Canadian Geriatrics Journal最新文献

{"title":"Relationship Between Social Activity and Frailty in Japanese Older Women During Restriction on Outings due to COVID-19.","authors":"Michiko Akita,&nbsp;Naoto Otaki,&nbsp;Miyuki Yokoro,&nbsp;Megumu Yano,&nbsp;Norikazu Tanino,&nbsp;Keisuke Fukuo","doi":"10.5770/cgj.24.507","DOIUrl":"https://doi.org/10.5770/cgj.24.507","url":null,"abstract":"<p><strong>Background: </strong>This study investigated the relationship between social activities and frailty during the restriction on outings due to COVID-19.</p><p><strong>Design: </strong>A cross-sectional study.</p><p><strong>Setting and subjects: </strong>This study was conducted in City Nishinomiya of Prefecture Hyogo, in Japan. A mail survey was carried out among women aged 65 years or older in May 2020. A population of 293 women aged 65 years or older living in the community was recruited for the study and 213 of them were analyzed.</p><p><strong>Measurements: </strong>The survey included questions on sex, age, height, weight, and social activity. Social activity consisted of participation in social organizations and their frequency, as well as frequency of interaction with family and friends. The survey also asked if regular social activity had been impeded by COVID-19.</p><p><strong>Results: </strong>A significant association was found between frailty and hindered interaction with friends (β: 0.176, <i>p</i> = .014). Multivariate linear regression analysis confirmed that this association was also significant in Model 1 (β: 0.158, <i>p</i> = .025), and Model 2 (β: 0.148, <i>p</i> = .034).</p><p><strong>Conclusions: </strong>No association between being hindered in social activity and frailty was found in older women living in the community during the restriction on outings due to COVID-19.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"24 4","pages":"320-324"},"PeriodicalIF":3.9,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/52/b7/cgj-24-320.PMC8629505.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39841645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CAGP-CCSMH Annual Scientific Meeting: Book of Abstracts","authors":"V. Authors","doi":"10.5770/cgj.25.595","DOIUrl":"https://doi.org/10.5770/cgj.25.595","url":null,"abstract":"Facilitate evidence-based shared decision-making with patients and caregivers using a tool (i.e. rank-heat plot) that ranks the comparative efficacy of pharmacologic and nonpharmacologic interventions across multiple treatment choices and outcomes of interest (i.e. agitation, aggression, depression, fractures, falls, stroke, and death) Update of the Canadian Coalition for Seniors Mental Health Guidelines on the Assessment and Treatment of Depression David Conn, Robert Madan, Cindy Grief, Chris Frank, Lori Amdam, Daniel Blumberger, Kiran Rabheru, Anar Dilara Background: In 2006 the Canadian Coalition for Seniors Mental Health (CCSMH) released four sets of national clinical guidelines focused on older adults. Sivan Klil-Drori, Natalie Phillips, Alita Fernandez, Shelly Solomon, Howard Chertkow Background: Progression of Alzheimer's disease and other types of dementia are commonly conceptualized in a specific order: (1) subjective cognitive impairment: subjective complaints without objective cognitive decline, (2) mild cognitive impairment (MCI): subjective complaints and objective cognitive decline, (3) dementia: objective cognitive decline and functional impairment. False-positive presentation of a person with cognitive decline (e.g., lack of insight, various personality characteristics, etc.). [...]over relying on subjective complaints should be considered in cognitive screening. Standardizing Care for Neuropsychiatric Symptoms and Quality of Life in Dementia (StaN): Opportunities and Challenges of Implementing Algorithmic Care Pathway in Long Term Care Setting Nilah Ahimsadasan, Steve Crawford, Sarah Colman, Peter Derkach, Nancy McKeough, Aviva Rostas, Zahinoor Ismail, Amer M Burhan, The StaN Study Group Background: 80% of patients with Alzheimer's disease experience neuropsychiatric symptoms, with Alzheimer disease agitation and aggression (AD-AA) being the most burdensome of these symptoms.","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"25 1","pages":"88 - 109"},"PeriodicalIF":3.9,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45189308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Qualitative and Quantitative Analysis of the Geriatrics Update: Clinical Pearls Course.","authors":"Peter Hoang,&nbsp;Lindsay Torbiak,&nbsp;Zahra Goodarzi,&nbsp;Heidi N Schmaltz","doi":"10.5770/cgj.24.503","DOIUrl":"https://doi.org/10.5770/cgj.24.503","url":null,"abstract":"<p><strong>Background: </strong>The University of Calgary Cumming School of Medicine Annual Geriatrics Update: Clinical Pearls Course (Geriatrics Update) is a one-day, continuing medical education (CME) course designed to enhance geriatrics competency for family physicians (FPs), given increasing population age and complexity. We aimed to evaluate how the course meets FPs' perceived learning needs and identify modifications that may better support FPs.