Canadian Geriatrics Journal最新文献

{"title":"Neuropsychiatric Symptoms and Psychotropic Medication Use Following SARS-Cov-2 Infection Among Elderly Residents in Long-Term Care Facilities.","authors":"Diana Cruz-Santiago, Xiangfei Meng, Michelle Canac-Marquis, Avik Sengupta, Jean-Philippe Brassard, Erik Pavey, Hélène Girouard, Donald C Vinh, Jean-Philippe Gouin","doi":"10.5770/cgj.28.770","DOIUrl":"10.5770/cgj.28.770","url":null,"abstract":"<p><strong>Background: </strong>SARS-CoV-2 infection can lead to persistent post-acute neuropsychiatric symptoms. Older adults with multimorbidity may be at increased risk of post-acute symptoms after COVID-19. The goals of the present study were to assess the associations of SARS-CoV-2 infection with neuropsychiatric symptoms and psychotropic medication prescription among older adults living in long-term care facilities.</p><p><strong>Methods: </strong>Nursing home residents (n=111) participated in this three-month longitudinal study. Nurse ratings of neuropsychiatric symptoms were conducted at baseline and at the three-month follow-up. SARS-CoV-2 infection status and psychotropic medication prescription were extracted from a medical chart review.</p><p><strong>Results: </strong>About 73.9% of participants were infected with SARS-CoV-2 on average 480.49 (SD= 228) days before study enrollment. There were no significant changes in neuropsychiatric symptoms during the study follow-up period. Participants with a SARS-CoV-2 infection had more agitation compared to those who were never infected. However, this effect disappeared after adjusting for age, sex, history of psychiatric disorder, neurocognitive status, and multimorbidity. Participants with SARS-CoV-2 had a higher number of psychotropic medication prescription. This effect was driven by increased use of antidepressants and antipsychotic medications.</p><p><strong>Conclusion: </strong>Both acute and short-term neuropsychiatric symptoms associated with COVID-19 may contribute to long-term psychoactive polypharmacy among older adults living in long-term facilities.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"28 1","pages":"67-72"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574655","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":"Variations in Prescribing Rates of End-of-Life Medications Among Long-Term Care Residents in Alberta Compared with Ontario-a Retrospective Cohort Study.","authors":"Jessica E Simon, Asmita Bhattarai, Zhi-Yun Apoint-Hao, Rhiannon L Roberts, Christina Milani, Colleen Webber, Vivian Ewa, Anna E Clarke, Sarina R Isenberg, Daniel Kobewka, Danial Qureshi, Shirley H Bush, Kaitlyn Boese, Amit Arya, Benoit Robert, James Downar, Peter Tanuseputro, Aynharan Sinnarajah","doi":"10.5770/cgj.28.811","DOIUrl":"10.5770/cgj.28.811","url":null,"abstract":"<p><strong>Background: </strong>Prescribing rates for subcutaneous medications may be an indicator of quality of end-of-life care in long-term care (LTC). It is not known if this system level measure is valid across jurisdictions. We compared prescribing rates of medications used for end-of-life symptom relief among LTC residents in Alberta and Ontario.</p><p><strong>Methods: </strong>This retrospective cohort study of LTC residents compared those who died between January 1, 2017, and March 17, 2020 in Alberta, with a published cohort from Ontario. Prescribed end-of-life medications during a resident's last 14 days of life were extracted from administrative dispensation records. LTC homes were ranked into quintiles based on prescribing rates within each home, and the home characteristics were described. The proportion of residents who transferred out of LTC in the last 14 days of life was also determined, as another quality measure.</p><p><strong>Results: </strong>We identified 10,038 decedents in 117 LTC homes. Among LTC decedents, 16.9% were prescribed ≥1 injectable end-of-life medication and 44.9% were prescribed at least one end-of-life medication by any route of administration, within the last 14 days of life. Across prescribing quintiles, there were no associations with transfer rates prior to death. Comparing Alberta to Ontario, there were markedly lower rates of injectable medicine prescribing (16.9% vs. 64.7%). Potential reasons and data limitations were explored.</p><p><strong>Conclusions: </strong>Rates of injectable end-of life medication prescribing differed across Alberta LTC homes; however, current provincial data limitations impact the validity of using these rates as a comparative indicator of the quality of end-of-life care.