International Emergency Nursing最新文献

{"title":"Challenges encountered by healthcare workers in managing door-to-balloon time of myocardial infarction: A survey","authors":"Amina Yasser Al Balushi , Lin Zhao , Karen Livesay","doi":"10.1016/j.ienj.2025.101677","DOIUrl":"10.1016/j.ienj.2025.101677","url":null,"abstract":"<div><h3>Background</h3><div>ST-segment elevation myocardial infarction (STEMI) demands aggressive and rapid medical intervention. Delays in Door-to-balloon time (DTB) of more than 90 min cause progressive damage to the cardiac tissue and require immediate medical intervention, including percutaneous coronary intervention (PCI). Nurses and doctors in STEMI management face several challenges that result in a delay in DTB time.</div></div><div><h3>Aim</h3><div>To investigate challenges nurses and doctors encounter in managing Door to Balloon (DTB) time for ST-elevation Myocardial Infarction (STEMI) patients.</div></div><div><h3>Method</h3><div>An online survey using Qualtrics software was distributed to all nurses and doctors working in the Emergency Room and Cardiac Catheterization Laboratory at the study site, which included a total of 150 staff members. The survey was conducted in August 2023 and lasted for one month. The questionnaire online link was sent to the participants and filled out by them through their smartphones.</div></div><div><h3>Results</h3><div>A total of 83 nurses and doctors responded to the questionnaire. The survey revealed several challenges encountered by nurses and doctors in STEMI management from highest to lowest based on response items in the Likert scale. In ER, the reported challenges related to the ECG interpretation (mean = 33, 47.8 %), followed by Process (mean = 31.5, 45.6 %), Resources (mean = 30.0, 43.5 %), Communication (mean = 28.8, 41.7 %), and Healthcare setting (28, 40.6 %). In CCL, the most reported challenges were related to Communication (mean = 10, 71.4 %). Followed by Resources (mean = 7.5, 53.5 %), and Healthcare setting (mean = 28, 40.6 %).</div><div>The primary outcomes showed no statistically significant association of predictable variables of Age groups with a p value of 0.612 (21–30 years, mean 3.31 ± 0.95, 31–40 years, mean 3.62 ± 1.17, 41–50 years, mean 3.7 ± 1.22), Educational groups with a p value of 0.481(Diploma 3.60 ± 1.23, Bachelor 3.33 ± 0.97, Postgraduate 3.79 ± 1.18), Years of experience groups with a p value of 0.659, two-tailed (10 years of experience 3.65 ± 1.23, and More than 10 years of experience 3.65 ± 1.23), and groups of certified with an ECG interpretation course with a p value of 0.583, two-tailed (Certified with an ECG interpretation course 3.62 ± 1.16 and not Certified with an ECG interpretation course 3.42 ± 1.08) on the Knowledge variable. Similarly, the outcomes showed no statistically significant association of predictable variables of Age with a p value of 0.615 (21–30 years, mean 31.91 ± 5.43, 31–40 years, mean 32.61 ± 6.38, 41–50 years, mean 30.31 ± 8.08) Educational groups with a p value of 0.325(Diploma 29.87 ± 7.75, Bachelor 31.93 ± 5.95, Postgraduate 33.41 ± 6.02), Years of experience groups with a p value of 0.813, two-tailed (10 years of experience 32 ± 6.283, and More than 10 years of experience 31.53 ± 7.27), certified with an ECG interpretation course with","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"83 ","pages":"Article 101677"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145020657","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 nurses’ roles in supporting surrogate decision-making through remote family meetings: Insights from COVID-19 visitation restrictions","authors":"Sadami Momiyama , Hayato Katayanagi , Makoto Nakabayashi , Tomoko Fujino , Yoshiko Sato , Takafumi Noguchi , Hidekazu Hishinuma","doi":"10.1016/j.ienj.2025.101709","DOIUrl":"10.1016/j.ienj.2025.101709","url":null,"abstract":"","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"83 ","pages":"Article 101709"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519699","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":"Empowering emergency nurses in crisis response – A quality improvement framework for enhanced preparedness and decision-making","authors":"Hesam Seyedin ,&nbsp;Shandiz Moslehi ,&nbsp;Sajjad Narimani","doi":"10.1016/j.ienj.2025.101711","DOIUrl":"10.1016/j.ienj.2025.101711","url":null,"abstract":"<div><h3>Introduction</h3><div>Emergency nurses face significant challenges in crisis response, including cognitive overload and institutional barriers, which compromise patient outcomes. This quality improvement (QI) initiative aimed to enhance crisis preparedness through evidence-based interventions, addressing gaps in risk perception, decision-making, and self-efficacy.</div></div><div><h3>Method</h3><div>A pre/post-intervention study was conducted at two academic medical centers (Level I trauma centers)150 emergency nurses. Interventions included simulation-based training, AI-driven decision-support tools, and protocol reforms. Data were collected at baseline, post-intervention, and six-month follow-up. Primary outcomes included risk perception accuracy, decision latency, and self-efficacy, which were analyzed using paired t-tests, repeated measures ANCOVA, control charts, and chi-square tests.