</p><p><strong>Methods: </strong>Descriptive data from 2018-2019 course evaluation surveys including demographic data, evaluations, and narrative feedback from participating FPs. Semi-structured phone and video-conferenced interviews with FPs were thematically analyzed each year.</p><p><strong>Results: </strong>Evaluation surveys had high response rates of FPs (52 or 61% in 2018; 39 or 58% in 2019). Most FP respondents (84% in 2018 and 82% in 2019) intended to make practice changes. FPs were significantly (<i>p</i>=.001) more confident on course objectives after the course in both years. All interviewees (n=20) described fulfilled perceived and unperceived learning needs and planned to return. The Geriatrics Update course is the primary source of Geriatrics CME for 60% of interviewees.</p><p><strong>Conclusions: </strong>Iterative evaluation of Geriatrics Update identified that the course is well received, and often FPs primary source of geriatric CME. Interviews provided additional context and descriptive feedback to improve course delivery and better meet FP learning needs.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"24 4","pages":"304-311"},"PeriodicalIF":3.9,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/dd/06/cgj-24-304.PMC8629497.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39841643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Updated Inventory and Projected Requirements for Specialist Physicians in Geriatrics.","authors":"Monisha Basu,&nbsp;Tracy Cooper,&nbsp;Kelly Kay,&nbsp;David B Hogan,&nbsp;José A Morais,&nbsp;Frank Molnar,&nbsp;Robert E Lam,&nbsp;Michael J Borrie","doi":"10.5770/cgj.24.538","DOIUrl":"https://doi.org/10.5770/cgj.24.538","url":null,"abstract":"<p><strong>Background: </strong>The predicted growth of Canadians aged 65+ and the resultant rise in the demand for specialized geriatric services (SGS) requires physician resource planning. We updated the 2011 Canadian Geriatrics Society physician resource inventory and created projections for 2025 and 2030.</p><p><strong>Methods: </strong>The number and full-time equivalents (FTEs) of geriatricians and Care of the Elderly (COE) physicians working in SGS were determined. FTE counts for 2025 and 2030 were estimated by accounting for retirements and trainees. A ratio of 1.25/10,000 population 65+ was used to predict physician resource requirements.</p><p><strong>Results: </strong>Between 2011 and 2019 the number of geriatricians and COE physicians increased from 276 (235.8 FTEs) and 128 (89.9 FTEs), respectively, to 376 (319.6 FTEs) and 354 (115.5 FTEs). This increase did not keep pace with the 65+ population growth. The current gap between supply and need is expected to increase.</p><p><strong>Discussion: </strong>The physician supply gap is projected to widen in 2025 and 2030. Increased recruitment and interdisciplinary team-based care, supported by enhanced funding models, and full integration of COE physicians in SGS could reduce this increasing gap. In contrast to pediatrician supply in Canada, the specialist physician resources available to the population 65+ reflect a disparity.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"24 3","pages":"200-208"},"PeriodicalIF":3.9,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9a/34/cgj-24-200.PMC8390327.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39388541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 and Long-Term Care: the Essential Role of Family Caregivers.","authors":"Whitney Hindmarch,&nbsp;Gwen McGhan,&nbsp;Kristin Flemons,&nbsp;Deirdre McCaughey","doi":"10.5770/cgj.24.508","DOIUrl":"https://doi.org/10.5770/cgj.24.508","url":null,"abstract":"<p><strong>Background: </strong>Those most at risk from severe COVID-19 infection are older adults; therefore, long-term care (LTC) facilities closed their doors to visitors and family caregivers (FCGs) during the initial wave of the COVID-19 pandemic. The most common chronic health condition among LTC residents is dementia, and persons living with dementia (PLWD) rely on FCGs to maintain their care provision. This study aims to evaluate the impact of visitor restrictions and resulting loss of FCGs providing in-person care to PLWD in LTC during the first wave of the COVID-19 pandemic.</p><p><strong>Method: </strong>An online survey and follow-up focus groups were conducted June to September 2020 (n=70). Mixed quantitative (descriptive statistics) and qualitative (thematic analysis) methods were used to evaluate study data.</p><p><strong>Results: </strong>FCGs were unable to provide in-person care and while alternative communication methods were offered, they were not always effective. FCGs experienced negative outcomes including social isolation (66%), strain (63%), and reduced quality of life (57%). PLWD showed an increase in responsive behaviours (51%) and dementia progression. Consequently, 85% of FCGs indicated they are willing to undergo specialized training to maintain access to their PLWD.