Journal of pharmacy practice最新文献

{"title":"Introduction of a Pre-admission Pharmacist Service Utilising the Surgical Ward Pharmacist.","authors":"Thao Dao, Patrick Lam","doi":"10.1177/08971900241262541","DOIUrl":"10.1177/08971900241262541","url":null,"abstract":"<p><p><b>Background:</b> The challenge with obtaining a best possible medication history (BPMH) post-surgery is the delay in clarifying medications due to decreased post-operative cognitive status and pain, which can lead to missed or late administration of medications. Studies have suggested that unintentional medication discrepancies at the time of admission are common in general medical patients. <b>Objectives:</b> To investigate if a pre-admission pharmacist completing BPMHs for adult elective surgery patients with planned overnight admission increases the proportion of patients with (i) a BPMH completed, (ii) medication reconciliation completed and (iii) all home medications charted correctly within 24 hours of admission. <b>Methods:</b> Patients in the pre-intervention group had a BPMH completed on admission as standard of care. Patients in the post-intervention group were contacted by the pre-admission pharmacist 1 to 3 business days prior to admission to complete a BPMH. The pre-admission pharmacist role was performed by a surgical ward pharmacist in addition to their daily workload. Descriptive statistics, Chi-squared test and Mann-Whitney U test were used to analyse the data. <b>Results:</b> The post-intervention group had more patients with a completed BPMH (47.2% vs 25.3%, <i>P</i> = .005), medication reconciliation (43.8% vs 15.5%, <i>P</i> = .0001) and all home medications charted correctly (36% vs 16.9%, <i>P</i> = .007) within 24 hours of admission compared with the pre-intervention group. <b>Conclusion:</b> The introduction of a pre-admission service utilising the surgical ward pharmacist increased the proportion of patients with a completed BPMH, medication reconciliation and home medications charted correctly within 24 hours of admission.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"35-42"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141331224","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":"The Effects of Opioid Administration on <i>Clostridioides Difficile</i> Infection: A Retrospective Cohort Study.","authors":"Erin Anderson, Brooke Hendrix Brown, Skyler Brown, Nikki Freeman, John R Yates","doi":"10.1177/08971900241273092","DOIUrl":"10.1177/08971900241273092","url":null,"abstract":"<p><p><b>Background:</b> <i>Clostridioides difficile</i> (<i>C. difficile</i>) is a leading cause of healthcare-associated infections. Using opioids while infected with <i>C. difficile</i> may hypothetically lead to reduced clearance of the organism and higher risk of progressing to severe or fulminant infection. <b>Objective:</b> The objective of this study was to determine if opioid use leads to worsening of <i>C. difficile</i> infection. <b>Methods:</b> This was a single-center, retrospective cohort study of patients with <i>C. difficile</i> infection. The primary endpoint was progression to severe or fulminant disease, defined as serum creatinine greater than 1.5 mg/dL or over 50% of baseline, white blood cells above 15,000 cells/mm³, shock requiring vasopressors, ileus, toxic megacolon, or vancomycin dose increase. Secondary outcomes included hospital length of stay and time to resolution of diarrhea. The groups were stratified based on average morphine milligram equivalents received during the treatment. <b>Results:</b> A total of 73 patients were included in the non-opioid group and 93 patients in the opioid group. The composite outcome occurred in 16 patients (21.9%) without opioids vs 26 patients (28.0%) with opioids; (<i>P</i> = 0.37). The average length of stay was 7.2 days without opioids and 9.3 days with opioids (<i>P</i> = 0.11) and the average time to resolution of diarrhea was 3.5 days without opioids and 5.5 days with opioids (<i>P</i> = 0.40). <b>Conclusion:</b> There was no significant difference in the rate of progression to severe or fulminant disease. There was a numerical trend towards increase in progression in patients who had opioids, primarily driven by those who had higher dosages of opioids used.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"69-73"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897661","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":"Bupropion in Comorbid Post-Traumatic Stress Disorder and Methamphetamine Use Disorder.","authors":"Jamie Kneebusch, Sanaz Farhadian","doi":"10.1177/08971900241276698","DOIUrl":"10.1177/08971900241276698","url":null,"abstract":"<p><p><b>Background:</b> Post-traumatic stress disorder (PTSD) and substance use disorder (SUD) frequently occur together. Serotonergic agents are preferred medications to treat PTSD, while bupropion is reserved due to limited evidence. Ongoing studies suggest bupropion may be effective for treating methamphetamine use disorder (MUD). Investigators aimed to evaluate if bupropion would confer benefit to patients with Diagnostic and Statistical Manual of Mental Disorders, Fifth edition diagnoses for PTSD and MUD compared to traditional pharmacotherapy. <b>Methods:</b> This