Hospital practice (1995)最新文献

{"title":"Modified infusion of recombinant tissue plasminogen activator in high-risk pulmonary thromboembolism with high bleeding risk: a case report.","authors":"Mohammad Hussein Hasin, Mostafa Ahmadi, Vafa Baradaran Rahimi, Bahram Shahri, Asal Yadollahi","doi":"10.1080/21548331.2024.2433934","DOIUrl":"https://doi.org/10.1080/21548331.2024.2433934","url":null,"abstract":"<p><p>High-risk pulmonary thromboembolism (PTE) is a form of venous thromboembolism that refers to severe obstruction of pulmonary vessels, which causes right ventricular failure and hemodynamic instability. High-risk PTE has a high mortality rate unless immediate reperfusion treatment is done. Systemic thrombolysis is recommended for patients with high-risk PTE. The approved regimen for high-risk PTE is the accelerated intravenous administration of recombinant tissue-type plasminogen activator (rtPA) 100 mg over 2 hours. Herein, we present a case of high-risk PTE in a 74-year-old woman with a high risk of bleeding due to a recent pelvic fracture and head trauma who was successfully treated with a slower infusion of 100 mg rtPA over 4 hours. The modified infusion rate of 100 mg rtPA over 4 hours is an effective regimen for thrombolysis in acute high-risk PTE. It might have a lower risk of bleeding complications, which makes it a good option for patients with high bleeding risk.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740569","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}

{"title":"Nomophobia: a challenge among healthcare professionals in Africa.","authors":"Reena Shah, Shan Lakhani, Jasmit Shah, Annastacia Mbithi, Aakanksha Singh, Zainab Gandhi, Priyal Mehta, Rahul Kashyap, Salim Surani","doi":"10.1080/21548331.2024.2432858","DOIUrl":"https://doi.org/10.1080/21548331.2024.2432858","url":null,"abstract":"<p><strong>Objectives: </strong>This study delves into implementing Global Provider's phone-lessness phobia (Global 3-P Study) within the healthcare sector in Africa through a multinational, cross-sectional, web-based survey from April 1st to 30 June 2023.</p><p><strong>Methods: </strong>Utilizing a modified Nomophobia Questionnaire (NMP-Q), the research explores four dimensions of nomophobia: the inability to communicate, loss of connectedness, difficulty accessing information, and sacrificing convenience. The Global Remote Research Scholars Program (GRRSP) conducted the study, employing a 'snowball technique' for survey dissemination.</p><p><strong>Results: </strong>A total of 1636 responses were collected from healthcare professionals in Africa, predominantly aged 26-45, with a majority identifying as Black-African (86.5%) and residing mainly in Kenya (61.6%). The survey revealed a higher prevalence of Android smartphone users (71.4%) than Apple iOS (25.6%). Participants reported spending substantial time on personal (3.1-5 hours) and work-related (up to 3 hours) smartphone activities. A significant portion of respondents felt uncomfortable (74.3%), annoyed (72.0%), and nervous (61.4%) at the prospect of not having constant smartphone access to information. Concerns about disruptions to smartphone connections, such as running out of battery or data, were prevalent among participants. Analysis of nomophobia levels revealed that 46.9% experienced moderate Nomophobia Level I and 41.1% reported severe levels, while Nomophobia Level II was reported by 51.8% with moderate levels and 37.2% with severe levels. Comparative analysis based on gender and age groups showed statistically significant differences. Males exhibited lower severity levels of nomophobia compared to females, and the 36-45 age group reported the highest prevalence of severe nomophobia.</p><p><strong>Conclusion: </strong>This study highlights the significant impact of nomophobia among healthcare professionals in Africa, indicating a need for interventions to mitigate its effects and promote healthy smartphone habits in this critical sector.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711287","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}

