Australasian Emergency Care最新文献

{"title":"As loud as a construction site: Noise levels in the emergency department","authors":"Corey Adams ,&nbsp;Ramya Walsan ,&nbsp;Rebecca McDonnell ,&nbsp;Anthony Schembri","doi":"10.1016/j.auec.2023.07.004","DOIUrl":"10.1016/j.auec.2023.07.004","url":null,"abstract":"<div><h3>Background</h3><p>The Emergency Department (ED), while being an integral part of healthcare systems, frequently experiences noise levels surpassing the World Health Organization's recommended thresholds. These excessive noise levels could considerably compromise the safety and wellbeing of both patients and staff.</p></div><div><h3>Methods</h3><p>To evaluate noise levels throughout the ED environment, this study utilized dosimeters to measure noise levels over a 24-hour period in six distinct locations, including the ED Waiting Room and Treatment areas.</p></div><div><h3>Results</h3><p>The study found that noise exceeded the WHO recommendations in all six areas of the ED for the entire 24-hour period. Peak noise levels were recorded up to 102.8 dB, which is as loud as noise levels at a construction site. The ED Waiting Room exhibited high peak and average noise levels, indicating the urgent need for quality improvement efforts. These findings align with the results of previous research, thereby suggesting that noise levels in the ED have remained problematic for more than a decade.</p></div><div><h3>Conclusion</h3><p>The findings of this study underscore the importance of addressing excessive noise levels in the ED to create a safe and therapeutic hospital environment for both patients and staff. Healthcare organizations must implement proactive measures to address excessive noise levels in the ED.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 1","pages":"Pages 26-29"},"PeriodicalIF":1.8,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2588994X23000507/pdfft?md5=8724fdf143fad4a5c0b242b59b9276b6&pid=1-s2.0-S2588994X23000507-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9926994","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":"Staff perceptions of barriers to self-harm care in the emergency department: A cross-sectional survey study","authors":"Hannah Richards ,&nbsp;Gowri Rajaram ,&nbsp;Michelle Lamblin ,&nbsp;Jonathan Knott ,&nbsp;Owen Connolly ,&nbsp;Sarah Hetrick ,&nbsp;Jo Robinson","doi":"10.1016/j.auec.2023.07.002","DOIUrl":"10.1016/j.auec.2023.07.002","url":null,"abstract":"<div><h3>Background</h3><p>Emergency departments (EDs) are often the first point of contact for people with self-harm; however, they do not always receive optimal care. The study objective was to examine the perspectives of ED staff who respond to self-harm presentations, perceived barriers to providing optimal, guideline-concordant care, and staff’s familiarity with existing guidelines.</p></div><div><h3>Methods</h3><p>An online cross-sectional survey comprising purpose-designed questions concerning self-harm in the ED was completed by 131 staff (83.2% nurses) from two hospitals in Victoria, Australia. Survey results were analysed using Stata version 16 and frequencies and percentages were calculated.</p></div><div><h3>Results</h3><p>Respondents reported knowledge of how to appropriately manage a person presenting with self-harm. However, lack of space (62.3%) and time (78.7%) to conduct the appropriate assessments, lack of self-harm training (71.8%), and limited awareness of or access to guidelines and recommendations for self-harm management within the ED (63.6%), were identified as primary barriers to their ability to appropriately manage these presenters.</p></div><div><h3>Conclusions</h3><p>Improvements to the ED environment and processes, as well as the provision of regular self-harm specific education and training for all ED staff are needed. Implementation of best-practice standards should prioritise guideline-concordant care, with a particular focus on the education needs of nursing staff.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 1","pages":"Pages 15-20"},"PeriodicalIF":1.8,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2588994X23000489/pdfft?md5=542a252986e47d3b0758c48f21e81054&pid=1-s2.0-S2588994X23000489-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10265846","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":"Secondary traumatic stress in partners of paramedics: A scoping review","authors":"Matthew A. Hill ,&nbsp;Jessica L. Paterson ,&nbsp;Amanda L. Rebar","doi":"10.1016/j.auec.2023.06.002","DOIUrl":"10.1016/j.auec.2023.06.002","url":null,"abstract":"<div><h3>Background</h3><p>Paramedics experience post-traumatic stress in their work, and many paramedics turn to their intimate partner for support. However, exposure to traumatic event details can leave partners vulnerable to secondary traumatic stress. Despite substantial research into reducing stress and improving support for paramedics, few studies have investigated their partners’ trauma experiences and support needs. This scoping review aimed to examine evidence regarding secondary traumatic stress in paramedic partners.</p></div><div><h3>Methods</h3><p><span>The MEDLINE, PsychINFO, </span>CINAHL, EMCare, and Sociology Source Ultimate databases were searched up to November 9, 2022. The results sections of studies published in English involving a sample of paramedic partners that examined the impact of paramedics’ work-related exposure to trauma on their intimate partner were extracted for analysis. This scoping review was guided by the Joanna Briggs Institute methodology. Key themes were generated using a framework synthesis approach.