Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis最新文献

{"title":"Eligibility and patient barriers to peritoneal dialysis in patients with advanced chronic kidney disease.","authors":"Saleem Abdulkarim,&nbsp;Jasmit Shah,&nbsp;Ahmed Twahir,&nbsp;Ahmed P Sokwala","doi":"10.1177/0896860821998200","DOIUrl":"https://doi.org/10.1177/0896860821998200","url":null,"abstract":"<p><strong>Introduction: </strong>The burden of chronic kidney disease (CKD) is increasing in Kenya and is a significant cause of morbidity and mortality. While definitive treatment is renal transplantation, many patients require kidney replacement therapy with haemodialysis (HD) or peritoneal dialysis (PD). The predominant modality utilized in Kenya is currently HD. There is a need to explore why PD remains underutilized and whether patient factors may be contributory to barriers that limit the uptake of PD.</p><p><strong>Methods: </strong>This was a descriptive cross-sectional study where patients with advanced CKD were assessed by a multidisciplinary team for PD eligibility using a standardized tool. Contraindications and barriers to the modality were recorded as was the presence or absence of support for the provision of PD. Demographic and clinical data were recorded using a standardized questionnaire. The impact of support on PD eligibility was determined.</p><p><strong>Results: </strong>We found that 68.9% patients were eligible for PD. Surgery-related abdominal scarring was the most common contraindication. Barriers to PD were identified in 45.9% and physical barriers were more common than cognitive barriers. Presence of support was associated with a significant increase in PD eligibility (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>The rate of eligibility for PD in this study was similar to that found in other populations. Surgical-related factors were the most commonly identified contraindication. Physical and cognitive barriers were commonly identified and may be overcome by the presence of support for PD.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"463-471"},"PeriodicalIF":2.8,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0896860821998200","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25430539","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":"Key elements in selection of pre-dialysis patients for home dialysis.","authors":"Anna A Bonenkamp,&nbsp;Tom D Y Reijnders,&nbsp;Anita van Eck van der Sluijs,&nbsp;E Christiaan Hagen,&nbsp;Alferso C Abrahams,&nbsp;Frans J van Ittersum,&nbsp;Brigit C van Jaarsveld","doi":"10.1177/08968608211023263","DOIUrl":"https://doi.org/10.1177/08968608211023263","url":null,"abstract":"<p><strong>Background: </strong>Most pre-dialysis patients are medically eligible for home dialysis, and home dialysis has several advantages over incentre dialysis. However, accurately selecting patients for home dialysis appears to be difficult, since uptake of home dialysis remains low. The aim of this study was to investigate which medical or psychosocial elements contribute most to the selection of patients eligible for home dialysis.</p><p><strong>Methods: </strong>All patients from a Dutch teaching hospital, who received treatment modality education and subsequently started dialysis treatment, were included. The pre-dialysis programme consisted of questionnaires for the patient, nephrologist and social worker, followed by an assessment of eligibility for home dialysis by a multidisciplinary team. Clinimetric assessment and logistic regression were used to identify domains and questions associated with home dialysis treatment.</p><p><strong>Results: </strong>A total of 135 patients were included, of whom 40 were treated with home dialysis and 95 with incentre haemodialysis. The key elements associated with long-term home dialysis treatment were part of the domains 'suitability of the housing', 'self-care', 'social support' and 'patient capacity', with adjusted odds ratios ranging from 0.13 for negative to 18.3 for positive associations.</p><p><strong>Conclusion: </strong>The assessment of contraindications by a nephrologist followed by the assessment of possibilities by a social worker or dialysis nurse who investigates four key elements, ideally during a home visit, and subsequent detailed education offered by specialized nurses is an optimal way to select patients for home dialysis.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"494-501"},"PeriodicalIF":2.8,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/08968608211023263","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39146291","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":"Computerized adaptive technology for the assessment of HRQOL of PD and CKD patients.","authors":"Fredric O Finkelstein,&nbsp;Monica Cimini,&nbsp;Susan H Finkelstein,&nbsp;Alan S Kliger","doi":"10.1177/0896860820959961","DOIUrl":"https://doi.org/10.1177/0896860820959961","url":null,"abstract":"<p><p>This study was designed as a pilot study to see whether electronic patient-reported outcome measures using computer adaptive technology (CAT) could be successfully implemented in clinics caring for chronic kidney disease (CKD) and peritoneal dialysis (PD) patients. The results demonstrate the feasibility of using CAT on an iPad to assess the symptom burden and health-related quality of life of both PD and CKD patients.