Pain Management Nursing最新文献

{"title":"Pain Assessment in the Patient Unable to Self- Report: Clinical Practice Recommendations in Support of the ASPMN 2024 Position Statement.","authors":"Keela Herr, Alison R Anderson, Caroline Arbour, Patrick J Coyne, Elizabeth Ely, Céline Gélinas, Renee C B Manworren","doi":"10.1016/j.pmn.2024.09.010","DOIUrl":"10.1016/j.pmn.2024.09.010","url":null,"abstract":"<p><p>Recognizing and managing pain is especially challenging for vulnerable populations who cannot communicate their discomfort. Because there is no valid and reliable objective measure of pain, the American Society for Pain Management Nursing advocates for comprehensive assessment practices articulated in a Hierarchy of Pain Assessment. These practices must gather relevant information to infer the presence of pain and evaluate a patient's response to treatment. Nurses and other healthcare providers must be advocates for those who cannot communicate their pain experience.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":"551-568"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ASPMN 2024 Position Statement: Pain Assessment in the Patient Unable to Self-Report.","authors":"Keela Herr, Alison R Anderson, Caroline Arbour, Patrick J Coyne, Elizabeth Ely, Céline Gélinas, Renee C B Manworren","doi":"10.1016/j.pmn.2024.09.009","DOIUrl":"10.1016/j.pmn.2024.09.009","url":null,"abstract":"<p><p>Recognizing and managing pain is especially challenging for vulnerable populations who cannot communicate their discomfort. Because there is no valid and reliable objective measure of pain, the American Society for Pain Management Nursing advocates for comprehensive assessment practices articulated in a Hierarchy of Pain Assessment. These practices require gathering relevant information to infer the presence of pain and evaluate a patient's response to treatment. Nurses and other healthcare providers must be advocates for those who cannot communicate their pain experience.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":"569-570"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Auricular Acupressure Adjunct Treatment for Opioid Tapering: A Randomized Pilot Feasibility Study.","authors":"Heather J Jackson, Micaela Arseneau, Michelle Terrell, Kim Steanson, Mary S Dietrich","doi":"10.1016/j.pmn.2024.07.010","DOIUrl":"10.1016/j.pmn.2024.07.010","url":null,"abstract":"<p><strong>Purpose: </strong>Opioid medications are necessary in the treatment of critically ill infants; however. prolonged use may lead to withdrawal syndrome. The purpose of this study was to assess feasibility of delivering an acupressure protocol for the treatment of iatrogenic withdrawal in a pediatric cardiac intensive care unit as well as impact and acceptance of acupressure as an adjunct treatment.</p><p><strong>Design: </strong>Randomized pilot feasibility trial.</p><p><strong>Methods: </strong>Acupressure stickers were applied and rotated to one ear every 1-3 days until withdrawal symptoms improved.</p><p><strong>Results: </strong>There were no serious adverse events, with only one reported incident of skin irritation. Recruiting benchmarks were exceeded. Weaning phases were significantly shorter in the acupressure group (medians 6.0 vs 22.0 respectively, p = .025, d = 0.90) and the control group used skin-to-skin contact as a comfort measure significantly more than the acupressure group (42.9% vs 6.3%, p = .18). Acupressure was accepted by parents, with an overall 96.2% rating their experience as positive, as measured by the Parent Client Satisfaction Questionnaire. The majority of health care providers (n = 19) were supportive, with 71.9% agreeing or completely agreeing acupressure is an acceptable adjunct for the treatment of withdrawal symptoms; 26.8% were neutral, as measured by the Acceptability of Intervention Measure, Intervention Appropriateness Measure, and Feasibility of Intervention Measure.</p><p><strong>Conclusions: </strong>Acupressure was found to be safe, feasible, and accepted by health care providers in a pediatric cardiac intensive care setting.</p><p><strong>Clinical implications: </strong>These findings support future research with larger sample sizes to improve clinical treatment of infants physically dependent on sedative medications.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":"591-595"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142081146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Associated Factors of Postoperative Acute Pain for Mothers Who Gave Birth With Cesarean Section: A Systematic Review and Meta-Analysis.","authors":"Basazinew Chekol Demilew, Negesse Zurbachew, Nega Getachew, Getachew Mekete, Diriba Teshome Lema","doi":"10.1016/j.pmn.2024.05.010","DOIUrl":"10.1016/j.pmn.2024.05.010","url":null,"abstract":"<p><strong>Background: </strong>Cesarean section frequently is associated with different undesirable postoperative outcomes. Acute postoperative pain is one of the most frequently experienced adverse outcomes that occurs as the result of actual tissue damage. Previous studies have shown inconsistent results regarding the prevalence and predictors of acute postoperative pain. Therefore, this study aimed to assess the pooled prevalence and associated factors of postoperative pain after cesarean section.