The Australian & New Zealand journal of obstetrics & gynaecology最新文献

{"title":"Current Breastfeeding Attitudes, Knowledge and Confidence of Obstetricians and Gynaecologists in Australia and New Zealand.","authors":"Gabrielle Cher, Diana M Bond, Natasha Nassar, Katy Hunt, Jane Svensson, Olga Aleshin, Antonia Shand","doi":"10.1111/ajo.70055","DOIUrl":"https://doi.org/10.1111/ajo.70055","url":null,"abstract":"<p><strong>Background: </strong>There are limited data on what obstetricians and gynaecologists (O&G) know and think about supporting breastfeeding women.</p><p><strong>Aims: </strong>To investigate breastfeeding attitudes, knowledge and confidence of Australian and New Zealand O&G specialists and trainees in educating, assessing and managing breastfeeding women.</p><p><strong>Materials and methods: </strong>An online REDCap survey was distributed via email in February 2023 to fellows and trainees of the Royal Australian New Zealand College of Obstetricians and Gynaecologists (RANZCOG). The survey included questions on demographic characteristics, knowledge, attitudes and confidence about breastfeeding.</p><p><strong>Results: </strong>Of 312 (11%) respondents, 63% were > 40 years old, 78% female and two-thirds had personally breastfed. Half had no formal breastfeeding education. Mean score related to attitude was 4.8/7 (71.1%) with higher scores associated with extra training (β = 0.44 (95% CI 0.04, 0.84)) and personal breastfeeding (β = 0.37 (95% CI 0.15, 0.60)). Mean correctly answered knowledge score was 9/12 (75%). After adjusting for covariates, the main factors associated with higher knowledge were personal breastfeeding (β = 0.45 (95% CI 0.21, 0.69)) and being female (β = 0.58 (95% CI 0.10, 1.07)). Overall mean confidence score was 4.8/7 (68.6%); however, only 37% felt confident in managing breastfeeding challenges, and 60% would value more breastfeeding education. Factors associated with increased confidence included personal breastfeeding (β = 0.52 (95% CI 0.31, 0.73)), increased age (β = 0.39 (95% CI 0.64, 0.71)), and extra training (β = 0.84 (95% CI 0.46, 1.21)).</p><p><strong>Conclusions: </strong>Confidence about breastfeeding in RANZCOG specialists and trainees was low. The majority of respondents wanted more formal and improved breastfeeding education and training. Breastfeeding educational resources and ongoing training should be developed for O&G trainees and specialists.</p>","PeriodicalId":520788,"journal":{"name":"The Australian & New Zealand journal of obstetrics & gynaecology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693149","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":"Clinical Experience and Major Learning Points Following the Implementation of the sFlt-1/PlGF Ratio in the Management of Suspected Preeclampsia in a South Australian Tertiary Hospital.","authors":"Annabel Lane, L U Amy, Anupam Parange, Gustaaf Dekker","doi":"10.1111/ajo.70046","DOIUrl":"https://doi.org/10.1111/ajo.70046","url":null,"abstract":"<p><strong>Introduction: </strong>The ability to measure pro-angiogenic (PlGF) and anti-angiogenic (sFlt-1) factors, specifically the sFlt-1/PlGF ratio, allows obstetricians to assess syncytiotrophoblast stress, a key mechanism in preeclampsia. In Australia, the introduction of this ratio to clinical practice, particularly its high negative predictive value, was led by Professor Brennecke (Melbourne). At our tertiary centre, adapted Victorian guidelines were introduced in October 2021. Despite multiple educational sessions, the transition from assessing 'end organ damage' to the 'placental syndrome' presented challenges for clinicians.</p><p><strong>Materials and methods: </strong>This retrospective audit examined 431 women over 20 months to assess the implementation of the sFlt-1/PlGF ratio. The primary objective was to identify key educational points to improve clinical decision-making and the accurate use of the ratio in a tertiary centre.</p><p><strong>Results: </strong>Of 750 tests, 79% (n = 596) were ordered according to guidelines. Among 154 tests ordered outside the guidelines, 57% (n = 88) were performed within a reassuring time frame from the previous test, 41% (n = 63) outside validated gestational windows, 1% (n = 2) with an unknown indication and 1% (n = 1) following a 'severe risk' result.</p><p><strong>Discussion: </strong>Common errors included repeating tests too frequently (despite the high negative predictive value over 3-4 weeks), testing prior to 20 weeks or after 37 weeks, and underestimating the prognostic value of very high sFlt-1/PlGF ratios.</p>","PeriodicalId":520788,"journal":{"name":"The Australian & New Zealand journal of obstetrics & gynaecology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661759","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":"Managing Acute Behavioural Disturbance in Perinatal Women: A Systematic and State of the Art Review of Guidelines.","authors":"Megan Galbally, Brendan Jansen, Rebecca Hill, Bo Egan, Josephine Power, Ryan Hodges, Mathew Coleman","doi":"10.1111/ajo.70048","DOIUrl":"https://doi.org/10.1111/ajo.70048","url":null,"abstract":"<p><strong>Background: </strong>Guidelines for managing acute behavioural disturbance typically exclusively focus on care for adults in mental health and related settings, how this should be adapted to safely manage in pregnancy and the early postpartum including in settings such as maternity wards is less clear.