Journal of the Intensive Care Society最新文献

{"title":"Silicone adhesive multilayer foam dressings for preventing facial pressure injuries in COVID-19 patients in prone position.","authors":"Pia Otto,&nbsp;Tobias Großkreutz,&nbsp;Stefan Köberich","doi":"10.1177/17511437221079122","DOIUrl":"https://doi.org/10.1177/17511437221079122","url":null,"abstract":"<p><p>The development of facial pressure injury (PI) during prone position is frequently described. During the COVID-19 pandemic, the number of patients with facial PIs increased. This quality improvement project describes the effectiveness of using silicone adhesive multilayer foams for preventing facial PIs in COVID-19 patients in need of prone position therapy. After introduction of foam dressing on chin and forehead to the standard protocol procedures for PI prevention, the decrease in number of patients developing facial PIs was statistically significant. Based on these results, the use of silicone adhesive multilayer foam will be implemented as a standard procedure for facial PIs prevention.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 3","pages":"332-334"},"PeriodicalIF":2.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8886309/pdf/10.1177_17511437221079122.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41132718","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":"The association between mean platelet volume and poor outcome in patients with COVID-19: Systematic review, meta-analysis, and meta-regression.","authors":"Ahmad Fariz Malvi Zamzam Zein,&nbsp;Catur Setiya Sulistiyana,&nbsp;Wilson Matthew Raffaelo,&nbsp;Raymond Pranata","doi":"10.1177/17511437221121234","DOIUrl":"10.1177/17511437221121234","url":null,"abstract":"<p><strong>Introduction: </strong>This study aims to assess the association between mean platelet volume (MPV) and poor outcome in patients with COVID-19.</p><p><strong>Methods: </strong>We performed a comprehensive literature search using the PubMed, Embase and Scopus databases with keywords \"2019-nCoV\" OR \"SARS-CoV-2\" OR \"COVID-19\" AND \"mean platelet volume\" OR \"MPV\" on 8 July 2021. The primary outcome was composite poor outcome, defined as severe COVID-19 or mortality. The pooled effect estimate was reported as mean differences in terms of MPV between the group with and without outcome.</p><p><strong>Results: </strong>There were 17 studies which consist of 4549 patients with COVID-19 were included in this study. The incidence of poor outcome was 25% (20%-30%). Mean MPV was found to be higher in the poor outcome group in compare to no poor outcome group (10.3 ± 1.9 fL vs 9.9 ± 1.7 fL). The mean MPV difference between both group was 0.47 fL [95% CI 0.27, 0.67], <i>p</i> < 0.001; <i>I</i>²: 62.91%, <i>p</i> < 0.001). In the sub-group analysis, patients with severe COVID-19 had higher MPV (mean difference 0.54 fL [95% CI 0.28, 0.80], <i>p</i> < 0.001; <i>I</i>²: 54.84%, <i>p</i> = 0.014). Furthermore, MPV was also higher in the mortality group (mean difference 0.54 fL [95% CI 0.29, 0.80], <i>p</i> = 0.020; <i>I</i>²: 71.11%, <i>p</i> = 0.004). Meta-regression analysis showed that the association between MPV and poor outcome was not affected by age (<i>p</i> = 0.789), gender (<i>p</i> = 0.167), platelets (<i>p</i> = 0.056), white blood cells (<i>p</i> = 0.639), and lymphocytes (<i>p</i> = 0.733).</p><p><strong>Conclusion: </strong>This meta-analysis indicated that increased MPV was associated with severity and mortality in patients with COVID-19. Further research is needed to determine the optimum cut-off point.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 3","pages":"299-308"},"PeriodicalIF":2.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10515336/pdf/10.1177_17511437221121234.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41172813","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":"A comparative study into the effects of venous and arterial blood on clot microstructure in critically unwell patients. Assessment of the diagnostic potential of a biomarker of haemostasis.","authors":"Suresh Pillai,&nbsp;Vanessa Evans,&nbsp;Gareth Davies,&nbsp;Matthew J Lawrence,&nbsp;Janet Whitley,&nbsp;Ceri E Battle,&nbsp;Phylip R Williams,&nbsp;Keith Morris,&nbsp;Phillip A Evans","doi":"10.1177/17511437211060154","DOIUrl":"https://doi.org/10.1177/17511437211060154","url":null,"abstract":"<p><p>Blood for coagulation analysis can be sampled from the arterial or venous system in intensive care units (ICU). The determination of clot microstructure and strength by fractal analysis (d_<i>f</i>) gives valuable information in a range of vascular haemostatic disease and sepsis. We aimed to determine if d_<i>f</i> could be measured equally and comparatively in arterial or venous blood, and 45 critically ill patients in an ICU were recruited. d_<i>f</i> was found to be readily measured in arterial blood with results comparable to those in venous blood and that add value of d_<i>f</i> as a potential marker of haemostasis in these patients.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 2","pages":"224-226"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10227903/pdf/10.1177_17511437211060154.