{"title":"Glucocorticoids treatment and adverse infectious events in rheumatic diseases.","authors":"Valeria Rella, Cinzia Rotondo, Raffaele Barile, Francesca Erroi, Francesco Paolo Cantatore, Addolorata Corrado","doi":"10.1080/21548331.2024.2423598","DOIUrl":"10.1080/21548331.2024.2423598","url":null,"abstract":"<p><p>It is well known that rheumatic diseases are characterized by an increased infection risk, due to several factors, such as an intrinsically dysfunctional immune system, disease activity, and the use of immunosuppressive drugs. Glucocorticoids are widely used therapeutic agents for treating several chronic inflammatory and immune diseases, due to their anti-inflammatory and immunosuppressive effects. Their use is burdened by well-known side effects in dose- and duration of use-dependent manner. Physicians need to be aware of the mechanism of action of glucocorticoids, their side effects, particularly infectious side effects, and the significance of cumulative dose and duration of glucocorticoid treatment. Additionally, physicians shoultdleveld have knowledge of each patient and their comorbidities. They could use appropriate tools for assessing glucocorticoid-related toxicity and morbidity, particularly in the context of chronic glucocorticoid administration. This comprehensive understanding is crucial for ensuring the proper and safe use of these drugs, particularly in terms of minimizing infectious risks. The aim of this review is to focus on available data concerning the infectious risk associated to glucocorticoid treatment in rheumatic diseases, highlighting the role of the correct drug management in clinical practice and the role of the disease itself in the occurrence of this worthy side effect. We conducted a review of randomized controlled trials and observational studies about glucocorticoid use in autoimmune/rheumatic diseases, analyzing the infectious risk during glucocorticoid therapy, and its relationship with the used dose and duration of treatment.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"1-13"},"PeriodicalIF":0.0,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547997","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}

{"title":"Characterizing hospitalists' comfort and familiarity with LGBTQ clinical topics.","authors":"Keshav Khanijow, Nicole Rosendale, Scott Wright, Rita S Lee, Scott Nass, Angela Keniston, Monika Dalal, Leah R Jager, Tyler Anstett","doi":"10.1080/21548331.2024.2414734","DOIUrl":"10.1080/21548331.2024.2414734","url":null,"abstract":"<p><strong>Objectives: </strong>Evidence has shown that lesbian, gay, bisexual, queer (LGBQ) and transgender patients (LGBTQ) experience disparities in health care delivery and clinical outcomes. As the predominant U.S. inpatient provider workforce, this paper's objective was to understand hospitalists' comfort with LGBTQ health.</p><p><strong>Methods: </strong>A 58-question anonymous online survey was distributed in 2019 to practicing hospitalists through the Society of Hospital Medicine regarding their experiences in caring for hospitalized LGBTQ patients.</p><p><strong>Results: </strong>Two hundred and eighteen hospitalist providers completed the entire survey. While hospitalists reported high levels of comfort in caring for these populations (LGBQ: 90.6%, Transgender: 77.8%), they acknowledged feeling less confident in their clinical competence (LGBQ: 71.6%, Transgender: 51.2%). Hospitalist providers who were themselves LGBQ reported more comfort with most aspects of LGBQ patient clinical care than heterosexual respondents (<i>p</i> < 0.05 for 4 of 6 comfort variables). Seventy-four percent of hospitalists wanted training to advance their knowledge and skills in working with LGBTQ patients.</p><p><strong>Conclusions: </strong>Hospitalist clinicians are regularly exposed to LGBTQ patients yet their comfort and expertise in caring for this vulnerable population is highly variable. Educational interventions that include reflective practice may serve to optimize hospitalists' ability to more confidently and competently serve LGBTQ patients.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476526","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}

{"title":"An insight into the updated pharmacotherapy of metabolic-associated fatty liver disease (MAFLD) or metabolic dysfunction-associated steatohepatitis (MASH) in lean individuals: a review.","authors":"Sanjay Bandyopadhyay, Shambo Samrat Samajdar, Sirshendu Chaudhuri, Saibal Das","doi":"10.1080/21548331.2024.2412513","DOIUrl":"10.1080/21548331.2024.2412513","url":null,"abstract":"<p><p>Metabolic-associated fatty liver disease (MAFLD) or metabolic dysfunction-associated steatohepatitis (MASH) in lean individuals represents a distinctive subset of MASH. Current pharmacotherapies, for MASH as demonstrated in clinical trials, predominantly target obese patients with limited consideration for lean MASH. We aimed to systematically review the literature on the pharmacotherapy of lean MASH. We searched standard medical databases, such as PubMed, Embase, Scopus, Cochrane CENTRAL, and ClinicalTrials.gov to identify eligible studies published in English up to 31 December 2023 regarding the effect of pharmacological interventions in individuals with lean MASH. We have summarized the role of various drug classes including peroxisome proliferator-activated receptor agonists, glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter 2 inhibitors, vitamin E, farnesoid X receptor agonists, selective thyroid hormone receptor-β agonists, and selective cholesterol absorption inhibitors. Consequently, lifestyle interventions, encompassing dietary modifications, exercise, and weight loss particularly directed at visceral obesity or achieving a reduction in body weight are recommended for all non-obese individuals with MASH. A highlight on the only available treatment recommendation for lean MASH is also presented. The available evidence regarding the efficacy of various drugs for the treatment of lean MASH is limited. Conclusive evidence is warranted from clinical trials exclusively involving lean individuals with MASH.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142362214","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}

