Pediatric quality & safety最新文献

{"title":"Improving Timeliness of Sweat Test for Cystic Fibrosis in All Infants with Out-of-range Screen.","authors":"Jaclyn Davis, Rachel Gordon, Kristen Richard, Cecelia DeBlasi, Lena Joseph, Christine Thayer, Emily Barsky, Gregory S Sawicki","doi":"10.1097/pq9.0000000000000848","DOIUrl":"10.1097/pq9.0000000000000848","url":null,"abstract":"<p><strong>Introduction: </strong>Early diagnosis of cystic fibrosis (CF) leads to better outcomes. CF newborn screening occurs in the United States, and the ultimate diagnosis requires referral for sweat chloride testing (SCT), ideally within 28 days of life. At our center, 60% of CF newborn SCTs occurred outside the recommended window. Recognizing known differences in CF detection by newborn screen across race and ethnicity groups, we also identified a gap in understanding of potential inequities in SCT timeliness in our center.</p><p><strong>Methods: </strong>We used the Model for Improvement to understand key drivers for late SCT, focusing on optimizing internal processes and partnership with primary care providers and patient families. We implemented iterative Plan-Do-Study-Act cycles to effect change. Additionally, we developed a tracking tool to evaluate timeliness by self-reported race, ethnicity, and primary language.</p><p><strong>Results: </strong>We improved the rate of timely SCT from 40% to greater than 80% within the first project year, which was sustained over the subsequent year. We identified disparities in SCT timeliness by demographic characteristics, with those identified as Hispanic, Black, and multiracial having lower rates of timely SCT compared with those identified as White. There was a trend toward a lower rate of timely SCT in those speaking a non-English language as their primary language.</p><p><strong>Conclusions: </strong>This work provided a framework for CF center-based improvement of the SCT process after an out-of-range CF screen, recognizing the importance of partnership with referring providers and understanding the patient voice. After uncovering disparities within our CF center, further work is needed to understand the drivers of these inequities and to develop and study solutions.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 6","pages":"e848"},"PeriodicalIF":1.2,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147944060","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 Case for a Medication Safety Curriculum for Residents in Pediatric Settings.","authors":"Haley Davis, Julianna Lau, Lisa M Rickey","doi":"10.1097/pq9.0000000000000859","DOIUrl":"10.1097/pq9.0000000000000859","url":null,"abstract":"","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 6","pages":"e859"},"PeriodicalIF":1.2,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147944061","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 Quality Improvement Initiative to Optimize Fever and Neutropenia Management in Oncology Patients.","authors":"Maya Ilowite, Mari M Nakamura, Hanna Wardell, Sarah Jones, David Johnson, Benjamin Ethier, Tanvi Sharma, Barbara Degar","doi":"10.1097/pq9.0000000000000858","DOIUrl":"10.1097/pq9.0000000000000858","url":null,"abstract":"<p><strong>Introduction: </strong>Antibiotic durations in pediatric oncology inpatients with fever and neutropenia are often long, increasing the risk of adverse effects and selecting for antibiotic-resistant organisms. This quality improvement initiative aimed to decrease the monthly average empiric antibiotic duration for this population to 7 days or fewer.</p><p><strong>Methods: </strong>Historically, a major driver of prolonged empiric antibiotic durations was treatment until bone marrow recovery. However, literature suggests that antibiotics may safely be stopped sooner in the absence of a documented infection. We created a clinical pathway that recommended a defined empiric antibiotic duration of 7 days in clinically stable patients. Using the Model for Improvement, the pathway was implemented and revised based on feedback from clinicians. To assess the initiative's impact, we measured the monthly average inpatient empiric antibiotic duration for oncology patients with fever and neutropenia. As a balancing measure, we tracked the monthly percentage of patients who had a positive blood culture within 72 hours of discontinuing antibiotics. We used statistical process control charts to evaluate changes over time.</p><p><strong>Results: </strong>The mean monthly average duration of inpatient empiric antibiotics for our target population decreased to 5.0 days. The percentage of patients who had a positive blood culture within 72 hours of discontinuing antibiotics remained stably low.</p><p><strong>Conclusions: </strong>By implementing a clinical pathway that recommended a defined empiric antibiotic duration in stable patients, we successfully decreased antibiotic exposure for oncology patients with fever and neutropenia. We did not observe increased bacteremia events during the project period.