Australasian Emergency Care最新文献

{"title":"Pre-hospital predictors of long-term survival from out-of-hospital cardiac arrest","authors":"Katherine Pemberton ,&nbsp;Richard C. Franklin ,&nbsp;Emma Bosley ,&nbsp;Kerrianne Watt","doi":"10.1016/j.auec.2022.10.006","DOIUrl":"10.1016/j.auec.2022.10.006","url":null,"abstract":"<div><h3>Objective</h3><p>To identify predictors of longer-term outcomes from adult out-of-hospital cardiac arrest of presumed cardiac aetiology.</p></div><div><h3>Methods</h3><p>In this retrospective cohort study, three large routinely collected databases were linked: 1)QAS Out-of-Hospital Cardiac (OHCA) Registry; 2)Queensland Hospital Admitted Patient Data Collection; and 3)Queensland Registrar General Death Registry. Participants were adult (18years+) residents of Queensland, who suffered an OHCA of presumed cardiac aetiology and had resuscitation attempted by QAS paramedics between 2002 and 2014. Four mutually exclusive outcomes were analysed: 1) No pre-hospital return of spontaneous circulation (ROSC) sustained to the Emergency Department (ED) or ROSC in ED; 2) Survival&lt; 30 days (Pre-hospital ROSC sustained to ED or ROSC in ED but death within 30 days; 3) survival between 30 and 364 days; and 4) survival to 365 + days. Multinomial logistic regression was used to calculate odds ratios and 95 % confidence intervals.</p></div><div><h3>Results</h3><p>Variables significantly predictive of survival to 365 + days after adjusting for all measured confounders are: an initial shockable rhythm; bystander witnessed events with bystander CPR; paramedic witnessed events; intubation placement; time of day (midday-2.59 pm); and attendance by Critical Care Paramedic (CCP).</p></div><div><h3>Conclusion</h3><p>From a service provision perspective, attendance of a CCP at an OHCA may be an important factor to achieve preferred long-term outcomes. Enhanced experience, exposure and expertise, together with extended clinical practice, may explain this finding.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 2","pages":"Pages 184-192"},"PeriodicalIF":1.8,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9566494","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":"Paramedic interactions with significant others during and after resuscitation and death of a patient","authors":"Harrison Risson,&nbsp;Bronwyn Beovich,&nbsp;Kelly-Ann Bowles","doi":"10.1016/j.auec.2022.08.007","DOIUrl":"10.1016/j.auec.2022.08.007","url":null,"abstract":"<div><h3>Background</h3><p>Out-of-hospital cardiac arrest often occurs at home, requiring paramedics to interact with family members and bystanders during resuscitation and inform them should the patient die. This study explores how paramedics navigate interactions and the changing needs of the patient and the bereaved.</p></div><div><h3>Methods</h3><p>Phenomenological methodology inspired individual, semi-structured interviews. Data was then coded using reflexive thematic analysis.</p></div><div><h3>Results</h3><p>Ten individual interviews with working paramedics with an average of 7.2 years of experience were analysed and resulted in four overarching themes. These themes encompassed communication goals and factors affecting their implementation. Four themes emerged: maximising patient outcome, minimising psychological trauma for significant others, paramedic engagement and communicating across cultures. Communication goals shift from maximising patient outcome to minimising psychological trauma for significant others during the resuscitation. Implementation of those goals is affected by paramedic engagement and communicating across cultures.</p></div><div><h3>Conclusions</h3><p>Paramedics used communication techniques based on personal and professional experiences, attempting to navigate limited resources, factors affecting paramedic engagement and a perceived lack of education and support in matters of grief and death.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 2","pages":"Pages 113-118"},"PeriodicalIF":1.8,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9573358","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 a specific training intervention with task interruptions on the quality of simulated advance life support: A randomized multi centered controlled simulation study","authors":"Jennifer Truchot ,&nbsp;Daphné Michelet ,&nbsp;Anne Laure Philippon ,&nbsp;David Drummond ,&nbsp;Yonathan Freund ,&nbsp;Patrick Plaisance","doi":"10.1016/j.auec.2022.10.001","DOIUrl":"10.1016/j.auec.2022.10.001","url":null,"abstract":"<div><h3>Purpose</h3><p>Task interruptions (TI) are frequent disturbances for emergency professionals performing advanced life support (ALS). The aim of our study was to evaluate a specific training intervention with TI on the quality of simulated ALS.</p></div><div><h3>Methods</h3><p>During this multi centered randomized controlled trial, each team included one resident, one nurse and one emergency physician. The teams were randomized for the nature of their training session: control (without interruption) or intervention (with TI). The primary outcome was non-technical skills assessed with the TEAM score. We also measured the no flow time, the Cardiff score and chest compression depth and rate.</p></div><div><h3>Results</h3><p>On a total of 21 included teams, 11 were randomized to a control training session and 10 to the specific TI training. During training, teams’ characteristics and skills were similar between the two groups. During the evaluation session, the TEAM score was not different between groups: median score for control group 33,5 vs 31,5 for intervention group. We also report similar no flow time and Cardiff score.