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"28 1","pages":"31-40"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574743","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":"Virtual Goals of Care Consultation for Advanced Frailty: a Qualitative Implementation Study Providing Insights from the Pandemic.","authors":"Nabha Shetty, Tanya MacLeod, Ashley Paige Miller, Melissa Buckler, Laurie Mallery, Anne-Marie Krueger-Naug, Maia von Maltzahn, Paige Moorhouse","doi":"10.5770/cgj.28.759","DOIUrl":"10.5770/cgj.28.759","url":null,"abstract":"<p><strong>Background: </strong>During the COVID-19 pandemic, long-term care (LTC) facilities faced challenges in establishing appropriate goals of care (GoC) for residents during health crises. To address this, a virtual specialist consultation program was implemented to align care interventions with residents' frailty and expected outcomes.</p><p><strong>Methods: </strong>We explored barriers and enablers to the implementation and sustainability of the program using structured interviews (n=20) with LTC leadership, health-care staff, and members of the program. Data were coded according to the constructs of the Consolidated Framework for Implementation Research (CFIR) using thematic analysis.</p><p><strong>Results: </strong>Participants described how the program improved care and reduced unnecessary transfers. Implementation was enabled by a high degree of tension for change, relative priority, relative advantage, and the team's shared mental model of frailty-care. Inconsistencies in GoC approaches and information silos between LTC and acute-care challenged implementation. Sustainability was hindered by decreased pandemic urgency, resulting in reallocation of resources to usual care. The need for a specialized GoC service in LTC became less obvious outside of a crisis.</p><p><strong>Conclusions: </strong>This implementation study provides important insights for future spread and scale of embedding virtual specialist consultation services into LTC. The findings underscore the importance of collegial relationships and shared care philosophies to effectively implement frailty-informed care initiatives during crises. However, sustaining cross-sectoral GoC services may be challenging amidst evolving workloads and prevailing cultural perceptions of end-of-life care needs.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"28 1","pages":"1-15"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574745","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 COVID-19 Pandemic and Dementia: a Multijurisdictional Meta-Analysis of the Impact of the First Two Pandemic Waves on Acute Health-care Utilization and Mortality in Canada.","authors":"Deniz Cetin-Sahin, Claire Godard-Sebillotte, Susan E Bronskill, Dallas Seitz, Debra G Morgan, Laura C Maclagan, Nadia Sourial, Jacqueline Quail, Andrea Gruneir, Machelle Wilchesky, Louis Rochette, Victoria Kubuta Massamba, Erik Youngson, Christina Diong, Eric E Smith, Geneviève Arsenault-Lapierre, Mélanie Le Berre, Colleen J Maxwell, Julie Kosteniuk, Delphine Bosson-Rieutort, Ting Wang, Kori Miskucza, Isabelle Vedel","doi":"10.5770/cgj.28.776","DOIUrl":"10.5770/cgj.28.776","url":null,"abstract":"<p><strong>Background: </strong>Previous studies on the impact of the coronavirus disease 2019 (COVID-19) pandemic on persons living with dementia (PLWD) were mostly conducted in a single jurisdiction or focused on a limited number of outcomes. Our study estimates the impact of the first two pandemic waves on emergency department (ED) visits (all-cause/ambulatory care sensitive conditions), hospitalizations (all-cause/30-day readmissions), and all-cause mortality in four Canadian jurisdictions.</p><p><strong>Methods: </strong>Using administrative databases from Alberta, Ontario, Saskatchewan, and Quebec, we assembled two closed retrospective cohorts (2019/pre-pandemic control and 2020/pandemic) of PLWD aged 65+. Within community and nursing home settings, the rates of the above-mentioned outcomes in three pandemic periods (first wave, interim period, second wave) were compared to the corresponding pre-pandemic periods. We performed random effects meta-analyses on the provincial incident rate ratios.</p><p><strong>Results: </strong>Pre-pandemic and pandemic cohorts included 167,095 vs. 173,240 (community) and 93,374 vs. 92,434 (nursing home) individuals, respectively. During the first wave, community and nursing home populations experienced significant declines in the rates of all-cause ED visits (36% vs. 40%) and hospitalizations (25% vs. 22%), which persisted in the following periods in the community. These declines were greater for the rates of ambulatory care sensitive condition ED visits and 30-day readmissions. Mortality was 36% higher in nursing homes (first wave) and 13% higher in the community (second wave).</p><p><strong>Conclusions: </strong>It is key to prepare for future health crises and ensure that PLWD receive necessary care and services and do not have such a high mortality rate. Attention should be equally given to PLWD living in their homes and nursing homes.