</p><p><strong>Aims: </strong>To undertake a systematic and state of the art review on managing acute behavioural disturbance (ABD) in perinatal (pregnant and postpartum) women.</p><p><strong>Materials and methods: </strong>A systematic review of national and international mental health guidelines for managing perinatal acute behavioural disturbance and a state of the art review synthesis of adult mental health management of acute behavioural disturbance principles, pregnancy and lactation pharmacotherapy principles, and obstetrics risks relevant to perinatal ABD management.</p><p><strong>Results: </strong>Only two published guidelines that included perinatal ABD were identified. Many overarching principles in ABD management are suitable for perinatal women, however adaptation of sedation and physical restraint is necessary to ensure safety in pregnancy. Identified were principles of pharmacological exposure and choice of agent in pregnancy that can be applied to ABD as well as principles in pregnancy that can be utilised for safer physical restraint.</p><p><strong>Conclusion: </strong>When managing ABD in pregnancy or postpartum including on maternity wards, many of the guiding principles such as the use of least restrictive practices and de-escalation can be applied without adaptation to perinatal period. However, when pharmacological agents and/or physical restraint are indicated then certain adaptations for pregnancy and lactation are required to ensure the safe care of women and infants.</p>","PeriodicalId":520788,"journal":{"name":"The Australian & New Zealand journal of obstetrics & gynaecology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319220","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":"Management of Molar-Pregnancy and Associated Gestational Trophoblastic Neoplasia at a Specialised Unit: 10-Year Review.","authors":"Harrison Odgers, Shannon Philp, Trevor Tejada-Berges","doi":"10.1111/ajo.70053","DOIUrl":"https://doi.org/10.1111/ajo.70053","url":null,"abstract":"<p><p>Patients diagnosed with gestational trophoblastic diseases (GTD) can develop malignant gestational trophoblastic neoplasia (GTN). ß-hCG monitoring is important in the early detection of GTN. The primary outcome of this study was to describe ß-hCG monitoring completion rates and time from GTN diagnosis to chemotherapy commencement for patients cared for by a specialised GTD unit within a Gynecologic Oncology department. Secondary outcomes included imaging findings, quantitative ß-hCG levels and gestational age at the time of GTD diagnosis, WHO/FIGO scores and chemotherapy outcomes for those who developed GTN, and the time taken for ß-hCG normalisation for both groups. We collected data for 164 patients with molar pregnancies and 28 patients with GTN requiring chemotherapy. ß-hCG monitoring completion was 93.9%, and the median time to chemotherapy commencement was 7 days. Additional data found a low risk of GTN diagnosis following a negative ß-hCG and high complete response rates to chemotherapy for GTN.</p>","PeriodicalId":520788,"journal":{"name":"The Australian & New Zealand journal of obstetrics & gynaecology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278139","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":"Comparison of Gestational Weight Gain and Maternal and Neonatal Outcomes Among Women With and Without a History of Bariatric Surgery: A Retrospective Cohort Study.","authors":"Tayla Miegel, Lisa Vincze, Taylor Guthrie, Helen Porteous, Shannon Huxtable, Susan De Jersey, Michelle Palmer","doi":"10.1111/ajo.70052","DOIUrl":"https://doi.org/10.1111/ajo.70052","url":null,"abstract":"<p><strong>Background: </strong>Australian bariatric surgery (BSurg) rates more than doubled between 2005 and 2015, with around half being women of childbearing age. Few studies have reported gestational weight gain (GWG), and maternal and neonatal outcomes in pregnant women after sleeve gastrectomy.</p><p><strong>Aims: </strong>This retrospective cohort study compared GWG, maternal and neonatal outcomes of women with and without a history of BSurg from one urban Australian hospital.</p><p><strong>Materials and methods: </strong>Eligible participants were pregnant women with and without a history of BSurg who gave birth between 2016 and 2020. A woman with BSurg was matched to one woman without BSurg based on age, pre-pregnancy body mass index (BMI) and estimated date of confinement. Demographic, pregnancy and GWG outcomes were sourced from hospital data and medical records. Chi-squared and t-tests were used to compare data between groups.</p><p><strong>Results: </strong>There were 210 participants (105 in each group) with a median pre-pregnancy BMI of 30.5 kg/m². The main BSurg type was sleeve gastrectomy (n = 87). Neonates of women post-BSurg had lower birthweights (BSurg: 3175 ± 484 g; non-BSurg: 3419 ± 562 g; p < 0.001). GWG (BSurg: 9 [4.9-13.9]kg; non-BSurg: 8.9 [3-15.3]kg, p = 0.987) and adherence to the Institute of Medicine's GWG recommendations (BSurg: 24%; non-BSurg: 22%, p = 0.897) were similar between groups. Women who conceived < 12 months after BSurg had on average 4.8 kg lower GWG (p < 0.001) and more had insufficient GWG (BSurg < 12 months:61%; BSurg ≥ 12 months: 25%, p = 0.002).