Letter to the Editor
Experience of Monitoring Subcutaneous Biological Treatment (Adalimumab) by Nurses in Chronic Inflammatory Diseases
Monitorización por enfermería de la administración de tratamientos biológicos subcutáneos (adalimumab) en enfermedades inflamatorias crónicas
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"Experience of Monitoring Subcutaneous Biological Treatment (Adalimumab) by Nurses in Chronic Inflammatory Diseases" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "349" "paginaFinal" => "350" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Lucinda Sánchez-Eslava, Hèctor Corominas, Manel Riera, Ramon Fíguls" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Lucinda" "apellidos" => "Sánchez-Eslava" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Hèctor" "apellidos" => "Corominas" "email" => array:2 [ 0 => "Hector.corominas@sanitatintegral.org" 1 => "vancor@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Manel" "apellidos" => "Riera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Ramon" "apellidos" => "Fíguls" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Enfermera Hospital de Dia polivalente, Hospital Dos de Maig de Barcelona, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unitat de Reumatologia, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Unitat de Reumatologia, Hospital Dos de Maig, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Monitorización por enfermería de la administración de tratamientos biológicos subcutáneos (adalimumab) en enfermedades inflamatorias crónicas" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Diseases such as rheumatoid arthritis (RA) and psoriatic arthritis (Apso) are chronic processes that require an early diagnosis, monitoring and active treatment.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The EPISER study showed that rheumatic diseases have an extraordinary frequency in the Spanish population and considerable social impact due to disability.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Biologic drugs block are diverse molecules and include tumor necrosis factor alpha blockers (infliximab/Remicade<span class="elsevierStyleSup">®</span>, adamilumab/Humira<span class="elsevierStyleSup">®</span>, etanercep/Embrel<span class="elsevierStyleSup">®</span>); others such as (rituximab/Mabthera<span class="elsevierStyleSup">®</span>), a monoclonal antibody cytotoxic to B lymphocytes, with anti-CD20 activity; inhibitors of co-stimulation (abatacept/Orencia<span class="elsevierStyleSup">®</span>); and interlekin-6 inhibitors (tocilizumab/Roactemra<span class="elsevierStyleSup">®</span>).<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> The administration of these therapies requires nursing personnel with experience to monitor their administration, and perform education tasks, care and the control of the appearance of adverse events.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,7,8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Coinciding with the installment in our center of a polyvalent day and the change of device (pen or syringe) of a new prescription of adalimumab,<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a> the double objective of our study was to: (a) know the opinion of patients treated with subcutaneous biologics with respect to the education given by the nurses staff, and (b) evaluate their preferences after using the two adalimumab (Humira<span class="elsevierStyleSup">®</span>) devices: syringe vs pen. An informative session was performed to patients treated with adalimumab, an anonymous questionnaire evaluating education by the nursing staff and a home questionnaire that evaluated different variables of the two devices, after administering a dose with the “adalimumab syringe” and another with the “adalimumab pen”. 16 patients treated with a preloaded syringe of Humira<span class="elsevierStyleSup">®</span> were included (7M/9F), diagnosed with RA (9/16) and Apso (7/16), with a mean age of 53.8 years (range: 29–77). The mean time since onset of disease was 7.5 years (range: 1–21 years), with a mean time treated with Humira<span class="elsevierStyleSup">®</span> of 20.43 months. Areas taught included: injection sites, device management and self-injection technique, transport and conservation of medication, elimination of residue, knowledge and specific care. In a second visit lasting 30<span class="elsevierStyleHsp" style=""></span>min, the nursing staff performed a global evaluation and supervised the self-administration of medication.