</div></div><div><h3>Results</h3><div>Post-intervention, nurses demonstrated a 32 % improvement in risk perception accuracy (p &lt; 0.01) and a 26 % reduction in decision-making time (p &lt; 0.05). Self-efficacy scores nearly doubled, rising from 45 % to 89 %. <strong>ED-specific process outcomes</strong> <!-->included a 40 % reduction in triage errors and a 35 % decrease in missed deteriorations with AI support. Improvements were sustained at the 6-month follow-up.</div></div><div><h3>Discussion</h3><div>The multimodal approach yielded statistically and clinically significant improvements, surpassing single-intervention studies. Sustainable implementation requires institutional support for technology integration and policy reforms. These findings advocate for widespread adoption of combined simulation, AI, and protocol strategies to empower nurses in crisis response.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"83 ","pages":"Article 101711"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145551502","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":"Response to the comments on “A systematic review on suction-based airway clearance devices for foreign body airway obstruction”","authors":"Francesco Limonti ,&nbsp;Natalino Palermo ,&nbsp;Miguel Angel Paludi ,&nbsp;Angelica Semeraro ,&nbsp;Daniele Ermanno ,&nbsp;Sandro Ganzino ,&nbsp;Nicola Ramacciati","doi":"10.1016/j.ienj.2025.101708","DOIUrl":"10.1016/j.ienj.2025.101708","url":null,"abstract":"","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"83 ","pages":"Article 101708"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416531","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 effectiveness of a gate channel device on pain in the pediatric emergency department: A randomized controlled trial","authors":"Ted J. Andrews ,&nbsp;Jill Fennell ,&nbsp;Brian H. Wrotniak ,&nbsp;Heather Territo","doi":"10.1016/j.ienj.2025.101704","DOIUrl":"10.1016/j.ienj.2025.101704","url":null,"abstract":"<div><h3>Objectives</h3><div>Phlebotomy is an important source of self-reported pain in the pediatric emergency department. The purpose of this study was to compare the effectiveness of Buzzy®, a vibrating cold device, to vapocoolant and control in reducing child-reported and parent-perceived pain during IV placement in the pediatric emergency department.</div></div><div><h3>Methods</h3><div>Patients ages 6–18 years who required IV insertion in the emergency department were randomized to Buzzy, vapocoolant or control groups. The Faces Pain Scale – Revised was used to assess both patient pain and parent perceived pain.</div></div><div><h3>Results</h3><div>171 patients were randomized into the 3 groups: 56 in the Buzzy group, 57 in the vapocoolant group and 58 in the control group. Patient-reported FACES pain scores decreased significantly from pre- to post-intervention in the Buzzy group (5.41 ± 2.90 to 3.58 ± 2.87, p &lt; 0.01) but not in the vapocoolant group (4.54 ± 2.65 to 3.84 ± 3.12, not significant), or the control group (5.03 ± 3.01 to 4.57 ± 3.43, not significant). Guardian-reported pain scores also showed significant reductions in the Buzzy group (3.46 ± 2.88 to 1.69 ± 2.28, p &lt; 0.01) and vapocoolant group (3.06 ± 2.93 to 2.24 ± 2.56, p &lt; 0.05), with no significant change in the control group (2.86 ± 2.85 to 2.79 ± 2.84).</div></div><div><h3>Conclusions</h3><div>This study supports the utility of Buzzy® as a clinically effective resource in the management of phlebotomy related pain and demonstrates that it is as good or better than vapocoolant in the pediatric emergency department.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"83 ","pages":"Article 101704"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145394626","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":"Effect of sleep quality on alarm fatigue among emergency nurses","authors":"Asuman Şener ,&nbsp;Tuğba Çınarlı ,&nbsp;Dilan Köse","doi":"10.1016/j.ienj.2025.101706","DOIUrl":"10.1016/j.ienj.2025.101706","url":null,"abstract":"<div><h3>Background</h3><div>Considering that patient care is provided for 24 h without interruption in the emergency service, the work roles in this service require a state of full wakefulness. Alarm fatigue is defined as the main cause of clinical alarm management problems. Alarm fatigue, that cannot be managed in a full sense, may make desensitize emergency nurses and may endanger patient safety.</div></div><div><h3>Aim</h3><div>The aim of the study was to determine the effect of sleep quality on alarm fatigue of emergency nurses.</div></div><div><h3>Methods</h3><div>This research used the descriptive, cross-sectional and correlational study pattern. The study was completed with 183 emergency nurses from May-November 2023. Data were collected using the Descriptive Information Form, Pittsburgh Sleep Quality Index (PSQI) and the Nurses’ Alarm Fatigue Scale. Data were analyzed using IBM SPSS V26 program.