{"title":"Chest tube size selection for pleural effusion: from the perspective of thoracic surgeons and pulmonologists.","authors":"Rayyan M Almusally, Hatem Elbawab, Hasan Alswiket, Ryad Alamry, Hawra Aldar, Maram Alismail, Zahra Albahrani, Zeead Alghamdi, Farouk AlReshaid, Mohammed Sabri","doi":"10.1080/21548331.2024.2401315","DOIUrl":"https://doi.org/10.1080/21548331.2024.2401315","url":null,"abstract":"<p><strong>Background: </strong>The current discourse within the thoracic surgical and pulmonological communities pertains to a contentious debate over the optimal selection criteria for thoracostomy tube diameters utilized in the management of pleural effusions. A comprehensive examination of the variables that inform the clinical decision-making paradigm for the determination of appropriate chest tube calibers is imperative to enhance patient management and elevate the prognostic results.</p><p><strong>Objectives: </strong>The objective of this inquiry is to elucidate the determinants that influence thoracic surgeons and pulmonologists in their selection of chest tube size for the management of pleural effusions.</p><p><strong>Methods: </strong>This cross-sectional study was based on an electronic questionnaire that was sent to the targeted populations through e-mail or a professional WhatsApp. The survey assessed the considerations of chest tube size selection as well as the respective advantages, disadvantages, and potential complications related to each size.</p><p><strong>Results: </strong>The conducted study encompassed participants, with a nearly even distribution between thoracic surgeons (49.1%) and pulmonologists (50.9%). Most of these practitioners are within tertiary-level medical institutions (82.1%). A preference for small-bore chest tubes (SBCT), defined as < 14 French (Fr), was indicated by 54.8% of participants. The drawbacks associated with SBCT, such as kinking (60%) and blockage (70%), influenced the decision-making process negatively, while pain was a significant factor in the selection against LBCT (64%). Ultrasound guidance was a positive influence for the selection of SBCT (55%). Complications associated with LBCT included visceral and vascular injuries (55.7%), wound infection (45.3%), re-expansion pulmonary edema (43.3%), and subcutaneous emphysema (57.5%). In contrast, malposition was a complication more commonly associated with SBCT (49.1%).</p><p><strong>Conclusion: </strong>The decision regarding chest tube size was influenced by several critical factors which included the nature of pleural effusion, the volume of pleural fluid, and potential complications specific to the size of the chest tube used.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297159","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}

{"title":"Prescription for crisis: the compounding effect of community drug shortages on Lebanon's healthcare system.","authors":"Elie Bou Sanayeh, Carolla El Chamieh, Georges Khattar","doi":"10.1080/21548331.2024.2401316","DOIUrl":"https://doi.org/10.1080/21548331.2024.2401316","url":null,"abstract":"<p><p>The multifaceted crises that Lebanon is facing have led to a shortage of medications in the country's community pharmacies. This shortage has triggered a cascade of adverse effects, rippling throughout the nation's healthcare system. In this report, we examine the causes, which range from economic turmoil to inadequate resource distribution, along with the profound impacts on public health, such as increased length of hospital stays and compromised patient care. The paper also proposes a suite of solutions aimed at mitigating the immediate challenges and paving the way for a more resilient healthcare framework.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297160","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}

{"title":"Assessing outcomes of intravenous insulin therapy in non-intensive care patients.","authors":"Mercedes Martinez Gil, Rodrigo Fonseca, Leila K Tehrani, Janna C Castro, Shon E Meek, Bithika M Thompson, Curtiss B Cook","doi":"10.1080/21548331.2024.2383556","DOIUrl":"10.1080/21548331.2024.2383556","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to compare outcomes of using intravenous insulin infusion (IVII) therapy for managing hyperglycemia in a non-intensive care unit (ICU) versus an ICU setting.</p><p><strong>Methods: </strong>We conducted a retrospective analysis on patients who received IVII for hyperglycemia. The analysis compared variables associated with hypoglycemic events while on IVII, and point-of-care blood glucose control and insulin regimens at discharge. Insulin administration errors occurring on IVII were determined.</p><p><strong>Results: </strong>Between November 2020 and August 2022, 881 patients received 1,106 IVIIs (780 in ICU and 326 non-ICU). A cumulative 468 days were spent on IVII in the non-ICU setting and 1564 in the ICU (total 2,032 days). The frequency of hypoglycemia on IVII was higher when provided in the non-ICU vs ICU (1.4% vs 0.7%), <i>p</i> < 0.01). Non-ICU patients had significantly higher average blood glucose during the last 24 h of the hospital stay (185 mg/dL vs 160 mg/dL, non-ICU vs. ICU, Pp < 0.01) and were more likely discharged with basal-bolus insulin therapy (<i>p</i> < 0.01). After adjusting for other variables, the probability of having hypoglycemia (OR 2.35; 95% CI 1.62-3.42; <i>p</i> < 0.001) was higher for the non-ICU cohort. In addition, patients who received IVII in the non-ICU settings had mean glucose levels nearly 26 mg/dL higher (95% CI 19.40-32.9, <i>p</i> < 0.001) at discharge vs. ICU. Seven cases of insulin errors were reported while on IVII in the non-ICU settings, compared to one in the ICU.</p><p><strong>Conclusions: </strong>A large number (468) of ICU days were avoided by providing IVII in the non-ICU setting. Of the more than 400 days of IVII therapy provided in the non-ICU, only 7 medication errors occurred. Further studies are needed to optimize IVII strategy for non-ICU patients.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"98-104"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141761418","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}