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"509-512"},"PeriodicalIF":2.8,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0896860820959961","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38458227","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":"Percutaneous reduction of omental prolapse following temporary peritoneal dialysis in a child.","authors":"Subrahmanian Sathiavageesan,&nbsp;Arun Karki,&nbsp;Melchizedek Kamalanathan,&nbsp;Ranjitha Ramajayam","doi":"10.1177/0896860821992603","DOIUrl":"https://doi.org/10.1177/0896860821992603","url":null,"abstract":"Prolapse of omentum through peritoneal dialysis (PD) catheter puncture site is a rare complication of PD, and there is no well-established guideline for management of omental prolapse. We report a case of omental prolapse through rigid PD catheter puncture site following removal of the catheter in a 3-year-old child and describe a technique for percutaneously reducing omental prolapse which could be performed by the nephrologist at the bed side. A 3-year-old male child who was on medical management for end-stage renal disease resulting from infantile nephrotic syndrome presented with profound uremic manifestations necessitating urgent start of PD. A pediatric rigid PD catheter (3 mm external diameter) with stylet was inserted about 1 cm above the umbilicus over the linea alba. Continuous exchange PD was performed for 48 h, and there was resolution of uremic manifestations. The rigid catheter was removed, and the puncture wound was left open since there was leakage of residual fluid. Four hours later omentum prolapsed through the puncture wound and the prolapse increased to attain a length of 3 cm during the next 4 h (Figure 1(a)). Abdomen remained soft and omentum appeared viable with pinkish hue and reddish submucosal capillary striae. Surgical reduction under general anesthesia with fascial closure was contemplated, however, considering the delay and complexity with such approach, percutaneous reduction of prolapsed omentum was attempted. Under intravenous midazolam sedation and local anesthesia, the distal part of the omentum was held with a non-toothed forceps and the proximal part emerging from the skin was gradually pushed millimeter-by-millimeter back into the peritoneal cavity through puncture site, using the tip of a disposable syringe. The last trace of omentum was pushed deep into the abdomen by inserting the entire length of the tip of the syringe into the puncture site. Abdomen after reduction of prolapsed omentum is shown in Figure 1(b). Skin and superficial fascia at the puncture site were closed with one through stitch. The procedure was performed at the bed side and completed in about 20 min. Prophylactic antibiotic was prescribed. A week later, the child appeared well, abdomen was soft, and there was no incisional hernia. Although rigid PD catheters are less preferred to flexible catheters, they find their utility in the treatment of acute kidney injury in resource poor setting. Omental prolapse following PD is a surgical emergency and prompt reduction is needed to prevent infection. There are scarce data on management of omental prolapse following PD. Backman et al., reported prolapse of omentum through a 2-mm","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"515-516"},"PeriodicalIF":2.8,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0896860821992603","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25375214","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 and caregiver perspectives on burnout in peritoneal dialysis.","authors":"Justin Oveyssi,&nbsp;Karine E Manera,&nbsp;Amanda Baumgart,&nbsp;Yeoungjee Cho,&nbsp;Derek Forfang,&nbsp;Anjali Saxena,&nbsp;Jonathan C Craig,&nbsp;Samuel Ks Fung,&nbsp;David Harris,&nbsp;David W Johnson,&nbsp;Peter G Kerr,&nbsp;Achilles Lee,&nbsp;Lorena Ruiz,&nbsp;Matthew Tong,&nbsp;Angela Yee-Moon Wang,&nbsp;Terence Yip,&nbsp;Allison Tong,&nbsp;Jenny I Shen","doi":"10.1177/0896860820970064","DOIUrl":"https://doi.org/10.1177/0896860820970064","url":null,"abstract":"<p><strong>Background: </strong>Peritoneal dialysis (PD) can offer patients more autonomy and flexibility compared with in-center hemodialysis (HD). However, burnout - defined as mental, emotional, or physical exhaustion that leads to thoughts of discontinuing PD - is associated with an increased risk of transfer to HD. We aimed to describe the perspectives of burnout among patients on PD and their caregivers.</p><p><strong>Methods: </strong>In this focus group study, 81 patients and 45 caregivers participated in 14 focus groups from 9 dialysis units in Australia, Hong Kong, and the United States. Transcripts were analyzed thematically.