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10297483","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":"WireSafe^TM - A pilot study of a novel safety engineered device designed to prevent guidewire retention and reduce sharps injuries during central venous catheter insertion.","authors":"Vikesh Patel,&nbsp;Faiz M Chemban,&nbsp;Sohel Samad,&nbsp;Thomas Swan,&nbsp;James Gooch,&nbsp;Jonathan Dean,&nbsp;Darcy Pearson,&nbsp;Robin Heij,&nbsp;Peter J Young,&nbsp;Maryanne Za Mariyaselvam","doi":"10.1177/17511437211069318","DOIUrl":"https://doi.org/10.1177/17511437211069318","url":null,"abstract":"Background Guidewire retention and sharps injury during central venous catheter insertion are errors that cause patient and healthcare professional harm. The WireSafeTM is a novel procedure safety pack engineered to prevent guidewire retention and sharps injury during central venous catheter insertion. This is a pilot study aimed to determine its acceptability, usability and safety during clinical practice. Methods An observational time and motion study was conducted comparing central venous catheter insertion and sharps disposal practice using standard versus WireSafeTM techniques. One-year following implementation, a structured survey was conducted to determine clinician opinion and experiences of using the WireSafeTM. Results 15 procedures were observed using standard practice and 16 using the WireSafeTM technique. The WireSafeTM technique decreased the time taken from removal of the guidewire to disposal of sharps (standard 11.4 ± 5.6 min vs WireSafeTM 8.7 ± 1.4 min, p = 0.035), as well as total procedure time (standard 16 ± 7 min vs WireSafeTM 14.2 ± 2 min, p = 0.17), although this latter trend did not reach significance. Clinicians frequently practiced unsafe behaviour during sharps disposal in the standard group (53%), but when using the WireSafeTM technique, 100% exhibited safe practice by transferring sharps to the bin inside the sealed WireSafeTM box. One-year following implementation, 20 clinicians participated in the structured survey. Clinicians across three different departments used the WireSafeTM in varying clinical situations and reported that its use for central line insertion was either easier (10/20) or no different (10/20) compared to standard practice. All clinicians (20/20) felt that the WireSafeTM reduced the risk of guidewire retention and all stated that they approved of the WireSafeTM technique, and supported its use for convenience and safety benefits. Conclusion Utilising the WireSafeTM for central line insertion facilitated earlier and safer sharps disposal, and the device was well supported by clinicians for its convenience and safety benefits.","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 2","pages":"195-200"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10227898/pdf/10.1177_17511437211069318.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10301621","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":"Cerebral oximetry in adult cardiac surgery: A closer look at outcomes.","authors":"Stephanie Harper,&nbsp;Danielle Eusuf,&nbsp;Jan Hansel,&nbsp;Clifford Shelton","doi":"10.1177/17511437211045322","DOIUrl":"https://doi.org/10.1177/17511437211045322","url":null,"abstract":"We discussed Bennett et al.’s randomised controlled trial on the use of cerebral oximetry to reduce the incidence of neurological impairment at our regional journal club, based in the North West School of Anaesthesia. 1 This study found a reduced duration of stay in intensive care and improved self-reported functional status at six months amongst 90 patients who received cerebral oximetry monitoring and protocolised interventions to maintain cerebral oxygen saturation above baseline, compared to 91 patients who received a ‘sham’ intervention (monitoring attached but not connected) for purposes. suggest that routine use of cerebral oximetry may have a role in cardiac surgery, we that the study may have been equipped to detect other important findings.","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 2","pages":"232-233"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10227900/pdf/10.1177_17511437211045322.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10301623","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":"Key elements of an evidence-based clinical psychology service within adult critical care.","authors":"Matthew Beadman,&nbsp;Mike Carraretto","doi":"10.1177/17511437211047178","DOIUrl":"https://doi.org/10.1177/17511437211047178","url":null,"abstract":"<p><p>The COVID-19 pandemic has generated renewed interest in the psychological rehabilitation needs of patients admitted to intensive care units. While the availability of embedded practitioner psychologists within adult critical care teams remains inconsistent, post numbers have increased in response to the clinical needs of the pandemic. As psychology services within adult critical care become more widely established, models for service provision will be required. We describe our experience of developing a model for the delivery of a clinical psychology service within critical care in a District General Hospital with specialist tertiary surgical and cancer services. The current paper describes a service design that is firmly rooted in psychological theory and the broader clinical health psychology evidence base. We hope that our learning will be helpful to others.