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 6","pages":"e858"},"PeriodicalIF":1.2,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943980","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":"Improving Influenza Vaccination in the Pediatric Emergency Department.","authors":"Courtney E Nelson, Shannon Baumer-Mouradian, Snezana Nena Osorio, Jack Stevens, Jonathan M Miller","doi":"10.1097/pq9.0000000000000855","DOIUrl":"10.1097/pq9.0000000000000855","url":null,"abstract":"<p><strong>Introduction: </strong>The American Academy of Pediatrics recommends annual influenza vaccination for patients aged 6 months or older. In 2019, our local pediatric emergency department (ED) vaccination rate was below the national average. We aimed to increase influenza vaccination screening from 53% to 95% and vaccine administration from 48% to 58% by March 2023.</p><p><strong>Methods: </strong>We included patients older than 6 months of age who were discharged from the ED, excluding those resuscitated or transferred from outside hospitals. Interventions included triage screening questions and electronic health record alerts to prompt vaccination. The baseline period was February-April 2020, with interventions during the next 3 influenza seasons, and a poststudy period from September 2023 to March 2024. Measures included vaccine administration (outcome), screening rate (process), provider discontinuation, family refusal, and discharge time (balancing). Data were analyzed using Shewhart charts (P and P').</p><p><strong>Results: </strong>We achieved nearly universal screening for vaccine eligibility (98%) and administered the vaccine to 70% of eligible patients during season 1 of implementation. Thereafter, the influenza screening rate dropped to 85% and 86% (seasons 2 and 3, respectively) and 79% (poststudy). Likewise, influenza immunization rates decreased below baseline in season 2 (37%) and remained low at 40% (season 3) and 50% (poststudy). There was no difference in parental refusal of the vaccine at the time of discharge; however, there was an increase in provider discontinuation from 1 consecutive season to the next.</p><p><strong>Conclusions: </strong>An ED-based influenza vaccine delivery model can be successful when the triage process includes screening, a consistent group of ED-based staff orders the vaccine, and there is effective use of the electronic health record.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 6","pages":"e855"},"PeriodicalIF":1.2,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147944125","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 Multidisciplinary Quality Improvement Initiative to Improve Hospital Throughput in a Pediatric Tertiary Care Center.","authors":"Satvika Mikkilineni, Rebecca Cantu, David M Spiro, Shelly Keller, Justin Criddle, Ryan Kwong, Sara C Sanders","doi":"10.1097/pq9.0000000000000857","DOIUrl":"10.1097/pq9.0000000000000857","url":null,"abstract":"<p><strong>Introduction: </strong>Overcrowding in the emergency department (ED) can lead to patient delays, increased medical errors, and increased left without being seen (LWBS) rates. Identifying systemic factors that hinder patient throughput can be beneficial to optimizing patient flow and thereby reducing LWBS rates. This quality improvement project aimed to improve hospital throughput in our pediatric tertiary care center through a multidisciplinary systemic approach.</p><p><strong>Methods: </strong>This study included patients admitted from the ED to an inpatient medical-surgical unit on the pediatric hospital medicine service. This project was a multidisciplinary effort with participation from the ED, hospital medicine, operations center, hospital administration, and nursing, who met biweekly to review data, assess the impact of changes, and discuss new interventions. The project's key drivers were the duration of the admission process, a shared mental model of admission and discharge processes, and inpatient efficiency. The team conducted a total of 10 interventions during the study period.</p><p><strong>Results: </strong>The percentage of patients admitted within 90 minutes increased from the baseline of 18% to 42% by the end of the study period. The escalation of care and LWBS rates decreased by the end of the study.</p><p><strong>Conclusions: </strong>A multidisciplinary approach to hospital throughput, incorporating initiatives from the ED and inpatient units for admission and discharge processes, along with the support from ancillary services, can significantly enhance patient flow throughout the hospital system.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 6","pages":"e857"},"PeriodicalIF":1.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147944118","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":"Increasing Point-of-care Ultrasound Scanning by Pediatric Emergency Medicine Fellows: A Quality Improvement Initiative.","authors":"Rosemary Thomas-Mohtat, Ashley Booth, Alia Fink, Eva I Rubio","doi":"10.1097/pq9.0000000000000854","DOIUrl":"10.1097/pq9.0000000000000854","url":null,"abstract":"<p><strong>Introduction: </strong>During the past 20 years, there has been an increased integration of point-of-care ultrasound (POCUS) curricula in pediatric emergency medicine (PEM) fellowships. Locally, our fellows were not achieving the recommended 150 scans target we set for graduation. We undertook this quality improvement initiative to increase POCUS scanning in our PEM fellowship.