Journal of Patient Safety最新文献

{"title":"A Simulation-Based Clinical Systems Testing at the Newly Built LMU University Hospital: Comparison Between In Situ Full-Scale Simulation and Process Simulation.","authors":"Selina Kim, Julia Schrader-Reichling, Marc Lazarovici, Benedikt Sandmeyer, Heiko Trentzsch","doi":"10.1097/PTS.0000000000001471","DOIUrl":"10.1097/PTS.0000000000001471","url":null,"abstract":"<p><strong>Background: </strong>Before opening new clinical facilities, the optimal preparation of health care personnel is essential. A simulation-based clinical systems testing (SbCST) using simulation is a valid instrument for reaching this goal. During SbCST, so-called latent safety threats (LSTs) can be identified that endanger patient safety. LSTs should be addressed before actual patient harm occurs. The aim of this study was to compare the outcomes and the categories of identified LSTs in 2 simulation types of SbCST, in situ full-scale simulation and process simulation.</p><p><strong>Methods: </strong>We conducted SbCST at the newly built LMU University Hospital using in situ full-scale simulation and process simulation. To evaluate SbCST, we used a pre-session and post-session survey. The participants also mapped the identified LSTs into risk matrices according to their probability of occurrence and their impact on patient safety and staff strain.</p><p><strong>Results: </strong>In total, 120 participants were included in the analysis. Regardless of the simulation type, most participants rated the simulation as (very) good and highlighted the usefulness of SbCST before the opening of new clinical facilities. In both simulation types, the majority of the identified LSTs included equipment, followed by team aspects, room layout, and accessibility. Regarding patient safety and staff strain, fewer LSTs were rated as highly severe in full-scale simulation than in process simulation.</p><p><strong>Conclusion: </strong>Our study showed that, depending on the construction progress, in situ full-scale and process simulation are both appropriate tools for identifying LSTs and preparing health care professionals to work in new clinical facilities. To support hospital administrators in prioritizing these items, the use of an existing risk management tool is valuable.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":"283-289"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13277720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146119795","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":"Safety of ABO-Incompatible Platelet Transfusions: A Multicenter Retrospective Cohort Study.","authors":"Abdulkerim Yildiz, Samet Yaman, Rafiye Çiftçiler, Serhat Çelik, Sedat Acar, Büşra Kasim Yaman, Bilge Zihar","doi":"10.1097/PTS.0000000000001470","DOIUrl":"10.1097/PTS.0000000000001470","url":null,"abstract":"<p><strong>Objectives: </strong>It is not always possible to access ABO-compatible platelet concentrates (PCs) for reasons such as short shelf life and not always being readily available. Therefore, blood centers have to develop strategies for the use of ABO-incompatible PCs. However, there are conflicting data regarding the safety of using ABO-incompatible platelet transfusions, especially concerning transfusion reactions.</p><p><strong>Methods: </strong>This multicenter, retrospective cohort study analyzed platelet transfusion records from 3 tertiary-level hospitals over a 9-year period (2016-2024). Data were extracted from institutional hemovigilance systems and electronic transfusion records. The transfusion outcomes were compared between ABO-compatible and ABO-incompatible PCs, focusing on the incidence of transfusion reactions (TRs).</p><p><strong>Results: </strong>A total of 21,470 PCs were transfused to 12,305 patients. TRs occurred in 17 cases, with an incidence of 0.79 per 1000 PCs. Of these reactions, 7 were febrile nonhemolytic transfusion reactions and 10 were allergic reactions. During the study period, 2791 ABO-incompatible PCs (12.9%) were transfused to 1248 patients. No significant difference was determined in the transfusion reaction rate between the ABO-compatible and incompatible groups (0.80 per 1000 vs. 0.71 per 1000, P =0.88). The distribution of TR types was similar in both groups ( P =0.787). No hemolytic reaction was observed.</p><p><strong>Conclusion: </strong>Although no significant difference in TR incidence was detected between ABO-compatible and incompatible PCs, this retrospective study-limited by low event frequency, and potential under-reporting-was not able to establish the safety of ABO‑incompatible transfusions. However, ABO-incompatible PCs may still be an option in resource-limited settings. Larger-scale prospective studies are necessary to further evaluate safety with standardized hemovigilance reporting.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":"296-299"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146197914","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":"\"The Process Is Built for Psychological Safety\": Behavioral Health Providers' Experiences Using a Systems-Based Information Integration Tool for Critical Incident Review.","authors":"Margaret L McGladrey, Tiffany Lindsey, Scott Fairhurst, Corinne Andriola, Elizabeth Riley, Carly Meyers, Michael Cull","doi":"10.1097/PTS.0000000000001452","DOIUrl":"10.1097/PTS.0000000000001452","url":null,"abstract":"<p><strong>Objectives: </strong>Learning from critical incidents is a major component of efforts to improve patient safety that increasingly center on system-level factors rather than individual errors to both address root causes of critical incidents and promote psychological safety in health care and social service agency cultures. However, there are limited studies of professionals' experiences with system-level critical incident review processes and how these experiences influence practice in behavioral health settings.