Anaesthesia最新文献

{"title":"Regional anaesthesia research priorities: a Regional Anaesthesia UK (RA-UK) priority setting partnership involving patients, carers and healthcare professionals","authors":"Owen Lewis,&nbsp;James Lloyd,&nbsp;Jenny Ferry,&nbsp;Alan J. R. Macfarlane,&nbsp;Jonathan Womack,&nbsp;Kariem El-Boghdadly,&nbsp;Clifford L. Shelton,&nbsp;Olivia Schaff,&nbsp;Tom J. Quick,&nbsp;Andrew F. Smith,&nbsp;Karin Cannons,&nbsp;Annabel Pearson,&nbsp;Leila Heelas,&nbsp;Daniel Rodger,&nbsp;John Marshall,&nbsp;Carol Pellowe,&nbsp;James S. Bowness,&nbsp;Rachel J. Kearns","doi":"10.1111/anae.16473","DOIUrl":"10.1111/anae.16473","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Regional anaesthesia provides important clinical benefits to patients but is underutilised. A barrier to widespread adoption may be the focus of regional anaesthesia research on novel techniques rather than evaluating and optimising existing approaches. Research priorities in regional anaesthesia identified by anaesthetists have been published, but the views of patients, carers and other healthcare professionals have not been considered previously. Therefore, we launched a multidisciplinary research priority setting partnership that aimed to establish key regional anaesthesia research priorities for the UK.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Research suggestions from key stakeholders (defined by their interaction with regional anaesthesia) were gathered using an online survey. These suggestions were analysed to identify common themes and then combined to formulate indicative research questions. After an extensive literature review, unanswered and partially answered questions were prioritised via an interim online survey and then ranked as a top 10 list during a final live virtual multidisciplinary prioritisation workshop.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 210 individuals completed the initial survey and suggested 518 research questions. Fifty-seven indicative questions were formed, of which three were considered fully answered after literature review and one not feasible. The interim online survey received 335 responses, which identified the 24 highest priority questions from the 53 presented. At the final live prioritisation workshop, through a nominal group process, we identified the top 10 regional anaesthesia research priorities. These aligned with three broad thematic areas: pain management (two questions); patient safety (six questions); and recovery from surgery (two questions).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>This initiative has resulted in a list of research questions prioritised by patients, carers and a multidisciplinary group of healthcare professionals that should be used to inform and support future regional anaesthesia research in the UK.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 2","pages":"170-178"},"PeriodicalIF":7.5,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between self-reported pain experiences in hospital and ratings of care, readmission and emergency department visits: a population-based study from New South Wales, Australia","authors":"Narisha Prasad, Jonathan Penm, Diane E. Watson, Bich N. H. Tran, Zhaoli Dai, Edwin C. K. Tan","doi":"10.1111/anae.16474","DOIUrl":"https://doi.org/10.1111/anae.16474","url":null,"abstract":"Evidence on patient experiences with pain in hospitals and its impact on post-discharge outcomes is limited. This study investigated the prevalence of pain in hospitals, patient characteristics associated with pain management adequacy, and the link between pain experiences, care ratings, readmission and emergency department visits after discharge.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"13 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative analgesic effectiveness of ultrasound-guided bilateral erector spinae plane block","authors":"Pinguo Fu","doi":"10.1111/anae.16485","DOIUrl":"10.1111/anae.16485","url":null,"abstract":"<p>While the study of Urmale Kusse et al. [<span>1</span>] makes a valuable contribution to the topic, I believe that several aspects warrant further discussion.</p><p>First, the sample size was based on a randomised controlled trial investigating postoperative analgesia in patients undergoing laparoscopic cholecystectomy [<span>2</span>]. The trial compared rectus sheath block with rectus sheath block and erector spinae plane block, which differs from the comparison in the current study. Thus, using this reference to calculate the sample size may not be appropriate. Additionally, the blinding in this study presents challenges, as the puncture sites for erector spinae plane block and rectus sheath block are located on the back and abdomen, respectively, compromising blinding for both patients and postoperative caregivers. The inclusion of placebo or sham blocks would have improved blinding.