</p></div><div><h3>Conclusion</h3><p>In this simulated ALS study, a specific training intervention with TI did not improve technical and non-technical skills. Further research is required to limit the impact of TI in emergency settings.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 2","pages":"Pages 153-157"},"PeriodicalIF":1.8,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9578580","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":"Medical retrieval of pregnant women in labour: A scoping review","authors":"Jessica McInnes ,&nbsp;Bridget Honan ,&nbsp;Richard Johnson ,&nbsp;Cheryl Durup ,&nbsp;Ajay Venkatesh ,&nbsp;Fergus William Gardiner ,&nbsp;Rebecca Schultz ,&nbsp;Breeanna Spring","doi":"10.1016/j.auec.2022.10.002","DOIUrl":"10.1016/j.auec.2022.10.002","url":null,"abstract":"<div><h3>Background</h3><p><span><span>Remote Australian women in labour often rely on retrieval services to allow birthing in specialist </span>obstetric centres. However, there is currently debate over when </span><em>not</em> to transfer a woman in labour, for risk of an in-transit birth, associated with worse neonatal outcomes.</p></div><div><h3>Methods</h3><p>A scoping review methodology was undertaken, to define the scope of published literature on the topic and identify gaps in the current knowledge.</p></div><div><h3>Results</h3><p><span>A total of seven full texts were deemed suitable for synthesis, which were all retrospective observational studies. Four themes from the studies’ findings were identified: population features, predicting time-to-birth, use of tocolysis and birth during </span>medical evacuation.</p></div><div><h3>Conclusion</h3><p>The evidence identified in this review was of low methodological quality and heterogenous. The key findings were that births in-flight are rare, despite geographical distances and long transport times, with a knowledge gap on predictors of time-to-birth.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 2","pages":"Pages 158-163"},"PeriodicalIF":1.8,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9578588","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":"A comparison of prospective observations and chart audits for measuring quality of care of musculoskeletal injuries in the emergency department","authors":"Fiona C.A. Coombes ,&nbsp;Kirsten Strudwick ,&nbsp;Melinda G. Martin-Khan ,&nbsp;Trevor G. Russell","doi":"10.1016/j.auec.2022.09.002","DOIUrl":"10.1016/j.auec.2022.09.002","url":null,"abstract":"<div><h3>Background</h3><p><span><span>Accurate and efficient data collection is crucial for effective evaluation of quality of care. The objective of this study is to compare two methods of data collection used to score quality indicators for musculoskeletal injury management in </span>Emergency departments: prospective observation, and chart </span>audit.</p></div><div><h3>Methods</h3><p>An analysis was undertaken of data collected from 633 patients who presented with a musculoskeletal injury to eight emergency departments in Queensland, Australia in 2016–17. Twenty-two quality indicators were scored using both prospective observation and chart audit data for each occasion of service. Quality indicators were included if they were originally published with both collection methods. Analyses were performed to compare firstly, the quality indicator denominators, and secondly, the quality indicator trigger rates, scored using each collection method. Chi Square statistics were used to identify significant differences.</p></div><div><h3>Results</h3><p>Prospectively collected data scored quality indicator denominators significantly (p value&lt;0.05) more often than chart audit data for five (22.7 %) of the 22 quality indicators. The remaining 17 quality indicators (77.3 %) showed no statistical differences. When comparing quality indicator trigger rates, 16 (72.7 %) had significantly different results between methods with 12 (54.5 %) scoring higher using prospective data and four (18.2 %) with chart audit data. The remaining six quality indicators (27.3 %) in this comparison showed no significant difference between chart and prospective data.</p></div><div><h3>Conclusion</h3><p>Quality indicators including aspects of care associated with patient safety, and those relying on clinician written orders or forms were adequately scored using either prospective observation or chart audit data. Whereas quality indicators relying on time-sensitive information, elements of a social history, general physical exams and patient education and advice scored higher using prospective observation data collection.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 2","pages":"Pages 132-141"},"PeriodicalIF":1.8,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9574816","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":"Impact of an emergency department rapid response system on inpatient clinical deterioration: A controlled pre-post study","authors":"Belinda Munroe ,&nbsp;Kate Curtis ,&nbsp;Margaret Fry ,&nbsp;Sharyn Balzer ,&nbsp;Panchalee Perara ,&nbsp;Tracey Couttie ,&nbsp;Karlie Royston ,&nbsp;Ping Yu ,&nbsp;Natasha Tidswell ,&nbsp;Julie Considine","doi":"10.1016/j.auec.2023.05.001","DOIUrl":"10.1016/j.auec.2023.05.001","url":null,"abstract":"<div><h3>Aim</h3><p>To determine the impact implementation of Emergency Department Clinical Emergency Response System (EDCERS) on inpatient deterioration events and identify contributing causal factors.