</p><p><strong>Methods: </strong>This is a systematic review and meta-analysis study that was performed on the basis of studies published within the last 10 years on the prevalence and associated factors of postoperative pain after cesarean section. After PubMed, Google Scholar, HINAR, Scopus, Web of Sciences, Cochrane, EMBASE, and gray literature extensive search for primary studies, their quality was assessed and data was extracted. STATA^MP, version 17.0, was used for all possible analyses of the study.</p><p><strong>Results: </strong>Twenty-eight studies were included in this systematic review and meta-analysis. The pooled prevalence of postoperative pain was 58% (95% confidence interval [CI] 48%, 67%) with heterogeneity (I² 99.33%). Incision length >10 centimeters (odds ratio [OR] 2.34 [95% CI 1.71, 2.97]); spinal anesthesia without adjuvant (OR 3.45 [95% CI 1.56, 5.33]); general type of anesthesia (OR 3.54 [95% CI 2.61, 4.48]); presence of preoperative anxiety (OR-1.73, 95% CI 1.12-2.35); and no peripheral nerve block (OR 3.23 [95% CI, 2.27-4.18]) were associated with the prevalence of postoperative pain significantly.</p><p><strong>Conclusions: </strong>The pooled prevalence of acute postoperative pain after cesarean section was high (58%), which needs more strategies for pain management. Incision length >10 centimeters, spinal anesthesia without adjuvants, general type of anesthesia, preoperative anxiety, and no peripheral nerve block were significantly associated with this prevalence.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":"e452-e464"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141734862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationships Between Function, Pain Severity and Psychological and Cognitive Levels in People With Chronic Neck Pain: Cross-Sectional Study.","authors":"Faruk Tanik, Derya Ozer Kaya","doi":"10.1016/j.pmn.2024.06.008","DOIUrl":"10.1016/j.pmn.2024.06.008","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the relationship between pain and functional levels with pain catastrophizing, rumination, decision-making, and critical thinking in people with chronic neck pain.</p><p><strong>Methods: </strong>The study included 62 patients with chronic neck pain who had presented to a physiotherapy center with pain complaints for at least 3 months. The visual analog scale for pain severity, the Neck Disability Index for functional level, the Pain Catastrophizing Scale, the Ruminative Thinking Scale, the Melbourne Decision-Making Scale I-II, and the Marmara Critical Thinking Inventory were used for assessments.</p><p><strong>Results: </strong>Activity pain, night pain, and disability were positively correlated with rumination (rho: 0.368, p = .003; rho: 0.423, p = <.001; rho = 0.334, p = .008). There was a positive correlation between night pain, disability, and pain catastrophizing (rho = 0.298, p = .019; rho = .434 p < .001). A negative correlation was observed between patients' pain severity and disability with critical thinking scores (rho = -0.393, p = .002; rho = -0.377 p = .003, rho = -0.428 p < .001, rho = -0.441 p < .001).</p><p><strong>Conclusions: </strong>The study suggested that there were positive correlations between pain severity and disability with rumination and pain catastrophizing. Additionally, chronic neck pain was found to have negative correlations with critical thinking scores, indicating potential impacts on cognitive processes. These findings may provide insights into the complex interplay between chronic pain and psychological factors, which can inform the development of interventions to enhance chronic pain management.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":"645-651"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141604010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Evaluation of Patient-Controlled Analgesia for Pain Crises in Sickle Cell Disease.","authors":"Şebnem Rumeli, Selin Azizoğlu, Mustafa Azizoğlu","doi":"10.1016/j.pmn.2024.06.011","DOIUrl":"10.1016/j.pmn.2024.06.011","url":null,"abstract":"<p><strong>Background: </strong>Vaso-occlusive crisis causing severe pain can be seen in patients with sickle cell anemia and potent opioids should be used in this process. Although sickle cell disease (SCD) patients use patient-controlled analgesia (PCA), we encountered no study evaluating this method from the participants' perspective.</p><p><strong>Aim: </strong>This descriptive study aimed to evaluate the use and effectiveness of PCA administered using the Mersin Algology Protocol (MAP) during painful episodes of SCD based on participants reports.</p><p><strong>Methods: </strong>After obtaining approval from the local ethics committee, 109 SCD participants using PCA as per the MAP between 2018 and 2020 were recruited for the study. The participants answered a 28-item questionnaire regarding their annual number of pain crises, sites of pain, knowledge about PCA, the number of times they used PCA, and the positive and negative aspects of the PCA method.