</p><p>Second, regarding the evaluation of postoperative analgesic outcomes, the study measured total opioid consumption and converted the 24-h opioid use into standardised morphine milligram equivalents (MME). The results showed mean (SD) opioid consumption of 3.5 (8.7) MME in the erector spinae plane block group vs. 8.2 (2.8) MME in the rectus sheath block group (p = 0.003). However, the minimum clinically important difference for 24-h postoperative opioid consumption is 10 MME [<span>3</span>], indicating that the observed difference between the two groups did not meet this threshold. I believe this may be attributed to the analgesic protocol employed, which involved administering medication based on pain assessment rather than patient-control. This approach may have resulted in delayed opioid administration, potentially compromising pain control, as a significant proportion of patients experienced moderate to severe pain (NRS 4–7) postoperatively. This could be related to the constraints typical of low- and middle-income settings.</p><p>Finally, I have concerns regarding the timeline of the nerve block procedures. Both blocks were performed while patients were anaesthetised. While rectus sheath block can be administered with the patient in a supine position, erector spinae plane block requires the patient to be in the lateral decubitus position. This necessitates repositioning the anaesthetised patient from supine to lateral and then back to supine, which is complex and time-consuming. However, the reported mean (SD) anaesthesia duration of 164 (16) min for the erector spinae plane block group and 159 (14) min for the rectus sheath block group; and the surgery duration of 150 (14) min for the erector spinae plane block group and 143 (18) min for the rectus sheath block group, do not indicate a longer non-surgical anaesthesia time for the erector spinae plane block group.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 2","pages":"216-217"},"PeriodicalIF":7.5,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16485","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"‘Flextension’: a new term to describe optimal head and neck positioning for airway management","authors":"Tim M. Cook,&nbsp;Nicholas Chrimes","doi":"10.1111/anae.16484","DOIUrl":"10.1111/anae.16484","url":null,"abstract":"<p>The optimal position, for much of non-infant airway management is often described colloquially as ‘the sniffing position’ or ‘sniffing the morning air’ [<span>1</span>]. The literature also includes the terms ‘drinking a (full) pint (of beer)’; ‘last orders’; ‘sniff for smoke’; ‘win with the chin’ [<span>2-4</span>]; and we find many use the term ‘first pint position’. These terms are either arcane or arguably trivialising the positioning they intend to describe. It is reported that they may be of limited benefit to those without previous knowledge of correct airway positioning [<span>4, 5</span>] and even to those with such knowledge [<span>6</span>]. It is also plausible that the descriptions may either translate poorly to other languages or be culturally unhelpful.</p><p>The airway position each of these terms intends to describe is that of elevating the head from the recumbent position in a supine patient. It has potential benefits in airway management during face mask ventilation, supraglottic airway placement, laryngoscopy and tracheal intubation. As such, it is important the concept is understood and well communicated.</p><p>As the anatomical positioning involves flexion of the lower cervical spine and extension of the upper cervical spine, we introduce the term ‘flextension’ (TC) and have developed an infographic (NC) to support its dissemination (Fig. 1). Flextension can be combined with torso elevation to better describe the ‘ramped’ position for airway management in patients who are obese. We have been using the term for several years now with good anecdotal feedback and local adoption, but it has yet to be described in the academic literature.</p><p>It is common to see inexperienced airway managers, who are familiar with the terms ‘sniffing position’ etc., when asked to position the patient before anaesthesia, place a pillow under the shoulders and extend the head on the neck. This leaves the lower cervical spine in the neutral or even extended position, rather than the desired flexed position. We believe widespread adoption of the term flextension will promote better understanding of head and neck positioning for airway management and, more importantly, provide a practical reminder.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 2","pages":"220-221"},"PeriodicalIF":7.5,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16484","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142690640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy of remimazolam tosilate for general anaesthesia in paediatric patients undergoing elective surgery: a multicentre, randomised, single-blind, controlled trial","authors":"Yu-Bo Fang, John Wei Zhong, Peter Szmuk, Yun-Long Lyu, Ying Xu, Shuangquan Qu, Zhen Du, Wangning Shangguan, Hua-Cheng Liu","doi":"10.1111/anae.16475","DOIUrl":"https://doi.org/10.1111/anae.16475","url":null,"abstract":"Remimazolam is an ultra-short-acting benzodiazepine sedative drug. This study aimed to compare the efficacy and safety of remimazolam with propofol for induction and maintenance of general anaesthesia in children undergoing elective surgery.