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 2","pages":"215-221"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10227902/pdf/10.1177_17511437211047178.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10290688","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":"Timing and burden of persistent critical illnessin UK intensive care units: An observational cohort study.","authors":"David A Harrison,&nbsp;Ben C Creagh-Brown,&nbsp;Kathryn M Rowan","doi":"10.1177/17511437211047180","DOIUrl":"https://doi.org/10.1177/17511437211047180","url":null,"abstract":"<p><strong>Background: </strong>Persistent critical illness is a recognisable clinical syndrome defined conceptually as when the patient's reason for being in the intensive care unit (ICU) is more related to their ongoing critical illness than their original reason for admission. Our objectives were: (1) to assess the day in ICU on which chronic factors (e.g., age, gender and comorbidities) were more predictive of survival than acute factors (e.g. admission diagnosis, physiological derangements) measured on the day of admission; (2) to assess the consistency of this finding across major patient subgroups and over time and (3) to compare case mix characteristics and outcomes for patients determined to develop persistent critical illness (based on ICU length of stay) with other patients.</p><p><strong>Methods: </strong>Observational cohort study using a high-quality clinical database from the national clinical audit of adult critical care. 217 adult ICUs in England, Wales and Northern Ireland. 835,946 adult patients admitted to participating ICUs between 1 April 2009 and 31 March 2016. The main outcome measure was mortality at discharge from acute hospital.</p><p><strong>Results: </strong>We fitted two statistical models ('chronic' and 'acute') and updated these based upon patients with an ICU length of stay of at least 1, 2, etc., up to 28 days. The discrimination of the chronic model first exceeded that of the acute model on day 11. Patients with longer stays (>10 days) comprised 9% of admissions but used 45% of ICU bed-days. After a mean ICU length of stay of 22 days and a subsequent 28 days in hospital, 30% died.</p><p><strong>Conclusions: </strong>Persistent critical illness is commonly encountered in clinical practice and is associated with increased healthcare utilisation and adverse outcomes. Improvements in our understanding of the longer term outcomes and in the development of tools to aid prognostication are urgently required - for humane as well as health economic reasons.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 2","pages":"139-146"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10227892/pdf/10.1177_17511437211047180.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10297477","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":"Dosage and clinical outcomes of medical emergency team and conventional referral mediated unplanned intensive care admissions.","authors":"Rajkumar Satyavolu,&nbsp;Mohammad Ishaq Ruknuddeen,&nbsp;Natalie Soar,&nbsp;Suzanne Melissa Edwards","doi":"10.1177/17511437211060157","DOIUrl":"https://doi.org/10.1177/17511437211060157","url":null,"abstract":"Background: Unplanned intensive care unit (ICU) admission occurs via activation of medical emergency team (MET) and conventional ICU referral (CIR), i.e., ICU consultation. We aimed to compare the dosage, association with unplanned ICU admissions and hospital mortality between MET and CIR systems. Methods: We performed a retrospective, single centre observational study on unplanned ICU admissions from hospital wards between July 2017 and June 2018. We evaluated the dosage (expressed per 1000 admissions) and association of CIR and MET system with unplanned ICU admission using Chi-square test. The relationship (unadjusted and adjusted to Australia and New Zealand risk of death (ANZROD) and lead time) between unplanned ICU admission pathway (MET vs CIR) and hospital mortality was tested by binary logistic regression analysis [Odds ratio (OR) with 95% confidence interval (CI)]. Results: Out of 38,628 patients hospitalised, 679 had unplanned ICU admission (2%) with an ICU admission rate of 18 per 1000 ward admissions. There were 2153 MET and 453 CIR activations, producing a dosage of 56 and 12 per 1000 admissions, respectively. Higher unplanned ICU admission was significantly associated with CIR compared to MET activation (324/453 (71.5%) vs 355/2153 (16.5%) p < 0.001). On binary logistic regression, MET system was significantly associated with higher hospital mortality on unadjusted analysis (OR 1.65 (95% CI: 1.09–2.48) p = 0.02) but not after adjustment with ANZROD and lead time (OR 1.15 (95% CI: 0.71–1.86), p = 0.58). Conclusions: Compared to CIR, MET system had higher dosage but lower frequency of unplanned ICU admissions and lacked independent association with hospital mortality.","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 2","pages":"178-185"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10227895/pdf/10.1177_17511437211060157.