</p></div><div><h3>Results</h3><p>Five qualitative studies and one quantitative study were included, indicating a paucity of literature regarding secondary traumatic stress in paramedic partners. Post-traumatic stress experienced by paramedics can crossover to paramedic partners in the form of secondary traumatic stress; furthermore, it can have widespread effects on couple functioning. While paramedic partners appear to recognise the need for effective coping strategies, they perceive that little support is available to them. Notably, effective strategies aimed at reducing secondary traumatic stress in paramedic partners are limited.</p></div><div><h3>Conclusion</h3><p>Further research is required to quantify secondary traumatic stress severity in paramedic partners and explore relationships between post-traumatic stress, secondary traumatic stress, and couple functioning. Further, evaluation of partner support needs and barriers to accessing support is warranted.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 1","pages":"Pages 1-8"},"PeriodicalIF":1.8,"publicationDate":"2023-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9769087","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":"Relationship between transition shock in novice emergency room nurses, quality of nursing care, and adverse patient events: The mediating role of emotional exhaustion","authors":"Leodoro J. Labrague","doi":"10.1016/j.auec.2023.07.001","DOIUrl":"10.1016/j.auec.2023.07.001","url":null,"abstract":"<div><h3>Background</h3><p>Transition shock<span><span>, experienced during the first two years of employment, has been attributed to decreased clinical performance and an overall decrease in work productivity among newly graduated nurses, as well as compromised patient safety outcomes. This study tested the intermediary effect of </span>emotional exhaustion<span> on the association between transition shock in novice emergency room (ER) nurses, adverse patient events, and nursing care quality.</span></span></p></div><div><h3>Methods</h3><p>A descriptive study was carried out involving 303 novice ER nurses from various emergency units in five different hospitals in Central Philippines, utilizing four standardized scales. Mediation testing was performed using Hayes' PROCESS macro in SPSS (Model 4).</p></div><div><h3>Results</h3><p>Transition shock in novice ER nurses was associated with an increased incidence of adverse patient events (β = 0.3897, p = 0.0005) and poorer nursing care quality (β = −0.2146, p = 0.0021). Furthermore, emotional exhaustion partially mediated the association between transition shock and the two patient-related outcomes: adverse patient events (β = 0.0477, 95 % CI = 0.0078–0.0997) and nursing care quality (β = −0.0142, 95 % CI = −0.0412 to −0.0095).</p></div><div><h3>Conclusions</h3><p>Transition shock in novice ER nurses contributed to heightened emotional exhaustion, which subsequently led to an increased incidence of adverse patient events and a decline in the quality of nursing care.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"27 1","pages":"Pages 9-14"},"PeriodicalIF":1.8,"publicationDate":"2023-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9779022","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":"Educational programs for implementing ultrasound guided peripheral intravenous catheter insertion in emergency departments: A systematic integrative literature review","authors":"Renee Stone ,&nbsp;Rachel M. Walker ,&nbsp;Nicole Marsh ,&nbsp;Amanda J. Ullman","doi":"10.1016/j.auec.2023.06.001","DOIUrl":"10.1016/j.auec.2023.06.001","url":null,"abstract":"<div><h3>Background</h3><p>Ultrasound-guided peripheral intravenous catheter insertion has been identified as an effective method to improve the success rate of cannulation, thereby improving patient experience. However, learning this new skill is complex, and involves training clinicians from a variety of backgrounds. The aim of this study was to appraise and compare literature on educational methods in the emergency setting used to support ultrasound guided peripheral intravenous catheter insertion by different clinicians, and how effective these current methods are.</p></div><div><h3>Review methods</h3><p>A systematic integrative review was undertaken using Whittemore and Knafl’s five stage approach. The Mixed Methods Appraisal Tool was used to assess the quality of the studies.</p></div><div><h3>Results</h3><p>Forty-five studies met the inclusion criteria, with five themes identified. These were: the variety of educational methods and approaches; the effectiveness of the different educational methods; barriers and facilitators of education; clinician competency assessments and pathways; clinician confidence assessment and pathways.</p></div><div><h3>Conclusions</h3><p>This review demonstrates that a variety of educational methods are being used in successfully training emergency department clinicians in using ultrasound guidance for peripheral intravenous catheter insertion. Furthermore, this training has resulted in safer and more effective vascular access. However, it is evident that there is a lack of consistency of formalised education programs available. A standardised formal education program and increased availability of ultrasound machines in the emergency department will ensure consistent practices are maintained, retained, therefore leading to safer practice as well as more satisfied patients.