</p></div><div><h3>Methods</h3><p>EDCERS was implemented in an Australian regional hospital, integrating a single parameter track and trigger criteria for escalation of care, and emergency, specialty and critical care clinician response to patient deterioration. In this controlled pre-post study, electronic medical records of patients who experienced a deterioration event (rapid response call, cardiac arrest or unplanned intensive care admission) on the ward within 72 h of admission from the emergency department (ED) were reviewed. Causal factors contributing to the deteriorating event were assessed using a validated human factors framework.</p></div><div><h3>Results</h3><p>Implementation of EDCERS reduced the number of inpatient deterioration events within 72 h of emergency admission with failure or delayed response to ED patient deterioration as a causal factor. There was no change in the overall rate of inpatient deterioration events.</p></div><div><h3>Conclusion</h3><p>This study supports wider implementation of rapid response systems in the ED to improve management of deteriorating patients. Tailored implementation strategies should be used to achieve successful and sustainable uptake of ED rapid response systems and improve outcomes in deteriorating patients.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 4","pages":"Pages 333-340"},"PeriodicalIF":1.8,"publicationDate":"2023-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9491541","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":"Preparing undergraduate student paramedics to consider their mental health during clinical placement in Australia","authors":"Anthony Weber ,&nbsp;Briella Weber ,&nbsp;Shannon Delport","doi":"10.1016/j.auec.2023.05.002","DOIUrl":"10.1016/j.auec.2023.05.002","url":null,"abstract":"<div><h3>Introduction</h3><p>This article explores the impact of mental health issues on paramedics in Australia, particularly Post-Traumatic Stress Disorder, caused by their exposure to high levels of stress. The prevalence of Post-Traumatic Stress Disorder is higher among paramedics than any other occupation, and this could be a cause for concern, especially for undergraduate student paramedics. The article examines the need to build resilience among student paramedics to help them handle the trauma they may experience during clinical placement.</p></div><div><h3>Methods</h3><p>This study conducted a two-step process to review literature and university handbooks to determine the level of education provided to paramedic students on Post-Traumatic Stress Disorder and resilience during clinical placement, due to the lack of research in this area. The first step involved a search for relevant articles, while the second step involved a search of the Australian Health Practitioner Regulation Agency website to identify paramedicine programs and a manual evaluation of each undergraduate pre-registration paramedicine curriculum in Australia.</p></div><div><h3>Results</h3><p>This study conducted a systematic search of national and international literature and Australian undergraduate pre-registration paramedicine programs to identify any studies pertaining to the education of paramedic students in resilience and Post Traumatic Stress Disorder. The search found that only 15 (5.95 %) of the 252 reviewed subjects had reference to mental health, resilience or Post-Traumatic Stress Disorder, with only 4 (1.59 %) of them discussing these topics in preparation for clinical practice. The study highlights the lack of emphasis on student paramedic self-care as an essential underpinning for clinical placement preparation in the curriculum.</p></div><div><h3><strong>Conclusion</strong></h3><p>This literature review concludes that appropriate training and support, teaching resilience, and promoting self-care are crucial in preparing paramedic students for the emotional and psychological demands of their work. Equipping students with these tools and resources can improve their mental health and well-being and enhance their ability to provide high-quality care to patients. Promoting self-care as a core value in the profession is essential in creating a culture that supports paramedics in maintaining their own mental health and well-being.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 4","pages":"Pages 341-345"},"PeriodicalIF":1.8,"publicationDate":"2023-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9860739","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":"Adherence to recommended guidelines for low back pain presentations to an Australian emergency department: Barriers and enablers","authors":"Janelle Heine ,&nbsp;Peter Window ,&nbsp;Sarah Hacker ,&nbsp;Jordan Young ,&nbsp;Gary Mitchell ,&nbsp;Shea Roffey ,&nbsp;Michelle Cottrell","doi":"10.1016/j.auec.2023.04.003","DOIUrl":"10.1016/j.auec.2023.04.003","url":null,"abstract":"<div><h3>Objective</h3><p>This study sought to evaluate the adherence to guidelines for the management of mechanical Low Back Pain within a single tertiary metropolitan Emergency Department setting. Our objectives were:</p><p></p><ul><li><span>1.</span><span><p>To identify the proportion of patients presenting to a single Emergency Department with mechanical Low Back Pain who received management in line with the guidelines; and</p></span></li><li><span>2.