report describes four patients with comorbid PTSD and MUD who had a positive response to medication regimens containing bupropion compared to non-bupropion regimens for their trauma symptoms. Investigators were able to compare this to a control group of 41 patients receiving serotonergic agents alone. <b>Case Report:</b> PTSD checklist-civilian scores at time of medication initiation, site discharge, and post-discharge in the bupropion and non-bupropion group were 77, 35, and 29, compared to 51 ± 15, 52 ± 20 and 53 ± 10, respectively. Rates of relapse, average time to relapse, and hospital utilization in the bupropion vs non-bupropion group were 25.0% vs 48.8%, 107 days vs 210 ± 191 days, and 0% vs 29.3%, respectively. <b>Discussion:</b> Use of bupropion showed a greater reduction in PTSD symptom severity and a lower frequency of methamphetamine relapse and hospital utilization. Though missing data limited inclusion of patients in all outcomes, quantitative data suggests benefit with bupropion in comorbid PTSD and MUD. <b>Conclusion:</b> This case series suggests the potential for earlier initiation of bupropion treatment in those with PTSD who have comorbid MUD.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"208-211"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142036117","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":"The Impact of a Methicillin-Resistant Staphylococcus Aureus Nasal Polymerase Chain Reaction Protocol on Vancomycin Length of Therapy Among Patients With Skin and Soft Tissue Infections.","authors":"Anel Couzo, Adia Griffin, Courtney M Willis, Julio Mendez, Kevin L Epps","doi":"10.1177/08971900241273175","DOIUrl":"10.1177/08971900241273175","url":null,"abstract":"<p><p><b>Objective:</b> We evaluated the impact of a methicillin-resistant Staphylococcus aureus (MRSA) nasal polymerase chain reaction (PCR) protocol on the vancomycin length of therapy (LOT) for skin and soft tissue infections (SSTIs). <b>Design:</b> Retrospective quasi-experimental pre- and post- MRSA nasal PCR protocol implementation study. <b>Setting:</b> Tertiary-care academic medical center in Jacksonville, Florida. <b>Patients:</b> Eligible patients received empiric vancomycin for SSTIs from January 1st to September 30th 2020 (pre-implementation group) and from January 1st to September 30th 2022 (post-implementation group). <b>Intervention:</b> The electronic health system software was modified to provide a best-practice advisory (BPA) prompt to the pharmacist upon order verification of vancomycin for patients with SSTIs. <b>Methods:</b> We reviewed patient records to determine the time from vancomycin prescription to de-escalation. The secondary outcomes were incidence of acute kidney injury (AKI), number of vancomycin levels collected, and hospital length of stay (LOS). <b>Results:</b> The study included 131 patients (pre-implementation, n = 86 and post-implementation, n = 45). There was no significant difference in vancomycin length of therapy (LOT) between implementation groups: mean LOT in days and standard deviation (SD) were 2.7 (1.9) and 2.6 (1.3), respectively, p-value 0.493. Of significance, in the post-implementation group, vancomycin LOT between patients with a negative and positive MRSA PCR were 2.3 (1.1) and 3.9 (1.6), p-value 0.006. There was no difference in secondary outcomes. <b>Conclusion:</b> The utilization of the MRSA nasal PCR to guide vancomycin de-escalation did not significantly change the vancomycin LOT, however in the post-implementation group there was a significant difference in vancomycin LOT between negative and positive MRSA PCRs.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"93-98"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141913069","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":"Nationwide Survey to Characterize and Compare the Research Experiences of American Society of Health-System Pharmacists-Accredited Postgraduate Year One Pharmacy Residency Programs.","authors":"Andrea Dressler, Robert W Seabury, William Darko, Wesley D Kufel, Jeffrey M Steele, Courtney Kelly, Ryan Andrew, Zachary Hayes, Christopher D Miller, Katie A Parsels","doi":"10.1177/08971900241273223","DOIUrl":"10.1177/08971900241273223","url":null,"abstract":"<p><p><b>Background:</b> Many Postgraduate Year One (PGY1) Pharmacy residencies provide research training however, details of this training are not well described. Publication rates have been utilized to assess residency research learning experiences. Higher publication rates have been reported by programs that have implemented a structured research learning experience. <b>Objective:</b> The primary objective was to identify differences in the research learning experiences for American Society of Health-System Pharmacists (ASHP) accredited PGY1 Pharmacy residencies with reported resident publication rates of ≥20% vs <20%. <b>Methods:</b> This survey was distributed to PGY1 Pharmacy residency program directors (RPDs). Seven sections were analyzed to identify research learning experience differences between programs with reported publication rates of ≥20% vs <20%: (1) program characteristics/research outcomes; (2) involved individuals; (3) requirements; (4) learning experience