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10298867","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":"The utility of bandemia in prognostication and prediction of mortality in sepsis.","authors":"Nivedita Prasanna,&nbsp;Benjamin DelPrete,&nbsp;Geoffrey Ho,&nbsp;David Yamane,&nbsp;Amira Elshikh,&nbsp;Amir Rashed,&nbsp;Andrew Sparks,&nbsp;Danielle Davison,&nbsp;Katrina Hawkins","doi":"10.1177/17511437211069307","DOIUrl":"https://doi.org/10.1177/17511437211069307","url":null,"abstract":"<p><p><i>Background:</i> Bandemia, defined as a band count >10%, is indicative of underlying infection and is increasingly being used for early detection of sepsis. While an absolute band level has been linked to worse outcomes, its trend has not been extensively studied as a prognostic marker. In this study, we assessed patients admitted to the ICU with sepsis or septic shock and evaluated the correlation between bandemia trends and clinical trajectory among these patients. <i>Methods:</i> This study was a retrospective chart review. Band counts, serum lactate levels, and SOFA scores at 0 and 72 h after admission to the ICU were collected. Patients were risk stratified into groups depending on their SOFA trends, and corresponding band trends and serum lactate levels were compared. <i>Results:</i> 134 patients were included for analysis. There was a statistically significant decrease in bandemia trends for patients with a reduction in SOFA scores <i>[median (IQR)-4.5 (-11, 0); p < 0.0001]</i>, and a statistically significant increase in bandemia trends for patients with worsening SOFA scores <i>[median (IQR) 4 (0, 8); p = 0.0007]</i>. <i>Conclusion:</i> Early trends of serum band levels in patients with sepsis or septic shock may help to predict a clinical trajectory and overall prognosis. More investigation is warranted as to whether incorporating bandemia trends, when used in conjunction with other known markers such as lactate levels, may help to guide bedside clinical decisions such as risk stratification, tailored therapies, and ultimately improve outcomes.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 2","pages":"201-205"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10227906/pdf/10.1177_17511437211069307.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10298865","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":"'Ticked off'? Can a new outcomes-based postgraduate curriculum utilising programmatic assessment reduce assessment burden in Intensive Care Medicine?","authors":"Christopher Smith,&nbsp;Mumtaz Patel","doi":"10.1177/17511437211061642","DOIUrl":"https://doi.org/10.1177/17511437211061642","url":null,"abstract":"<p><strong>Context: </strong>Increasing dissatisfaction with existing methods of assessment in the workplace alongside a national drive towards outcomes-based postgraduate curricula led to a recent overhaul of the way Intensive Care Medicine (ICM) trainees are assessed in the United Kingdom. Programmatic assessment methodology was utilised; the existing 'tick-box' approach using workplace-based assessment to demonstrate competencies was de-emphasised and the expertise of trainers used to assess capability relating to fewer, high-level outcomes related to distinct areas of specialist practice.</p><p><strong>Methods: </strong>A thematic analysis was undertaken investigating attitudes from 125 key stakeholders, including trainees and trainers, towards the new assessment strategy in relation to impact on assessment burden and acceptability.</p><p><strong>Results: </strong>This qualitative study suggests increased satisfaction with the transition to an outcomes-based model with capability judged by educational supervisors. However, reflecting frustration relating to current assessment in the workplace, participants felt assessment burden has been significantly reduced. The approach taken was felt to be an improved method for assessing professional practice; there was enthusiasm for this change. However, this research highlights trainee and trainer anxiety regarding how to 'pass' these expert judgement decisions of capability in the real world. Additionally, concerns relating to the impact on subgroups of trainees due to the potential influence of implicit biases on the resultant fewer but 'higher stakes' interrogative judgements became apparent.</p><p><strong>Conclusion: </strong>The move further towards a constructivist paradigm in workplace assessment in ICM reduces assessment burden yet can provoke anxiety amongst trainees and trainers requiring considered implementation. Furthermore, the perception of potential for bias in global judgements of performance requires further exploration.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":"24 2","pages":"170-177"},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10227897/pdf/10.1177_17511437211061642.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10297478","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}