</p><p><strong>Conclusion: </strong>Neonates of women who had BSurg prior to pregnancy had lower birthweights than neonates of women of similar age, pre-pregnancy BMI and confinement date. Delaying pregnancy for 12 months post-BSurg may be associated with adequate GWG.</p>","PeriodicalId":520788,"journal":{"name":"The Australian & New Zealand journal of obstetrics & gynaecology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236763","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":"Day-Case Laparoscopic Hysterectomy: A Successful Pilot in Regional New Zealand.","authors":"Ben McLaughlin, Jonathan Panckhurst, Richard Carpenter","doi":"10.1111/ajo.70049","DOIUrl":"https://doi.org/10.1111/ajo.70049","url":null,"abstract":"<p><p>We conducted a day-case total laparoscopic hysterectomy service improvement project at Nelson Public Hospital, New Zealand, in August and September, 2024. A retrospective analysis was performed, and a voluntary patient questionnaire administered, at the 4-week postoperative review. Five participants were recruited and successfully discharged on the day of surgery without complication, and either agreed or strongly agreed with the statement, 'I would recommend day-case total laparoscopic hysterectomy to friends and family'. Qualitative feedback was strongly positive. We conclude that with appropriate infrastructure and resourcing, offering day-case total laparoscopic hysterectomy in a regional centre is both viable and acceptable to patients.</p>","PeriodicalId":520788,"journal":{"name":"The Australian & New Zealand journal of obstetrics & gynaecology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164700","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":"'That Doesn't Sound Right': A Qualitative Study Exploring the Information Seeking Behaviour of Current Long-Acting Reversible Contraceptive Users in Australia.","authors":"Cassandra Caddy, Meredith Temple-Smith, Jacqueline Coombe","doi":"10.1111/ajo.70044","DOIUrl":"https://doi.org/10.1111/ajo.70044","url":null,"abstract":"<p><strong>Objective(s): </strong>Accessible and accurate information about long-acting reversible contraception (LARC) is important in addressing misperceptions and ensuring consumers can make informed decisions about their use, yet little is known about consumers' experiences of searching for and being provided information about LARC.</p><p><strong>Methods: </strong>Individual semi-structured 'Zoom' interviews were conducted with people living in Australia aged 18-45, who were currently using a LARC or whose LARC was removed within the past 6 months. Data were analysed using reflexive thematic analysis.</p><p><strong>Results: </strong>A total of 23 interviews were conducted between October 2022-January 2023. Participants were actively engaged in seeking information about LARC prior to initiation and/or during its use. Participants sought information from a variety of sources to validate, or support information previously acquired and made judgements on the accuracy of different sources. Hearing the experiences of other LARC users was highly valued and viewed as providing information not available from other sources, especially in regard to expected side effects. Although healthcare providers were seen as the best source of information, many participants reported dissatisfaction with clinical interactions.</p><p><strong>Conclusion: </strong>Consumers used a variety of information sources when making decisions about LARC and highly valued hearing other LARC users experiences. Healthcare providers and organisations should consider incorporating lived experiences of LARC into evidence-based information to meet the needs of consumers.</p>","PeriodicalId":520788,"journal":{"name":"The Australian & New Zealand journal of obstetrics & gynaecology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164709","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":"'Fostering the Future': Exploring Barriers and Enablers to Doctors Pursuing a Clinician Educator Pathway in Obstetrics and Gynaecology.","authors":"Sarah Van Der Hock, Naomi Holbeach, Edwina Coghlan","doi":"10.1111/ajo.70047","DOIUrl":"https://doi.org/10.1111/ajo.70047","url":null,"abstract":"<p><p>The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) is committed to developing a sustainable, high-quality clinical education workforce. To train exceptional doctors, exceptional educators are needed. In order to better understand the barriers and enablers to careers as a clinician-educator in Obstetrics and Gynaecology, further research related to the educator experience is required. We argue that renewed efforts to address these barriers and enablers are needed to support Obstetricians and Gynaecologists with expertise and passion for teaching, as they contribute significantly to the training and sustainability of the current and future medical workforce. Those supports should target the following areas identified from this literature review: institutional support and culture, personal motivation and interest, balance of clinical service and delivery of education and career impact and advancement. Amid rising numbers of medical students, post-pandemic challenges in the hospital and workforce pressures for specialists and general practitioners in Australia, it is essential to prioritise clinical education strategic planning and research. This review contributes to the literature by supporting existing efforts to develop structured educator pathways such as the new RANZCOG Academy of Clinician Educators.