International Emergency Nursing最新文献

{"title":"The accuracy of triage classification using Emergency Severity Index","authors":"Krisada Suamchaiyaphum ,&nbsp;Allison R. Jones ,&nbsp;Shea Polancich","doi":"10.1016/j.ienj.2024.101537","DOIUrl":"10.1016/j.ienj.2024.101537","url":null,"abstract":"<div><h3>Introduction</h3><div>Accurate emergency triage is essential for timely and appropriate care based on patient acuity. We sought to evaluate triage accuracy among emergency department (ED) nurses and examine potential influencing factors.</div></div><div><h3>Methods</h3><div>We conducted an observational study using an electronic medical record chart review of 100 patients admitted at one of three EDs in a large academic medical system in the southern United States from December 1 to 7, 2021. Descriptive statistics were used to summarize the data. We compared the nurses’ initial assigned triage acuity level documented in the medical chart with triage acuity assigned using the Emergency Severity Index Version 4 handbook and assessed inter-rater agreement using Cohen’s kappa coefficient.</div></div><div><h3>Results</h3><div>Overall triage accuracy was 67%, with most patients (62%) triaged as ESI level 3; under- and over-triage occurred in 25% and 8% of cases, respectively. Cohen’s kappa coefficient was 0.437, indicating moderate interrater reliability between the triage nurses and the ESI handbook. Triage accuracy varied across ED locations and patient characteristics of sex (male: 55.6%, female: 72.3%), type of complaint (trauma: 57.1%, non-trauma: 69.4%), shift (day: 63.5%, night: 73.0%), and mode of arrival (ambulance: 80.8%, ambulatory: 65.2%, and private vehicle: 37.5%).</div></div><div><h3>Conclusion</h3><div>Triage inaccuracy may be attributed to a combination of nursing- and patient-specific factors. Further study of those factors associated with triage accuracy is warranted.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"77 ","pages":"Article 101537"},"PeriodicalIF":1.8,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Children with medical complexity in the emergency department: Parent experiences and information needs","authors":"Danielle Lysak ,&nbsp;Samina Ali ,&nbsp;Susan Neufeld ,&nbsp;Shannon Scott","doi":"10.1016/j.ienj.2024.101532","DOIUrl":"10.1016/j.ienj.2024.101532","url":null,"abstract":"<div><h3>Background</h3><div>Children with complex medical needs constitute a growing number of pediatric patients that utilize the emergency department, disproportionately more than children outside of this category. Our objective for this qualitative study was to explore information needs and experiences of parents accessing emergency health care for their child with medical complexity.</div></div><div><h3>Methods</h3><div>Qualitative description guided this study. Parent participants were recruited via purposive sampling and individually interviewed within a pediatric specialty clinic at a Canadian pediatric tertiary care center. Inductive content analysis organized interview data from parents.</div></div><div><h3>Results</h3><div>Nine, 60–90 min individual interviews were conducted with parents of a child with medical complexity; four content categories emerged: How the emergency department is different for children with medical complexity, parents as key care coordinators, emergency department experience and resilience, and communication and learning preferences.</div></div><div><h3>Conclusion</h3><div>These families openly shared their experience with pediatric emergency care. Strategies to support transfer of pertinent health information for children with complex medical needs are needed in the emergency department. Interviews with parents of children with complex medical needs provided key insights to inform and improve the care provided in the emergency department for this growing population of children.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"77 ","pages":"Article 101532"},"PeriodicalIF":1.8,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“Caught in the middle”- emergency doctors and nurses’ experiences of ethical dilemmas in end of life care: A qualitative study","authors":"Oluwatomilayo (Tomi) Omoya,&nbsp;Anita De Bellis,&nbsp;Katrina Breaden","doi":"10.1016/j.ienj.2024.101535","DOIUrl":"10.1016/j.ienj.2024.101535","url":null,"abstract":"<div><h3>Objective</h3><div>The integration of end of life care into emergency work is gaining momentum, especially in Australia. Emergency doctors and nurses are increasingly required to make decisions regarding the provision of end of life care. The importance of end of life care for patients and their families in the emergency department is well documented, but ethical dilemmas that arise in end of life care provision are not widely researched.</div></div><div><h3>Methods</h3><div>A qualitative interpretative design and phenomenological approach were used to create an understanding and meaning about ethical dilemmas faced by emergency nurses and doctors in end of life care. Sixteen doctors and nurses were purposively recruited through professional organisations. Data were collected using semi-structured in-depth interviews. Interviews were audio-taped, transcribed verbatim, and thematically analysed using a qualitative seven stage thematic analysis.