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 4","pages":"Pages 352-359"},"PeriodicalIF":1.8,"publicationDate":"2023-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10141001","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":"Occupational violence in a tertiary emergency department: A retrospective descriptive study","authors":"Alexander Joyce ,&nbsp;Richard Pellatt ,&nbsp;Jamie Ranse ,&nbsp;Amy Doumany ,&nbsp;Emma Hall ,&nbsp;Amy Sweeny ,&nbsp;Gerben Keijzers","doi":"10.1016/j.auec.2023.05.003","DOIUrl":"10.1016/j.auec.2023.05.003","url":null,"abstract":"<div><h3>Objective</h3><p>Occupational violence in emergency departments (EDs) impacts staff and patients. Most hospitals have a response mechanism called a ‘Code Black’ or similar. We aimed to determine the incidence of Code Black activations in a tertiary ED and describe contributory factors, management strategies and adverse events.</p></div><div><h3>Methods</h3><p>Descriptive study in a tertiary ED in South-East Queensland in 2021. Adult patients for who a Code Black had been activated were eligible. Data were obtained from a prospectively collected Code Black database, supplemented with retrospective electronic medical records.</p></div><div><h3>Results</h3><p>There were 386 Code Black events. The incidence of Code Black activation was 11.0 per 1000 adult ED presentations. Individuals requiring Code Black activation were 59.6 % male with a mean age of 40.9 years. The primary diagnosis was mental illness related in 55.1 %. Alcohol was a suspected factor in 30.9 %. When Code Black activation occurred, median length of stay increased. Restraint including physical, chemical or both were used in 54.1 % of Code Blacks.</p></div><div><h3>Conclusion</h3><p>Occupational violence occurs at a three-fold greater incidence within this ED than reported elsewhere. This study reinforces other literature suggesting an increase in occupational violence, demonstrating the need for dedicated preventative strategies for patients at risk of agitation.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 4","pages":"Pages 346-351"},"PeriodicalIF":1.8,"publicationDate":"2023-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9655664","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":"Pre-hospital peripheral intravenous catheter insertion practice: An integrative review","authors":"Eleanor Golling ,&nbsp;Thea van de Mortel ,&nbsp;Nigel Barr ,&nbsp;Peta-Anne Zimmerman","doi":"10.1016/j.auec.2022.08.006","DOIUrl":"10.1016/j.auec.2022.08.006","url":null,"abstract":"<div><h3>Background</h3><p><span>Peripheral intravenous catheters (PIVCs) are widely used within healthcare settings. There is substantial hospital-based research, particularly in </span>Emergency Departments<span>, supporting the need to reduce inappropriate PIVCs due to associated risks. However, there is limited research into pre-hospital practice. This review aims to determine the rates of pre-hospital PIVC insertions, how many remain unused, and to explore paramedic PIVC decision-making.</span></p></div><div><h3>Methods</h3><p>A systematic search of research databases was undertaken using an integrative review methodology. Articles published between 2011 and April 2022 were included. The Mixed Methods Appraisal Tool was used to assess the quality of the studies.</p></div><div><h3>Results</h3><p>Fifteen studies were included. Rates of PIVC insertions ranged from 21% to 58%. Up to 72% of PIVCs remained unused in the pre-hospital setting. Paramedic decision-making was not well reported, though erring of the side of caution and inserting a “just in case” PIVC was identified.</p></div><div><h3>Conclusion</h3><p>There are limited articles on pre-hospital PIVC practice, particularly in Australian settings. Research is required to understand factors influencing practice and provide contemporary evidence to inform the development of guidance specific to the pre-hospital setting to reduce the numbers of inappropriate PIVCs.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 2","pages":"Pages 105-112"},"PeriodicalIF":1.8,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9566465","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 staff perceptions of their roles in providing end of life care","authors":"Oluwatomilayo (Tomi) Omoya,&nbsp;Anita De Bellis,&nbsp;Katrina Breaden","doi":"10.1016/j.auec.2022.09.001","DOIUrl":"10.1016/j.auec.2022.09.001","url":null,"abstract":"<div><h3>Background</h3><p>End of life care<span> in the emergency department is environmentally and culturally challenging. The aim of this study was to determine Australian emergency department doctors and nurses’ perceptions of their roles in providing end of life care in this environment.</span></p></div><div><h3>Methods</h3><p><span>Perceptions of end-of-life care roles were identified through semi-structured interviews with doctors and nurses using Dieklemann’s seven interpretative stages of analysis guided by phenomenological interpretive underpinnings (hermeneutics). Nine nurses and seven doctors were recruited using purposive sampling. Organisations for emergency doctors (Australasian College for Emergency Medicine: ACEM) and emergency nurses (College of </span>Emergency Nursing Australasia: CENA) were approached to advertise the study and recruit participants across Australia via email.