</p>","PeriodicalId":520788,"journal":{"name":"The Australian & New Zealand journal of obstetrics & gynaecology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164706","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":"Prevalence and Severity of Endometriosis at Laparoscopic Treatment of Tubal Ectopic Pregnancy.","authors":"Jennifer Dean, Stephen Lee, Charlotte Reddington, Claudia Cheng, Michal Amir, Martin Healey","doi":"10.1111/ajo.70050","DOIUrl":"https://doi.org/10.1111/ajo.70050","url":null,"abstract":"<p><strong>Background: </strong>Endometriosis may have a causal role in ectopic pregnancies.</p><p><strong>Aims: </strong>To observe the prevalence and staging of endometriosis in women at the time of laparoscopic treatment of tubal ectopic pregnancy.</p><p><strong>Methods: </strong>Prospective observational cohort study carried out in a tertiary obstetrics and gynaecology hospital. Seventy participants with ectopic pregnancy requiring laparoscopic treatment were recruited. A pre-operative questionnaire was completed by patients regarding symptoms of endometriosis and gynaecological history. A post operative questionnaire was completed by the surgical team regarding site of ectopic pregnancy, presence or absence of endometriosis and severity of endometriosis.</p><p><strong>Results: </strong>After the exclusion of patients with non-tubal ectopic pregnancies, results were examined for 65 patients. Of the 65 histologically confirmed ectopic pregnancies, 36 had laparoscopically confirmed endometriosis, demonstrating a prevalence rate of 55% in our cohort. r-ARSM stage I or II (minimal or mild) disease made up 92% (33/36) of cases. There was little correlation between severity of patient symptoms and severity of endometriosis on laparoscopic evaluation.</p><p><strong>Conclusion: </strong>This study demonstrates endometriosis is significantly more common in women with surgically managed tubal EP compared to the general population.</p>","PeriodicalId":520788,"journal":{"name":"The Australian & New Zealand journal of obstetrics & gynaecology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164708","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":"Impact of Metabolic Surgery on Gestational Diabetes Mellitus: A Cohort Analysis.","authors":"Jasmine Wintour, Sarjana Afrin, Nicole Buxton, Mercy Madzivanyika, Katie Wynne","doi":"10.1111/ajo.70051","DOIUrl":"https://doi.org/10.1111/ajo.70051","url":null,"abstract":"<p><strong>Background: </strong>With the upsurge of obesity in Australia and worldwide, the incidence of metabolic surgery is increasing in women of reproductive age. Metabolic surgery reduces the rate of gestational diabetes mellitus, however, the risk remains about that for the general population.</p><p><strong>Aim: </strong>To evaluate maternal and perinatal outcomes of consecutive women with GDM post-metabolic surgery presenting to an endocrine antenatal clinic in a single tertiary centre.</p><p><strong>Methods: </strong>A retrospective cohort study of women with GDM after metabolic surgery were audited between 2020 and 2024.</p><p><strong>Results: </strong>This cohort of 36 women were aged 32.9 (± 4.7) years and 3.3 (±2.0) years post-surgery with the majority undergoing sleeve gastrectomy (97.2%). Gestational diabetes was diagnosed at 25 (±6⁺⁰) weeks. Screening identified carbohydrate inadequacy or inconsistency (18/36, 50%) and micronutrient deficiency (34/36, 94.4%) were common, with 26/36 (72.2%) women deficient in more than one micronutrient. Insulin therapy was required in 16 women. Recurrent hypoglycaemia occurred in 10 (27.8%) women. Women birthed at 38 (±1⁺⁰) weeks, with unplanned Caesarean delivery in six (16.7%) women. Composite adverse neonatal outcomes occurred in 22/36 (61.1%) of births. Hypoglycaemia (< 2.6 mmol/L) occurred in 8/36 (22.2%) of neonates; 1/36 (2.8%) were small-for-gestational age, and 2/36 (5.6%) large-for-gestational age. A higher neonatal birthweight was observed in women with reported pre-pregnancy BMI ≥ 30 kg/m² and women requiring insulin.</p><p><strong>Conclusion: </strong>Nutritional deficiencies occur commonly in women with gestational diabetes after metabolic surgery. There was a high rate of composite adverse neonatal outcome suggesting that these pregnancies may be higher risk. Further research is required to evaluate the optimal methods of screening and recommended glycaemic targets.</p>","PeriodicalId":520788,"journal":{"name":"The Australian & New Zealand journal of obstetrics & gynaecology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164707","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}