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The variables evaluated were: pain at 0 and 15<span class="elsevierStyleHsp" style=""></span>min post-injection, difficulty in managing the device, global evaluation and preference for one device over the other (pen vs preloaded syringe). For the evaluation we used a visual analog scale (VAS: 0–10), but given the reduced number of patients in our sample, results were grouped on a 1–4 scale. VAS: 0 (1), 1–3 (2), 4–7 (3) and 8–10 (4). All of the patients gave their informed consent to participate in the study.</p><p id="par0025" class="elsevierStylePara elsevierViewall">81.25% of patients (13/16) self-administered the medication and in 18.75% (3/16) someone else did (family or nurse). 50% of patients (8/16) received nursing education prior to treatment, positively evaluating it when answering the following questions: (a) global evaluation of attention and education received: 100% considered it “very good” on a scale (does not know: 0, very deficient: 1, deficient: 2, normal: 3, good: 4 and very good: 5); (b) evaluation of the time employed by the nurses visit: 100% considered it “very satisfactory” on a scale (does not know: 0, very scarce: 1, scarce: 2, regular: 3, satisfactory: 4 and very satisfactory: 5), and (c) in the usefulness of the education received: 5/8 (62.5%) considered it “very good” and 3/8 (37.5%) “good” on a scale (does not know: 0, very inadequate: 1, inadequate: 2, normal: 3, good: 4 and very good: 5). Of those, 7/8 (87.5%) would have liked to have received it and 1/8 (12.5%) did not know. Through the home questionnaires data were collected that allowed the evaluation of the two devices in 13/16 patients. One could not evaluate the pen due to infection and 2 gave no final information. The main variables under evaluation were: post-injection pain at 0 and 15<span class="elsevierStyleHsp" style=""></span>min, difficulty managing the device and preference for one device over the other.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The grouped mean of baseline pain of the syringe with respect to the pen during administration in 13/16 patients was 2.15 and 2.0 (<span class="elsevierStyleItalic">P</span>=.4) (scale 1–4) (chi squared test); with respect to pain 15<span class="elsevierStyleHsp" style=""></span>min after the injection there was a significant difference between both devices, 1.85 and 1.46 (<span class="elsevierStyleItalic">P</span>=.035) (scale 1–4). Comparing the difficulty in managing both devices, the syringe proved to be more complex (2.08) than the pen (1.46), with a significance level of <span class="elsevierStyleItalic">P</span>=.03. There were no significant differences regarding the global evaluation between both mechanisms (<span class="elsevierStyleItalic">P</span>=.55). The results with respect to the preferred device were: syringe 1/13 (8%), pen 7/13 (54%) and regardless 5/13 (38%).</p><p id="par0035" class="elsevierStylePara elsevierViewall">After comparing both devices, patients with RA and Apso treated in our center considered the pen more manageable than the syringe, they have less pain at 15<span class="elsevierStyleHsp" style=""></span>min post-injection with the pen and a high percentage of them would use the pen. The care of the patient with chronic inflammatory diseases must be approached from a teamwork perspective, including the physician, nurses and physical therapist, etc., always with the end of offering a global evaluation.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Sánchez-Eslava L, et al. Monitorización por enfermería de la administración de tratamientos biológicos subcutáneos (adalimumab) en enfermedades inflamatorias crónicas. Reumatol Clin. 2011. <span class="elsevierStyleInterRef" href="doi:10.1016/j.reuma.2011.04.004">doi:10.1016/j.reuma.2011.04.004</span>.