</p><p><strong>Results: </strong>The mean age of the participants was 28.80 ± 11.5 years. Ninety-nine (90.8%) of the participants considered PCA superior to other pain management methods they had used previously. The 53 participants (48.6%) who waited for their pain to worsen before administering the demand dose expressed fear of taking high doses of medication. As the number of times a participant used PCA increased, NRS scores for pain at the time of demand dosing decreased from 7-10 to 4-6 (p = .013). Eighty-five (78%) of the participants reported having no problems related to the device or drug while using PCA.</p><p><strong>Conclusion: </strong>We found that PCA was used more correctly by participants with more experience using the device. Participants who delay demand dosing do so because of anxiety about developing dependence and to avoid high doses.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":"576-583"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141627342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opioid-Induced Constipation and Associated Symptoms After Orthopedic Trauma.","authors":"Gabriela Ortega, Alexa Lisenby, Tatiana Getz, Wenhui Zhang, Kenneth Mueller, Mara L Schenker, Sydney A Axson, Nicholas A Giordano","doi":"10.1016/j.pmn.2024.06.012","DOIUrl":"10.1016/j.pmn.2024.06.012","url":null,"abstract":"<p><strong>Purpose: </strong>Opioid-induced constipation is an adverse effect often experienced among patients taking prescription opioid medication. Despite frequent opioid prescribing after orthopedic injury, there is a dearth of research examining opioid-induced constipation presentations in this population. This analysis examines the frequency of opioid-induced constipation manifestations and association with patient-reported outcomes among participants prescribed opioid medication following orthopedic injury.</p><p><strong>Design: </strong>Secondary analysis of 86 clinical trial participants following orthopedic trauma.</p><p><strong>Methods: </strong>Participants were assessed 2-weeks postoperatively with the following measures: Patient-Reported Outcome Measurement Information System (PROMIS) Pain Interference, PROMIS Physical Function, past 24-hour average pain intensity captured on the numeric pain rating scale, and the Patient Assessment of Constipation Symptoms (PAC-SYM) questionnaire. Linear regressions examined the association between PAC-SYM scores and both pain intensity and PROMIS T-scores while accounting for injury severity and opioid medication dosage.</p><p><strong>Results: </strong>Most participants (69%) reported experiencing opioid-induced constipation symptoms and 7% reported moderate to severe symptoms. Compared to those without symptoms, participants reporting opioid-induced constipation symptoms were found to have a 3-point increase in PROMIS Pain Interference (95% Confidence Interval [CI]: 0.28-5.90; p = .032), a 3-point decline in PROMIS Physical Function (95% CI: -6.57 to -0.02; p = .049), and a 1.7-point increase in average pain scores (95% CI: 0.50-3.01; p = .007) at 2-weeks following surgery.</p><p><strong>Conclusions: </strong>Opioid-induced constipation symptoms are common after orthopedic trauma and linked to increased pain interference and pain intensity as well as reduced physical function.</p><p><strong>Clinical implications: </strong>Nurse-led assessments of opioid-induced constipation can support the timely delivery of interventions to alleviate symptoms and potentially improve patient-reported outcomes after injury.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":"615-621"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Predictors of Medication Compliance in Patients With Acute Herpetic Neuralgia.","authors":"Hui Lyu, Ling-Yan Wang, Rui-Xia Wang, Han Sheng, Jian-Mei Xia, Jun-Ya Cheng","doi":"10.1016/j.pmn.2024.07.002","DOIUrl":"10.1016/j.pmn.2024.07.002","url":null,"abstract":"<p><strong>Purpose: </strong>Pain is one of the most common and harmful symptoms experienced by individuals with acute herpetic neuralgia (AHN). In this population, studies to determine the causes that affect patients taking medications compliance are rare. This study aimed to construct a predictive model for medication compliance of patients with AHN and to verify its performance.</p><p><strong>Design and methods: </strong>In this prospective study of 398 patients with AHN who were discharged from a tertiary hospital with medications from July 2020 to October 2022, we used logistic regression analysis to explore the predictive factors of medication compliance of patients with AHN and to construct a nomogram. The area under the curve was used to evaluate the predictive effect of the model.</p><p><strong>Results: </strong>A predictive model of drug compliance of patients with AHN was constructed based on the following four factors: disease duration, pain severity before treatment, medication beliefs, and comorbidity of chronic diseases. The area under the curve of the model was 0.766 (95% confidence interval [0.713, 0.819]), with a maximum Youden's index of 0.431, sensitivity of 0.776, and specificity of 0.655. A linear calibration curve was found with a slope close to 1.</p><p><strong>Conclusions: </strong>The prediction model constructed in this study had good predictive performance and provided a reference for early clinical screening of independent factors that affected the medication compliance of patients with AHN.