in which they are considering withholding or withdrawing life-sustaining therapies against the wishes of the patient's family.</p><p><strong>Measures: </strong>This study sought to better understand the way in which pediatric critical care clinicians navigate situations in which families request life-sustaining therapies that the team feels may be inappropriate.</p><p><strong>Outcomes: </strong>We conducted a series of semi-structured group interviews with pediatric critical care faculty and used these data to create a case-based, ten-question ethical dilemma survey, which was disseminated nationally to pediatric intensivists. This paper explores participant responses to survey question three, which presented a case in which family requests continuation of ventilatory/nutritional support after severe traumatic brain injury with minimal recovery potential.</p><p><strong>Outcomes: </strong>Most participants reported that they would offer the requested interventions; however, there was substantial variation among participants regarding the best next steps. Participants who chose to submit free-text responses described thoughtfully attempting to balance avoiding prolongation of suffering and respecting parents' roles as decision-makers for their child.</p><p><strong>Conclusions/lessons learned: </strong>The variation between participants in their approach to this ethical dilemma underscores its difficulty, as well as the importance of institutional support structures (e.g. ethics, legal, risk management, palliative care). In a healthcare system with limited resources to support families taking care of critically ill and technology-dependent children, our study underscores a need for training, practice, and institutional support for physicians assisting families in navigating these decisions.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}