NPJ Primary Care Respiratory Medicine最新文献

{"title":"Prevalence, diagnostic accuracy, and healthcare utilization patterns in patients with COPD in primary healthcare: a population-based study.","authors":"Marc Vila, Antoni Sisó-Almirall, Andrea Ocaña, Alvar Agustí, Rosa Faner, Alicia Borras-Santos, Luis González-de Paz","doi":"10.1038/s41533-025-00419-9","DOIUrl":"10.1038/s41533-025-00419-9","url":null,"abstract":"<p><p>Underdiagnosis and overdiagnosis commonly occur in Chronic Obstructive Pulmonary Disease (COPD) patients. We assessed diagnostic accuracy, clinical characteristics, healthcare utilization, and care plan registration for patients undergoing primary care. We conducted a cross-sectional, population-based study using a health record registry from four primary healthcare centers in Catalonia (Spain) for patients aged ≥15 years. The variables included sociodemographic characteristics, dyspnea, comorbidities, spirometry results, treatments, and healthcare use. Logistic regression models were used to analyze differences between patients with and without airflow limitation, and ordinal logistic regression models were used to examine the association between disease severity and healthcare use. Among the 2610 patients, 54% had spirometry data, 29.5% had confirmed airflow obstruction, and 24% were overdiagnosed according to the GOLD criteria. Patients without airflow obstruction were younger (OR: 0.98, 95% CI: 0.96-0.99) and more likely to be current smokers (OR: 1.44, 95% CI: 1.13-1.84). Airflow obstruction severity was significantly associated with increased use of emergency home ambulance use (OR: 1.7, 95% CI: 1.23-2.35), emergency department visits (OR: 1.48, 95% CI: 1.11-1.99), and hospital admission (OR: 1.8, 95% CI: 1.32-2.47), but not primary care visits and follow-up frequency. COPD is frequently overdiagnosed in primary healthcare settings. The severity of airflow obstruction is associated with increased healthcare utilization, including hospital admissions. Improved diagnostic accuracy and management may enhance COPD care and reduce healthcare costs.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":"35 1","pages":"17"},"PeriodicalIF":3.1,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11928675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143677115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Qualitative insights into planning implementation of FeNO-guided asthma management in primary care.","authors":"G Lewis, K Morton, M Santillo, L Yardley, K Wang, B Ainsworth, S Tonkin-Crine","doi":"10.1038/s41533-025-00418-w","DOIUrl":"10.1038/s41533-025-00418-w","url":null,"abstract":"<p><p>Fractional exhaled nitric oxide (FeNO) testing is used in primary care in some areas of the UK to aid asthma diagnosis but is used less frequently for managing asthma. A randomised controlled trial (RCT) is investigating whether an intervention, including FeNO testing and a clinical algorithm, improves outcomes for patients with asthma. This study was conducted to explore potential for implementation of the intervention. The study aim was to explore views of those with a vested interest in implementing the FeNO intervention into primary care asthma reviews. In-depth, semi-structured interviews were conducted online with individuals, including those with experience in policymaking, healthcare management, National Health Service commissioning, as healthcare professionals (HCPs) with extended roles, and patients and advocates. Inductive thematic analysis was conducted for nineteen interviews. Findings suggest complex interplay of barriers, contextual issues and facilitators. Overall, participants perceived FeNO-informed asthma management would enhance care, if used appropriately and flexibly according to context, for example planning implementation alongside remote reviews. Easier, equitable access to funded FeNO equipment would be needed for national implementation. Participants suggested motivation of all involved in future implementation may be increased by guidelines recommending FeNO, and by use of financial incentives and champions sharing best practice examples. In conclusion, financial obstacles were reiterated as a primary barrier to FeNO use. Despite barriers, facilitating implementation by harnessing prominent cost-benefits could persuade decision makers and clinicians. Findings lay early foundations for development of an implementation strategy.