Pub Date : 2000-12-01DOI: 10.1080/0742-969X.2000.11882964
J. Sweers
{"title":"When Someone You Love is Dying: Making Wise Decisions at the End of Life. David Clark and Peter Emmett","authors":"J. Sweers","doi":"10.1080/0742-969X.2000.11882964","DOIUrl":"https://doi.org/10.1080/0742-969X.2000.11882964","url":null,"abstract":"","PeriodicalId":77421,"journal":{"name":"The Hospice journal","volume":"15 1","pages":"56 - 57"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/0742-969X.2000.11882964","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"59937994","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}
Pub Date : 2000-12-01DOI: 10.1080/0742-969X.2000.11882962
A. Hecht
(2000). Clinical Dimensions of Anticipatory Mourning: Theory and Practice in Working with the Dying, Their Loved Ones, and Their Caregivers. Therese A. Rando, Ed. The Hospice Journal: Vol. 15, No. 4, pp. 53-55.
{"title":"Clinical Dimensions of Anticipatory Mourning: Theory and Practice in Working with the Dying, Their Loved Ones, and Their Caregivers. Therese A. Rando, Ed.","authors":"A. Hecht","doi":"10.1080/0742-969X.2000.11882962","DOIUrl":"https://doi.org/10.1080/0742-969X.2000.11882962","url":null,"abstract":"(2000). Clinical Dimensions of Anticipatory Mourning: Theory and Practice in Working with the Dying, Their Loved Ones, and Their Caregivers. Therese A. Rando, Ed. The Hospice Journal: Vol. 15, No. 4, pp. 53-55.","PeriodicalId":77421,"journal":{"name":"The Hospice journal","volume":"137 1","pages":"53 - 55"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/0742-969X.2000.11882962","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"59938093","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}
Pub Date : 2000-09-01DOI: 10.1080/0742-969X.2000.11882956
D. Wilkie, Janice Kampbell, S. Cutshall, Heather Halabisky, Hilda Harmon, Linda P. Johnson, Lynn Weinacht, Mark Rake-Marona
ABSTRACT Aims: In a randomized controlled clinical trial (RCCT), we examined the effects of four massages on pain intensity, prescribed IM morphine equivalent doses (IMMSEQ), hospital admissions, and quality of life (QoL). Methods: Of 173 referred patients, 29 (14 control, 15 massage) completed this pilot study. Subjects were 69% male and aged 63 years on average. Licensed therapists administered four, twice-weekly massages. Baseline and outcome measurements were obtained by other team members before the first and after the fourth massages. Results: Pain intensity, pulse rate, and respiratory rate were significantly reduced immediately after the massages. At study entry, the massage group reported higher pain intensity (2.4 ± 2.8 vs. 1.6 ± 2.1) which decreased by 42% (1.4 ± 1.5) compared to a 25% reduction in the control group (1.2 ± 1.3) (p > .05). IMMSEQ doses were stable or decreased for eight patients in each group and increased for seven massage and six control group patients. One massage group and two control group patients were hospitalized. All initial QoL scores were higher in the massage group than in the control group, but only current QoL was statistically significant. Both groups reported improved global QoL. The control group reported slight improvement in current QoL and satisfaction with QoL whereas these two aspects of QoL declined in the massage group even though their average QoL scores were higher than the control group at the end of the study. Conclusions: We demonstrated feasibility of conducting an RCCT in which we systematically implemented massage as a nonpharmacologic comfort therapy along with our usual hospice care. The massage intervention produced immediate relaxation and pain relief effects. A power analysis based on trends in the longer-term effects indicate that a study with 80 subjects per group is likely to detect statistically significant effects of usual hospice care with twice-weekly massage therapy sessions on pain intensity, analgesic dosages, and quality of life. Lessons we learned from conducting this pilot study are being used to improve documentation of our hospice program outcomes and to plan a definitive study. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com ]
