Journal of Patient Safety最新文献

{"title":"Experiences of Activities Perceived as Delegable Among Nurses in Medical and Surgical Settings Can Help to Guide Health Care Policies: A Qualitative Phenomenological Study.","authors":"Silvia Gonella, Alessio Conti, Martina Arlorio, Paola Cuoghi, Valerio Dimonte, Sara Campagna","doi":"10.1097/PTS.0000000000001389","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001389","url":null,"abstract":"<p><strong>Objectives: </strong>Nurses may invest up to 70% of their working time in activities outside the nursing scope of practice. Gaining insight into their experiences may inform policy decisions. This paper explores nurses' experiences of activities they perceived as delegable.</p><p><strong>Methods: </strong>This is a secondary analysis of qualitative data that contributed to a mixed-methods explanatory sequential study. Twenty nurses who work in the medical and surgical wards of four Italian public hospitals were purposively identified and interviewed. Inductive thematic analysis was performed.</p><p><strong>Results: </strong>Three main themes: (1) missing delegation, (2) losing role identity, and (3) being at the breaking point. The moral obligation to compensate for organizational deficiencies and poor relational dynamics was the main reason for missing delegation. Nurses felt in an assembly line with increased risk of errors and threats to patients' safety, overwhelmed by the workload, dissatisfied with the quality of care provided, and experienced several negative feelings, including anger, annoyance, demoralization, and frustration.</p><p><strong>Conclusions: </strong>Organizational and educational support is essential to develop effective delegation abilities.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Care Paramedic-administered Ketamine in British Columbia, Canada: A Patient Safety-focused Observational Study.","authors":"Tania Johnston, Christopher Mistiades, Roxane Beaumont-Boileau, Joseph Acker, Alan M Batt","doi":"10.1097/PTS.0000000000001390","DOIUrl":"10.1097/PTS.0000000000001390","url":null,"abstract":"<p><strong>Objectives: </strong>In Western Canada, British Columbia Emergency Health Services (BCEHS) aimed to enhance prehospital pain management by authorizing Primary Care Paramedics (PCP) to administer intranasal (IN) ketamine. The objective of this study is to describe patient safety implications of expanding PCP scope to include IN ketamine.</p><p><strong>Methods: </strong>This retrospective, observational study reviewed patient care records of the first 100 consecutive patient encounters where PCPs administered IN ketamine for pain between December 2020 and September 2021. Data analysis used the Canadian Quality and Patient Safety Institute and Rights of Medication Administration frameworks.</p><p><strong>Results: </strong>Of the 100 patients, 74% met the analgesia clinical practice guideline (CPG) criteria: adult, trauma, and moderate to severe pain. Most injuries (31%) involved extremities or hips/pelvis (18%). With 6 cases missing data, an 11.2% dosage error rate (>5 mg deviation) was identified. In 14 cases, PCPs did not contact mandatory clinical support and administered ketamine outside of the CPG. Documentation errors occurred in 25% of patient encounters, particularly with pain scores (20), patient weight (15), and vital signs (8), possibly indicating incomplete patient assessments. No instances of adverse patient outcomes resulting from dosing errors or missed consultations were observed throughout the study.</p><p><strong>Conclusions: </strong>This study highlights the safety implications of PCP-administered ketamine, including concerns about weight-based dosing, CPG compliance, and documentation standards. The key competencies of the Canadian Patient Safety Institute framework offer a foundation for addressing these safety concerns before expanding ketamine administration for broader PCP practice.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facilitators and Barriers Associated With the Use of Barcode Technologies in Drug Preparation and Administration in Hospital Settings-A Narrative Review of Qualitative Studies.","authors":"Sini Kuitunen, Laura Laakkonen, Katja Janhunen, Kirsi Kvarnström, Carita Linden-Lahti","doi":"10.1097/PTS.0000000000001381","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001381","url":null,"abstract":"<p><strong>Objectives: </strong>Barcode technologies are commonly used in hospital settings to improve medication safety. However, the implementation of these systems poses several challenges. This narrative review aims to synthesize qualitative studies exploring the facilitators and barriers associated with using barcode technologies in clinical environments.</p><p><strong>Methods: </strong>This review is grounded in the theory of systems-based risk management. A comprehensive literature search was conducted in November 2022 across 3 databases: CINAHL; MEDLINE (Ovid); and Scopus. Two independent reviewers utilized a predetermined SPIDER (Sample; Phenomenon of Interest; Design; Evaluation; Research type) tool for article selection by using Covidence software. The qualitative data from the selected studies were systematically summarized.