Advanced Journal of Emergency Medicine最新文献

{"title":"Necrotizing Fasciitis in a Patient with Diabetes Mellitus.","authors":"Mahbube Ebrahimpur, Mahnaz Pejman-Sani, Neda Alijani","doi":"10.22114/AJEM.v0i0.59","DOIUrl":"https://doi.org/10.22114/AJEM.v0i0.59","url":null,"abstract":"Case presentation: A 46-year-old man was admitted to the emergency department with complaints of fever and skin lesions in the right leg since 3 days before. Moreover, he revealed a history of 5 years of poorly controlled diabetes mellitus despite being on oral medication. On physical examination, he was oriented and the following vital signs were observed: blood pressure: 80/60 mmHg; pulse rate: 90 beats/min; respiratory rate: 18 breaths/min; and oral temperature: 38 °C. Two large erythematous lesions with central necrosis in the upper segment of the right leg were noticed. Further examination revealed crepitation of the same right leg segment. Laboratory findings revealed the following: white blood cell (WBC) count, 17,000/mm3; hemoglobin, 15 g/dl; sodium, 125 meq/l; potassium, 3.8 meq/l; blood glucose, 400 mg/dl; blood urea nitrogen, 45 mg/dl; creatinine, 2.4 mg/dl; and bicarbonate,13 meq/l. Plain X-ray of right leg revealed gas formation in the soft tissues, which was a diagnostic criterion for necrotizing fasciitis (Figure 1). The patient was treated immediately with intravenous fluid, broad spectrum empiric antibiotics (meropenem plus vancomycin), and insulin infusion; moreover, urgent surgical consultation was requested. He underwent emergency debridement within few hours of hospitalization.","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"2 3","pages":"e37"},"PeriodicalIF":0.0,"publicationDate":"2018-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/df/35/AJEM-2-e37.PMC6549199.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40450888","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":"Educational Intervention Effect on Pain Management Quality in Emergency Department; a Clinical Audit.","authors":"Maryam Janati,&nbsp;Hamid Kariman,&nbsp;Elham Memary,&nbsp;Elnaz Davarinezhad-Moghadam,&nbsp;Ali Arhami-Dolatabadi","doi":"10.22114/AJEM.v0i0.45","DOIUrl":"https://doi.org/10.22114/AJEM.v0i0.45","url":null,"abstract":"<p><strong>Introduction: </strong>Pain is a frequent complaint of patients who are referred to the emergency department (ED), which is ignored or mismanaged and, almost always, approached in terms of determining the cause of pain instead of pain management. Pain management is a challenging issue in the ED.</p><p><strong>Objective: </strong>This study was conducted to determine the effect of emergency resident's education about pain assessment and pain-relief drugs in the improvement in pain management.</p><p><strong>Method: </strong>A clinical audit was carried out during the year 2015 in the ED of Imam Hossein Hospital, Tehran, Iran. All patients over 16-year-old who had been complaining of pain or another complaint that included pain were eligible. Data were collected using a preformed checklist. One senior emergency medicine resident was responsible for filling the checklist. In the first phase, patients were enrolled into the study and were divided into two groups according to whether they had or did not have a pain management order. In the second phase, the first- and second-year emergency medicine residents were trained during the various classes that they were required to attend, through a workshop conducted by experienced professors, and based on existing valid guidelines. In the third phase, patients were enrolled into the study, and the same checklists were completed.</p><p><strong>Results: </strong>A total of 803 patients (401 before training and 402 after) were assessed. The mean age of the patients before and after training of the residents was 59.19 ± 44.45 and 40.24 ± 19.40 years, respectively. The demographic characteristics of patients were not significantly different before and after the training period (p > 0.05). The most common cause of pain was soft tissue injury, both before (36.3%) and after training (34.3%). The most frequent drug that was administered for pain control was morphine, both before (62.5%) and after (41.4%) training. Although the number of patients with moderate pain intensity was higher during the after-training period, pain control quality was described to be better in this group and success rate of pain control was significantly increased after training (p < 0.001).</p><p><strong>Conclusion: </strong>Findings from the present study showed that there was a significant deficiency in pain management of the admitted patients, and the most common reason for this was the physician's fear of the drug's side effects. However, significant progress was seen after the training regarding pain management process in ED.</p>","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"2 2","pages":"e16"},"PeriodicalIF":0.0,"publicationDate":"2018-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/28/ac/AJEM-2-e16.PMC6549047.