</div></div><div><h3>Results</h3><div>Of nurses, 96.2 % worked shifts and 38.8 % stated their monthly working hours were more than 240 h. Of those working shifts, 77.6 % slept after their shift, 56.8 % experienced sleep problems and 43.3 % stated they required support to be able to easily fall asleep. The mean scores on the Nurses’ Alarm Fatigue Scale were 24.98 ± 6.16, while mean scores for the PSQI were 9.08 ± 3.48. There was a statistically significant, low level positive correlation between PSQI scores and Alarm Fatigue Scale scores (r = 0.178). Additionally, the simple linear regression model created with the aim of investigating the effect of PSQI scores on Alarm Fatigue Scale scores was identified to be statistically significant (F = 5.897; p = 0.016).</div></div><div><h3>Conclusion</h3><div>With the aim of empowering nurses working irregular night shifts in institutions providing health services, offering education and teaching programs should be considered. In conclusion, our research will help to create a safer, more effective and encouraging hospital environment for both patients and emergency service nurses.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"83 ","pages":"Article 101706"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145402520","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":"Adaptation and validation of the critical care family needs inventory – Emergency department (CCFNI-ED) in Indonesian emergency care settings","authors":"Rafi Achmad Rukhama ,&nbsp;Raditya Bagus Septian ,&nbsp;Desy Listyaningrum","doi":"10.1016/j.ienj.2025.101695","DOIUrl":"10.1016/j.ienj.2025.101695","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to assess the validity, reliability, and cultural adaptation of the Critical Care Family Needs Inventory – Emergency Department (CCFNI-ED) into the Indonesian language.</div></div><div><h3>Methods</h3><div>The study was conducted in three phases, including the translation and cultural adaptation process, content and face validation by six emergency nursing experts, and construct validity and reliability testing through a cross-sectional survey of 120 family members of patients in three emergency departments in Indonesia. Data analysis included the item-level content validity index (I-CVI), Cronbach’s alpha, item-total correlation, and exploratory factor analysis (EFA).</div></div><div><h3>Results</h3><div>The results showed a total Cronbach’s alpha value of 0.931, with all subscales having values greater than 0.70. The I-CVI value for all items was 1, indicating excellent content validity. EFA yielded six factors from 24 items, explaining 64.7 % of the total variance, with all items showing loadings ≥ 0.50 and communalities &gt; 0.50. The correlations between subscales were significant (p &lt; 0.01), with the strongest relationship observed between participation and communication (r = 0.720).</div></div><div><h3>Conclusions</h3><div>The CCFNI-ED instrument is valid and reliable for assessing family needs in patient care within emergency settings. This can enhance the quality of family-centered services in emergency departments.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"83 ","pages":"Article 101695"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239845","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":"Implementation science in the field of emergency nursing practice: A scoping review","authors":"Hailong Hou ,&nbsp;Yan Jiang ,&nbsp;Mingmin Luo ,&nbsp;Tianjiao Dong ,&nbsp;Shiqi Xiao","doi":"10.1016/j.ienj.2025.101679","DOIUrl":"10.1016/j.ienj.2025.101679","url":null,"abstract":"<div><h3>Background</h3><div>Emergency nursing is an essential component of the healthcare system, with its effectiveness directly impacting patient clinical outcomes. With the advancement of evidence-based nursing, the application of Implementation Science (IS) in emergency nursing has become a key factor in enhancing nursing quality and patient safety. However, the scope and effect of IS application within emergency nursing are not fully understood.</div></div><div><h3>Aim(s)</h3><div>To map and synthesize the depth and breadth of research on implementation science in the field of emergency nursing.</div></div><div><h3>Methods</h3><div>This scoping review followed the Arksey and O’Malley’s scoping review methodology. Systematic searches were conducted in databases including PubMed, Web of Science, Cochrane Library, CINAHL, and Embase. The search covered study up to November 2023, with included studies summarized and analyzed.</div></div><div><h3>Results</h3><div>A total of 24 studies were included, indicating the preliminary application of IS in emergency nursing. Applications ranged from common disease care, emergency care for special populations, improvements in patient care processes, and enhancements in emergency nursing quality.</div></div><div><h3>Conclusion</h3><div>The application of IS in emergency nursing shows potential, contributing to improved nursing quality, patient safety, and treatment outcomes. Further exploration and promotion of IS in emergency nursing can enhance the efficiency of the entire emergency care system.