</p><p><strong>Conclusion: </strong>FCGs need continuous access to PLWD they care for in LTC to continue providing essential care.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"24 3","pages":"195-199"},"PeriodicalIF":3.9,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f5/ce/cgj-24-195.PMC8390326.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39388540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Avoidable Hospitalizations in Persons with Dementia: a Population-Wide Descriptive Study (2000-2015).","authors":"Claire Godard-Sebillotte,&nbsp;Erin Strumpf,&nbsp;Nadia Sourial,&nbsp;Louis Rochette,&nbsp;Eric Pelletier,&nbsp;Isabelle Vedel","doi":"10.5770/cgj.24.486","DOIUrl":"https://doi.org/10.5770/cgj.24.486","url":null,"abstract":"<p><strong>Background: </strong>Whether avoidable hospitalizations in community-dwelling persons with dementia have decreased during primary care reforms is unknown.</p><p><strong>Methods: </strong>We described the prevalence and trends in avoidable hospitalizations in population-based repeated yearly cohorts of 192,144 community-dwelling persons with incident dementia (Quebec, 2000-2015) in the context of a province-wide primary care reform, using the provincial health administrative database.</p><p><strong>Results: </strong>Trends in both types of Ambulatory Care Sensitive Condition (ACSC) hospitalization (general and older population) and 30-day readmission rates remained constant with average rates per 100 person-years: 20.5 (19.9-21.1), 31.7 (31.0-32.4), 20.6 (20.1-21.2), respectively. Rates of delayed hospital discharge (i.e., alternate level of care (ALC) hospitalizations) decreased from 23.8 (21.1-26.9) to 17.9 (16.1-20.1) (relative change -24.6%).</p><p><strong>Conclusions: </strong>These figures shed light on the importance of the phenomenon, its lack of improvement for most outcomes over the years, and the need to develop evidence-based policies to prevent avoidable hospitalizations in this vulnerable population.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"24 3","pages":"209-221"},"PeriodicalIF":3.9,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/45/ee/cgj-24-209.PMC8390329.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39388542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychotherapeutic Interventions for Dementia: a Systematic Review.","authors":"Paweena Sukhawathanakul,&nbsp;Alexander Crizzle,&nbsp;Holly Tuokko,&nbsp;Gary Naglie,&nbsp;Mark J Rapoport","doi":"10.5770/cgj.24.447","DOIUrl":"https://doi.org/10.5770/cgj.24.447","url":null,"abstract":"<p><strong>Background and objectives: </strong>While a range of psychotherapeutic interventions is available to support individuals with dementia, comprehensive reviews of interventions are limited, particularly with regard to outcomes related to adjustment and acceptance. The current review assesses studies that evaluated the impact of various forms of psychotherapeutic interventions on acceptance and adjustment to changing life circumstances for older adults with cognitive impairment.</p><p><strong>Research design and methods: </strong>A systematic search of PubMed, PsycINFO, and CINAHL databases was conducted, restricted to articles published in English within the last 16 years (from 2003 to 2019). Twenty-four articles were identified that examined the effects of psychotherapeutic interventions on outcomes related to acceptance and adjustment which included internalizing symptoms, quality of life, self-esteem, and well-being. Fifteen studies examined interventions targeted towards individuals with cognitive impairment, while nine studies also targeted their caregivers.</p><p><strong>Results: </strong>Interventions that impacted outcomes related to acceptance and adjustment (e.g., adaptation, depressive symptoms, helplessness, self-esteem, and quality of life) varied in their theoretical approach, which incorporated elements of cognitive behavioural therapy (CBT), problem-solving therapy, psychotherapy, reminiscence therapy, interpersonal therapy, mindfulness-based therapy, and meaning-based, compassion-focused therapy. Among all interventions, reductions in depression were the most commonly reported treatment outcome particularly among interventions that incorporated problem-focused and meaning-based therapies. Mixed findings were reported with regard to outcomes related to helplessness, quality of life, self-esteem, and life satisfaction indices for individuals with cognitive impairment.</p><p><strong>Discussion and implications: </strong>There is some support for the effectiveness of psychotherapeutic interventions on improving acceptance and adjustment in older adults with cognitive impairment, particularly with regard to reducing depressive symptoms.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"24 3","pages":"222-236"},"PeriodicalIF":3.9,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9a/ca/cgj-24-222.PMC8390328.