BJGP Open最新文献

{"title":"Correction: Exploring the facilitators and barriers to addressing social media's impact on anxiety within primary care: a qualitative study.","authors":"","doi":"10.3399/BJGPO.2024.9998","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.9998","url":null,"abstract":"","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146478","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":"Action on elevated natriuretic peptide in primary care: a retrospective cohort study.","authors":"Cornelia Jc Vermeer, Monika Hollander, Anne Jm Stolk, Amy Groenewegen, G J Geersing, Frans H Rutten, Huberta E Hart","doi":"10.3399/BJGPO.2024.0017","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0017","url":null,"abstract":"<p><strong>Background: </strong>Natriuretic peptides (NPs) are released by increased ventricular wall stress, most often caused by heart failure (HF). NP level measurement helps select patients clinically suspected of HF who need echocardiography. Yet, the diagnostic actions following NP testing in daily primary care are poorly studied.</p><p><strong>Aim: </strong>To assess the diagnostic actions taken by general practitioners (GPs) in patients with an elevated NP level.</p><p><strong>Design & setting: </strong>Retrospective observational study in general practices in the Netherlands.</p><p><strong>Method: </strong>In patients with an elevated NP level between July 2017 and July 2022 diagnostic actions were gathered during three months following NP testing. We compared patients with an elevated NP level referred for echocardiography to those not referred by univariable analyses.</p><p><strong>Results: </strong>Among 902 patients, 394 (43.7%) had an elevated NP level. Median age was 75.0 (IQR 18.0) years, 68.8% were female. In total, 166 (42.1%) were referred for echocardiography and 114 (28.9%) underwent additional ECG recording. 30/166 (18.1%) referred patients were labelled HF by the cardiologist within three months after NP testing compared to 29/228 (12.7%) not referred. Referred patients were compared to those not referred younger (69.7 vs. 74.1 years, <i>P</i><.001), less already known to a cardiologist (46.3% vs. 62.3%, <i>P</i>=.002), and had less marginally increased BNP levels (35-50 pg/mL) (19.9% vs. 37.5%, <i>P</i><.001).</p><p><strong>Conclusions: </strong>Three out of five patients with an elevated NP level are not referred for echocardiography by GPs. Restraint to refer patients were older age, a marginally elevated BNP value, and already being under control of a cardiologist.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134111","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":"'ThinkCancer!': randomised feasibility trial of a novel practice-based early cancer diagnosis intervention.","authors":"Stefanie Lj Disbeschl, Annie K Hendry, Alun Surgey, Daniel Walker, Nia Goulden, Bethany F Anthony, Richard Neal, Nefyn H Williams, Zoë Susannah Jane Hoare, Julia Hiscock, Rhiannon Tudor Rt Edwards, Ruth Lewis, Clare Wilkinson","doi":"10.3399/BJGPO.2023.0220","DOIUrl":"10.3399/BJGPO.2023.0220","url":null,"abstract":"<p><strong>Background: </strong>UK cancer deaths remain high; primary care is key for earlier cancer diagnosis as half of avoidable delays occur here. Improvement is possible through lower referral thresholds, better guideline adherence, and better safety-netting systems. Few interventions target whole practice teams. We developed a novel whole-practice team intervention to address this.</p><p><strong>Aim: </strong>To test the feasibility and acceptability of a novel, complex behavioural intervention, 'ThinkCancer!', for assessment in a subsequent Phase III trial.</p><p><strong>Design & setting: </strong>Pragmatic, superiority pilot randomised controlled trial (RCT) with an embedded process evaluation and feasibility economic analysis in Welsh general practices.</p><p><strong>Method: </strong>Clinical outcome data were collected from practices (the unit of randomisation). Practice characteristics and cancer safety-netting systems were assessed. Individual practice staff completed evaluation and feedback forms and qualitative interviews. The intervention was adapted and refined.</p><p><strong>Results: </strong>Trial recruitment and workshop deliveries took place between March 2020 and May 2021. Trial progression criteria for recruitment, intervention fidelity, and routine data collection were met. Staff-level fidelity, retention, and individual level data collection processes were reviewed and amended. Interviews highlighted positive participant views on all aspects of the intervention. All practices set out to liberalise referral thresholds appropriately, implement guidelines, and address safety-netting plans in detail.</p><p><strong>Conclusion: </strong>'ThinkCancer!' appears feasible and acceptable. The new iteration of the workshops was completed and the Phase III trial has been funded to assess the effectiveness and cost-effectiveness of this novel professional behaviour change intervention. Delivery at scale to multiple practices will likely improve fidelity and reach.