摘要目的:在一项随机对照临床试验(RCCT)中,我们研究了四种按摩对疼痛强度、处方吗啡当量剂量(IMMSEQ)、住院率和生活质量(QoL)的影响。方法:173例转诊患者中,29例(对照组14例,按摩组15例)完成本初步研究。受试者69%为男性,平均年龄63岁。有执照的治疗师每周进行两次按摩。基线和结果测量由其他团队成员在第一次按摩前和第四次按摩后获得。结果:按摩后疼痛强度、脉搏率、呼吸率均明显降低。在研究开始时,按摩组报告了更高的疼痛强度(2.4±2.8 vs. 1.6±2.1),与对照组(1.2±1.3)减少25% (p < 0.05)相比,疼痛强度降低了42%(1.4±1.5)。每组8例患者的IMMSEQ剂量稳定或减少,按摩组7例患者和对照组6例患者的IMMSEQ剂量增加。推拿组1例,对照组2例。按摩组的所有初始生活质量评分均高于对照组,但只有当前生活质量有统计学意义。两组都报告了总体生活质量的改善。对照组在目前的生活质量和对生活质量的满意度方面略有改善,而按摩组在生活质量的这两个方面有所下降,尽管他们的平均生活质量评分在研究结束时高于对照组。结论:我们证明了进行RCCT的可行性,在RCCT中,我们系统地将按摩作为一种非药物舒适疗法与我们通常的临终关怀一起实施。按摩干预产生了立即放松和缓解疼痛的效果。一项基于长期效果趋势的功效分析表明,一项每组80名受试者的研究可能会发现,每周两次的常规临终关怀按摩治疗对疼痛强度、止痛剂剂量和生活质量的影响具有统计学意义。我们从这项初步研究中学到的经验,正被用来改善我们安宁疗护计划结果的文件,并计划一项明确的研究。[文章副本收费,可从霍沃斯文件递送服务:1-800-342-9678。电子邮件地址:getinfo@haworthpressinc.com
{"title":"Effects of Massage on Pain Intensity, Analgesics and Quality of Life in Patients with Cancer Pain: A Pilot Study of a Randomized Clinical Trial Conducted Within Hospice Care Delivery","authors":"D. Wilkie, Janice Kampbell, S. Cutshall, Heather Halabisky, Hilda Harmon, Linda P. Johnson, Lynn Weinacht, Mark Rake-Marona","doi":"10.1080/0742-969X.2000.11882956","DOIUrl":"https://doi.org/10.1080/0742-969X.2000.11882956","url":null,"abstract":"ABSTRACT Aims: In a randomized controlled clinical trial (RCCT), we examined the effects of four massages on pain intensity, prescribed IM morphine equivalent doses (IMMSEQ), hospital admissions, and quality of life (QoL). Methods: Of 173 referred patients, 29 (14 control, 15 massage) completed this pilot study. Subjects were 69% male and aged 63 years on average. Licensed therapists administered four, twice-weekly massages. Baseline and outcome measurements were obtained by other team members before the first and after the fourth massages. Results: Pain intensity, pulse rate, and respiratory rate were significantly reduced immediately after the massages. At study entry, the massage group reported higher pain intensity (2.4 ± 2.8 vs. 1.6 ± 2.1) which decreased by 42% (1.4 ± 1.5) compared to a 25% reduction in the control group (1.2 ± 1.3) (p > .05). IMMSEQ doses were stable or decreased for eight patients in each group and increased for seven massage and six control group patients. One massage group and two control group patients were hospitalized. All initial QoL scores were higher in the massage group than in the control group, but only current QoL was statistically significant. Both groups reported improved global QoL. The control group reported slight improvement in current QoL and satisfaction with QoL whereas these two aspects of QoL declined in the massage group even though their average QoL scores were higher than the control group at the end of the study. Conclusions: We demonstrated feasibility of conducting an RCCT in which we systematically implemented massage as a nonpharmacologic comfort therapy along with our usual hospice care. The massage intervention produced immediate relaxation and pain relief effects. A power analysis based on trends in the longer-term effects indicate that a study with 80 subjects per group is likely to detect statistically significant effects of usual hospice care with twice-weekly massage therapy sessions on pain intensity, analgesic dosages, and quality of life. Lessons we learned from conducting this pilot study are being used to improve documentation of our hospice program outcomes and to plan a definitive study. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com ]","PeriodicalId":77421,"journal":{"name":"The Hospice journal","volume":"15 1","pages":"31 - 53"},"PeriodicalIF":0.0,"publicationDate":"2000-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/0742-969X.2000.11882956","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"59937426","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}
Pub Date : 2000-09-01DOI: 10.1080/0742-969X.2000.11882954
Stephenie V. Brinson, Q. Brunk
ABSTRACT The purpose of this phenomenological study was to identify coping strategies of rural family caregivers who were caring for an elderly relative in a home hospice situation. Each of the six participants were interviewed on two occasions exploring their caregiving experience with a focus on coping strategies. Colaizzi’s six step phenomenological method was employed for data analysis. Participant caregivers specifically identified coping strategies of support, adaptive activities, spiritual means, and avoidance. The collected data were analyzed and the findings compared to related caregiving literature. Implications for nursing practice and future research opportunities are discussed. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com ]
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Pub Date : 2000-09-01DOI: 10.1080/0742-969X.2000.11882955