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"83 ","pages":"Article 101679"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049652","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":"Factors influencing triage competence in emergency nurses: The role of resilience, social support, and work-related factors","authors":"JianMei Chen ,&nbsp;JiaHui Ma ,&nbsp;Ao Zhao ,&nbsp;XueHuan Huang","doi":"10.1016/j.ienj.2025.101681","DOIUrl":"10.1016/j.ienj.2025.101681","url":null,"abstract":"<div><h3>Aims</h3><div>This multi-center cross-sectional correlational study examined whether psychological resilience, perceived social support, and work-related factors were independently associated with triage competence among emergency nurses.</div></div><div><h3>Background</h3><div>Triage nurses play a vital role in emergency care, yet factors shaping their competence remain underexplored. Psychological resilience and social support may significantly impact performance. Understanding these influences is crucial for targeted interventions. <em>Design:</em>A cross-sectional study was conducted from May to December 2024, involving 291 emergency triage nurses from 30 hospitals across China.</div></div><div><h3>Methods</h3><div>Data were collected via self-administered questionnaires using multi-center convenience sampling. Instruments included the Triage Competence Scale, Psychological Resilience Scale, and Perceived Social Support Scale. Analyses comprised descriptive statistics, ANOVA, t-tests, and multiple linear regression.</div></div><div><h3>Results</h3><div>In the multivariable model including 14 candidate predictors, career development prospects (<em>p</em> = 0.001), work environment (<em>p</em> = 0.040), internal resilience (<em>p</em> &lt; 0.001), and family support (<em>p</em> = 0.040) were independently associated with higher triage competence. The model explained 66.6 % of the variance (adjusted R² = 0.666; F (14, 276) = 42.219, <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div><strong>Career</strong> prospects, a supportive work environment, resilience, and family support significantly influence triage competence. Improving triage competence requires targeted interventions, including resilience training, career development programs, and supportive work environments, to enhance nurse performance and ultimately improve patient outcomes.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"83 ","pages":"Article 101681"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145119007","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":"Nurses’ perspectives on providing analgesia in the Italian prehospital emergency setting: A phenomenological study","authors":"Francesca Sandroni ,&nbsp;Martina Pia Pugliese ,&nbsp;Silvia Magagna ,&nbsp;Stefano Sebastiani ,&nbsp;Boaz Gedaliahu Samolsky Dekel ,&nbsp;Guglielmo Imbriaco","doi":"10.1016/j.ienj.2025.101696","DOIUrl":"10.1016/j.ienj.2025.101696","url":null,"abstract":"<div><h3>Background</h3><div>Effective pain management is a fundamental aspect of prehospital emergency care. However, numerous barriers, including inconsistent protocols, limited pharmacological options, and documentation gaps, hinder optimal pain relief. Emergency medical services (EMS) nurses play a crucial role in assessing and managing pain, yet their perspectives on prehospital analgesia remain underexplored.</div></div><div><h3>Objective</h3><div>This study aims to explore the experiences and perceptions of Italian EMS nurses regarding prehospital pain management, identifying key challenges and potential improvements.</div></div><div><h3>Methods</h3><div>A qualitative study was conducted using an interpretative phenomenological approach. Semi-structured interviews were performed with 14 EMS nurses from various Italian regions. Data was analyzed through thematic analysis, identifying recurring themes related to pain assessment, treatment, and documentation.</div></div><div><h3>Results</h3><div>Five main themes emerged: (1) variability in analgesia protocols and pharmacological options, (2) inconsistent pain assessment and documentation, (3) challenges in pain management related to specific patient populations or environmental and logistical factors, (4) nurses’ personal experiences shaping their approach to pain management, and (5) interprofessional collaboration challenges. While nurses emphasized the importance of systematic pain evaluation, barriers such as legal restrictions, inconsistent protocols, and limited pharmacological options were frequently reported.</div></div><div><h3>Conclusion</h3><div>Prehospital pain management by EMS nurses in Italy faces significant challenges. Expanding protocol-approved pharmacological options, improving documentation practices, and enhancing training for pain management in vulnerable populations could improve care. A standardized, evidence-based national framework is needed to optimize pain relief and ensure equitable patient outcomes.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"83 ","pages":"Article 101696"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245568","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}