</p><p><strong>Results: </strong>The search found 197 articles, of which 11 studies from 6 countries met the inclusion criteria. All included studies identified barriers, while 7 studies also highlighted facilitators. Seven common themes emerged as facilitators and barriers: efficacy; implementation; leadership; medication safety; process; technology; and user experience. Three themes-materials; system design; and work environment-were exclusively associated with barriers. Workarounds, such as bypassing barcoding, omitting process steps, and unauthorized process steps, were reported in 8 studies as responses to the barriers.</p><p><strong>Conclusions: </strong>This review underscores the complexity of implementing and maintaining high-leverage, technology-based systemic defenses in clinical practice. The findings provide a foundation for the improvement of the safety and usability of barcode technologies in hospital settings. Future research should focus on developing and testing interventions that address the identified barriers and enhance the facilitators to optimize the use of barcode systems.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nursing Recommendations to Improve Discharge and Care Transitions From the Bedside.","authors":"Eve Emmanouilidou, Dhwani Krishnan, Elizabeth Kaplan, Vivien Moritz, Ishita Kaloti, Sachi Sengupta, Linda Czypinski, Erin Dowling, Wendy Simon, Anna Dermenchyan","doi":"10.1097/PTS.0000000000001382","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001382","url":null,"abstract":"<p><strong>Background: </strong>Discharge planning is a complex and critical process that ensures continuity of care, reduces postdischarge complications, and prevents hospital readmissions. Bedside nurses, central to this process, offer valuable perspectives on barriers to safe discharge and care transitions. This study aimed to identify common challenges in discharge planning and highlight nurse-driven solutions to improve patient safety.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted with nurses from medical telemetry, cardiac observation, and short-stay observation units at a 520-bed tertiary academic teaching hospital from March 21 to April 30, 2022. Using the Agency for Healthcare Research and Quality's IDEAL Discharge Planning and Implementation Handbook as a framework, the survey assessed key challenges related to discharge and transitions of care. Participants rated their agreement with identified challenges, proposed solutions, and provided additional insights through an anonymous, 1-time survey.</p><p><strong>Results: </strong>Of 217 nurses contacted, 108 completed the survey (50% response rate). The majority identified significant barriers, including communication failures among care teams, care coordination gaps, medication reconciliation issues, and inadequate patient preparedness for discharge. Proposed solutions included implementing structured interprofessional communication protocols, enhancing discharge education strategies, and optimizing medication reconciliation processes.</p><p><strong>Conclusions: </strong>This study underscores the systemic and operational barriers to safe discharge from the perspective of bedside nurses. Implementing targeted, evidence-based interventions informed by frontline staff insights can improve patient outcomes, reduce preventable harm, and enhance the discharge experience for patients and families.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Surgeon Age and Patient Hemodynamic Instability in Pheochromocytoma Surgery: A Multicenter Cohort Study.","authors":"Sarah Chambers Skinner, Léa Pascal, Stéphanie Polazzi, Florian Fanget, Laurent Brunaud, Denis Collet, Bertrand Dousset, Fabrice Ménégaux, Eric Mirallié, Frédéric Sebag, Franck Zinzindohoue, Jean-Christophe Lifante, Antoine Duclos","doi":"10.1097/PTS.0000000000001387","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001387","url":null,"abstract":"<p><strong>Objective: </strong>To quantify the association between surgeon age and intraoperative hemodynamic instability (IHI) occurrence during pheochromocytoma surgery.</p><p><strong>Background: </strong>Surgeons must master technical and nontechnical skills to limit IHI occurrence during pheochromocytoma resection, a rare, complex surgery.</p><p><strong>Methods: </strong>This retrospective cohort study included data from adult patients who underwent pheochromocytoma surgery undertaken by surgeons aged 30 to 65 in 8 high-referral university hospitals in France from 01/01/2000 to 12/31/2016. Surgeon experience was quantified using surgeon's age at the time of surgery, and performance was evaluated using IHI occurrence. GEE logistic regression models, adjusted for potential confounders related to the patient and surgical procedure, were used to determine the probability of IHI according to surgeon age, independently of the surgeon-anesthesiologist duo and each surgeon's annual surgical volume.