Susan W. Gray, Marilyn R. Zide, H. Wilker
ABSTRACT The major goals of bereavement groups are to help resolve the conflicts of separation, facilitate the completion of grief tasks, provide a social support system, and give permission to mourn. This article describes how the Solution Focused Brief Therapy (SFBT) model can be applied to bereavement groups. In addition, the authors’ provide examples of techniques useful for setting the beginning foundation for bereavement group work in the rural community. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com ]
{"title":"Using the Solution Focused Brief Therapy Model with Bereavement Groups in Rural Communities: Resiliency at Its Best","authors":"Susan W. Gray, Marilyn R. Zide, H. Wilker","doi":"10.1080/0742-969X.2000.11882955","DOIUrl":"https://doi.org/10.1080/0742-969X.2000.11882955","url":null,"abstract":"ABSTRACT The major goals of bereavement groups are to help resolve the conflicts of separation, facilitate the completion of grief tasks, provide a social support system, and give permission to mourn. This article describes how the Solution Focused Brief Therapy (SFBT) model can be applied to bereavement groups. In addition, the authors’ provide examples of techniques useful for setting the beginning foundation for bereavement group work in the rural community. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com ]","PeriodicalId":77421,"journal":{"name":"The Hospice journal","volume":"35 1","pages":"13 - 30"},"PeriodicalIF":0.0,"publicationDate":"2000-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/0742-969X.2000.11882955","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"59937413","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}
Pub Date : 2000-09-01DOI: 10.1080/0742-969X.2000.11882958
C. Ryan
ABSTRACT Hospice patients are more likely to die at home than patients involved in conventional medical care, but the proportion of home deaths varies between programs. A study of the effect of hospice administrative characteristics on inpatient death rates is presented. Data from hospice programs that operated in New York State between 1993 and 1995 were obtained from the State Health Department and from publications of the National Hospice Organization. Inpatient death rates varied significantly between different operating structures: 11% for hospices that were divisions of home health care agencies; 34% for hospices that were divisions of hospital corporations; and 20% for hospices that were independent hospice corporations. This difference was explained by the presence of dedicated inpatient hospice units: Programs with such units demonstrated higher inpatient death rates than those without (42% versus 11%; P < .00001). Though not necessarily causal, these associations should be of interest to patients, physicians, families, and policymakers. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com ]
{"title":"Association Between Administrative and Ownership Characteristics of Hospices and Their Proportion of Inpatient Deaths","authors":"C. Ryan","doi":"10.1080/0742-969X.2000.11882958","DOIUrl":"https://doi.org/10.1080/0742-969X.2000.11882958","url":null,"abstract":"ABSTRACT Hospice patients are more likely to die at home than patients involved in conventional medical care, but the proportion of home deaths varies between programs. A study of the effect of hospice administrative characteristics on inpatient death rates is presented. Data from hospice programs that operated in New York State between 1993 and 1995 were obtained from the State Health Department and from publications of the National Hospice Organization. Inpatient death rates varied significantly between different operating structures: 11% for hospices that were divisions of home health care agencies; 34% for hospices that were divisions of hospital corporations; and 20% for hospices that were independent hospice corporations. This difference was explained by the presence of dedicated inpatient hospice units: Programs with such units demonstrated higher inpatient death rates than those without (42% versus 11%; P < .00001). Though not necessarily causal, these associations should be of interest to patients, physicians, families, and policymakers. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com ]","PeriodicalId":77421,"journal":{"name":"The Hospice journal","volume":"15 1","pages":"63 - 74"},"PeriodicalIF":0.0,"publicationDate":"2000-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/0742-969X.2000.11882958","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"59937659","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}