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40449007","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":"Reverse Triage to Increase the Hospital Surge Capacity in Disaster Response.","authors":"Mehrdad Esmailian,&nbsp;Mohammad-Hossein Salehnia,&nbsp;Mehrdad Shirani,&nbsp;Farhad Heydari","doi":"10.22114/AJEM.v0i0.48","DOIUrl":"https://doi.org/10.22114/AJEM.v0i0.48","url":null,"abstract":"<p><strong>Introduction: </strong>Successful and effective management of large-scale disasters and epidemics requires pre-established systematic plans to minimize the damage and control the situation. With an increasing number of people in need of urgent medical care, hospitals must improve their response capacity, being at the forefront of responding to disasters and incidents. One way to develop the hospital capacity in disaster response is by reverse triage (RT).</p><p><strong>Objective: </strong>The current study was conducted to investigate the role of RT to create additional hospital surge capacity in one of the major referral academic hospitals of Isfahan, Iran.</p><p><strong>Method: </strong>This cross-sectional study was conducted in 2015 at Al-Zahra Subspecialty Hospital, Isfahan, Iran. The ten most common diseases leading to hospitalization in each ward of the hospital in 2014 were reviewed and, based on the prevalence, sorted and listed. Academic instructions for making a decision and possibility of early discharge was written and approved by an expert panel. On a day that was not set previously, the pre-selected in-charge person of each department was asked to run the RT following the instructions, and the number and percentage of those who were eligible for discharge via RT were determined.</p><p><strong>Results: </strong>The total BOR in Al-Zahra Hospital in 2014 was about 80%, so it was estimated that almost 140 out of 700 beds are vacant. The results showed that by using RT, 108 (20%) hospitalized cases could be discharged, and considering the bed occupancy rate of about 80% and 140 vacant beds, a total of 248 beds could be provided following RT.</p><p><strong>Conclusion: </strong>Running RT in 41 wards and units of Isfahan Al-Zahra Hospital, on average, added 108 beds to the hospital capacity. This increment is not the same in all wards, as the role of intensive care units in RT for surge capacity is insignificant.</p>","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"2 2","pages":"e17"},"PeriodicalIF":0.0,"publicationDate":"2018-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/24/96/AJEM-2-e17.PMC6549049.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40450417","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":"Upper Gastrointestinal Bleeding as Delayed Presentation of Traumatic Diaphragmatic Hernia; a Case Report.","authors":"Ali Arhami-Dolatabadi,&nbsp;Mohammadmehdi Forouzanfar,&nbsp;Sahar Mirbaha","doi":"10.22114/AJEM.v0i0.44","DOIUrl":"https://doi.org/10.22114/AJEM.v0i0.44","url":null,"abstract":"<p><strong>Introduction: </strong>Traumatic diaphragmatic hernia (TDH) is one of the critical complications resulting from penetrating chest trauma. The rate of undiagnosed TDH equivocates 12-60%. The significant part of complications happens 1-4 years after the primary damage. Here, we report a case of delayed TDH presented with upper gastrointestinal bleeding (GIB) as an excuse to discuss this issue.</p><p><strong>Case presentation: </strong>The patient was a 35-year-old man, admitted with objection of abdominal pain. A nasogastric tube was inserted and fixed that resulted in drainage of about 500cc dark blood. He was candidate for emergent endoscopy due to upper GIB. During resuscitation measures, he suddenly developed respiratory distress that could not be justified by upper GIB alone. Therefore, bedside sonography discovered some soft tissue apart from lung tissue in the left hemithorax. After performing diagnostic measures, with diagnosis of diaphragmatic herniation and strangulation he underwent emergent surgery.</p><p><strong>Conclusion: </strong>Small diaphragmatic lesions, which usually result from stab wounds, may develop into larger injuries if left untreated and they might lead to a diaphragmatic hernia with a potential risk of early or late complications and mortality. One of the rare complications is GIB, which should be considered in a patient with past history of trauma and presentation of GIB.</p>","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"2 3","pages":"e36"},"PeriodicalIF":0.0,"publicationDate":"2018-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/49/b0/AJEM-2-e36.PMC6549205.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40538926","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":"Coagulation Disorder following Red Clover (Trifolium Pratense) Misuse: a Case Report.","authors":"Sahar Karimpour-Reihan,&nbsp;Elnaz Firuzei,&nbsp;Malihe Khosravi,&nbsp;Mahsa Abbaszade","doi":"10.22114/ajem.v0i0.30","DOIUrl":"https://doi.org/10.22114/ajem.v0i0.30","url":null,"abstract":"<p><strong>Introduction: </strong>An increasing variety of alternative health care products and supplements known as over-the-counter (OTC) or non-prescription herbal medicines are taken by patients for different reasons. Unfortunately, these self-prescribed remedies have many food and drug interactions and unknown adverse effects and can lead to some important consequences.