</p><p><strong>Results: </strong>Nine hundred ninety pheochromocytoma surgeries performed by 44 surgeons were analyzed. There was a concave relationship between surgeon age and IHI (P=0.012). Standardized rates of IHI were 71.7% (95% CI: 60.9%-82.6%) at 30 years, reached a minimum of 50.4% (45.9%-54.7%) at 48 years, and were 70.2% (55.7%-80.2%) at 65 years. Among low-volume surgeons, IHI occurrence was more likely in those aged 55 to 65 compared with those aged 45 to 55 [adjusted odds ratios=1.71 (1.04 to 2.80)]. Among high-volume surgeons, IHI was more likely to occur in surgeons aged 30 to 44 compared with those aged 45-55 [2.05 (1.10 to 3.83)].</p><p><strong>Conclusions: </strong>Our results suggest that in pheochromocytoma surgery surgeon performance could peak at mid-career, and then plateau and decline. Solutions that help surgeons maintain performance throughout their careers might be beneficial.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Evaluation of a Multifaceted Intervention Program for Preventing Medication Administration Errors by Nurses.","authors":"Won Hee Sim","doi":"10.1097/PTS.0000000000001345","DOIUrl":"10.1097/PTS.0000000000001345","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to develop and evaluate a multifaceted intervention program based on the Systems Engineering Initiatives for Patient Safety (SEIPS) model to prevent medication administration errors (MAEs) by nurses in an adult general ward of a comprehensive hospital in Seoul, South Korea.</p><p><strong>Methods: </strong>The program was developed using the Analysis, Design, Development, Implementation, Evaluation (ADDIE) model with a 3-round Delphi survey conducted with 16 experts. Strategies were categorized under the SEIPS model and finalized into a program with 9 domains and 21 interventions. A pretest-posttest design with 73 nurses (36 experimental, 37 control) evaluated the program's effectiveness in a tertiary care hospital in Seoul, South Korea. Surveys on patient safety culture, medication safety practices, and error rates were analyzed before and after a 3-month intervention using double-difference and time-series methods.</p><p><strong>Results: </strong>The DID analysis demonstrated significant improvements in patient safety culture perception (0.42, P <0.001) and medication safety compliance (0.53, P <0.001), with large effect sizes ( d =1.07 and d =1.41, respectively). However, changes in self-reported medication error rates between groups were not statistically significant ( P =0.555), likely due to the short intervention period.</p><p><strong>Conclusion: </strong>The program improved patient safety awareness and medication safety compliance, validating its approach. This study highlights the importance of theoretically based interventions and suggests shifting from solely nurse education to addressing systemic issues for medication safety.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":"226-239"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comprehensive Analysis of Patient Safety Research in Nursing: Trends, Topics, and Future Directions.","authors":"Nam-Ju Lee, Nari Kim","doi":"10.1097/PTS.0000000000001347","DOIUrl":"10.1097/PTS.0000000000001347","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to comprehensively analyze patient safety research in the field of nursing over the past 20 years to identify key research topics and emerging trends.</p><p><strong>Methods: </strong>Structural topic modeling, a text mining methodology to identify latent topics from large volumes of unstructured textual data, was conducted on 6072 articles published in the Ovid Medline, Ovid Embase, Cumulative Index to Nursing and Allied Health Literature, and PubMed databases from January 2000 to April 2023. Based on the structural topic modeling results, we performed the Mann-Kendall trend test and conducted community detection.</p><p><strong>Results: </strong>The analysis identified 39 unique topics, which were categorized into 4 communities: medication safety, structure, processes, and outcomes. Interest in patient safety culture, patient safety education, and qualitative research methodologies has been increasing, while traditional topics such as medical error analysis and nurse staffing have shown a decreasing trend.</p><p><strong>Conclusions: </strong>The scope of patient safety research in the field of nursing is gradually expanding, with an evident shift in research focus. Our findings provide crucial information for setting future research directions and advancing nursing practice and policy, ultimately contributing to improvements in patient safety.