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":"35 1","pages":"16"},"PeriodicalIF":3.1,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inhalation technique-related errors after education among asthma and COPD patients using different types of inhalers - systematic review and meta-analysis.","authors":"Monika Marko, Rafał Pawliczak","doi":"10.1038/s41533-025-00422-0","DOIUrl":"10.1038/s41533-025-00422-0","url":null,"abstract":"<p><p>In asthma and chronic obstructive pulmonary disease (COPD) incorrect use of inhalers is still common. The aim of the study was to detect whether education improves inhalation skills and whether the type of education influenced the educational effect depending on the device. A systematic review and meta-analysis for errors during inhalation before and after education was performed. The selected data allowed for education assessment of dry powder (DPIs) and pressurised metered dose (pMDI/MDIs) inhalers in a meta-analysis. Education reduced critical errors (risk ratio [RR], 0.28, 95% confidence interval [CI]: 0.17, 0.47, P < 0.00001) and any incorrect use events for DPI (RR = 0.38, 95% CI: 0.21, 0.70, P = 0.002) and pMDI/MDIs, (RR = 0.16, 95% CI: 0.11, 0.23, P < 0.00001). Education improves patient's inhalation skills regardless of the device. The educational effect for pMDI/MDIs depends on the type of educational approach which has not been demonstrated for DPIs.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":"35 1","pages":"15"},"PeriodicalIF":3.1,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The asthma diagnosis jigsaw puzzle: an adaptable teaching concept to facilitate the diagnosis of asthma in adults and children presenting to primary care.","authors":"D Ryan, J W H Kocks, S Williams, J Correia de Sousa, M Barne, M J Bates, I Bouloukaki, L Daines, E Gaillard, V Mak, A Ostrem, A Barnard","doi":"10.1038/s41533-024-00410-w","DOIUrl":"10.1038/s41533-024-00410-w","url":null,"abstract":"<p><p>The asthma diagnosis jigsaw puzzle is a clinical practice and teaching concept conceived in clinical practice and refined through an expert multidisciplinary consensus process by academics and clinicians with an interest in primary respiratory care. The concept incorporates guidance to facilitate the effective diagnosis of adults or children with asthma in primary care where misdiagnosis is common. The jigsaw puzzle metaphor teaches a problem-solving approach to diagnosis, introducing the concept of diagnosis over time and in no particular sequence. Puzzle pieces can be collected from the domains of presentation, history, symptoms and physical examination, as well as objective tests. The clinician's challenge is to complete the diagnostic jigsaw puzzle testing the likelihood of a picture which can be recognised as asthma. This approach aligns with symptom-based pattern-recognition approaches taught to primary care clinicians which gets easier and more reliable with experience. Relational continuity, or informational continuity through the patient record, is integral to the process of puzzle completion. Where non-fitting puzzle pieces are encountered, alternative or additional diagnoses should be considered and/or referral to secondary care pursued. As a metaphor, 'puzzle completion' may be used within clinical communication encounters, addressing the importance of partnership working ('completing the puzzle together'), uncertainty (deciding 'which pieces fit') and changes in symptoms over time (enabling the 'puzzle picture to become clearer'). Adaptation of this teaching concept has started through translation of educational resources, including puzzle pieces. Supporting case vignettes developed locally will contextualise the jigsaw puzzle teaching concept. The Asthma Diagnosis Jigsaw Puzzle teaching concept has been piloted in North Macedonia and is also developed for educational workshops by primary care health educators in Malaysia, India and Uganda.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":"35 1","pages":"14"},"PeriodicalIF":3.1,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11910506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BREATHLEssness in INDIA (BREATHE-INDIA): realist review to develop explanatory programme theory about breathlessness self-management in India.","authors":"Joseph Clark, Naveen Salins, Mithili Sherigar, Siân Williams, Mark Pearson, Seema Rajesh Rao, Anna Spathis, Rajani Bhat, David C Currow, Kirsty Fraser, Srinagesh Simha, Miriam J Johnson","doi":"10.1038/s41533-025-00420-2","DOIUrl":"10.1038/s41533-025-00420-2","url":null,"abstract":"<p><p>Breathlessness is highly prevalent in low and middle-income countries (LMICs). Low-cost, non-drug, breathlessness self-management interventions are effective in high-income countries. However, health beliefs influence acceptability and have not been explored in LMIC settings. Review with stakeholder engagement to co-develop explanatory programme theories for whom, if, and how breathlessness self-management might work in community settings in India. Iterative and systematic searches identified peer-reviewed articles, policy and media, and expert-identified sources. Data were extracted in terms of contribution to theory (high, medium, low), and theories developed with stakeholder groups (doctors, nurses and allied professionals, people with lived experiences, lay health workers) and an International Steering Group (RAMESES guidelines (PROSPERO42022375768)). One hundred and four data sources and 11 stakeholder workshops produced 8 initial programme theories and 3 consolidated programme theories. (1) Context: breathlessness is common due to illness, environment, and lifestyle. Cultural beliefs shape misunderstandings about breathlessness; hereditary, part of aging, linked to asthma. It