</p><p><strong>Methods: </strong>This mixed-methods study explores how practitioners at the largest behavioral health agency in California perceived the use of the Safe Systems Improvement Tool to learn from critical incidents, including deaths by suicide, overdoses, and near misses.</p><p><strong>Results: </strong>Survey and interview data from behavioral health practitioners indicated that for critical incident reviews, empathetic facilitation, deliberate preparation, and expectation-setting before meetings support psychological safety and systems change. Participants recommended including front-line as well as clinical and supervisory staff in critical incident reviews and developing clear timelines for implementing follow-up recommendations.</p><p><strong>Conclusions: </strong>The application of critical incident reviews in behavior health agencies can be effective not only in identifying root causes and quality improvement opportunities through the aggregation of data across events, but also in fostering cultures of psychological safety to reduce individual blame and defensiveness while promoting transparent system-wide assessment and transformation.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":"245-250"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145821738","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":"Concordance Between Pediatric Safety Indicator Measure Sets Across a Sample of Pediatric Hospitals.","authors":"Phillip D Hahn, Al Ozonoff, Carly E Milliren","doi":"10.1097/PTS.0000000000001456","DOIUrl":"10.1097/PTS.0000000000001456","url":null,"abstract":"<p><strong>Background: </strong>The Centers for Medicare and Medicaid Services Hospital-Acquired Conditions (HAC) Reduction Program and the Agency for Healthcare Research and Quality Pediatric Quality Indicators (PDI) measure sets are commonly used in pediatric hospitals to assess patient safety and quality and rank performance. This study examined whether choice of HAC or PDI measure set matters when evaluating hospital performance ranking.</p><p><strong>Methods: </strong>This retrospective cohort study used inpatient data from 42 hospitals in the Pediatric Health Information System (PHIS) for pediatric patients (0-17 y) discharged from 2021 to 2022. We extracted 8 HAC and 7 PDI measures, ranking hospital performance on each measure. We calculated a summary measure reflecting average performance using the geometric mean of ranks across each measure set and examined concordance in rankings.</p><p><strong>Results: </strong>There was a moderate-to-strong linear association between hospital rankings using the HAC versus PDI measure sets ( r =0.63; P <0.001), with no significant difference in overall ranking between measure sets (median difference=-0.5; P =0.84) and moderate agreement in ranking quartile (K lw =0.46). Absolute differences in ranking were ≥10 for 14 (33%) hospitals, 5 to 9 for 12 (30%), and 1 to 4 for 14 (33%), whereas only 2 (5%) hospitals were ranked identically on both measure sets.</p><p><strong>Conclusions: </strong>Summary rankings were broadly similar between HAC and PDI measure sets. However, some hospitals exhibited large discrepancies, ranking among the top performers on one measure set but near the bottom on the other. Pediatric hospitals should consider measure definitions and applicability to hospital-specific patient populations when selecting safety and quality measure sets for performance evaluation and ranking.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":"251-255"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769576","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":"Operating Room Traffic, Door Opening and Closing: A Clinical Observational Study.","authors":"Arzu Aslan Basli, Ayşe Gökce Işıklı, Serhat Hüseyin, Sevim Akbal","doi":"10.1097/PTS.0000000000001459","DOIUrl":"10.1097/PTS.0000000000001459","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study is to determine the frequency of opening of operating room doors during cardiovascular surgery operations, the number of personnel entering and exiting, and the reasons for these entries.</p><p><strong>Materials and methods: </strong>This descriptive observational study was carried out in the cardiovascular surgery operating rooms of a university hospital. Using purposive sampling, 22 consecutive surgeries were observed, and data were collected with an \"Intraoperative Observation Form.\" Descriptive statistics were used for analysis.</p><p><strong>Results: </strong>The mean number of door openings per procedure was 74.18±41.54, corresponding to 16.92±7.33 openings per hour. Individuals opening the doors were support staff (27.8%), nurses (24.7%), perfusionists/others (18.9%), surgeons (15.6%), and anesthesiologists/anesthesia technicians (13.1%). The leading reason for entry was equipment retrieval (27.2%). Notably, 20.3% of entries were unrelated to the ongoing surgery.</p><p><strong>Conclusion: </strong>Operating-room traffic is characterized by frequent door openings and substantial personnel movement, conditions that may degrade air quality and heighten the risk of surgical-site infection. Educational initiatives, improved equipment planning, and institutional policy development are recommended to reduce unnecessary traffic.