{"title":"Outcomes and complications of heart failure with iron deficiency anemia: a nationwide analysis.","authors":"Abdulmajeed Alharbi, Momin Shah, Nahush Bansal, Allison Franz, Eun Seo Kwak, Anas Alsughayer, Mohammed Mhanna, Ayman Salih, Abdelrhman Mohamed, Qutaiba Qafisheh, Ragheb Assaly","doi":"10.1080/21548331.2024.2337615","DOIUrl":"10.1080/21548331.2024.2337615","url":null,"abstract":"<p><strong>Introduction: </strong>Heart failure is a pressing public health concern, affecting millions in the United States and projected to rise significantly by 2030. Iron deficiency, prevalent in nearly half of ambulatory heart failure patients, contributes to anemia and diminishes patient outcomes. In this study, we aim to evaluate the impact of iron deficiency anemia on acute heart failure hospitalizations outcomes.</p><p><strong>Methods: </strong>Utilizing the 2019 National Inpatient Sample (NIS) database, a retrospective observational study assessed 112,864 adult patients hospitalized with heart failure and 7,865 cases also had a concomitant diagnosis of iron deficiency anemia (IDA).</p><p><strong>Results: </strong>Among 112,864 heart failure hospitalizations in 2019, approximately 7% had concomitant iron deficiency anemia (IDA). Heart failure patients with IDA exhibited distinct demographic characteristics, with females comprising 51.1% (<i>p</i> < 0.01) and higher rates of complicated hypertension (<i>p</i> < 0.01), complicated diabetes (<i>p</i> < 0.01), and peripheral vascular disease (<i>p</i> < 0.01). Adjusted mean LOS for patients with IDA was significantly longer at 1.31 days (95% CI 0.71-1.47; <i>p</i> < 0.01), persisting in both HFpEF and HFrEF subgroups. While total hospital charges were comparable in HFpEF, HFrEF patients with IDA incurred significantly higher charges ($13427.32, 95% CI: 1463.35-$25391.29, <i>p</i> = 0.03) than those without IDA. Complications such as atrial fibrillation and acute kidney injury were notably more prevalent in HFpEF and HFrEF patients with IDA.</p><p><strong>Conclusion: </strong>The study highlighted that iron deficiency in heart failure patients leads to extended hospital stays, increased costs, and heightened risks of specific complications, particularly in HFrEF. Our study emphasized the implications of IDA in patients with heart failure ranging from prolonged hospitalizations and increased costs. Addressing iron deficiency is crucial, given its substantial impact on heart failure hospitalizations and outcomes, emphasizing the need for proactive diagnosis and management.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"84-90"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337074","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}

{"title":"Benign acute myositis in an adult: case-based review.","authors":"N Kazi, M Mehmed, X Chen, O Asya, D Sarma, P Hnynn Si, A H Abdelhafiz","doi":"10.1080/21548331.2024.2357508","DOIUrl":"10.1080/21548331.2024.2357508","url":null,"abstract":"<p><p>Myositis is a clinical condition with a wide spectrum of clinical presentation. We present the case of 33 years old woman with acute history of pain and swelling of both legs. Investigations confirmed acute bilateral myositis of both calf muscles. She responded well to conservative management with full recovery. Benign acute myositis is more common in children and usually follows viral infection. Although our case may represent an adult form of benign acute childhood myositis, she had no history of preceding infections. Benign acute myositis is increasingly reported in adults. It appears to be self-limited with spontaneous full recovery. The diagnosis is largely based on clinical features. Therefore, clinicians should be aware of this type of myositis to avoid unnecessary invasive investigations.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"113-118"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140959307","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}