</p><p><strong>Results: </strong>We identified two themes. <i>Suffering an unrelenting responsibility</i> contributed to burnout, as patients and caregivers felt overwhelmed by the daily regimen, perceived their life to be coming to a halt, tolerated the PD regimen for survival, and had to bear the burden and uncertainty of what to expect from PD alone. <i>Adapting and building resilience</i> against burnout encompassed establishing a new normal, drawing inspiration and support from family, relying on faith and hope for motivation, and finding meaning in other activities.</p><p><strong>Conclusions: </strong>For patients on PD and their caregivers, burnout was intensified by perceiving PD as an unrelenting, isolating responsibility that they had no choice but to endure, even if it held them back from doing other activities in life. More emphasis on developing strategies to adapt and build resilience could prevent or minimize burnout.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"484-493"},"PeriodicalIF":2.8,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0896860820970064","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38596626","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":"Overcoming barriers and building a strong peritoneal dialysis programme - Experience from three South Asian countries.","authors":"Klara Paudel,&nbsp;Ahad Qayyum,&nbsp;Abdul Wm Wazil,&nbsp;Sanjib K Sharma,&nbsp;Kalpana Shrestha,&nbsp;Stanley Fan,&nbsp;Agnes Haris,&nbsp;Fredric O Finkelstein,&nbsp;Nishanthe Nanayakkara","doi":"10.1177/08968608211019986","DOIUrl":"https://doi.org/10.1177/08968608211019986","url":null,"abstract":"<p><p>The development of peritoneal dialysis (PD) programmes in lower-resource countries is challenging. This article describes the learning points of establishing PD programmes in three countries in South Asia (Nepal, Sri Lanka and Pakistan). The key barriers identified were government support (financial), maintaining stable supply of PD fluids, lack of nephrologist and nurse expertise, nephrology community bias against PD, lack of nephrology trainee awareness and exposure to this modality. To overcome these barriers, a well-trained PD lead nephrologist (PD champion) is needed, who can advocate for this modality at government, professional and community levels. Ongoing educational programmes for doctors, nurses and patients are needed to sustain the PD programmes. Support from well-established PD centres and international organisations (International Society of Peritoneal Dialysis (ISPD), International Society of Nephrology (ISN), International Pediatric Nephrology Association (IPNA) are essential.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"480-483"},"PeriodicalIF":2.8,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/08968608211019986","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39050599","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":"The peritoneal dialysis orders objective structured clinical examination (OSCE): A formative assessment for nephrology fellows.","authors":"Lisa K Prince,&nbsp;Brian C Y'Barbo,&nbsp;Robert Nee,&nbsp;Christina M Yuan","doi":"10.1177/08968608211000542","DOIUrl":"https://doi.org/10.1177/08968608211000542","url":null,"abstract":"<p><strong>Background: </strong>Peritoneal dialysis (PD) management is a fundamental nephrology skill, especially with the recent emphasis on home dialysis. We report a prospective multicentre cohort study of a formative objective structured clinical examination (OSCE) assessing competence in managing PD-associated bacterial peritonitis, using the unified model of construct validity.</p><p><strong>Methods: </strong>The OSCE was developed by the principal investigators and reviewed by two subject matter experts. The test committee (eight nephrologists and one PD nurse) assessed test item difficulty/relevance and determined passing score. There were 22 test items (7 evidence-based/standard-of-care questions). Passing score was 16/22 (73%). No item had median relevance less than 'important', and all were easy to medium difficulty. Content validity index was 0.91. Preliminary validation (16 board-certified volunteers): mean score was 19 ± 2, with 94% (15/16) passing. Kappa = 0.85 [95% confidence interval (CI) 0.77-0.94]. Cronbach's <i>α</i> = 0.70.</p><p><strong>Results: </strong>Eighty-seven fellows (16 programmes) were tested; 67% passed. Fellows scored significantly less than validators: 17 ± 3 versus 19 ± 2, <i>p</i> < 0.001 [95% CI 1.2-3.6]. Eighty-six per cent of evidence-based/standard-of-care questions were answered correctly by validators versus 54% by fellows; <i>p</i> < 0.001. Ninety-three per cent of fellows recognized that sufficient criteria were present to diagnose peritonitis, but only 17% correctly indicated all three. Seventy-seven per cent recognized peritonitis-associated ultrafiltration failure, but only 17% prescribed 21 days of antibiotic treatment for gram-negative peritonitis. Eighty-five per cent of fellows surveyed agreed/strongly agreed that the OSCE was useful in self-assessing proficiency. Second-year in-training examination and OSCE scores were positively correlated (Pearson's <i>r</i> = 0.57, <i>p</i> < 0.00).