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"1 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142690644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breaking barriers: achieving equitable access to postoperative critical care","authors":"Shalini Patel,&nbsp;James R. Day","doi":"10.1111/anae.16486","DOIUrl":"10.1111/anae.16486","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 1","pages":"13-17"},"PeriodicalIF":7.5,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Train the rescuers","authors":"Peter Hambly,&nbsp;Chris Frerk","doi":"10.1111/anae.16483","DOIUrl":"10.1111/anae.16483","url":null,"abstract":"<p>We congratulate Nathanson et al. for their timely editorial [<span>1</span>], and share their regret that lives continue to be lost to preventable errors. Twenty years ago, the death in similar circumstances of Elaine Bromiley led to the creation of the charity we now represent.</p><p>The reasons why skilled and conscientious practitioners make such errors are well-established. We know that human beings under stress are prone to ‘mind lock’ – rigid fixation on a diagnosis or course of action – and confirmation bias, where contradictory data (such as an abnormal capnography trace) are ignored, while corroborative information (such as breath sounds) is favoured. Sense of time dissipates and memory recall becomes difficult. These are fundamentally human responses and no amount of training will prevent them.</p><p>However, there is a common thread in all these tragedies, which is too often overlooked. In nearly all cases, senior colleagues arrived to assist within minutes, but these rescuers failed to cut through the ‘mind lock’ and followed the primary caregiver down the wrong, fatal, path. The role of rescuer is critically important but almost completely undefined. It is something few if any of us are formally trained in, yet it is in dire need of a formal, structured and, above all, standardised approach. In short, if we're going to train our way out of this problem, we need to train the rescuers.</p><p>Some of the attributes that make a good rescuer can be found in guidelines from the Association of Anaesthetists for implementing human factors in anaesthesia [<span>2</span>]. Much of it is counterintuitive (for example, the advice to stand back and analyse rather than pile in and do something) or counter-cultural (using checklists rather than relying on memory). Yet these seeds are sown on barren ground. How often does the <i>Quick Reference Handbook</i> sit on a shelf uselessly while a crisis is unfolding?</p><p>Specific rescuer training would reinforce these skills, while also achieving the aim of rehearsing rare scenarios, all of which is easily done in a simulator. Above all, such training should be standardised nationally, so that everyone involved in an incident, rescuer and rescuee, knows exactly how it will play out. This is a big challenge, but one that falls to our profession alone.</p><p>Finally, while we recognise the value of teams training together, the costs are enormous and insisting on this counsel of perfection too often leads to teams not training at all. Pilots are required to take a simulator assessment every 6 months, in which they rehearse their responses to rare emergencies in exactly the way envisaged by Nathanson et al., and they do so individually. Aircrews do not train as teams, yet no-one has died from an accident on a British commercial aircraft for 35 years.</p><p>Would that we could say the same for anaesthesia.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 2","pages":"221-222"},"PeriodicalIF":7.5,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16483","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142679141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating tracheal intubation ergonomics: practitioner experience and laryngoscope type","authors":"Soichiro Inoue, Kosuke Hamabe, Hirokiyo Nomura","doi":"10.1111/anae.16482","DOIUrl":"https://doi.org/10.1111/anae.16482","url":null,"abstract":"&lt;p&gt;We read with interest the study by Ding et al. [&lt;span&gt;1&lt;/span&gt;]. The application of augmented reality technology to medical procedures is a promising advancement, and we concur with the authors' perspective on its potential to reduce occupational health risks in medical professions, while also enhancing procedural safety and accuracy. We have a concern about the study's data on Macintosh and videolaryngoscopes. It is unclear if the results are generalisable without accounting for the practitioners' proficiency levels.&lt;/p&gt;\u0000&lt;p&gt;We conducted a series of studies investigating the postural changes and gaze distribution during tracheal intubation in a simulation setting using motion capture and eye-tracking, focusing on comparisons between novice and experienced practitioners [&lt;span&gt;2, 3&lt;/span&gt;]. The vertical head movement during tracheal intubation using the Macintosh laryngoscope differed significantly between novices and experts. Novices exhibited downward movement of 23.5 cm from mouth opening to tracheal tube insertion, whereas the experts showed downward movement of only 3.5 cm [&lt;span&gt;2&lt;/span&gt;]. Furthermore, when using the McGrath® videolaryngoscope (Medtronic, Watford, UK), the novices exhibited a downward movement of the head of 10.7 cm, whereas the experts hardly lowered their heads [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;Our findings are consistent with those of Ding et al. [&lt;span&gt;1&lt;/span&gt;] regarding how the degree of forward flexion varies with the type of laryngoscope used. However, our study further shows that posture during tracheal intubation differs markedly between novices and experts. Specifically, novices