CANADIAN JOURNAL OF HOSPITAL PHARMACY最新文献

{"title":"Besoin d’une étoile polaire pour guider la pratique de la pharmacie canadienne.","authors":"Zack Dumont","doi":"10.4212/cjhp.3428","DOIUrl":"https://doi.org/10.4212/cjhp.3428","url":null,"abstract":"","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"76 1","pages":"79-80"},"PeriodicalIF":0.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9817217/pdf/cjhp-76-79.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10121178","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":"Anticoagulation Interventions by Pharmacists in Acute Care.","authors":"Taylor McVannel,&nbsp;Kirsten Tangedal,&nbsp;Aleina Haines,&nbsp;William M Semchuk","doi":"10.4212/cjhp.3276","DOIUrl":"https://doi.org/10.4212/cjhp.3276","url":null,"abstract":"<p><strong>Background: </strong>Clinical pharmacy key performance indicators (cpKPIs) relate to activities performed by pharmacists that have been shown to improve patient outcomes. Within Saskatchewan Health Authority (SHA) Regina, most cpKPIs are incorporated into the organization's clinical practice standards, which provide guidance in prioritizing care, especially for high-risk medications, including anticoagulants. To track pharmacists' interventions associated with clinical practice standards, a locally developed electronic data-capture system (known as AIM High) was implemented.</p><p><strong>Objectives: </strong>To quantify and describe pharmacists' anticoagulation interventions on 16 wards with dedicated ward-based clinical pharmacists and to compare intervention rates between the cardiology and internal medicine wards to further evolve the organization's practice model.</p><p><strong>Methods: </strong>Data from the electronic data-capture system were retrospectively analyzed for a 5-year period (January 2016 to December 2020).</p><p><strong>Results: </strong>A total of 94 201 interventions were recorded in the AIM High system (average 362 interventions per week or 26 interventions per pharmacist per week). Of these, 15 661 (16.6%) cited the anticoagulation standard (average 60 anticoagulation interventions per week or 4 anticoagulant interventions per pharmacist per week). For the cardiology and internal medicine wards, 4183 of 11 888 (35.2%) and 9034 of 54 843 (16.5%) interventions cited the anticoagulation standard, respectively. The top 4 types of anticoagulation interventions were dose changed (<i>n</i> = 4372 or 27.9%), drug started or restarted (<i>n</i> = 3867 or 24.7%), patient education (<i>n</i> = 3094 or 19.8%), and drug discontinued (<i>n</i> = 2944 or 18.8%).</p><p><strong>Conclusion: </strong>Dedicated ward-based clinical pharmacists were following clinical practice standards incorporating the majority of cpKPIs to complete anticoagulation interventions. The types of anticoagulation interventions evolved over time and were influenced by the patient population.</p>","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"76 2","pages":"126-130"},"PeriodicalIF":0.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10049768/pdf/cjhp-76-126.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10137422","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":"Pharmacy Practice in Quebec Emergency Departments: A Survey Study.","authors":"Jessica Doiron,&nbsp;Madeleine Genest,&nbsp;Julie Morin,&nbsp;Jean-Francois Patenaude-Monette,&nbsp;Pierre-Olivier Monast,&nbsp;Nathalie Marceau,&nbsp;Eric Villeneuve","doi":"10.4212/cjhp.3262","DOIUrl":"https://doi.org/10.4212/cjhp.3262","url":null,"abstract":"<p><strong>Background: </strong>According to a Canadian survey conducted in 2013, 37 of the 67 Quebec emergency departments (EDs) in hospitals with more than 50 beds reported having a pharmacist within the department. However, based on the 17 responses to the survey, it was not possible to determine patient care services offered by Quebec ED pharmacists, because the data were aggregated across all Canadian respondents. A provincial survey was undertaken to further define ED pharmacy practice within Quebec.</p><p><strong>Objectives: </strong>To measure pharmacist involvement in EDs in the province of Quebec and to describe patient care services and interventions offered by these pharmacists.</p><p><strong>Methods: </strong>A 47-question survey was sent to 33 directors of pharmacy departments, representing 90 hospitals and institutes with EDs in the province of Quebec. The directors of pharmacy were asked to forward the survey to an ED pharmacist for completion or to partially answer the survey themselves if their facilities had no pharmacists practising in the ED. The survey evaluated the presence of pharmacists in the ED, their training, the interventions they performed, and their involvement within the department. The presence and role of ED pharmacy technical staff were also evaluated.</p><p><strong>Results: </strong>Of the 43 completed surveys received, 30 reported at least 1 pharmacist providing patient care within the facility's ED. The most common tasks performed by ED pharmacists were, in decreasing order of frequency, answering questions from the multidisciplinary team, adjusting medications according to patients' allergies or their renal or hepatic function, managing drug interactions, and clarifying prescriptions. Pharmacists also reported teaching pharmacy students and residents and supporting the team in the resuscitation area.