</p><p><strong>Conclusions: </strong>The OSCE may be used to formatively assess fellow proficiency in managing PD-associated peritonitis.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"472-479"},"PeriodicalIF":2.8,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/08968608211000542","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25528024","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":"Peritonitis after endoscopic marking in a peritoneal dialysis patient: Could it be chemical?","authors":"Pamela Gallo,&nbsp;Giuseppe Ferro,&nbsp;Ileana Benedetti,&nbsp;Chiara Somma,&nbsp;Pietro Claudio Dattolo","doi":"10.1177/0896860820908134","DOIUrl":"https://doi.org/10.1177/0896860820908134","url":null,"abstract":"Peritoneal dialysis patients have higher risk for peritonitis after colonoscopy, due to microperforations of the colonic wall or spontaneous bacterial translocation. The 2016 International Society for Peritoneal Dialysis guidelines suggests antibiotic prophylaxis. Peritoneal spreading of dye during endoscopic tattooing is a complication of colonoscopy reported in the literature. We present a case of culture-negative peritonitis in a peritoneal dialysis patient who underwent an endoscopic tattooing of a colon cancer. Optical microscopy of the peritoneal fluid revealed many","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"429-430"},"PeriodicalIF":2.8,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0896860820908134","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37681322","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":"Eosinophilic peritonitis induced by sucroferric oxyhydroxide.","authors":"Saori Minato,&nbsp;Haruhisa Miyazawa,&nbsp;Taisuke Kitano,&nbsp;Mitsutoshi Shindo,&nbsp;Kiyonori Ito,&nbsp;Yuichiro Ueda,&nbsp;Keiji Hirai,&nbsp;Taro Hoshino,&nbsp;Susumu Ookawara,&nbsp;Yoshiyuki Morishita","doi":"10.1177/0896860820915019","DOIUrl":"https://doi.org/10.1177/0896860820915019","url":null,"abstract":"<p><p>A 49-year-old woman developed eosinophilic peritonitis 2 months after starting continuous ambulatory peritoneal dialysis because of congenital right kidney hypoplasia and chronic glomerulonephritis. This was shown to have been induced by sucroferric oxyhydroxide, an iron-based phosphate binder, using a drug-induced lymphocyte stimulation test. Her eosinophilic peritonitis was improved after stopping the administration of sucroferric oxyhydroxide without providing any immunosuppressive agents.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"419-421"},"PeriodicalIF":2.8,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0896860820915019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37774868","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":"Response to: International Society for Peritoneal Dialysis practice recommendations: Prescribing high-quality goal-directed peritoneal dialysis.","authors":"Ayman Karkar","doi":"10.1177/0896860820917827","DOIUrl":"https://doi.org/10.1177/0896860820917827","url":null,"abstract":"I read with great interest the recently published ‘International Society for Peritoneal Dialysis practice recommendations: prescribing high-quality goal-directed peritoneal dialysis’ Peritoneal Dialysis International, 1–10, 2020, DOI: 10.1177/0896860819895364, where the authors/ working group have very nicely summarized and informatively updated the 2006 International Society for Peritoneal Dialysis guidelines. It was noticed in these recommendations that the description of the section ‘Which dialysis solution? – B. Use of neutral pH, low GDP PD solutions’ was so concise, that is, focusing only on preservation of residual renal function (RRF) and improving urine output despite the low certainty evidence that use of these fluids may have little or no effect on technique survival or mortality. However, there were no comments and/or clarifying the strength of evidence on (a) preservation of peritoneal membrane, (b) peritonitis or (c) peritoneal ultrafiltration (UF), which presumably all are very much related to the technique survival and time-on-therapy. This is especially the case in patients who lost their RRF, and where cost implications need to be taken in consideration! Most of previous studies, including randomized clinical trials and meta-analysis, didn’t show any effect of the neutral pH low glucose degradation product peritoneal dialysis solutions on improving peritoneal UF, if not decreasing it. While the mechanism of improving the RRF and urine output by these solutions is not clear, the RRF and peritoneal UF are interdependent. For example, higher peritoneal UF and the resultant relative volume contraction could directly promote a transient or permanent decrease in urine output and measured RRF, while increases in RRF may actually be due to relative volume expansion as a result of diminished peritoneal UF.","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"425-426"},"PeriodicalIF":2.8,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0896860820917827","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37825914","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}