exhibit a greater forward flexion, whereas experts maintain a relatively straight posture with minimal head displacement, although the precise angle of upper body flexion was not quantified in our study. Similar findings have been reported in studies using different evaluation methods in simulation settings. Grundgeiger et al. found that novices exhibited significantly more flexion of the trunk and neck compared with experts [&lt;span&gt;4&lt;/span&gt;]. Although Ding et al. cited this, they did not mention the differences between novices and experts. In addition, Matthews et al. measured the distance from the patient's nose to the manikin's chin and reported that it was significantly shorter in the novice than the expert group, indicating that novices tended to crouch, while experts maintained a more upright posture during tracheal intubation [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;In conclusion, it may not be accurate to claim that all users adopt a forward-leaning posture when using the Macintosh or videolaryngoscope. The failure to account for operator experience may influence the conclusion of such studies significantly, as the degree of forward flexion during tracheal intubation can vary considerably between novices and experts. This possibility of misinterpretation could limit the applicability of augmented reality technology and overestimate its benefit for experi","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"34 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total videoscopic tracheal intubation: a technical modification to reduce the risk of unrecognised oesophageal intubation.","authors":"James Wright, Sandeep Sudan","doi":"10.1111/anae.16481","DOIUrl":"10.1111/anae.16481","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mandatory training for rare anaesthetic events or mandatory safety preparedness – the beatings will continue until morale improves, or is it time for a carrot and not a stick?","authors":"Tim Murphy","doi":"10.1111/anae.16480","DOIUrl":"10.1111/anae.16480","url":null,"abstract":"&lt;p&gt;Nathanson et al. [&lt;span&gt;1&lt;/span&gt;], supported by Kane et al. in a subsequent letter [&lt;span&gt;2&lt;/span&gt;], call for mandatory standards of training for rare anaesthetic events and mandatory safety preparedness. Their implicit assumption is that, with more training, anaesthetists will become less error-prone, performance will improve and, therefore, outcomes from uncommon, life-threatening peri-operative events will also improve. I believe this assumption merits challenge.&lt;/p&gt;&lt;p&gt;Mandatory training for rare peri-operative events and safety preparedness is an integral part of anaesthesia training delivered through various methods including didactic sessions; formal and informal education; scientific meetings; literature review; and simulation laboratories. It is a key component of the curriculum for the Fellowship of the Royal College of Anaesthetists. Ongoing regular training and education in all aspects of anaesthesia is also a fundamental part of clinical practice. So perhaps it is more accurate to call for different training in the management of rare peri-operative events, begging the question ‘will this make things better?’&lt;/p&gt;&lt;p&gt;Time for ongoing training must be utilised wisely. Is it possible to show that suboptimal management of rare events can be ameliorated through participation in a revised and different mandatory training programme? This proof might be elusive, since a tendency towards failure to perform perfectly (especially at times of high stress, pressure, complexity and surprise) is a fundamental part of the human condition. What makes us human also makes us error-prone and while this may be modifiable it is fundamentally ineradicable and cannot be dissipated by the setting of an inhuman standard.&lt;/p&gt;&lt;p&gt;Introduced in 2009, ‘Never Events’ aimed to reduce preventable errors in healthcare. An editorial argued that labelling them as such was ineffective and highlighted the issues with negative framing [&lt;span&gt;3&lt;/span&gt;]. Despite this, these events persist. Nathanson et al. liken fatal unrecognised oesophageal intubation to a never event, estimating its annual occurrence at &lt; 1. As long as anaesthetists are humans, this number may never reach zero, no matter how much mandatory training we are required to complete.&lt;/p&gt;&lt;p&gt;Is it necessary to establish a new standard requiring training completion, with implicit sanctions for non-compliance? We adhere to both imposed professional standards, like those set by the General Medical Council, and moral and personal performance standards. It is contentious to suggest that implementation of a new explicit standard (and corresponding sanction) will bring about the desired improvement in human performance.&lt;/p&gt;&lt;p&gt;Nathanson et al. call for a paradigm shift, and I would echo this, albeit a different one. The seven completed National Audit Projects highlight deficiencies in human performance and suggest areas for improvement. An alternative approach could focus solely on successful anaesthetic management, pr","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 2","pages":"219-220"},"PeriodicalIF":7.5,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16480","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}