</p><p><strong>Methods: </strong>We implemented a quality improvement project from July 2020 to June 2021. Our primary aim was to increase the number of scans performed monthly by the fellows from 3 to 5 scans per fellow per month. After querying the fellows and identifying barriers to POCUS scanning, we implemented interventions targeted at increasing longitudinal scanning, transparency, and accountability in the achievement of target scan numbers.</p><p><strong>Results: </strong>The number of scans per fellow per month increased from a baseline of 3 to 7.6 scans per fellow per month. All graduating fellows met the target of 150 scans by graduation. The impact was sustained 5 years later.</p><p><strong>Conclusions: </strong>The most effective interventions included required quarterly supervised scanning, maintaining a transparent scan-count dashboard, and encouraging scanning with co-fellows when working clinically. These strategies can be incorporated by other PEM training programs.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 6","pages":"e854"},"PeriodicalIF":1.2,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147944056","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":"Using a Quality Improvement Initiative to Decrease Oxygen Toxicity among Mechanically Ventilated Children.","authors":"Salim Aljabari, Ethan Gillett, Zach Settle, Esma Birisci, Abdallah Dalabih","doi":"10.1097/pq9.0000000000000849","DOIUrl":"10.1097/pq9.0000000000000849","url":null,"abstract":"<p><strong>Introduction: </strong>Excessive oxygen supplementation in critically ill children can lead to hyperoxia, resulting in systemic toxicity and worse outcomes. Despite evidence linking hyperoxia to adverse outcomes, the overuse of oxygen therapy remains a widespread practice. This quality improvement initiative aimed to reduce hyperoxia exposure among mechanically ventilated children in the pediatric intensive care unit at Arkansas Children's Hospital, aligning with the Second Pediatric Acute Lung Injury Consensus Conference guidelines.</p><p><strong>Methods: </strong>A multidisciplinary team implemented interventions in 2 Plan-Do-Study-Act cycles. The first cycle focused on staff education and standardizing oxygen saturation (SpO₂) goals (90%-97%) in electronic health records. The second cycle introduced a best practice advisory to alert bedside staff when SpO₂ exceeded 97% with the fraction of inspired oxygen (FiO₂) greater than 0.21, prompting FiO₂ weaning. Hyperoxia was defined as SpO₂ 98%-100% with FiO₂ greater than 0.21. We collected hourly SpO₂-FiO₂ data pairs from mechanically ventilated patients and calculated hyperoxia rates monthly.</p><p><strong>Results: </strong>Baseline data (January 2021 through June 2022) showed an average hyperoxia rate of 54.8%. Following the first Plan-Do-Study-Act cycle, the rate decreased to 41.0%, and after best practice advisory implementation, it further dropped to 28%, sustaining this reduction for more than 12 months. Mortality and mechanical ventilation duration did not change significantly (11.7%-9.4%, <i>P</i> = 0.12; and 8.16-4.8 d, <i>P</i> = 0.11, respectively).</p><p><strong>Conclusions: </strong>Using quality improvement methodology and electronic health record-based clinical decision support tools, we successfully reduced hyperoxia rates among mechanically ventilated children in the pediatric intensive care unit. This initiative highlights the importance of standardized oxygen management and real-time staff reminders in improving care practices.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 6","pages":"e849"},"PeriodicalIF":1.2,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147944091","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":"Ultrasound Image Capture during Central Venous Catheter Insertions: A Quality Improvement Study.","authors":"Sam Biniazan, Andrew J Lautz, Marc Mecoli, Erika L Stalets, Matthew W Zackoff","doi":"10.1097/pq9.0000000000000852","DOIUrl":"10.1097/pq9.0000000000000852","url":null,"abstract":"<p><strong>Introduction: </strong>Central venous catheter (CVC) insertion is one of the most common interventions in the pediatric intensive care unit (PICU). Although lifesaving, CVC insertion also carries significant risks of morbidity and mortality-risks that ultrasound guidance can help reduce. This study described a quality improvement initiative aimed at increasing the rate of ultrasound documentation of correct guidewire position before vessel dilation during CVC insertions.</p><p><strong>Methods: </strong>This study developed a novel workflow for capturing images from ultrasound machines used during CVC insertions in a PICU and uploading them into the electronic health record. A specific, measurable, achievable, relevant, time-based aim and key driver diagram guided the interventions. A failure modes and effects analysis identified failure points and informed Plan-Do-Study-Act cycles to increase the rate of successful ultrasound image capture and upload.</p><p><strong>Results: </strong>Between July 1, 2023, and March 31, 2025, critical care fellows and attendings performed 270 new CVC insertions within the PICU. Successful image capture and upload rates reached a monthly high of 64% and a mean completion rate of 58%. The key process metric for placing an electronic health record order required for image upload reached a monthly high of 100% and a mean completion rate of 83%.