Hospice patients are more likely to die at home than patients involved in conventional medical care, but the proportion of home deaths varies between programs. A study of the effect of hospice administrative characteristics on inpatient death rates is presented. Data from hospice programs that operated in New York State between 1993 and 1995 were obtained from the State Health Department and from publications of the National Hospice Organization. Inpatient death rates varied significantly between different operating structures: 11% for hospices that were divisions of home health care agencies; 34% for hospices that were divisions of hospital corporations; and 20% for hospices that were independent hospice corporations. This difference was explained by the presence of dedicated inpatient hospice units: Programs with such units demonstrated higher inpatient death rates than those without (42% versus 11%; P < .00001). Though not necessarily causal, these associations should be of interest to patients, physicians, families, and policy-makers.
{"title":"Association between administrative and ownership characteristics of hospices and their proportion of inpatient deaths.","authors":"C. Ryan","doi":"10.1300/J011V15N03_05","DOIUrl":"https://doi.org/10.1300/J011V15N03_05","url":null,"abstract":"Hospice patients are more likely to die at home than patients involved in conventional medical care, but the proportion of home deaths varies between programs. A study of the effect of hospice administrative characteristics on inpatient death rates is presented. Data from hospice programs that operated in New York State between 1993 and 1995 were obtained from the State Health Department and from publications of the National Hospice Organization. Inpatient death rates varied significantly between different operating structures: 11% for hospices that were divisions of home health care agencies; 34% for hospices that were divisions of hospital corporations; and 20% for hospices that were independent hospice corporations. This difference was explained by the presence of dedicated inpatient hospice units: Programs with such units demonstrated higher inpatient death rates than those without (42% versus 11%; P < .00001). Though not necessarily causal, these associations should be of interest to patients, physicians, families, and policy-makers.","PeriodicalId":77421,"journal":{"name":"The Hospice journal","volume":"23 1","pages":"63-74"},"PeriodicalIF":0.0,"publicationDate":"2000-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85916117","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}
Pub Date : 2000-06-29DOI: 10.1080/0742-969X.2000.11882957
P. Kovacs
ABSTRACT While research has always been an important component of the hospice movement in this country, increasingly hospices are involved in research as a result of demands for outcome measures and greater accountability. In addition to the more traditional research strategies, hospice researchers are encouraged to use participatory action research (PAR) in their efforts to better understand, document, and evaluate services. This article describes PAR and provides an example of a modified usage of PAR with a hospice program serving persons with AIDS. Whether used primarily in the planning phase of research or in conducting and reporting results as well, PAR maximizes input from those who know hospice best-staff, volunteers, patients, and caregivers. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com ]
{"title":"Participatory Action Research and Hospice: A Good Fit","authors":"P. Kovacs","doi":"10.1080/0742-969X.2000.11882957","DOIUrl":"https://doi.org/10.1080/0742-969X.2000.11882957","url":null,"abstract":"ABSTRACT While research has always been an important component of the hospice movement in this country, increasingly hospices are involved in research as a result of demands for outcome measures and greater accountability. In addition to the more traditional research strategies, hospice researchers are encouraged to use participatory action research (PAR) in their efforts to better understand, document, and evaluate services. This article describes PAR and provides an example of a modified usage of PAR with a hospice program serving persons with AIDS. Whether used primarily in the planning phase of research or in conducting and reporting results as well, PAR maximizes input from those who know hospice best-staff, volunteers, patients, and caregivers. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com ]","PeriodicalId":77421,"journal":{"name":"The Hospice journal","volume":"15 1","pages":"55 - 62"},"PeriodicalIF":0.0,"publicationDate":"2000-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/0742-969X.2000.11882957","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"59937544","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}