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"28 1","pages":"16-30"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574739","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":"To What Extent are Alberta Nursing Homes and Supportive Living Facilities Integrated with Their Community? A Sequential Quantitative-Qualitative Study.","authors":"Michelle C Gao, Saima Rajabali, Adrian Wagg","doi":"10.5770/cgj.28.783","DOIUrl":"10.5770/cgj.28.783","url":null,"abstract":"<p><strong>Background: </strong>Nursing homes and supportive living facilities (continuing care homes [CCH]) are often regarded as separate from their communities. Although occasional studies highlight volunteering or intergenerational activities, there is little systematic evaluation of the existence of activities in CCH that may promote community integration.</p><p><strong>Methods: </strong>Study Design: The study utilized a sequential quantitative-qualitative approach: cross-sectional survey followed by semi-structured interviews. Setting: All registered long-term care (nursing home) and supportive living facilities (Levels 3, 4, and 4 Dementia) within Alberta. Subjects: The survey and interviews were conducted with directors of care. The survey was distributed to 334 facilities. Data saturation in the interviews was reached with seven participants.</p><p><strong>Results: </strong>140 responses were received; 116 were analyzable (34.7% response rate). The range of activities varied widely. Prior to Covid-19, the most common were spiritual activities entering CCH (96.5%) and volunteers entering CCH (93.0%); CCH rarely had activities such as child daycare (5.2%). 12.9% of spiritual activities entering CCH had not been restarted following the pandemic, but homes were planning to restart this activity (16) or start it as a new activity (1). There was no statistically significant relationship between any activity and facility owner-operator model, size, type, or geography (urban/rural) at any survey time category. Four themes emerged from the interviews: resident quality of life and well-being, home's capacity and openness, sources of support, and planning and programming for implementation.</p><p><strong>Conclusions: </strong>This study addresses a knowledge gap regarding community integration in CCH and provides insight on the types of community-integrated activities occurring in Alberta's CCH.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"28 1","pages":"53-66"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574740","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":"Breaking the Inverse Care Law for Fall Prevention Programs: a Collaborative and Community-led Approach.","authors":"Nicholas C Chan, Joe Pedulla, Alicia Remark, Sue Bartleman, Ana Macpherson, Howard Abrams, Melissa Chang","doi":"10.5770/cgj.28.799","DOIUrl":"10.5770/cgj.28.799","url":null,"abstract":"","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"28 1","pages":"103-104"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574630","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":"Thank You to Our Reviewers in 2024.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"28 1","pages":"105"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574658","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":"Laboratory Test Use and Values in the Last Year of Life-a Matched Cohort Design.","authors":"Rhiannon L Roberts, Haris Imsirovic, Robert Talarico, Wenshan Li, André Carrington, Kruti Patel, Douglas Manuel, Peter Tanuseputro, Steven Hawken, Colleen Webber","doi":"10.5770/cgj.28.808","DOIUrl":"10.5770/cgj.28.808","url":null,"abstract":"<p><strong>Background: </strong>As individuals approach death, they experience declines in their cognitive, physical, motor, sensory, physiologic, and psychosocial functions. In this exploratory study we examined individuals' physiologic changes in the last year of life by examining laboratory tests commonly used in clinical practice.</p><p><strong>Methods: </strong>Using health administrative datasets, we conducted an observational matched cohort study to assess laboratory test use and values over a decedent's last 12 months and a matched observation window for non-decedents. Laboratory tests included tests for electrolytes: potassium and sodium; complete blood count: hemoglobin and leukocytes; diabetes: hemoglobin A1c; and kidney or liver function: albumin-serum, alanine aminotransferase, and creatinine.</p><p><strong>Results: </strong>We identified 376,463 decedents, 367,474 (97.6%) of whom were matched to non-decedents (similar age and sex). For each test, the proportion of non-decedents who received the test was stable over the 12-month observation period. A higher proportion of decedents had a laboratory test than non-decedents for all but the diabetes test. As decedents neared death, there was a gradual increase in test use until their final month of life, when test use dramatically increased. Across all laboratory tests, test values remained similar for non-decedents over the 12-month observation period. However, for decedents, there were differences in the magnitude and direction of the test values over the 12 months.