is stigmatised and poorly understood as a treatable issue. People often use rest, incense, or tea, while avoiding physical activity due to fear of worsening breathlessness. Trusted voices, such as healthcare workers and community members, can help address misconceptions with clear, simple messages. (2) Breathlessness intervention applicability: nonpharmacological interventions can work across different contexts when they address unhelpful beliefs and behaviours. Introducing concepts like \"too much rest leads to deconditioning\" aligns with cultural norms while promoting beneficial behavioural changes, such as gradual physical activity. Acknowledging breathlessness as a medical issue is key to improving patient and family well-being. (3) Implementation: community-based healthcare workers are trusted but need simple, low-cost resources/skills integrated into existing training. Education should focus on managing acute episodes and daily breathlessness, reducing fear, and encouraging behavioural change. Evidence-based tools are vital to gain support from policymakers and expand implementation. Breathlessness management in India must integrate symptom management alongside public health and disease treatment strategies. Self-management interventions can be implemented in an LMIC setting. However, our novel methods indicate that understanding the context for implementation is essential so that unhelpful health beliefs can be addressed at the point of intervention delivery.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":"35 1","pages":"13"},"PeriodicalIF":3.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11906595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A service evaluation following the implementation of computer guided consultation software to support primary care reviews for chronic obstructive pulmonary disease.","authors":"B Chakrabarti, E McKnight, M G Pearson, L Dowie, J Richards, M Choudhury-Iqbal, R Malone, M Osborne, C Cooper, L Davies, R M Angus","doi":"10.1038/s41533-025-00421-1","DOIUrl":"10.1038/s41533-025-00421-1","url":null,"abstract":"<p><p>This study evaluates the impact of using a Clinical Decision Support System software in the form of a computer-guided consultation (CGC) when conducting Chronic Obstructive Pulmonary Disease (COPD) reviews in primary care. 5221 patients on the COPD register underwent CGC review with 21.1% found not to have COPD. Previously unrecognised cardiac disease was highlighted by the CGC in 7% of confirmed COPD cases. CGC review resulted in the number of patients possessing a self-management plan rising from 62-85%. 13% were found to have sub-optimal inhaler technique during CGC review with the CGC prompting correction in all cases. Only 26% of patients identified by the CGC as appropriate for Pulmonary Rehabilitation (PR) referral had previously attended a PR program. The integration of technology in the form of clinical decision support system software results in greater implementation of guideline-level care representing a scalable solution when performing COPD reviews.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":"35 1","pages":"12"},"PeriodicalIF":3.1,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11897336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing competence of primary care respiratory healthcare professionals to deliver a psychologically-based intervention for people with COPD: results from the TANDEM study.","authors":"V Wileman, L Steed, H Pinnock, M Kelly, R Sohanpal, K Heslop-Marshall, Sjc Taylor","doi":"10.1038/s41533-025-00416-y","DOIUrl":"10.1038/s41533-025-00416-y","url":null,"abstract":"<p><p>Management of long-term conditions is a significant challenge in contemporary health care as people often require support for both physical and psychological symptoms. Assessing the competence of healthcare professionals delivering psychologically informed interventions informs decisions about future implementation. This is a comprehensive intervention fidelity assessment nested within a randomised controlled trial. We developed a bespoke intervention fidelity assessment framework to assess the competence of primary care respiratory nurses, physiotherapists and occupational therapists delivering a cognitive behavioural intervention for people with COPD. A total of 180 (representing 15% of trial cases) intervention audio files, from 36 intervention arm participants, were coded. The intervention was delivered with acceptable adherence for most components. Therapeutic competency was achieved and comparable with previous research studies. Interpersonal skills and focus had higher competency whilst guided discovery and application of appropriate change techniques was lower but still adequate. Skills improved over time and with an increased number of clients. With proper training and supervision, primary care respiratory nurses, physiotherapists and occupational therapists can deliver cognitive behavioural interventions with acceptable therapeutic competency but questioning and change techniques may need particular focus in training and greater practice.