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":"e479-e486"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141996263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating Complementary Therapies in Managing Phantom Limb Pain: A Case Review.","authors":"Njood Y ALfaifi, Elizabeth J Winokur","doi":"10.1016/j.pmn.2024.07.007","DOIUrl":"10.1016/j.pmn.2024.07.007","url":null,"abstract":"<p><strong>Objectives: </strong>This paper describes phantom limb pain (PLP), its impact on patients, and the various treatment options, including pharmacologic and complementary therapies. It investigates the efficacy of incorporating complementary and alternative therapies, both invasive and noninvasive, for amputees who have not achieved satisfactory results with pharmacologic treatments and suffer from adverse drug events. Furthermore, with the predicted increase in limb amputations, it is crucial for nurses, as frontline providers, to understand PLP, be prepared to manage persistent pain and associated psychological and functional issues and educate patients and families about alternative treatment options.</p><p><strong>Approach: </strong>The review includes recent studies on pharmacologic interventions for PLP, case reports, and randomized clinical trials on non-pharmacologic complementary therapies, covering both invasive and noninvasive modalities. Studies from 2013 to 2022 were identified using the PubMed search engine with terms such as \"Amputation,\" \"phantom limb pain,\" \"invasive therapies,\" and \"non-invasive therapies.\"</p><p><strong>Results and conclusion: </strong>The pathogenesis of PLP remains unclear, complicating the identification of causes and the selection of targeted therapies for each patient. Uncontrolled PLP can severely impact the quality of life, causing psychological distress and loss of productivity. Traditional pharmacologic therapy often requires supplementation with other options due to PLP's refractory nature. A comprehensive, multimodal treatment plan, including non-pharmacologic therapies, can enhance rehabilitation and reduce complications. Incorporating these therapies can decrease reliance on medications, particularly opioids, and mitigate side effects. Although many potential PLP treatments exist, further clinical studies are needed to determine their effectiveness and establish protocols for optimizing patient outcomes.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":"659-665"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Pain Management in the Intensive Care Unit by Assessment.","authors":"Reidun K N M Sandvik, Maida Mujakic, Ingvild Haarklau, Gosselin Emilie, Asgjerd L Moi","doi":"10.1016/j.pmn.2024.06.013","DOIUrl":"10.1016/j.pmn.2024.06.013","url":null,"abstract":"<p><strong>Purpose: </strong>Patients in the intensive care unit suffer from pain caused by life-threatening illness or injury but also treatments such as surgery and nursing procedures such as venipuncture. Unconsciousness following head trauma or sedation stage complicates self-report, and both under- and over-management of pain can occur. Inadequate assessment and treatment might follow from unsuitable pain assessment practices. The aim of this study was to evaluate the effect of the implementation of a pain assessment tool on nurses` documentation of pain and the administration of analgesia and sedation.</p><p><strong>Design: </strong>Quantitative pre-post design.</p><p><strong>Methods: </strong>The study was conducted at one intensive care unit at a university hospital and involved 60 patient records and 30 pre-implementations and 30 post-implementations of the Critical-Care Pain Observation Tool (CPOT).</p><p><strong>Results: </strong>After implementation, a 38% adherence rate was found. The frequency of nurses' pain evaluations increased significantly from 1.3 to 2.3 per nursing shift. The implementation of CPOT also improved how often nurses identified pain by use of facial expressions, muscle tension, and cooperation with the mechanical ventilator, whereas focus on vital signs dropped (p = .014). A larger proportion of patients (17%) received paracetamol after the CPOT implementation compared with before (8%). Findings were statistically significant at p < .01.</p><p><strong>Conclusions: </strong>Implementation of CPOT increased the frequency of pain evaluations, and the observable patient behavior was more often interpreted as pain-related. Nurses' adherence rate to sustained patient behavior focus being modest highlights the essential need for ongoing improvements in practice. Implementation of a new tool must be followed by non-pharmacological and pharmacological pain management steps.</p><p><strong>Clinical implications: </strong>Implementing the CPOT as a pain assessment tool has the potential to enhance assessment practices. However, it is important to note that simply increasing assessment frequency does not guarantee nursing interventions to alleviate pain. This indicates the need for additional steps to be taken in order for nurses to complete the pain assessment cycle and effectively address interventions and reassessments.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":"606-614"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}