</p><p><strong>Conclusions: </strong>The majority of respondents reported having at least 1 pharmacist in the ED. Compared with previous Canadian results, this survey had more respondents from Quebec with better representation of ED pharmacy practice in the province. Patient care services provided by pharmacists were variable, possibly because of a lack of standardized practice guidelines.</p>","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"76 1","pages":"7-13"},"PeriodicalIF":0.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9817218/pdf/cjhp-76-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10139383","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":"Opioid and Sedative Coprescription: Prescribing Patterns after an ICU Admission.","authors":"Tiffany Tozer,&nbsp;Meghan MacKenzie,&nbsp;Sarah Burgess,&nbsp;Osama Loubani,&nbsp;Heather Neville","doi":"10.4212/cjhp.3245","DOIUrl":"https://doi.org/10.4212/cjhp.3245","url":null,"abstract":"<p><strong>Background: </strong>Opioid misuse constitutes a health care crisis in Canada, and coprescription of opioids with sedatives has been associated with adverse events. Opioids and sedatives are frequently administered in the intensive care unit (ICU). The rate of continuation of opioid-sedative combinations after an ICU admission at the study institution was unknown.</p><p><strong>Objectives: </strong>To determine the rates of opioid and sedative coprescriptions following an ICU admission and to identify factors associated with continuation of hospital-initiated opioid-sedative coprescriptions at ICU transfer and hospital discharge.</p><p><strong>Methods: </strong>This retrospective chart review involved patients admitted to ICUs at a tertiary care centre between April 1, 2018, and March 31, 2019. Baseline characteristics were obtained from a clinical database and medication information from medication reconciliation forms. An opioid coprescription was defined as prescription of an opioid in combination with a sedative (benzodiazepine, z-drug, gabapentinoid, tricyclic antidepressant, or antipsychotic), and hospital-initiated coprescriptions encompassed various predefined scenarios of therapy started or modified before ICU transfer. Factors associated with hospital-initiated opioid coprescription were analyzed by multivariable logistic regression.</p><p><strong>Results: </strong>A total of 735 patients met the inclusion criteria. At ICU transfer, 23.0% (169/735) of the patients had an opioid coprescription, and 87.0% (147/169) of these coprescriptions were hospital-initiated. At hospital discharge, 8.6% (44/514) of the patients had an opioid coprescription, and 56.8% (25/44) of these coprescriptions were hospital-initiated. Male sex, home opioid coprescription, surgical patient, prolonged hospital stay, and in-hospital death were significantly associated with hospital-initiated opioid coprescription at the time of ICU transfer. Home opioid coprescription was significantly associated with opioid coprescription at the time of hospital discharge.</p><p><strong>Conclusions: </strong>Hospital-initiated opioid coprescriptions accounted for the majority of opioid coprescriptions at ICU transfer and hospital discharge. Pharmacists should assess all opioid coprescriptions to determine whether discontinuation and/or dose reduction is appropriate.</p>","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"76 1","pages":"29-39"},"PeriodicalIF":0.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9817220/pdf/cjhp-76-29.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10139385","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 Framework for Evaluating the Implementation of Biosimilar Drugs.","authors":"Lisa Milgram,&nbsp;Sarah Wheeler,&nbsp;Andrea Adamic,&nbsp;Mirhad Loncar,&nbsp;Micheal Guirguis,&nbsp;Betty Jo McCabe","doi":"10.4212/cjhp.3272","DOIUrl":"https://doi.org/10.4212/cjhp.3272","url":null,"abstract":"<p><strong>Background: </strong>The introduction of biosimilar drugs has significant effects on health care systems, and a variety of approaches are required to support acceptance, adoption, and use of these drugs. Literature exists on the enablers of, and barriers to, biosimilar implementation, but frameworks that support the evaluation of biosimilar implementation strategies are currently lacking.</p><p><strong>Objective: </strong>To develop an evaluation framework for assessing the effects of biosimilar implementation strategies on patients, clinicians, and publicly funded drug programs.</p><p><strong>Methods: </strong>The scope of the evaluation was determined by a pan-Canadian working group through the creation of a logic model of activities and expected outcomes associated with biosimilar implementation. Each component of the logic model was considered under the RE-AIM framework, which led to a set of evaluation questions and indicators. Feedback to inform the final framework was sought from stakeholders through focus group sessions and written responses.