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":"e29-e39"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dental Anesthesia Guidelines and Regulations of US States and Major Professional Organizations: A Review.","authors":"Natalie B Simon, Kara M Barnett, BobbieJean Sweitzer, Nicole Gates, Steve Yun, Kristie Kim, Bridget Marcinkowski, Joseph M Hendrix","doi":"10.1097/PTS.0000000000001320","DOIUrl":"10.1097/PTS.0000000000001320","url":null,"abstract":"<p><p>This summary reviews guidelines and regulations pertaining to dental anesthesia across the United States, including guidelines of the American Dental Association (ADA), American Association of Oral and Maxillofacial Surgeons (AAOMS), and American Society of Anesthesiologists (ASA). The analysis addresses a range of requirements, including definitions of anesthesia and requirements for training and certification across professional societies and the 50 US states, with a focus on office-based settings. Strikingly, substantial variation exists among state rules and regulations and the ADA, AAOMS, and ASA guidelines with implications for variations of care, outcomes, and patient safety. We examined definitions of sedation and general anesthesia, patient selection and evaluation, fasting requirements, emergency preparedness, drug administration, monitoring, equipment, procedure selection, education and training requirements, permit requirements, life support certifications, reporting of adverse events, and inspection requirements. This comprehensive analysis serves to educate dental practitioners and office staff, patients, primary care providers, and state dental boards about the regulatory landscape of dental anesthesia. Our findings establish a foundation for future research and policy development aimed at improving consistency, best practices, and safety in dental anesthesia practices.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":"258-281"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comprehensive Approach to Reducing Patient Safety Indicators (PSI-90).","authors":"Anthony Duncan, Rachel Leyk, Devendranath Mannuru, Steven Briggs, Khaled Zreik","doi":"10.1097/PTS.0000000000001312","DOIUrl":"10.1097/PTS.0000000000001312","url":null,"abstract":"<p><strong>Background: </strong>PSI-90, a composite measure comprising ten indicators, reflects the quality of care during hospital stays. The Hospital-Acquired Condition Reduction Program (HACRP), a Centers for Medicare and Medical Services (CMS) program, assesses hospital performance based on quality measures, including PSI-90, with financial implications for poor performers.</p><p><strong>Objectives: </strong>To evaluate PSI events, establish workflows for accurate documentation, and foster collaboration across clinical and administrative teams, with the ultimate objective of reducing PSI events.</p><p><strong>Methods: </strong>Essential actions involved designating a PSI nurse reviewer and a quality physician advisor, securing the involvement of executive leadership, adopting computer-assisted coding technology, and promoting teamwork among Clinical Documentation Improvement (CDI), coding, and Health Information Management (HIM) teams.</p><p><strong>Results: </strong>The collaborative efforts yielded a 45% reduction in PSI events, leading to estimated cost avoidance of $1.4 million, and exemption from HACRP penalties. Lessons learned encompassed the importance of executive leadership support, data-driven decision-making, and ongoing education.</p><p><strong>Conclusion: </strong>This study shows the significance of collaboration, leadership support, and data utilization in PSI reduction efforts. Furthermore, it shows benefit of a surgical quality officer in advancing patient safety, aligning with ACS recommendations.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":"e24-e28"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of Fall Occurrence in Hospitals and the Factors Influencing Falls That Require Additional Medical Care: Based on an Accident Database.","authors":"A Hiyama","doi":"10.1097/PTS.0000000000001333","DOIUrl":"10.1097/PTS.0000000000001333","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to analyze accident reports of hospitals across Japan, and identify the characteristics of fall occurrence in hospitals and the factors influencing falls that require additional medical care.</p><p><strong>Methods: </strong>Data on falls that occurred inside hospitals between 2012 and 2021 were collected from the Project to Collect Medical Near-Miss/Adverse Event Information database of the Japan Council for Quality Health Care. The data were analyzed using binomial logistic regression analysis (the reduced variable method, likelihood ratio) with the requirement/nonrequirement of additional medical care as the dependent variable.</p><p><strong>Results: </strong>Out of all falls that occurred between 2012 and 2021, 78.9% required additional medical care. Of these, 758 reported irreversible disability, and 57 reported deaths. Most falls occur in the hospital room or corridor. The orthopedic surgery and psychiatry departments were the most common departments associated with fall occurrence. Gait disturbance and dementia/amnesia were the most common conditions prevailing before the fall. Weekdays (odds ratio=1.151), mornings (odds ratio=1.117), and two-shift work schedules (odds ratio=1.261) were the determinants of falls requiring additional medical care.</p><p><strong>Conclusions: </strong>Falls requiring additional care in Japanese hospitals were more likely to occur on weekdays and mornings. Staffing conditions, rather than months of experience and hours worked the week before, determined falls requiring additional medical care.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":"290-296"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}