</span><span><p>To understand and describe factors that can influence clinicians’ (non-) adherence to the guidelines.</p></span></li></ul></div><div><h3>Methods</h3><p>A two-stage multi-methods study design was undertaken. Stage 1 involved a retrospective chart audit of patients presenting with a diagnosis of mechanical Low Back Pain to establish documented adherence to clinical guidelines. Stage 2 explored clinicians’ perspectives towards factors influencing adherence to the guidelines via a study-specific survey and follow up focus groups.</p></div><div><h3>Results</h3><p>The audit demonstrated low adherence to the following guidelines: (i) appropriate prescription of analgesia, (ii) targeted education and advice, and (iii) attempts to mobilise. Three major themes were identified as factors influencing adherence to the guidelines: (1) clinician driven influences and factors, (2) workflow processes, and (3) patient expectations and behaviours.</p></div><div><h3>Conclusion</h3><p>There was low adherence to some published guidelines and factors influencing adherence to the guidelines were multi-factorial. Understanding the factors that influence care decisions and developing strategies to address these can improve Emergency Department management of mechanical Low Back Pain.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 4","pages":"Pages 326-332"},"PeriodicalIF":1.8,"publicationDate":"2023-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9847913","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 that contribute to patient length of stay in the emergency department: A time in motion observational study","authors":"Karlie Payne ,&nbsp;Dante Risi ,&nbsp;Anna O’Hare ,&nbsp;Simon Binks ,&nbsp;Kate Curtis","doi":"10.1016/j.auec.2023.04.002","DOIUrl":"10.1016/j.auec.2023.04.002","url":null,"abstract":"<div><h3>Objectives</h3><p>Increased Emergency Department length of stay impacts access to emergency care and is associated with increased patient morbidity, overcrowding, reduced patient and staff satisfaction. We sought to determine the contributing factors to increased length of stay in our mixed ED.</p></div><div><h3>Methods</h3><p>A real-time observational study was conducted at Wollongong Hospital over a continuous 72-h period. Times of intervention, assessment and treatment were recorded by dedicated emergency medical or nurse observers. The time from triage to each event was calculated and descriptive analyses performed. Free text comments were analysed using inductive content analysis.</p></div><div><h3>Results</h3><p>Data were collected on 381 of 389 eligible patients. The largest time delays were experienced by patients who required a CT, specialist review and/or an inpatient bed. Registrars and nurse practitioners were the most efficient in reaching a decision to admit or discharge. The time from triage to specialist review increased with the number requested (148 min for one, 224 min for two and 285 min for three). The longest length of stay was experienced by mental health and paediatric patients.</p></div><div><h3>Conclusions</h3><p>The main delays contributing to ED length of stay were CT imaging and specialist reviews. Overcrowding in ED need targeted, site-specific interventions.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 4","pages":"Pages 321-325"},"PeriodicalIF":1.8,"publicationDate":"2023-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9780309","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":"Epidemiology and management of traumatic brain injury in a regional Queensland Emergency Department","authors":"Matthew I. Hiskens ,&nbsp;Tesfaye S. Mengistu ,&nbsp;Bauke Hovinga ,&nbsp;Neale Thornton ,&nbsp;Karen B. Smith ,&nbsp;Gary Mitchell","doi":"10.1016/j.auec.2023.04.001","DOIUrl":"10.1016/j.auec.2023.04.001","url":null,"abstract":"<div><h3>Background</h3><p>There is a paucity of traumatic brain injury<span> (TBI) data in Australia in the regional and rural context. This study aimed to investigate the epidemiology, severity, causes, and management of TBI in a regional north Queensland population to plan acute care, follow up, and prevention strategies.</span></p></div><div><h3>Methods</h3><p><span>This retrospective study analysed TBI patients presenting to Mackay Base Hospital Emergency Department (ED) in 2021. We identified patients using head injury </span>SNOMED<span> codes, and analysed patient characteristics with descriptive and multivariable regression analysis.</span></p></div><div><h3>Results</h3><p>There were 1120 head injury presentations, with an overall incidence of 909 per 100,000 people per year. The median (IQR) age was 18 (6−46) years. Falls were the most common injury mechanism (52.4% of presentations). 41.1% of patients had a Computed Tomography (CT) scan, while 16.5% of patients who met criteria had post traumatic amnesia (PTA) testing. Age, being male and Indigenous status were associated with higher odds of moderate to severe TBI.</p></div><div><h3>Conclusion</h3><p>TBI incidence in this regional population was higher than metropolitan locations. CT scan was undertaken less frequently than in comparative literature, and low rates of PTA testing were undertaken. These data provide insight to assist in planning prevention and TBI-care services.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 4","pages":"Pages 314-320"},"PeriodicalIF":1.8,"publicationDate":"2023-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9475684","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}