</p><p><strong>Results: </strong>An evaluation framework was created that articulates evaluation questions and indicators across 5 priority areas: stakeholder engagement, patient experience, patient outcomes, clinician experience, and system sustainability and affordability. Stakeholder feedback was obtained through 9 focus group sessions with a total of 87 participants. Feedback was used to refine the framework on the basis of stakeholder priorities and feasibility.</p><p><strong>Conclusions: </strong>Through extensive stakeholder consultation, an evaluation framework was developed to measure and monitor the effects of biosimilar implementation on the 5 identified priority areas, as well as to inform future biosimilar implementations. This framework can be used as a starting point for evaluating the implementation of biosimilars across health care systems.</p>","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"76 2","pages":"109-116"},"PeriodicalIF":0.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10049771/pdf/cjhp-76-109.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10137425","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":"Discerning Clinician Perceptions of an Established Opioid Stewardship (DISCLOSE) Program.","authors":"Cynthia Ramasubbu,&nbsp;Kseniya Chernushkin,&nbsp;Karen Ng,&nbsp;Michael Legal","doi":"10.4212/cjhp.3292","DOIUrl":"https://doi.org/10.4212/cjhp.3292","url":null,"abstract":"<p><strong>Background: </strong>The Opioid Stewardship Program (OSP) was created to promote safe and rational prescribing of opioids, where the risks associated with providing opioids for patients must be balanced against the risk of patients experiencing uncontrolled pain. The pharmacist-led OSP was established at 2 Fraser Health Authority (FHA) sites, British Columbia, to provide clinical services through patient referrals and screening. The rate of acceptance of OSP pharmacists' recommendations has been high, but there was a need to assess clinicians' perceptions of the program.</p><p><strong>Objectives: </strong>To assess the perceptions of health care professionals at FHA hospitals offering the OSP regarding various aspects of the program and to identify areas of the program that could be modified to further optimize service delivery.</p><p><strong>Methods: </strong>A prospective cross-sectional survey was distributed to about 250 targeted health care professionals, who answered questions regarding their perceptions of the OSP. Data were analyzed using simple descriptive statistics.</p><p><strong>Results: </strong>A total of 71 respondents initiated the survey, of whom 59 were included in the final analyses. Most participants indicated that the OSP pharmacists' suggestions were valuable for optimizing pain management (52/57, 91%) and preventing adverse events (49/56, 88%). Most participants were satisfied with the quality of communication (51/56, 91%), timeliness to consults (51/52, 98%), and recommendations provided (52/55, 95%). Increasing knowledge transfer, improving communication about intentions for patient follow-up, and expanding services at current sites and to other sites were recommended to improve the OSP.</p><p><strong>Conclusions: </strong>Clinicians responding to the survey reported a high level of satisfaction with and positive views of the pharmacist-led OSP. Providing more education and clarifying intentions for patient follow-up are modifications that could be made to improve the program.</p>","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"76 1","pages":"63-70"},"PeriodicalIF":0.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9817221/pdf/cjhp-76-63.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10139386","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":"Comparison of a Fully Weight-Based Protocol with a Non-Weight-Based Dosage Titration Protocol for IV Unfractionated Heparin: A Before-and-After Study.","authors":"Thomas Cameron,&nbsp;Doson Chua,&nbsp;Stephen Shalansky,&nbsp;Edwin Tam,&nbsp;Erica Wang","doi":"10.4212/cjhp.3265","DOIUrl":"https://doi.org/10.4212/cjhp.3265","url":null,"abstract":"<p><strong>Background: </strong>Unfractionated heparin (UFH) is used for the prevention and treatment of arterial or venous thromboembolism. The dosage for IV infusion of UFH is generally based on the patient's weight, with adjustment to a specific target for activated partial thromboplastin time (aPTT). In May 2019, the UFH protocols at the study institution were changed from being fully weight-based (i.e., for both initial dosing and subsequent dosage titrations) to weight-based initial dosing and non-weight-based dosage titrations, but the relative effectiveness of these 2 approaches was not known.</p><p><strong>Objectives: </strong>The primary objective was to compare the effectiveness in achieving therapeutic aPTT with the fully weight-based and non-weight-based dosage titration protocols. The secondary objective was to compare the effectiveness of the non-weight-based dosage titration protocol with that of the previous fully weight-based one for patients with low-target aPTT.