structure; (5) educational methods; (6) formal education; (7) barriers/RPD perceptions. Variables with <i>P</i> < 0.05 on logistic regression were considered statistically significant. <b>Results:</b> The survey response rate was 31.3% (308/984). Significant positive predictors for reported publication rates of ≥20% were: involved individuals: research director/coordinator, individuals trained in statistics, non-pharmacy medical staff; requirements: Collaborative Institutional Training Initiative training, research seminars/training courses, research manuscript; learning experience structure: research committee; educational methods: didactic residency-led lectures/courses, formal workshops, self-taught online modules; and formal education: manuscript preparation. <b>Conclusion:</b> This study suggests there are differences in the research learning experiences at PGY1 Pharmacy residencies with reported resident publications rates of ≥20% vs <20%. We encourage PGY1 Pharmacy residency programs to consider implementing elements associated with reported resident publication rates of ≥20%.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"128-140"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008957","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":"A Pilot Study Describing DOAC Level Results and Association With Clinical Outcomes.","authors":"Brittni Gochnauer, Anne Rodino, Sarah Russell, Kristin Bradley","doi":"10.1177/08971900241262363","DOIUrl":"10.1177/08971900241262363","url":null,"abstract":"<p><p><b>Purpose:</b> Describe direct oral anticoagulant (DOAC) level ordering and interpretation practices in association with clinical outcomes at a vascular medicine clinic. <b>Methods:</b> This study was a retrospective, observational study including patients who had a DOAC level ordered and assessed while on DOAC therapy. The primary outcome was the proportion of DOAC levels within previously reported ranges. Secondary outcomes included thrombotic events, major and clinically relevant non-major bleeding events, and the proportion of DOAC level results which prompted a change in the therapeutic plan. <b>Results:</b> A total of 43 patients who had a DOAC level ordered while on DOAC therapy were included in the study. More patients were on apixaban than other DOACs, and the most common indication for anticoagulation was deep vein thrombosis (DVT) or pulmonary embolism (PE). The most common reasons for ordering DOAC levels included history of gastric bypass (n = 20) and drug-drug interactions (n = 8). Most patients on apixaban had in-range levels (n = 24) compared to out of-range levels (5 patients). More patients on rivaroxaban had a level out-of-range (n = 10) than in-range (n = 4). One patient had a DVT, resulting in hospitalization and change in DOAC therapy. Two patients had bleeding events, with 1 hospitalization and change in DOAC therapy. DOAC level results also prompted changes in therapeutic plans for 9 of the patients. <b>Conclusion:</b> DOAC level results did not always correlate with expected outcomes, and further research is warranted to clarify which clinical situations may benefit from ordering DOAC levels.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"149-154"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141331223","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":"Diabetes Care in A Safety Net Hospital: Impact of a Pharmacist Transitional Care Service.","authors":"Shanelle M Murray, Laura M Traynor, Larissa Carli, Heather Rhodes, Ann M Brigino, Rajani M Wikelius","doi":"10.1177/08971900241256776","DOIUrl":"10.1177/08971900241256776","url":null,"abstract":"<p><p><b>Background:</b> Diabetes is associated with increased risk of hospital readmission and imposes a significant economic burden on patients and healthcare systems. Literature suggests that pharmacist-led transitions-of-care (TOC) services reduce hospital readmissions and improve patient outcomes and data within safety-net hospitals is limited. <b>Methods:</b> This was a single-center evaluation to assess the impact of pharmacist-led diabetes TOC services on hospital readmissions among diabetes patients vs standard care (SC). The evaluation included patients admitted from 11/1/2021-2/28/2022 and 10/19/2022-2/28/2023 who had a primary diagnosis of diabetes mellitus, were admitted for a diabetes-related reason, or were seen by the endocrine consult service during admission. The primary outcome was 30-day readmissions. Secondary outcomes included time to readmission, readmission diagnosis, changes in HbA1c, completion of follow-up visits, and number of pharmacist interventions at follow-up. <b>Results:</b> There were 109 patients included (TOC n = 65; SC n = 44) and 13.8% (9/65) of TOC and 18.2% (8/44) of SC patients readmitted within 30 days (<i>P</i> = .235). Average time to readmission was 15.3 days in the TOC and 10.4 days in the SC cohorts. There were no diabetes-related readmissions in the TOC cohort. Over 60% (5/8) of readmissions in the SC cohort were diabetes-related. The average change in HbA1c was -2.5% in the TOC cohort and -1.2% in the SC cohort, <i>P</i> = .046. Approximately 51% of TOC patients completed an outpatient follow-up visit and nearly 70% of those patients had an intervention made at that time. <b>Conclusion:</b> Pharmacist-led diabetes TOC services within a safety-net hospital may reduce hospital readmissions and improve clinical outcomes.