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853942","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":"Identifying where hospital and community trusts are managing general practices in England: a service mapping study.","authors":"Charlotte Davies, Catherine L Saunders, Fifi Olumogba, Manbinder Sidhu, Jon Sussex","doi":"10.3399/BJGPO.2023.0173","DOIUrl":"10.3399/BJGPO.2023.0173","url":null,"abstract":"<p><strong>Background: </strong>Organisations providing secondary care in the NHS in England have historically not also provided primary health care, but this is changing. Data on where this kind of 'vertical integration' is happening are lacking, making it difficult to evaluate its impact.</p><p><strong>Aim: </strong>To compile a comprehensive list of instances of secondary care trusts running general practices in England, to enable evaluation of the impact of such arrangements.</p><p><strong>Design & setting: </strong>This service mapping study comprises review, collation, synthesis, and analysis of published information describing secondary and primary care provision in the NHS in England in March 2021.</p><p><strong>Method: </strong>Desk-based collection, including hand-searching, of secondary care organisations' statutory annual reports. Triangulation via comparison with national data on general practices, the general practice workforce and practice contracts.</p><p><strong>Results: </strong>It was possible to construct a database of all instances of trusts running general practices in England as of 31 March 2021. We have identified 26 trusts running a total of 85 general practices, operating across a total of 116 practice sites. These practices have on average fewer patients and fewer GP full-time equivalents than other general practices, and before becoming vertically integrated were performing less well in the Quality and Outcomes Framework.</p><p><strong>Conclusion: </strong>We recommend that national statistics recording the details of general practices contracting with the NHS should include whether each practice is owned by another organisation and whether that is an NHS trust, another public body, or a private organisation. Such data are required to enable evaluation of the impacts of this kind of vertical integration.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139479409","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":"Signs and symptoms of serious illness in adults with acute abdominal pain presenting to ambulatory care: a systematic review.","authors":"Anouk Tans, Thomas Struyf, Rune Geboers, Toon Smeets, Yorick Asselbergh, Emmanuel Declerck, Luca Bloemen, Ann van den Bruel","doi":"10.3399/BJGPO.2023.0245","DOIUrl":"10.3399/BJGPO.2023.0245","url":null,"abstract":"<p><strong>Background: </strong>Acute abdominal pain is a common complaint, caused by a variety of conditions, ranging from acutely life-threatening to benign and self-limiting, with symptom overlap complicating diagnosis. Signs and symptoms may be valuable when assessing a patient to guide clinical work.</p><p><strong>Aim: </strong>Summarising evidence on the accuracy of signs and symptoms for diagnosing serious illness in adults with acute abdominal pain in an ambulatory care setting.</p><p><strong>Design & setting: </strong>We performed a systematic review, searching for prospective diagnostic accuracy studies that included adults presenting with acute abdominal pain to an ambulatory care setting.</p><p><strong>Method: </strong>Six databases and guideline registers were searched, using a comprehensive search strategy. We assessed the risk of bias, and calculated descriptive statistics and measures of diagnostic accuracy. Results were pooled when at least four studies were available.</p><p><strong>Results: </strong>Out of 18 923 unique studies, 16 studies with moderate to high-risk bias were included. Fourteen clinical features met our criteria, including systolic blood pressure <100 mmHg (positive likelihood ratio [LR+]7.01), shock index >0.85, uterine cervical motion tenderness (LR+5.62 and negative likelihood ratio [LR-]8.60), and a self-assessment questionnaire score >70 (LR+12.20) or <25 (LR-0.19). Clinical diagnosis made by the clinician had the best rule-in ability (LR+24.6).</p><p><strong>Conclusions: </strong>We identified 14 signs and symptoms that can influence the likelihood of a serious illness, including pain characteristics, systemic signs, gynaecological signs, and clinician's overall assessment. The risk of bias was moderate to high, leading to uncertainty and preventing us from making firm conclusions. This highlights the need for better research in this setting.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140869872","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":"Sex differences and trends in managing cardiovascular risk factors in primary care: a dynamic cohort study.","authors":"Geert Smits, Michiel L Bots, Monika Hollander, Sander van Doorn","doi":"10.3399/BJGPO.2024.0175","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0175","url":null,"abstract":"<p><strong>Background: </strong>Treatment targets for cardiovascular risk management make no distinction between women and men.</p><p><strong>Aim: </strong>To explore sex differences in achieving treatment targets in patients that participated in a nurse-led, integrated CVRM care programme in primary care between 2013 and 2019.