</p></div><div><h3>Results</h3><p>Results were categorised into four themes namely: role perception; the intensive nature of the role; emotional burden; and role integration. The participants stated that end of life care was provided according to their professional roles and responsibilities. Doctors and nurses had distinct tasks, some of which overlapped. The accounts of the participants in relation to their understanding of each other’s roles highlighted differences in how nurses perceived the role of doctors, and vice versa. The participants spoke about aspects that had an impact on their role of practicing end of life care in the emergency department setting.</p></div><div><h3>Conclusions</h3><p>In this study, all participants expressed concern for dying patients in the emergency department. The delivery of quality end of life care was believed to be paramount and required staff to work together to achieve the best outcome for the dying patient and their families. Regardless of the similarities and differences that were perceived within their roles, the nurses and doctors believed that their main objective was to ensure that comfort care was provided to dying patients.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 2","pages":"Pages 126-131"},"PeriodicalIF":1.8,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9573360","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":"Mental Health First Aid training for paramedic students: An evaluation study","authors":"Daniel P. Wadsworth ,&nbsp;Matthew Warren-James ,&nbsp;David Duncan ,&nbsp;Lisa Clegg","doi":"10.1016/j.auec.2022.09.003","DOIUrl":"10.1016/j.auec.2022.09.003","url":null,"abstract":"<div><h3>Background</h3><p>The combination of first-year placements, an increasing proportion of mental health callouts, and the high incidence of mental illness in health-professional tertiary students means standard curricula may not adequately prepare early-year paramedic students for mental health challenges.</p></div><div><h3>Methods</h3><p>A retrospective online survey was used to explore the experiences of paramedic students who have completed Mental Health First Aid (MHFA) training within their undergraduate studies. The content-validated survey explored the relevance, appropriateness, and novelty of MHFA training, and invited participants to reflect on the course strengths and weaknesses.</p></div><div><h3>Results</h3><p>The majority of 102 respondents, predominantly female first- and second-year paramedic students aged 18–24 years, agreed the content was relevant (86%) and appropriate (88%), with 73% agreeing they would recommend to other university students. Thematic analysis identified strengths of the course as perceived increases in mental health literacy and empowerment to act on mental health concerns. A weakness was students perceived the course did not prepare them adequately for clinical practice.</p></div><div><h3>Conclusion</h3><p>The inclusion of MHFA early in paramedic curricula is appropriate and relevant, increasing mental health literacy and empowering students to recognise and act upon mental health concerns. Application of practical scenarios may further enhance student learning experiences.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 2","pages":"Pages 142-148"},"PeriodicalIF":1.8,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9575549","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 training, experience, and confidence with out-of-hospital childbirth (OOHB) in Australia","authors":"Michella G. Hill ,&nbsp;Belinda Flanagan ,&nbsp;Brennen Mills ,&nbsp;Sara Hansen ,&nbsp;Luke Hopper","doi":"10.1016/j.auec.2022.08.008","DOIUrl":"10.1016/j.auec.2022.08.008","url":null,"abstract":"<div><h3>Background</h3><p><span>Out-of-hospital births<span> (OOHBs) are rare representing ∼0.05% of prehospital callouts. OOHBs are at increased risk of complications including life-threatening conditions such as postpartum haemorrhage and neonate resuscitation. This research investigated Australian </span></span>paramedics perceptions of’ training, experience, and confidence with OOHBs.</p></div><div><h3>Methods</h3><p>Semi-structured qualitative interviews were undertaken in late 2021 via online conference or face-to-face. Sessions were audio-recorded and transcribed. Data was analysed and coded into over-arching themes using thematic analysis.</p></div><div><h3>Results</h3><p>Fourteen participants were interviewed from military, industrial, and jurisdictional ambulance services. Nine participants were female, and experience ranged from 1.5 to 20 years. Six Australian states were represented, incorporating rural and metropolitan regions. Participants reported sporadic or infrequent training. No participant had exposure to OOHBs during their undergraduate degree, with the most experienced paramedic only attending six births. Participants with little/no experience reported low confidence, and even more experienced participants reported anxiety when attending OOHBs, particularly if there were long distances to definitive care or potential complications.</p></div><div><h3>Conclusion</h3><p>Many paramedics expressed low confidence and high anxiety regarding OOHBs, especially regarding complications. Many felt insufficient time was dedicated to OOHBs during education and training. This has the capacity to impact on patient care and outcomes.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 2","pages":"Pages 119-125"},"PeriodicalIF":1.8,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9573361","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}