</p><p><strong>Case presentation: </strong>Here a case of bleeding disorder in a 28-year-old woman taking red clover is reported. She had no history of warfarin use, but warfarin was detected in her blood serum analysis.</p><p><strong>Conclusion: </strong>This agent is a source of natural coumarin and can cause an increase of international normalized ratio (INR) and bleeding. It is important that prescribers be alert to the possible disadvantage of herbal remedies and also probable herb-drug and herb-food interactions.</p>","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"2 2","pages":"e20"},"PeriodicalIF":0.0,"publicationDate":"2018-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f7/f5/AJEM-2-e20.PMC6549048.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40561465","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":"Critical Care Medicine: Bangladesh Perspective.","authors":"Nafseen Mostafa","doi":"10.22114/AJEM.v0i0.79","DOIUrl":"https://doi.org/10.22114/AJEM.v0i0.79","url":null,"abstract":"","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"2 3","pages":"e27"},"PeriodicalIF":0.0,"publicationDate":"2018-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c6/c3/AJEM-2-e27.PMC6549198.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40561498","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":"Blunt, Penetrating and Strangulating; Suicidal, Homicidal, Accidental and Sport-Related Neck Injuries: a Case Series and Literature Review.","authors":"Devendra Richhariya,&nbsp;Vivekanshu Verma,&nbsp;Yatin Mehta","doi":"10.22114/AJEM.v0i0.78","DOIUrl":"https://doi.org/10.22114/AJEM.v0i0.78","url":null,"abstract":"<p><strong>Introduction: </strong>Presentation of neck injuries in ER can be with or without neurological deficit. Trauma victims with multiple injuries should be examined for neck injuries as these injuries are potentially life threatening. Further neck movement should be restricted by applying the cervical collar until further radiological investigations rule out the spine injury. Early identification and treatment of neck injuries whether spine, vascular, or muscular injury improve the morbidity and mortality in polytrauma patients.</p><p><strong>Case presentation: </strong>In a series of case presentations of neck injuries through various modes, the first case of neck injury was related to road traffic accident presented with neck pain and paraplegia. In the second case, neck injury was due to suicidal hanging presented with ligature mark over the neck. Third case was related to Indian traditional sport-related neck injury presented with severe neck pain stiffness. In the fourth case, neck injury was due to gunshot and presented with bullet entry wound and quadriparesis.</p><p><strong>Conclusion: </strong>Neck injury in the absence of associated injuries is rarely seen after blunt and penetrating trauma, but can result in devastating outcomes if left unrecognized. A high index of suspicion and early intervention are critical.</p>","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"2 3","pages":"e33"},"PeriodicalIF":0.0,"publicationDate":"2018-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/72/f5/AJEM-2-e33.PMC6549204.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40562004","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":"Radial Head Subluxation: Possible Effective Factors on Time to Re-use the Affected Limb.","authors":"Farhad Heydari,&nbsp;Babak Masoumi,&nbsp;Shiva Samsamshariat","doi":"10.22114/AJEM.v0i0.70","DOIUrl":"https://doi.org/10.22114/AJEM.v0i0.70","url":null,"abstract":"<p><strong>Introduction: </strong>Radial head subluxation (RHS) is a common disorder in children. Although it is not accompanied by any important short- or long-term sequel, it could make the parents worried about.</p><p><strong>Objective: </strong>The purpose of this study was to determine the possible effective factors that may influence time to use the affected limb.</p><p><strong>Methods: </strong>This cross-sectional study was conducted prospectively during the years 2014 to 2016. All children under the age of 6 years who visited the emergency department (ED) and were diagnosed as having RHS were eligible. The patients' baseline information was recorded. After the reduction, the time until the affected arm use returned was recorded. The possible relationship between the baseline data and time to re-use the affected limb was assessed.</p><p><strong>Results: </strong>During the study period, 112 children with a mean age of 30.18 ± 18.18 months were evaluated (53% male). Among the children who visited the ED during the first 4 hours and thereafter, 84% and 60%, respectively, re-used their limb in less than 10 minutes after reduction (p = 0.004). Also, 55% of children less than or equal to 24 months and 89% over the age of 24 months re-used the arm in 10 minutes (p < 0.001). The success rate of the first reduction maneuver was significantly lower in children with a recurrent dislocation (p = 0.001).</p><p><strong>Conclusion: </strong>It is likely that age less than or equal to 24 months and ED visit after 4 hours of the event lead to a longer duration for re-using the affected arm following reduction.