</p><p><strong>Conclusions: </strong>This study developed and implemented a novel workflow for PICU proceduralists to increase the rate of ultrasound image capture during CVC insertion. Although work continues toward achieving the primary objective, the study provided key insights into the consistent capture of ultrasound images, supporting enhanced safety during CVC insertion.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 6","pages":"e852"},"PeriodicalIF":1.2,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147944093","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":"Improving Documentation of Language Interpreter Use to Increase Compliance, Quality, and Safety.","authors":"Cara E Texler, Emily Sentman, Charles Hardy, Lydia Michael, Shravani Vundavalli, Maria Moauro, Anup D Patel","doi":"10.1097/pq9.0000000000000847","DOIUrl":"10.1097/pq9.0000000000000847","url":null,"abstract":"<p><strong>Introduction: </strong>The standard of care for language interpretation in healthcare encounters is well established and supported by civil rights law and hospital policy. However, the use of language interpreters for healthcare communication is inconsistent for families who use languages other than English. To promote interpreter use and improve compliance, a quality improvement team implemented a project to enhance documentation of interpreter use in clinical notes.</p><p><strong>Methods: </strong>The team developed a rule-based electronic health record tool to prompt documentation of interpreter use for the right patient at the right time. The team piloted and revised the tool in a primary care setting, and then implemented and disseminated it in a more complex inpatient pediatric hospital setting. The team measured compliance with documentation in hospital pediatric history and physical and discharge summary notes using statistical process control p-charts. Balancing measures included the authors' time spent documenting interpreter use and perceived difficulty in documenting in the clinical notes.</p><p><strong>Results: </strong>On the hospital pediatrics service, the rate of compliant documentation in history and physical notes increased from 15% to 74% and was sustained for 14 months. Compliant documentation for discharge summary notes increased from 11% to 93% and sustained for 14 months.</p><p><strong>Conclusions: </strong>Electronic health record tools designed to document interpreter use can effectively prompt and monitor compliance through integrated and rule-based systems. Thus, they are essential for comprehensive quality improvement initiatives that encourage clinicians to use language interpreters and optimize communication, quality, and safety for children and families who use languages other than English.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 6","pages":"e847"},"PeriodicalIF":1.2,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147944130","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":"Reduced Intravenous Vancomycin Use and Cost Savings in a Pediatric Hemodialysis Unit: A Quality Report.","authors":"Shrea Goswami, Neha Pottanat","doi":"10.1097/pq9.0000000000000846","DOIUrl":"10.1097/pq9.0000000000000846","url":null,"abstract":"<p><strong>Introduction: </strong>Intravenous (IV) vancomycin is used in patients receiving chronic hemodialysis (HD) for the treatment of central venous catheter-related infections. Excessive use of IV vancomycin leads to high costs and an increase in multidrug-resistant organisms. Our primary aim was to reduce IV vancomycin use for suspected central venous catheter-related infections in our pediatric chronic HD unit by 50% within 1 year. Our secondary aim was to reduce the total cost of IV vancomycin use by 50%.</p><p><strong>Methods: </strong>With a quality improvement framework, the key interventions include (1) provider education on antibiotic stewardship, related to IV vancomycin and its associated risks; (2) identification of alternative topical/enteral antibiotics; (3) development and implementation of an exit-site scoring tool; and (4) development of a treatment-based algorithm to standardize choice of antibiotic related to exit-site score.</p><p><strong>Results: </strong>We used a statistical process control chart to demonstrate that IV vancomycin use declined from an average of 24 doses per 1,000 patient-days in the preintervention period (August 1, 2018, to August 31, 2019) to 5.1 vancomycin doses per 1,000 patient-days in the postintervention period (September 1, 2019, to July 31, 2020). Additionally, the IV vancomycin cost decreased from $81,297 per 1,000 patient-days during the preintervention period to $14,053 per 1,000 patient-days during the postintervention period.</p><p><strong>Conclusions: </strong>A stepwise incorporation of interventions, including education, the development of a novel exit-site scoring tool, and a treatment-based algorithm, resulted in a 78% decrease in IV vancomycin use in our pediatric chronic HD unit within 1 year and an 82% decrease in associated costs.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 6","pages":"e846"},"PeriodicalIF":1.2,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147944134","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}