Pub Date : 2000-06-01DOI: 10.1080/0742-969X.2000.11882949
M. Letizia, J. Shenk, T. D. Jones
ABSTRACT An alternative route to oral medications used by some hospice programs is intermittent injections of medications using an indwelling subcutaneous butterfly needle. The nurse places the infusion sets and instructs caregivers on medication administration. Although this method has become more common in hospice care, it has not received much attention in part because of a lack of data to support its efficacy. This study describes the use of intermittent subcutaneous medications for symptom relief in a home hospice program. A chart review was conducted of the 191 patients who received medications by this route during three calendar years; 77% had cancer. The average duration of hospice care was 25 days; on average, intermittent subcutaneous medications were instituted 4 days prior to the patient’s death. The main indications for this route were inability to swallow/somnolence (65%), and pain unresponsive to oral medication (19%). Symptoms to be controlled by this method were pain (88%), anxiety (72%), and dyspnea (4%). Morphine was used most frequently for pain, and Ativan was used most frequently for anxiety. Side effects from the medications and problems with this route of administration were rarely reported, thereby supporting the practicality of this method in hospice care. These results form the foundation for a prospective study that is documenting staff, patient, and caregiver variables that impact on the effectiveness and manageability of this method of symptom management in hospice care. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com ]
{"title":"Intermittent Subcutaneous Injections for Symptom Control in Hospice Care: A Retrospective Investigation","authors":"M. Letizia, J. Shenk, T. D. Jones","doi":"10.1080/0742-969X.2000.11882949","DOIUrl":"https://doi.org/10.1080/0742-969X.2000.11882949","url":null,"abstract":"ABSTRACT An alternative route to oral medications used by some hospice programs is intermittent injections of medications using an indwelling subcutaneous butterfly needle. The nurse places the infusion sets and instructs caregivers on medication administration. Although this method has become more common in hospice care, it has not received much attention in part because of a lack of data to support its efficacy. This study describes the use of intermittent subcutaneous medications for symptom relief in a home hospice program. A chart review was conducted of the 191 patients who received medications by this route during three calendar years; 77% had cancer. The average duration of hospice care was 25 days; on average, intermittent subcutaneous medications were instituted 4 days prior to the patient’s death. The main indications for this route were inability to swallow/somnolence (65%), and pain unresponsive to oral medication (19%). Symptoms to be controlled by this method were pain (88%), anxiety (72%), and dyspnea (4%). Morphine was used most frequently for pain, and Ativan was used most frequently for anxiety. Side effects from the medications and problems with this route of administration were rarely reported, thereby supporting the practicality of this method in hospice care. These results form the foundation for a prospective study that is documenting staff, patient, and caregiver variables that impact on the effectiveness and manageability of this method of symptom management in hospice care. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com ]","PeriodicalId":77421,"journal":{"name":"The Hospice journal","volume":"15 1","pages":"1 - 11"},"PeriodicalIF":0.0,"publicationDate":"2000-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/0742-969X.2000.11882949","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"59936985","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}