</div></div><div><h3>Results</h3><div>The overarching constitutive pattern ‘decision making processes’ was conceptualised within the two identified major themes including: 1) Short-term (ST) versus Long-term (LT) ethical dilemmas and; 2) Individual versus community ethical dilemmas. These themes were uncovered using the phenomenological hermeneutic concepts of epoche (openness) to construct meaning and understanding for participants.</div></div><div><h3>Conclusions</h3><div>In this study, the frequent experiences of ethical dilemmas by emergency doctors and nurses demonstrated that end of life care in the emergency department was challenging. The stated experiences were related to barriers that contributed to the complexities reported in making ethical decisions at the end of life. Therefore, an understanding of ethical principles is needed to navigate care for patients and their families for the best possible outcomes.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"77 ","pages":"Article 101535"},"PeriodicalIF":1.8,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigation of the knowledge, attitude and behavior of medical personnel and related needs for emergency rescue in public health emergencies","authors":"Li Yao ,&nbsp;Tingrui Wang ,&nbsp;Anli Feng ,&nbsp;Taotao Shen ,&nbsp;Lihong Yu ,&nbsp;Yaling Li ,&nbsp;Yinhua Wang","doi":"10.1016/j.ienj.2024.101531","DOIUrl":"10.1016/j.ienj.2024.101531","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The frequent occurrence of Public Health Emergencies (PHEs) presents a significant challenge to global health security. As the primary responders in PHE situations, the comprehensive capabilities of medical personnel to address these emergencies are of global concern.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Aim&lt;/h3&gt;&lt;div&gt;This study aims to evaluate the knowledge, attitudes, and behaviors of medical personnel regarding emergency rescue in public health emergencies in Guizhou Province, China. Additionally, it seeks to explore their related needs to inform the development of intervention strategies, ultimately enhancing the ability of medical personnel to manage public health emergencies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A descriptive cross-sectional design was employed to assess the knowledge, attitudes, and behaviors of medical personnel concerning emergency rescue and the related needs of PHEs. Data collection involved a questionnaire evaluating the knowledge, attitudes, and behaviors of medical personnel regarding the emergency rescue of PHEs, along with a self-designed questionnaire assessing the needs of medical personnel in responding to PHEs. Univariate analysis and multiple linear regression were utilized to analyze the factors influencing medical personnel’s knowledge, attitudes, and behaviors in response to PHEs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 4,074 medical personnel were surveyed. The results indicated that the knowledge, attitudes, and behaviors of medical personnel regarding PHEs were at a high level. Additionally, the related needs of medical personnel for PHEs included training, psychological support, and behavioral support. Differences were observed in the scores of emergency rescue knowledge among medical personnel based on age, years of experience, educational background, and positions (&lt;em&gt;P&lt;/em&gt; &lt; 0.05). Furthermore, variations in scores related to emergency rescue were noted across different age groups, years of experience, educational backgrounds, and professional titles (&lt;em&gt;P&lt;/em&gt; &lt; 0.05). Significant differences were also found in the scores of medical staff based on years of experience and hospital grades in their responses to PHEs (&lt;em&gt;P&lt;/em&gt; &lt; 0.05). Emergency rescue knowledge was influenced by factors such as anxiety and fear, years of experience, and professional titles when confronted with PHEs. Similarly, anxiety and fear, years of experience, and professional titles were identified as influencing factors for emergency rescue attitudes. Lastly, the grade of the hospital where the medical staff were employed emerged as a significant factor affecting emergency rescue behavior.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Medical personnel play a vital role in the emergency rescue of PHEs however, there are notable differences in their knowledge, attitudes, and behaviors. It is recommended that targeted training, psychological support, and behavioral incentives be strengthened to enhance","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"77 ","pages":"Article 101531"},"PeriodicalIF":1.8,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is person-centred care in Swedish ambulance service? − A qualitative exploratory study","authors":"Amanda Jacobsen ,&nbsp;Malin Tistad ,&nbsp;Anna Bergström ,&nbsp;Anna Hörberg ,&nbsp;Lars Wallin ,&nbsp;Andreas Rantala","doi":"10.1016/j.ienj.2024.101529","DOIUrl":"10.1016/j.ienj.2024.101529","url":null,"abstract":"<div><h3>Introduction</h3><div>Healthcare in Sweden is moving towards a more person-centred approach in which patients are respected as capable individuals with unique needs. Partnership, the co-creation of health plans, and documentation are core components of this approach. The ambulance service is medical- and task-oriented, possibly placing it in conflict with the goals of person-centred care (PCC).