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Training program for patients with multiple sclerosis at the start of immunomodulatory therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Harto-Castaño" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Enferm Clin" "fecha" => "2007" "volumen" => "17" "paginaInicial" => "267" "paginaFinal" => "271" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17961470" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Observed and expected frequency of co-morbid chronic diseases in rheumatic patients" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "EPISER Study Group" "etal" => false "autores" => array:4 [ 0 => "E. Loza" 1 => "J.A. Jover" 2 => "L. Rodriguez-Rodriguez" 3 => "L. Carmona" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2007.078659" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2008" "volumen" => "67" "paginaInicial" => "418" "paginaFinal" => "421" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17981917" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The prevalence of rheumatoid arthritis in the general population of Spain" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Carmona" 1 => "V. Villaverde" 2 => "C. Hernández-García" 3 => "J. Ballina" 4 => "R. Gabriel" 5 => "A. Laffon" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rheumatology" "fecha" => "2002" "volumen" => "41" "paginaInicial" => "88" "paginaFinal" => "95" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11792885" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multimorbidity: prevalence, effect on quality of life and daily functioning, and variation of this effect when one condition is a rheumatic disease" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "EPISER Study Group" "etal" => false "autores" => array:4 [ 0 => "E. Loza" 1 => "J.A. Jover" 2 => "L. Rodriguez" 3 => "L. Carmona" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.semarthrit.2008.01.004" "Revista" => array:6 [ "tituloSerie" => "Semin Arthritis Rheum" "fecha" => "2009" "volumen" => "38" "paginaInicial" => "312" "paginaFinal" => "319" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18336872" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A trial of etanercept, a recombinant tumor necrosis factor receptor: Fc fusion protein, in patients with rheumatoid arthritis receiving methotrexate" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.E. Weinblatt" 1 => "J.M. Kremer" 2 => "A.D. Bankhurst" 3 => "K.J. Bulpitt" 4 => "R.M. Fleischmann" 5 => "R.I. Fox" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199901283400401" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1999" "volumen" => "340" "paginaInicial" => "253" "paginaFinal" => "259" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9920948" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy of B-cell-targeted therapy with rituximab in patients with rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.C. Edwards" 1 => "L. Szczepanski" 2 => "J. Szechinski" 3 => "A. Filipowicz-Sosnowska" 4 => "P. Emery" 5 => "D.R. Close" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa032534" "Revista" => array:7 [ "tituloSerie" => "N Engl J Med" "fecha" => "2004" "volumen" => "350" "paginaInicial" => "2572" "paginaFinal" => "2581" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15201414" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1590865808000376" "estado" => "S300" "issn" => "15908658" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Safety-related regulatory actions for biologicals approved in the United States and the European Union" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T.J. Giezen" 1 => "A.K. Mantel-Teeuwisse" 2 => "S.M. Straus" 3 => "H. Schellekens" 4 => "H.G. Leufkens" 5 => "A.C. Egberts" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.300.16.1887" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2008" "volumen" => "300" "paginaInicial" => "1887" "paginaFinal" => "1896" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18940975" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Safety of tumour necrosis factor-alpha antagonists" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Khanna" 1 => "M. McMahon" 2 => "D.E. Furst" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Drug Saf" "fecha" => "2004" "volumen" => "27" "paginaInicial" => "307" "paginaFinal" => "324" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15061685" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "HUMIRA pen: a novel autoinjection device for subcutaneous injection of the fully human monoclonal antibody adalimumab" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Kivitz" 1 => "O.G. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 15 | 26 |