</p><p><strong>Design & setting: </strong>We conducted a dynamic cohort study in the Eindhoven region, south-east of The Netherlands METHOD: We assessed outcomes of three biological risk factors (systolic blood pressure, low density lipoprotein-cholesterol and estimated glomerular filtration rate) and four lifestyle factors (smoking, physical activity, alcohol intake and body mass index). Points (1=on target; 0=not on target) were assigned for biological risk factors, lifestyle factors and an overall score. Using the annual results, we applied, multivariable regression models to study trends over time and differences in trends between women and men.</p><p><strong>Results: </strong>The number of participants increased from 24 889 to 38,067, mean age increased from 67.3 to 71.5 years, with around 52% women each year. The average of seven risk factors on target increased significantly from 4.6 to 4.9 in women, and from 4.7 to 5.0 in men, with no statistical difference between women and men. Differences between women and men in 2013 in the number of both biological and lifestyle factors on target did not materially change over time.</p><p><strong>Conclusion: </strong>Integrated cardiovascular management care led to improvements in cardiovascular risk factors on target, equally well in women than in men. Differences in risk factors on target between women and men in 2013 were still present in 2019.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142093871","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":"Continuity of care and mortality in patients with type 2 diabetes.","authors":"Eero H Mellanen, Timo Kauppila, Hannu Kautiainen, Mika T Lehto, Ossi Rahkonen, Kaisu H Pitkälä, Merja K Laine","doi":"10.3399/BJGPO.2024.0144","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0144","url":null,"abstract":"<p><strong>Background: </strong>How continuity of general practitioner care (GP-CoC) affects mortality in patients with type 2 diabetes (T2D) is unclear.</p><p><strong>Aim: </strong>The aim of this study was to examine the effect of having no continuity of care (CoC) and GP-CoC on mortality in primary health care (PHC) patients with T2D.</p><p><strong>Design & setting: </strong>Cohort study in patients aged 60 years or older with T2D within the public PHC of the city of Vantaa, Finland.</p><p><strong>Method: </strong>Inclusion period was between 2002-2011 and follow-up period between 2011-2018. Six groups were formed (no appointments, one appointment and Modified, Modified Continuity Index [MMCI] quartiles). Mortality was measured with standardized mortality ratio (SMR) and adjusted hazard ratio (aHR). GP-CoC was measured with MMCI. Comorbidity status was determined with Charlson comorbidity index (CCI).</p><p><strong>Results: </strong>In total 11,020 patients were included. Mean follow-up time was 7.3 years. SMRs for the six groups (no appointments, one appointment, MMCI quartiles) were 2.46 (95%CI: 2.24-2.71), 3.55 (3.05-4.14), 1.15 (1.06-1.25), 0.97 (0.89-1.06), 0.92 (0.84-1.01) and 1.21 (1.11-1.31), respectively. With continuous MMCI, mortality formed a u-curve. The inflection point was at a MMCI value of 0.65 with corresponding SMR of 0.86. Age and CCI adjusted HR for death between men and women was 1.45 (1.35-1.58).</p><p><strong>Conclusions: </strong>Patients with no CoC had the highest mortality. In patients having care over time, the effect of GP-CoC on mortality was minor and mortality turned to rise with high GP-CoC.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142093870","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":"Translating in-person care to telehealth: analysis of GP consultations on musculoskeletal conditions.","authors":"Yifu Li, Simon Chan, Lawrence Lu, Tim M Jackson, Hania Rahimi-Ardabili, Annie Ys Lau","doi":"10.3399/BJGPO.2024.0013","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0013","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic led to a rapid transition to telehealth particularly in general practice (GP) where continuous care for chronic conditions such as musculoskeletal (MSK) is provided.</p><p><strong>Aim: </strong>To determine the appropriateness of telehealth for MSK by identifying whether in-person tasks can be supported remotely via telehealth.</p><p><strong>Design & setting: </strong>This study is a secondary analysis of the HaRI dataset. This dataset comprises of 281 videos of recorded GP consultations. The data set includes 10 general practitioners, across 8 separate clinics and was collected during 2017 in the United Kingdom.</p><p><strong>Method: </strong>Content analysis was conducted to identify the clinical tasks, physical examinations and physical artefacts used during the consultations. A scoring method applying two key metrics was developed to assess the translatability of clinical tasks to telehealth.</p><p><strong>Results: </strong>Across the 31 MSK consultations analysed, 12 clinical tasks, five physical examinations and 12 physical artefacts were observed. Of clinical tasks, 17% (2/12) were deemed to be 'easily translatable over telehealth' and 50% (5/12) were deemed 'relatively easy to be translated over telehealth'. Only 17% (2/12) of tasks were rated 'moderately translatable over telehealth', and 17% (2/12) were deemed 'potentially translatable over telehealth'. No clinical tasks in this study were categorised as untranslatable to telehealth. The average telehealth translatability score was 7.1/10.