</p><p><strong>Conclusion: </strong>Our findings indicate distinct changes in decedents' laboratory test use and values over their last 12 months. Future work should explore whether laboratory tests could predict survival or improve the performance of mortality prediction models.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"28 1","pages":"73-86"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574649","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 Canadian Coalition for Seniors' Mental Health Canadian Clinical Practice Guidelines for Assessing and Managing Behavioural and Psychological Symptoms of Dementia (BPSD).","authors":"Stacey Hatch, Dallas P Seitz, Marie-Andrée Bruneau, Vivian Ewa, Sid Feldman, Yael Goldberg, Zahra Goodarzi, Nathan Herrmann, Debbie Hewitt Colborne, Alexandre Henri-Bhargava, Zahinoor Ismail, Julia Kirkham, Sanjeev Kumar, Krista L Lanctôt, Wade Thompson, Jennifer Porter, Jennifer A Watt","doi":"10.5770/cgj.28.820","DOIUrl":"10.5770/cgj.28.820","url":null,"abstract":"<p><p>In Canada, approximately 730,000 people are currently living with dementia. Over 75% will experience behavioural and psychological symptoms of dementia (BPSD). There is a lack of consensus on best practices for the assessment and management of BPSD. In 2024, the Canadian Coalition for Seniors Mental Health (CCSMH) developed a Clinical Practice Guideline (CPG) for assessing and managing BPSD, specifically for agitation, depression, anxiety, psychosis, and sexual expressions of potential risk, and deprescribing antipsychotics and psychotropic medications. Development of the BPSD CPG followed the Guideline International Network (GIN)-McMaster Guideline Development checklist. The guideline is intended for people living with dementia, caregivers of people living with dementia, and health-care providers in community, outpatient, inpatient, long-term care, and other residential care settings. Recommendations were informed by a Canada-wide prioritization exercise to identify CPG topics and preferred terms for describing BPSD. A systematic review of existing dementia CPGs, an overview of systematic reviews on assessing and managing BPSD, and systematic reviews of tools for measuring psychosis, anxiety, and depressive symptoms in people living with dementia was undertaken, along with a rapid review of studies of pharmacologic and nonpharmacologic interventions for reducing sexual expressions of potential risk in people living with dementia. Guideline panel members voted on recommendation strength and quality of evidence, per the Grading of Recommendations, Assessment, Development, and Evaluations approach. This CPG resulted in 11 good practice statements and 63 guideline recommendations that will inform BPSD best practices in a Canadian health-care context.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"28 1","pages":"91-102"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574738","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":"Assessing Cognition Remotely: Expanding the Reach of Cognitive Testing for Older Adults at Risk for Dementia in a Randomized Controlled Trial.","authors":"Aidan Steeves, Karla Faig, Chris McGibbon, Andrew Sexton, Pamela Jarrett","doi":"10.5770/cgj.28.790","DOIUrl":"10.5770/cgj.28.790","url":null,"abstract":"<p><p>Little is known about whether cognitive assessments can be completed remotely by older adults at risk for dementia, and there is no consensus on which tool is best. The SYNchronising Exercises, Remedies in GaIt and Cognition at Home (SYNERGIC@Home) study evaluated the feasibility of a home-based, double-blind, randomized-controlled trial to improve gait and cognition in individuals at risk for dementia. This paper reports a secondary analytic outcome of the cognitive tests used. The three aims were: 1) to examine whether the Montreal Cognitive Assessment (MoCA 8.1 Audiovisual), Cognitive-Functional Composite2 (CFC2), and Telephone Cognitive Screen (T-CogS) could be administered remotely; 2) to compare each tool; 3) to evaluate changes in cognition following the intervention. Sixty participants were randomized to one of four physical/cognitive exercise intervention arms, with 52 participants completing the intervention. Cognitive tests were done in the homes of participants via Zoom for Healthcare™. All 52 participants completed the assessments. The interquartile range (IQR) for the MoCA was 4, the CFC2 was 8, and the T-CogS was 1. At baseline, 11.5% scored perfectly on the MoCA, 0% scored perfectly on the CFC2, and 62% scored perfectly on the T-CogS. Scores on the MoCA (<i>p</i>=.076), CFC2 (<i>p</i>=.053), and T-CogS (<i>p</i>=.281) were not statistically significantly different from baseline to post-intervention. This study demonstrates that these cognitive tests can be administered remotely, with the MoCA and the CFC2 being the most sensitive to variability in scores.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"28 1","pages":"87-90"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574625","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}