</p><p><strong>Methods: </strong>A single-centre, retrospective, observational before-and-after study was conducted for patients receiving therapeutic UFH for any indication. Patients in the \"before\" group (fully weight-based protocol) were treated from January 2015 to October 2016, and those in the \"after\" group (non-weight-based titration) from January to October 2020.</p><p><strong>Results: </strong>From a total of 1969 charts screened, 137 patients treated according to the fully weight-based protocols and 130 patients treated according to the non-weight-based titration protocols were included. In terms of the co-primary objective, the median number of dosage adjustments to achieve therapeutic anticoagulation was 1 in both groups (<i>p</i> = 0.48), and the proportion of patients with therapeutic anticoagulation at 24 h was similar (96.2% [125/130] with the non-weight-based titration protocols versus 99.3% [136/137] with the fully weight-based protocols; <i>p</i> = 0.09). Among patients treated according to the low-target UFH protocols, those with the non-weight-based titration protocol were less likely to have therapeutic anticoagulation at first measurement of aPTT than those with the fully weight-based protocol (37.9% [25/66] versus 44.6% [41/92], <i>p</i> = 0.033).</p><p><strong>Conclusions: </strong>This retrospective, observational, before-and-after study showed that the effectiveness of the non-weight-based dosage titration protocols in achieving therapeutic aPTT was similar to that of fully weight-based UFH protocols.</p>","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"76 1","pages":"23-28"},"PeriodicalIF":0.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9817222/pdf/cjhp-76-23.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10121179","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":"TRIBUTE TO THE REVIEWERS OF THE <i>CANADIAN JOURNAL OF HOSPITAL PHARMACY</i>.","authors":"","doi":"10.4212/cjhp.3449","DOIUrl":"https://doi.org/10.4212/cjhp.3449","url":null,"abstract":"","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"76 2","pages":"141"},"PeriodicalIF":0.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10049764/pdf/cjhp-76-141.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10137423","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":"Pharmacists Are Medication Stewards.","authors":"Cynthia A Jackevicius","doi":"10.4212/cjhp.3409","DOIUrl":"https://doi.org/10.4212/cjhp.3409","url":null,"abstract":"","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"76 1","pages":"3-4"},"PeriodicalIF":0.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9817219/pdf/cjhp-76-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10139388","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":"Evaluating the Influence of IV Ketamine on Postoperative Opioid Use for Surgical Patients at a Tertiary Care Centre.","authors":"Danielle Porter,&nbsp;Sharon Yamashita,&nbsp;Martin Van Der Vyver,&nbsp;Romina Marchesano","doi":"10.4212/cjhp.3309","DOIUrl":"https://doi.org/10.4212/cjhp.3309","url":null,"abstract":"<p><strong>Background: </strong>Subanesthetic doses of ketamine have been shown to improve the efficacy of opioids, increase pain control, and exemplify opioid-sparing effects when used as postoperative analgesia for adults.</p><p><strong>Objectives: </strong>To determine, for surgical patients, the impact of IV ketamine infusions on opioid use in hospital, overall and within 24 h before discharge, as well as pain scores.</p><p><strong>Methods: </strong>A retrospective matched cohort study was conducted, in which surgical patients exposed to ketamine were compared with those not exposed to ketamine, among admissions from January 1, 2018, to February 28, 2020. Patients were matched for age, surgical service, and sex.</p><p><strong>Results: </strong>A total of 104 patients were included in the study. Overall, there was no significant difference in mean total opioid use in hospital for patients exposed and not exposed to ketamine (171.7 mg versus 115.5 mg oral morphine equivalent [OME], <i>p</i> = 0.09), nor was there any difference in opioid use in the 24 h before discharge (28.2 mg versus 18.2 mg OME, <i>p</i> = 0.14). Patient-reported pain scores did not differ between groups. More patients in the ketamine group experienced hallucinations than in the group not exposed to ketamine (5 versus 0, <i>p</i> = 0.024).</p><p><strong>Conclusions: </strong>Overall, subanesthetic doses of IV ketamine used postoperatively in surgical patients did not decrease opioid use or patient-reported pain. More patients who received ketamine had documented hallucinations. These results will help guide postoperative analgesia practice and strategies to reduce opioid use.</p>","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"76 1","pages":"48-55"},"PeriodicalIF":0.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9817225/pdf/cjhp-76-48.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10139389","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}