</p>","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"2 2","pages":"e19"},"PeriodicalIF":0.0,"publicationDate":"2018-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/28/9d/AJEM-2-e19.PMC6549051.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40549761","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":"The Cost of Leaving the Emergency Department without Notice; a Cross-sectional Study.","authors":"Sahar Mirbaha,&nbsp;Mohammadmehdi Forouzanfar,&nbsp;Mohammadmehdi Mohebi,&nbsp;Hamid Kariman","doi":"10.22114/AJEM.v2i1.43","DOIUrl":"https://doi.org/10.22114/AJEM.v2i1.43","url":null,"abstract":"<p><strong>Introduction: </strong>Leaving the hospital without notice is among the problems that can inflict financial and non-financial burdens on the health care system of a country.</p><p><strong>Objective: </strong>The present study was carried out with the aim of evaluating the prevalence of leaving without notice cases in the emergency department (ED) of one of the major teaching hospitals of Tehran affiliated with Shahid Beheshti University of Medical Sciences and calculating the direct costs resulting from it.</p><p><strong>Methods: </strong>This study was a retrospective cross-sectional one carried out during 1 year from 2016 to 2017 in one of the teaching hospitals of Tehran affiliated with Shahid Beheshti University of Medical Sciences. Sampling was performed via census method and the study population consisted of the profiles of all the patients who had left the hospital without notice or checking out after being admitted to the hospital. To gather the required data for this study, a checklist consisting of questions regarding sex, age, insurance coverage, and the amount of money they owed the hospital was used. Statistical analysis was performed using the software IBM Statistics for Windows v22 and P-value<0.05 was considered significant.</p><p><strong>Results: </strong>Out of the total of 39946 patients visiting the ED of the studied hospital during 1 year, 1692 (4.2%) had left the hospital without checking out. Below 30 years age range was the most common age range with 46.9% (794 patients) and 72.9% of the patients leaving without notice were men. Based on the findings obtained, male patients without insurance coverage had attempted to leave the hospital without notice more than others (p<0.001). The total cost inflicted by leaving without notice throughout the studied year was 1,755,286,279 Rials, which is equal to 0.0059 of the total annual income of the ED.</p><p><strong>Conclusion: </strong>Throughout the year this study was performed, a total of 1.2% of all the visitors of the ED of a hospital affiliated with Shahid Beheshti University of Medical Sciences left the hospital without notice or checking out, which inflicted a considerable cost on the ED.</p>","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"2 1","pages":"e6"},"PeriodicalIF":0.0,"publicationDate":"2018-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/56/a1/AJEM-2-e6.PMC6548103.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37308095","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":"Analysis of Factors and Medical Errors Involved in Patient Complaints in a European Emergency Department.","authors":"Pauline Haroutunian,&nbsp;Mohammed Alsabri,&nbsp;François Jerome Kerdiles,&nbsp;Hassan Adel Ahmed Abdullah,&nbsp;Abdelouahab Bellou","doi":"10.22114/AJEM.v0i0.34","DOIUrl":"https://doi.org/10.22114/AJEM.v0i0.34","url":null,"abstract":"<p><strong>Introduction: </strong>Patients' complaints from Emergency Departments (ED) are frequent and can be used as a quality assurance indicator.</p><p><strong>Objective: </strong>Factors contributing to patients' complaints (PCs) in the emergency department were analyzed.</p><p><strong>Methods: </strong>It was a retrospective cohort study, the qualitative variables of patients' complaints visiting ED of a university hospital were compared with Chi-Square and t test tests.</p><p><strong>Results: </strong>Eighty-five PC were analyzed. The factors contributing to PC were: communication (n=26), length of stay (LOS) (n=24), diagnostic errors (n=21), comfort and privacy issues (n=7), pain management (n=6), inappropriate treatment (n=6), delay of care and billing issues (n=3). PCs were more frequent when patients were managed by residents, during night shifts, weekends, Saturdays, Mondays, January and June. Moreover, the factors contributing to diagnostic errors were due to poor communication, non-adherence to guidelines and lack of systematic proofreading of X-rays. In 98% of cases, disputes were resolved by apology and explanation and three cases resulted in financial compensation.</p><p><strong>Conclusion: </strong>Poor communication, LOS and medical errors are factors contributing to PCs. Improving communication, resolving issues leading to slow health care provision, adequate staffing and supervision of trainees may reduce PCs.</p>","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"2 1","pages":"e4"},"PeriodicalIF":0.0,"publicationDate":"2017-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/37/5f/AJEM-2-e4.PMC6548105.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37308093","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}