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":"256-260"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145960551","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":"Early Recognition of Hemodynamic Deterioration in Hospitalized Children Using Situational Awareness Vital Electronic Scout Software.","authors":"Carla Q Anderson, Kris Kormos, Jane Hartman, James F Bena, Amrit Gill, Shannon L Morrison, Nancy M Albert","doi":"10.1097/PTS.0000000000001436","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001436","url":null,"abstract":"<p><strong>Introduction: </strong>Identification of early hemodynamic changes ensures optimal patient outcomes. We examined if a second-generation, electronic health record-based pediatric hemodynamic software system with semi-automated early warning [Situational Awareness Vital Electronic Scout (SAVES)] identified actionable warning levels with greater accuracy.</p><p><strong>Methods: </strong>Using a retrospective medical records review, hospitalized nonintensive care children's encounters were included if they had first-generation warning system [Pediatric Early Warning System (PEWS)] software data. Clinicians manually entered data and warning levels were automatically created. An analyst applied PEWS data into the SAVES software that automatically included key patient characteristics from health records. Using descriptive analyses, PEWS and SAVES data were assessed in 3 ways: all data points, the first data point, and one randomly selected data point per encounter.</p><p><strong>Results: </strong>In total, 693,962 PEWS data-point rows from 43,505 encounters among 26,131 unique in-patients were included. Of patients, 20% were transferred to intensive care during their hospital stay. Over 90% of the time points of data using PEWS and SAVES were equally accurate based on warning category level; however, in 6.0 to 8.86% of data points, the warning level varied, with SAVES prompting higher warning levels in all 3 assessment methods. Compared with the PEWS assessment scores, SAVES scores were 3.2 times (first record) to 13 times (all data points) more likely to have higher warning levels.</p><p><strong>Discussion: </strong>The SAVES system identified higher early warning levels than PEWS.</p><p><strong>Conclusions: </strong>Accurate data, collected efficiently, facilitates recognition of subtle clinical changes before status deterioration.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":"22 4","pages":"308-313"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266696","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":"Redesigning From Work-as-Imagined to Work-as-Done: A Systems Safety Approach to Bedside Medication Storage.","authors":"Kerri Kuntz, Matthew T Nare, April Assee, Damon Pabst, Sarah Dierking, Jennifer McDonnell, Sarah Fouquet","doi":"10.1097/PTS.0000000000001472","DOIUrl":"10.1097/PTS.0000000000001472","url":null,"abstract":"<p><strong>Purpose: </strong>This quality improvement study aimed to address challenges in medication storage and accessibility in an acute pediatric care setting. By examining current processes, improvement opportunities were identified to enhance medication availability and reduce errors by introducing new locked medication storage boxes for multiuse, patient-specific medications.</p><p><strong>Methods: </strong>This quality improvement study was conducted in a 38-bed medical-surgical unit at a large Midwestern pediatric hospital. The study consisted of 3 phases: preintervention, simulation, and postintervention. Preintervention included near miss frequency counts, bedside medication audits, time observation audits, and a knowledge survey. The simulation phase involved in-situ simulations over 2 shifts with ten nurses (n=10), measuring success rates, task completion times, workload, and task difficulty and confidence ratings. Postintervention activities repeated the initial measures collected during the preintervention phase.</p><p><strong>Results: </strong>Participants showed a higher task success rate (94.6%) for the work-as-imagined procedure compared with a work-as-done (60%) and intervention (89%) processes. Overall, the intervention process decreased perceived workload according to the unweighted NASA-Task Load Index (NASA-TLX) scores and decreased task time compared with the work-as-imagined storage process. Confidence in task completion was highest for work-as-imagined, with a slight decrease in difficulty for the intervention or work-as-done.</p><p><strong>Conclusions: </strong>This study underscores the importance of identifying and addressing gaps between organizational policies or standard operating procedures and actual practices while engaging frontline staff. The implementation of new medication lockboxes significantly improved the medication storage process, demonstrating the effectiveness of quality improvements methods in enhancing both safety and efficiency. These findings highlight the value of a collaborative, systems-based approach in driving meaningful improvements in health care settings, ultimately contributing to better patient outcomes and operational efficiency.