</div></div><div><h3>Aim</h3><div>To explore how nurses in the Swedish ambulance service describe PCC.</div></div><div><h3>Method</h3><div>A qualitative interview study with eight nurses who served as facilitators for implementing ambulance PCC. Data was analysed using content analysis.</div></div><div><h3>Findings</h3><div>The analysis resulted in the main category <em>Ambulance PCC is diffuse but applicable</em> and in the three categories: <em>Do good based on an ethical approach, Assemble the patient‘s narrative from multiple sources</em> and <em>Create and agree on a plan.</em></div></div><div><h3>Conclusion</h3><div>Ambulance PCC is perceived as a diffuse concept, with unclear translation into practice. The findings highlight the need to determine appropriate levels of care, manage technical equipment without disrupting communication and embody attributes such as calmness and empathy. Despite its ambiguity, ambulance PCC was seen as applicable across all care stages, although requiring adjustments based on urgency, individual circumstances and care setting.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"77 ","pages":"Article 101529"},"PeriodicalIF":1.8,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guidelines for patient care used by registered nurses in the emergency room: Mapping of Swedish governing documents","authors":"Veronica Pavedahl ,&nbsp;Inger K Holmström ,&nbsp;Martina Summer Meranius ,&nbsp;Ulrica von Thiele Schwarz ,&nbsp;Åsa Muntlin","doi":"10.1016/j.ienj.2024.101536","DOIUrl":"10.1016/j.ienj.2024.101536","url":null,"abstract":"<div><h3>Introduction</h3><div>Guidelines are important for guiding clinical practice and governing registered nurses’ work in an emergency room to enable them to secure quality of care and patient safety in a life-saving situation. However, guidelines are not always systematically prepared, or evidence based. This study aimed to map and describe the content of Swedish guidelines governing the registered nurses’ work in emergency rooms.</div></div><div><h3>Methods</h3><div>A descriptive cross-sectional design, together with a thematic synthesis of content of the submitted guidelines. The data were analyzed with descriptive statistics and a thematic synthesis. Quality of the guidelines was measured using a modified version of the AGREE II instrument.</div></div><div><h3>Results</h3><div>The result is based on 190 included guidelines, collected from 37 participating emergency departments. The registered nurses’ work in emergency rooms was guided by an instrumental and task-oriented approach to care, with a wide variation in how the registered nurses’ work was described in the guidelines. The quality of the guidelines was poor. The registered nurse was reported as target user in 15 % (n = 29) of the guidelines. None of the guidelines described the population to whom they were meant to apply. In 17 % (n = 32) there was an explicit link between recommendations and supporting evidence.</div></div><div><h3>Conclusions</h3><div>There is a need to improve guidelines to support registered nurses in assessing, treating, and providing fundamental care for patients with life-threatening illnesses in an equal, evidence-based, and person-centered way. Registered nurses should play an active role in the development of the guidelines governing their work.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"77 ","pages":"Article 101536"},"PeriodicalIF":1.8,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lived experience of Filipino nurses as uninvolved bystanders in Out-of-Hospital emergencies","authors":"Vincent C. Pananganan,&nbsp;Joana Mariz C. Pananganan","doi":"10.1016/j.ienj.2024.101520","DOIUrl":"10.1016/j.ienj.2024.101520","url":null,"abstract":"<div><h3>Background</h3><div>Occurrences of out-of-hospital emergencies (OHE) underscored the vital roles of bystanders yet nurses on some occasions may take on this role uninvolved.</div></div><div><h3>Methodology</h3><div>This study employed a qualitative research design specifically a Husserlian Descriptive Phenomenology to explore the lived experience of nurses who became uninvolved bystanders in OHE.</div></div><div><h3>Results</h3><div>Semi structured in-depth interviews with nine nurses revealed four central themes: (1) recognizing an ambiguous situation, (2) acknowledging the required competence and confidence, (3) dealing with negative emotions, and (4) caring for oneself and the victim.</div></div><div><h3>Conclusion</h3><div>Nurses, as uninvolved bystanders, were confronted with an ambiguous situation which underscored their psychosocial needs. Even if societal expectations dictate nurses to take on an active role, at times being uninvolved in OHE reflects a ‘caring individual’ who balances professional knowledge, skills, and attitude resulting in the protection of patients and upholding personal welfare.