| 2024 October | 41 | 27 | 68 |
| 2024 September | 40 | 26 | 66 |
| 2024 August | 55 | 41 | 96 |
| 2024 July | 43 | 31 | 74 |
| 2024 June | 39 | 22 | 61 |
| 2024 May | 42 | 30 | 72 |
| 2024 April | 43 | 30 | 73 |
| 2024 March | 37 | 30 | 67 |
| 2024 February | 33 | 29 | 62 |
| 2024 January | 34 | 29 | 63 |
| 2023 December | 34 | 36 | 70 |
| 2023 November | 38 | 39 | 77 |
| 2023 October | 43 | 34 | 77 |
| 2023 September | 57 | 40 | 97 |
| 2023 August | 67 | 18 | 85 |
| 2023 July | 40 | 32 | 72 |
| 2023 June | 33 | 27 | 60 |
| 2023 May | 36 | 17 | 53 |
| 2023 April | 21 | 13 | 34 |
| 2023 March | 26 | 30 | 56 |
| 2023 February | 48 | 29 | 77 |
| 2023 January | 26 | 22 | 48 |
| 2022 December | 58 | 42 | 100 |
| 2022 November | 60 | 36 | 96 |
| 2022 October | 47 | 47 | 94 |
| 2022 September | 39 | 34 | 73 |
| 2022 August | 52 | 31 | 83 |
| 2022 July | 63 | 41 | 104 |
| 2022 June | 79 | 30 | 109 |
| 2022 May | 62 | 55 | 117 |
| 2022 April | 47 | 58 | 105 |
| 2022 March | 61 | 47 | 108 |
| 2022 February | 45 | 38 | 83 |
| 2022 January | 47 | 44 | 91 |
| 2021 December | 23 | 35 | 58 |
| 2021 November | 32 | 47 | 79 |
| 2021 October | 45 | 56 | 101 |
| 2021 September | 36 | 44 | 80 |
| 2021 August | 33 | 45 | 78 |
| 2021 July | 28 | 31 | 59 |
| 2021 June | 32 | 40 | 72 |
| 2021 May | 60 | 52 | 112 |
| 2021 April | 141 | 99 | 240 |
| 2021 March | 69 | 47 | 116 |
| 2021 February | 51 | 32 | 83 |
| 2021 January | 33 | 22 | 55 |
| 2020 December | 37 | 19 | 56 |
| 2020 November | 28 | 20 | 48 |
| 2020 October | 22 | 13 | 35 |
| 2020 September | 39 | 25 | 64 |
| 2020 August | 21 | 16 | 37 |
| 2020 July | 33 | 20 | 53 |
| 2020 June | 39 | 26 | 65 |
| 2020 May | 45 | 13 | 58 |
| 2020 April | 31 | 14 | 45 |
| 2020 March | 17 | 4 | 21 |
| 2020 February | 2 | 0 | 2 |
| 2020 January | 16 | 0 | 16 |
| 2019 September | 4 | 0 | 4 |
| 2019 June | 2 | 0 | 2 |
| 2019 March | 2 | 0 | 2 |
| 2019 January | 3 | 0 | 3 |
| 2018 May | 7 | 0 | 7 |
| 2018 April | 79 | 8 | 87 |
| 2018 March | 53 | 5 | 58 |
| 2018 February | 47 | 3 | 50 |
| 2018 January | 46 | 2 | 48 |
| 2017 December | 43 | 3 | 46 |
| 2017 November | 43 | 4 | 47 |
| 2017 October | 29 | 6 | 35 |
| 2017 September | 44 | 22 | 66 |
| 2017 August | 45 | 5 | 50 |
| 2017 July | 37 | 10 | 47 |
| 2017 June | 47 | 13 | 60 |
| 2017 May | 35 | 13 | 48 |
| 2017 April | 25 | 4 | 29 |
| 2017 March | 20 | 32 | 52 |
| 2017 February | 15 | 10 | 25 |
| 2017 January | 25 | 4 | 29 |
| 2016 December | 50 | 20 | 70 |
| 2016 November | 38 | 1 | 39 |
| 2016 October | 54 | 12 | 66 |
| 2016 September | 47 | 6 | 53 |
| 2016 August | 38 | 8 | 46 |
| 2016 July | 36 | 6 | 42 |
| 2016 June | 0 | 12 | 12 |
| 2016 May | 0 | 9 | 9 |
| 2016 April | 2 | 0 | 2 |
| 2016 March | 1 | 10 | 11 |
| 2015 December | 2 | 0 | 2 |
| 2015 August | 3 | 0 | 3 |
| 2015 July | 21 | 7 | 28 |
| 2015 June | 27 | 6 | 33 |
| 2015 May | 35 | 17 | 52 |
| 2015 April | 28 | 11 | 39 |
| 2015 March | 17 | 7 | 24 |
| 2015 February | 35 | 8 | 43 |
| 2015 January | 28 | 7 | 35 |
| 2014 December | 33 | 12 | 45 |
| 2014 November | 37 | 13 | 50 |
| 2014 October | 37 | 9 | 46 |
| 2014 September | 23 | 7 | 30 |
| 2014 August | 25 | 19 | 44 |
| 2014 July | 36 | 12 | 48 |
| 2014 June | 41 | 15 | 56 |
| 2014 May | 47 | 12 | 59 |
| 2014 April | 51 | 7 | 58 |
| 2014 March | 48 | 20 | 68 |
| 2014 February | 47 | 16 | 63 |
| 2014 January | 39 | 13 | 52 |
| 2013 December | 28 | 8 | 36 |
| 2013 November | 26 | 13 | 39 |
| 2013 October | 51 | 7 | 58 |
| 2013 September | 47 | 12 | 59 |
| 2013 August | 44 | 17 | 61 |
| 2013 July | 36 | 9 | 45 |
| 2013 June | 34 | 7 | 41 |
| 2013 May | 34 | 15 | 49 |
| 2013 April | 42 | 18 | 60 |
| 2013 March | 39 | 19 | 58 |
| 2013 February | 35 | 16 | 51 |
| 2013 January | 32 | 12 | 44 |
| 2012 December | 32 | 14 | 46 |
| 2012 November | 17 | 11 | 28 |
| 2012 October | 19 | 18 | 37 |
| 2012 September | 17 | 3 | 20 |
| 2012 July | 2 | 0 | 2 |
| 2012 June | 3 | 0 | 3 |
| 2012 May | 3 | 0 | 3 |
| 2012 April | 3 | 0 | 3 |
| 2012 March | 2 | 0 | 2 |
| 2012 February | 6 | 0 | 6 |
| 2012 January | 6 | 0 | 6 |
| 2011 December | 10 | 0 | 10 |
| 2011 November | 6 | 0 | 6 |
| 2011 October | 9 | 0 | 9 |
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