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":"334-339"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031234","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":"Factors Associated With Nurses' Intention to Report Medical and Care Errors: A Systematic Review.","authors":"Ahmad Alshurman, Said Abusalem, Ratchneewan Ross, Chizimuzo T C Okoli","doi":"10.1097/PTS.0000000000001483","DOIUrl":"10.1097/PTS.0000000000001483","url":null,"abstract":"<p><p>Medical and care errors are common in health care, posing serious risks to patient safety, with over 10% of patients being harmed annually. Despite efforts to reduce errors, underreporting persists, as nurses report only about 20% of incidents. Understanding the factors that influence nurses' intention to report errors is essential for developing effective strategies to improve reporting and patient safety. This systematic review aimed to identify factors associated with nurses' intention to report medical and care errors. A comprehensive search was conducted in 3 databases (PubMed, CINAHL, and PsycINFO) and Google Scholar using a combination of MeSH and synonymous terms related to medication errors, medical errors, care errors, intention to report, and nurses. Twenty-seven articles were included in the analysis. The review revealed that interpersonal characteristics such as attitude, subjective norms, and perceived behavioral control were found to have a significant relationship with nurses' intention to report medical errors. In addition, organizational environmental factors like patient safety culture and climate, nonpunitive responses to errors, open communication, teamwork, management support, task-oriented culture, organizational learning, reporting awareness, leadership behavior, and psychological safety positively influence error-reporting intentions. Furthermore, some demographic characteristics, including nurses' age, level of education, years of experience, and prior exposure to medication errors positively impacted reporting behaviors. This review results highlight the multifaceted nature of factors influencing nurses' intention to report medical errors. Understanding the complex interplay of attitude, subjective norms, perceived behavioral control, and other contextual factors is crucial to promote a reporting culture that enhances patient safety.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":"e87-e98"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202832","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":"Implementation Science: Deepening the Methodological Foundation to Enhance Patient Safety Interventions.","authors":"Daren Zhao","doi":"10.1097/PTS.0000000000001502","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001502","url":null,"abstract":"","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":"22 4","pages":"e80"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266682","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":"Case Difficulty and Non-Routine Events by Surgical Team Members in a Large Prospective Observational Study at 5 Veterans Affairs Medical Centers.","authors":"Matthew B Weinger, Jason S Slagle, Jessica Feinleib, Samuel K Nwosu, Robert A Greevy, Rebecca A Schroeder, Martha Shively, Irene D Feurer, Robert M Pousman, Daniel J France, Theodore Speroff","doi":"10.1097/PTS.0000000000001475","DOIUrl":"10.1097/PTS.0000000000001475","url":null,"abstract":"<p><strong>Background: </strong>Excessive workload is associated with degraded operator performance and outcomes. The construct of surgical \"team workload\" is poorly specified, and anesthesiologist workload has rarely been measured concurrent with that of operating room nurses and surgeons during the same cases. We sought to measure workload, operationalized as individual and team \"case difficulty,\" as well as the occurrence of non-routine events, from all surgical team members.</p><p><strong>Methods: </strong>This multicenter prospective observational study at 5 Veterans Affairs medical centers involved 1107 non-cardiac surgical procedures. Individual and team \"case difficulty\" ratings (1 \"very easy\" to 10 \"very difficult\") and the reported occurrence of non-routine events (ie, deviations from optimal care) were independently collected through facilitated survey from surgeons, anesthesia professionals, and operating room nurses before incision (pre-case) and again after skin closure (post-case).</p><p><strong>Results: </strong>At least one non-routine event was reported by at least one team member in 464 (42.0%) of the cases. Overall, nurses were the most likely to report an NRE (in 57% of NRE-containing cases), whereas surgeons were the least likely (40%). Anesthesia professionals and nurses had similar ratings for both the pre-case and post-case difficulty ratings. Surgeons' pre-case and post-case difficulty ratings were at least one unit greater than either of the other two OR team members ( P <0.01). Post-case, anesthesia and nursing team difficulty ratings were at least 0.4 units higher than individual ratings ( P <0.01), whereas surgeons' pre-case and post-case ratings were similar. Only nurses' individual case difficulty ratings were significantly lower post-case versus pre-case. Individual role and team case difficulty ratings were both associated with the reporting of non-routine events.</p><p><strong>Conclusions: </strong>Capturing surgical team case difficulty ratings and non-routine events is feasible and may shed insight into factors affecting surgical performance. In particular, pre-case difficulty ratings may be a complementary predictor of surgical risk.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":"268-277"},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146054756","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}