</p><p><strong>Conclusion: </strong>Most clinical tasks observed during in-person GP consultations with MSK patients are translatable to telehealth. Further research is necessary to investigate the long-term efficacy and safety of telehealth utilisation for MSK in primary care.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082064","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":"'Picking up the pieces': primary care practitioners' experiences of cancer care reviews.","authors":"Dipesh P Gopal, Stephanie Jc Taylor, Ping Guo, Nikolaos Efstathiou","doi":"10.3399/BJGPO.2024.0064","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0064","url":null,"abstract":"<p><strong>Background: </strong>The number of people who are living with and beyond cancer is increasing in England. Primary care delivers cancer care via structured proactive conversations which are incentivised through the Quality and Outcomes Framework (QoF): 'cancer care reviews' (CCRs). Declining workforce numbers, increasing patient demand, CCR policy changes in 2020 and the onset of the coronavirus disease 2019 (COVID-19) pandemic, highlight a need to explore how staff deliver CCRs.</p><p><strong>Aim: </strong>To explore primary care staff experiences with CCRs, identify their view of CCRs, how they conduct CCRs and their perceived value of CCRs.</p><p><strong>Design & setting: </strong>Descriptive qualitative study in general practices in England.</p><p><strong>Method: </strong>Semi-structured online interviews with 15 primary care staff; data analysis using reflexive thematic analysis.</p><p><strong>Results: </strong>Four themes were identified: varied and evolving perception of cancer, the delivery and impact of CCRs, changes to CCR delivery during the COVID-19 pandemic, ways to complement CCRs. Primary care staff felt that the way that cancer was perceived by patients, including those from ethnic minority backgrounds, impacted how CCRs were delivered. Cancer care involved acknowledging the challenge of a cancer diagnosis, helping decode jargon, and addressing unmet care needs. The pandemic resulted in remote CCR delivery for some practices. Staff suggested community cancer teams to provide cancer care alongside existing services.</p><p><strong>Conclusion: </strong>Staff adopted the new 3- and 12-month format CCRs despite the COVID-19 pandemic. Clinical staff may benefit from better training on cancer as a long-term condition and how cancer is perceived by people from diverse ethnic backgrounds.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082063","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":"Patient experiences of remote consulting with chronic fatigue syndrome/myalgic encephalomyelitis and fibromyalgia: a qualitative study.","authors":"Helen Leach, Abi Eccles, Carolyn A Chew-Graham, Helen Atherton","doi":"10.3399/BJGPO.2024.0079","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0079","url":null,"abstract":"<p><strong>Background: </strong>Remote and digital consulting in primary care has rapidly expanded since March 2020. It is important to understand patient experiences, particularly for those living with complex long-term conditions, to identify how care can best be delivered, including within the remote space.</p><p><strong>Aim: </strong>To explore the experiences of people living with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis [CFS/ME] and Fibromyalgia when consulting remotely in primary care.</p><p><strong>Design & setting: </strong>Semi-structured interviews with patients living with CFS/ME and fibromyalgia in general practice in England METHOD: Semi-structured interviews were carried out with 13 participants. The interviews were transcribed and analysed thematically according to a Foucauldian theoretical framework.</p><p><strong>Results: </strong>All participants highlighted needing to feel believed by clinicians. Many reported difficulties with telephone and online consulting due to the lack of physical communication. Positive outcomes were reported when there was a good relationship with a clinician. Continuity in care and recognising the complexity of these conditions were also considered important.</p><p><strong>Conclusion: </strong>This study allowed people living with CFS/ME and Fibromyalgia to describe their experiences when consulting remotely. Participants highlighted needing to feel listened to and felt they benefited from an ongoing relationship with a clinician although this was difficult to achieve when consulting remotely. Some advantages of remoted consulting were reported, particularly when symptoms were troublesome. Flexible access systems with a range of consultation modalities or preferred clinician(s) availability could improve healthcare encounters, particularly given the increased use of remote consulting, in primary care.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082062","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}