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":"35 1","pages":"11"},"PeriodicalIF":3.1,"publicationDate":"2025-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11873302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burden of illness among patients with asthma prescribed inhaled corticosteroids/long-acting β₂-agonists.","authors":"Shiyuan Zhang, Alexandrosz Czira, Julia Harley, Kieran J Rothnie, Lauren Lee, Mark Small","doi":"10.1038/s41533-024-00402-w","DOIUrl":"10.1038/s41533-024-00402-w","url":null,"abstract":"<p><p>Inhaled corticosteroids (ICS) plus long-acting β₂-agonists (LABA) are recommended for maintenance-only or maintenance and reliever therapy (MART) in patients with asthma. However, real-world data on ICS/LABA as maintenance-only or MART are limited. This study characterized clinical, economic, and humanistic burdens of asthma in Canada, China, Europe, Japan, and the US, using data collected from patients and physicians via a cross-sectional survey (Asthma Disease Specific Programme). Patients were ≥18 years of age with physician-confirmed asthma and receiving fixed-dose ICS/LABA for ≥3 months. Mean physician-reported symptom-free days over the past 30 days ranged from 10.1-20.6 days, and 31.5-34.6% of ICS/LABA users self-reported not well-controlled asthma. SABA co-prescription was reported in 8.8-67.8% of patients. These findings highlight the continued disease burden among ICS/LABA users, with the high level of SABA co-prescription indicating potentially inappropriate prescribing of ICS/LABA as MART or detrimental reliance on SABA medication in addition to MART.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":"35 1","pages":"10"},"PeriodicalIF":3.1,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in low global warming potential inhaler prescribing: A UK-wide cohort comparison from 2018-2024.","authors":"Simon M Barry, Gareth R Davies, Julian Forton, Sarah Williams, Richard Thomas, Paul Paxton, Grace Moore, Chris R Davies","doi":"10.1038/s41533-025-00415-z","DOIUrl":"10.1038/s41533-025-00415-z","url":null,"abstract":"<p><p>We performed a retrospective cohort analysis comparing trends in low global warming potential (GWP) inhaler prescribing in primary care in England, Scotland, Wales and Northern Ireland between 2018 and 2024 using national prescribing data. There was little change in England, a reduction from 36.6-31.0% in Scotland, a reduction from 36.7-33.2% in Northern Ireland, and an increase from 30.8-41.1% in Wales. Only in Wales was there a simultaneous reduction in high GWP inhalers and an increase in low GWP inhalers. Over the time period of the study there has been a saving of 20,303 tonnes of carbon dioxide equivalent in Wales.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":"35 1","pages":"9"},"PeriodicalIF":3.1,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in clinical characteristics between coronavirus disease 2019 (COVID-19) and influenza: a systematic review and meta-analysis.","authors":"Yingying Han, Jia Guo, Xingzhao Li, Zhuan Zhong","doi":"10.1038/s41533-025-00414-0","DOIUrl":"10.1038/s41533-025-00414-0","url":null,"abstract":"<p><p>The coronavirus disease 2019 (COVID-19) epidemic has brought major challenges to the global health system, and influenza is also a problem that cannot be ignored. We aimed to explore and compare the clinical characteristics of COVID-19 and influenza to deepen the understanding of these two diseases and provide some guidance for clinicians to make differential diagnoses. We searched PubMed, Embase and Web of Science for articles and performed a meta-analysis using Stata 14.0 with a random-effects model. This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. One hundred articles involving 226,913 COVID-19 patients and 201,617 influenza patients were included, and all the articles included patients with these two diseases as experimental and control groups. Compared to influenza, COVID-19 was more common among men (OR = 1.46, 95% CI: 1.23-1.74) and people with a higher body mass index (MD = 1.43, 95% CI: 1.09-1.77). The proportion of current smokers among COVID-19 patients was lower than that among influenza patients (OR = 0.25, 95% CI: 0.18-0.33). Patients with COVID-19 had longer stays in the hospital (MD = 3.20, 95% CI: 2.58-3.82) and ICU (MD = 3.10, 95% CI: 1.44-4.76), required mechanical ventilation more frequently (OR = 2.30, 95% CI: 1.77-3.00), and had higher mortality (OR = 2.22, 95% CI: 1.93-2.55). We also found significant differences in some blood parameters between the two groups of patients. Upper respiratory symptoms were more obvious in influenza patients, and the proportion of comorbidities was higher than that among COVID-19 patients. There are some differences in the major characteristics, symptoms, laboratory findings and comorbidities between COVID-19 patients and influenza patients. COVID-19 patients often require more medical resources and have worse clinical outcomes.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":"35 1","pages":"8"},"PeriodicalIF":3.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}