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"122-127"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141093613","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":"Alpha2 Agonist Use in Critically Ill Adults: A Focus on Sedation and Withdrawal Prevention.","authors":"Ashley Schuler, Connie H Yoon, Erica Caffarini, Alexander Heine, Alyssa Meester, Danielle Murray, Angela Harding","doi":"10.1177/08971900241263171","DOIUrl":"10.1177/08971900241263171","url":null,"abstract":"<p><p>The management of sedation in critically ill adults poses a unique challenge to clinicians. Dexmedetomidine, an α₂ agonist, has a unique mechanism and favorable pharmacokinetics, making it an attractive intravenous option for sedation and delirium in the intensive care unit. However, patients may be at risk for withdrawal with prolonged use, adding to the complexity of sedation and agitation management in this patient population. Enteral α₂ agents have the benefit of cost savings and ease of administration, thus playing a role in the ability to decrease intravenous sedative use and prevent dexmedetomidine withdrawal. Clonidine and guanfacine are the two most common enteral α₂ agents utilized for this purpose, however, there is a paucity of evidence regarding the comparative benefit between the two agents. The decision to use one vs the other agent should be determined based on their differing pharmacology, pharmacokinetics, and side effect profile. The most effective dosing strategy for these agents is also unknown. Ultimately, more robust literature is required to determine enteral α₂ agonists place in therapy. This narrative review evaluates the currently available literature on the use of α₂ agonists in critically ill adults with an emphasis on sedation, delirium, and withdrawal.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"155-167"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141440546","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":"Development of a Medication-Use Evaluation Template for Andexanet Alfa in the Reversal of Anticoagulation With Factor Xa Inhibitors.","authors":"Toni Fera, Allison Burnett, Jessica Grandoni, Mary R Moore, Barbara B Nussbaum, Charles V Pollack, Anne E Rose, Sarah A Spinler, Michael B Streiff, Charles J Turck, John Fanikos","doi":"10.1177/08971900241263164","DOIUrl":"10.1177/08971900241263164","url":null,"abstract":"<p><p>Medication-use evaluations are meant to ensure that medication-use processes are consistent with prevailing standards of care, assure optimal use of therapy, and reduce the risk of medication-related problems. Reversal agents for direct oral anticoagulants are a worthy focus for medication-use evaluations for reasons of efficacy, safety, and cost. A multidisciplinary team of experts developed 2 medication-use evaluation templates illustrating the application of professional society guidelines to the appropriate use of andexanet alfa.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"7-12"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11639411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141731298","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}

{"title":"Temporal Effect of CYP3A4/5 Induction on Ticagrelor's Pharmacodynamic Effects: A Case Series.","authors":"Thomas W Szymanski, Matthew R Rockhold, Jordan L Lacoste","doi":"10.1177/08971900241273095","DOIUrl":"10.1177/08971900241273095","url":null,"abstract":"<p><p>Ticagrelor is contraindicated in combination with cytochrome P450 3A4 and 3A5 enzyme (CYP3A4/5) inducers due to increased clearance, causing diminished antiplatelet effects. The emergent nature of acute coronary syndromes (ACS) may preclude scrutinization of home medications before P2Y₁₂ inhibitor administration. The purpose of this case series is to establish the temporal impact of CYP3A4/5 enzyme induction on ticagrelor's pharmacodynamic effect by utilizing VerifyNow platelet aggregation studies. This was a retrospective case series of three patients who were taking a CYP3A4/5-inducing medication and loaded with ticagrelor for ACS. The duration of ticagrelor's antiplatelet effect was dramatically shortened in the presence of background CYP3A4/5 induction. The offset of antiplatelet effect, defined by platelet reactivity units (PRU), was 10-24 hours in the presence of CYP3A4/5 enzyme induction compared to the anticipated 36-48 hours. This was consistent across CYP3A4/5-inducing medications including carbamazepine, phenobarbital, and phenytoin. This study demonstrates rapid return of platelet function after a ticagrelor loading dose in the presence of CYP3A4/5-inducing medications. Monitoring of PRU every 6-12 hours with subsequent loading with clopidogrel or prasugrel should be considered. Larger scale studies are warranted to confirm these results.</p>","PeriodicalId":16818,"journal":{"name":"Journal of pharmacy practice","volume":" ","pages":"204-207"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988203","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}