</div></div><div><h3>Recommendations</h3><div>There is a need to sufficiently and legally safeguard the welfare of respondents in OHE, and provide additional education and training to effectively manage OHE. Further research is recommended for policy development.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"77 ","pages":"Article 101520"},"PeriodicalIF":1.8,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of emergency nurses in surrogate decision-making in Japan: Qualitative insights into nursing support for patient families","authors":"Sadami Momiyama ,&nbsp;Shizuko Gomi ,&nbsp;Hiroyuki Nozaki ,&nbsp;Mikiko Hasegawa ,&nbsp;Tomoki Gomi ,&nbsp;Mariko Yoshida ,&nbsp;Akemi Ono ,&nbsp;Makoto Nakabayashi ,&nbsp;Norihiko Noguchi ,&nbsp;Atushi Igarashi","doi":"10.1016/j.ienj.2024.101527","DOIUrl":"10.1016/j.ienj.2024.101527","url":null,"abstract":"","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"77 ","pages":"Article 101527"},"PeriodicalIF":1.8,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142511136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency department nurses’ intrinsic motivation: A bridge between empowering leadership and thriving at work","authors":"Cuicui Li ,&nbsp;Yushuo Niu ,&nbsp;Ying Xin ,&nbsp;Xiaohong Hou","doi":"10.1016/j.ienj.2024.101526","DOIUrl":"10.1016/j.ienj.2024.101526","url":null,"abstract":"<div><h3>Background</h3><div>The relationship between empowering leadership, intrinsic motivation, and thriving at work among emergency department nurses is unclear. Thriving at work can raise employees’ job satisfaction and lower their tendency to quit. High workloads and unpleasant workplace experiences may result in emergency department nurses thriving less at work. It has been demonstrated that intrinsic motivation and empowering leadership are both linked to thriving at work in employees.</div></div><div><h3>Aim</h3><div>To investigate the relationship between empowering leadership and thriving at work among emergency department nurses, as well as the mediating function of intrinsic motivation in this relationship.</div></div><div><h3>Methods</h3><div>The 337 emergency department nurses were polled using general information questionnaire, Empowering Leadership Scale, Intrinsic Motivation Scale, and Thriving at Work Scale. Structural equation modeling was used for data analysis.</div></div><div><h3>Results</h3><div>Positive relationships existed between thriving at work and empowering leadership and intrinsic motivation. Intrinsic motivation was a mediator of the relationship between empowering leadership and thriving at work.</div></div><div><h3>Conclusions</h3><div>Intrinsic motivation is one mechanism by which empowering leadership can influence emergency department nurses thriving at work. Nurse managers should adopt an empowering leadership style and take steps to activate the intrinsic motivation of emergency department nurses, thereby increasing nurses’ ability to thrive at work.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"77 ","pages":"Article 101526"},"PeriodicalIF":1.8,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trauma nursing practitioners’ preferences for training for trauma specialist nurses based on job competencies","authors":"Liu Yang ,&nbsp;Die Han ,&nbsp;Xiaolu Liu ,&nbsp;Lingjun Luo ,&nbsp;Qing Zhou ,&nbsp;Mei Chen","doi":"10.1016/j.ienj.2024.101525","DOIUrl":"10.1016/j.ienj.2024.101525","url":null,"abstract":"<div><h3>Introduction</h3><div>Optimizing trauma nurse training is of great significance in enhancing nurses’ professional skills, strengthening their emergency response capabilities, facilitating career development, and improving patient rescue success rates. This study aims to investigate the preferences of trauma nursing practitioners for trauma specialist nurse training based on job competency.</div></div><div><h3>Methods</h3><div>631 Trauma nursing practitioners from 20 hospitals in Guizhou Province, China, participated in this cross-sectional study. The instruments used were the General Information Questionnaire and the Self-designed training preference questionnaire for trauma specialist nurses based on job competency theory. Questionnaires are distributed and collected through online questionnaires.</div></div><div><h3>Results</h3><div>93.03% of trauma nursing practitioners expressed their willingness to participate in trauma nurse specialist training, of which 80.35% had high-level training needs. 78.92% of trauma nursing practitioners expressed their hope to receive trauma nurse specialist training through operational demonstration training, online live broadcasts, and scenario simulation drills. Among the various dimensions of job competency, the highest demand was for professional knowledge, skills, and ability.</div></div><div><h3>Conclusion</h3><div>Trauma nursing practitioners highly value and recognize the professional training of trauma nurse specialists and prefer training methods that are highly practical and can directly improve clinical skills. The research results provide an important basis for further optimizing the training program for trauma nurse specialists.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"77 ","pages":"Article 101525"},"PeriodicalIF":1.8,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}