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39388543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving End-of-Life Care for People with Dementia in LTC Homes During the COVID-19 Pandemic and Beyond.","authors":"Sharon Kaasalainen,&nbsp;Lynn Mccleary,&nbsp;Shirin Vellani,&nbsp;Jose Pereira","doi":"10.5770/cgj.24.493","DOIUrl":"https://doi.org/10.5770/cgj.24.493","url":null,"abstract":"<p><p>COVID-19 pandemic has resulted in a significant increase in deaths in long-term care homes (LTCH). People with dementia living in LTCHs represent one of the most frail and marginalized populations in Canada. The surge of COVID-19 cases in LTCHs and rationing of health-care resources during the pandemic have amplified the pre-existing need for improvements in palliative and end-of-life care in LTCHs. This position statement, created by a task force commissioned by the Alzheimer Society of Canada, provides recommendations for a multipronged coordinated approach to improving palliative and end-of-life care of people with dementia living in LTCHs during the COVID-19 pandemic and beyond.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"24 3","pages":"164-169"},"PeriodicalIF":3.9,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b7/8b/cgj-24-164.PMC8390320.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39385596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrated Community Collaborative Care for Seniors with Depression/Anxiety and any Physical Illness.","authors":"Richard Shulman,&nbsp;Reenu Arora,&nbsp;Rose Geist,&nbsp;Amna Ali,&nbsp;Julia Ma,&nbsp;Elizabeth Mansfield,&nbsp;Sara Martel,&nbsp;Jane Sandercock,&nbsp;Judith Versloot","doi":"10.5770/cgj.24.473","DOIUrl":"https://doi.org/10.5770/cgj.24.473","url":null,"abstract":"<p><strong>Background: </strong>We report on the feasibility and effectiveness of an integrated community collaborative care model in improving the health of seniors with depression/anxiety symptoms and chronic physical illness.</p><p><strong>Methods: </strong>This community collaborative care model integrates geriatric medicine and geriatric psychiatry with care managers (CM) providing holistic initial and follow-up assessments, who use standardized rating scales to monitor treatment and provide psychotherapy (ENGAGE). The CM presents cases in a structured case review to a geriatrician and geriatric psychiatrist. Recommendations are communicated by the CM to the patient's primary care provider.</p><p><strong>Results: </strong>187 patients were evaluated. The average age was 80 years old. Two-thirds were experiencing moderate-to-severe depression upon entry and this proportion decreased significantly to one-third at completion. Qualitative interviews with patients, family caregivers, team members, and referring physicians indicated that the program was well-received. Patients had on average six visits with the CM without the need to have a face-to-face meeting with a specialist.</p><p><strong>Conclusion: </strong>The evaluation shows that the program is feasible and effective as it was well received by patients and patient outcomes improved. Implementation in fee-for-service publicly funded health-care environments may be limited by the need for dedicated funding.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"24 3","pages":"251-257"},"PeriodicalIF":3.9,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d1/7e/cgj-24-251.PMC8390319.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39385982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a Supplemental Assessment Tool for Younger Residents in Long-Term Care.","authors":"Emma J Hazelton-Provo,&nbsp;Lori E Weeks","doi":"10.5770/cgj.24.465","DOIUrl":"https://doi.org/10.5770/cgj.24.465","url":null,"abstract":"<p><strong>Background: </strong>It has been established that the needs of long-term care residents under 65 are distinct from those of older residents, and that these needs are not sufficiently met through the current model of LTC. Our goal was to create a supplemental assessment tool that can be used at the time of assessment to better represent the needs of this population.</p><p><strong>Methods: </strong>Residents in the target age group (between 18 and 64), and staff who work with the target age group, were interviewed individually to identify important questions to be asked in the assessment tool. A preliminary tool was presented to the participants in a focus group, and feedback was used to make modifications to the tool.</p><p><strong>Results: </strong>Questions developed from the study addressed several unique needs of this population, including the role of technology in their well-being, the need for time with visitors, and the need for supports as they transition in to LTC.</p><p><strong>Conclusions: </strong>The needs of younger residents in LTC are unique, and through interviews with residents and staff we developed an assessment tool to better represent those needs at the time of admission.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"24 3","pages":"170-173"},"PeriodicalIF":3.9,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a7/14/cgj-24-170.PMC8390330.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39388537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}