Pub Date : 2024-07-16DOI: 10.24884/2072-6716-2024-25-2-60-67
A. Bichun, N. V. Petrova, N. S. Slyadneva, V. O. Bozhko
The purpose of the study is to improve the provision of assistance in the sudden cessation of the circulatory system when the victim is on the surface not suitable for the CPR. The objectives are to assess the possibility of using the manoeuvre of the victim for carrying out CPR from an inappropriate surface to the floor. Manoeuvre for the move of the victim — the patent for the invention RU 2803376 C2 was carried out by doctors and followed by statistical analysis of the anonymous questionnaire after the manoeuvre. The time of manoeuvre, simplicity, comfort in performance was analysed. Results. The manoeuvre time up to 3 seconds; the vast majority of participants rated the manoeuvre as simple and comfortable for execution. Conclusion. The manoeuvre of the victim gives the possibility of an immediate and effective CPR in the case of the victim with sudden cessation of circulation on the surface inappropriate for her to be conducted by CPR; suitable for rescuers with any level of training; easy to train.
{"title":"Assessing the effectiveness of safely moving the victim to a horizontal surface for basic cardiopulmonary resuscitation","authors":"A. Bichun, N. V. Petrova, N. S. Slyadneva, V. O. Bozhko","doi":"10.24884/2072-6716-2024-25-2-60-67","DOIUrl":"https://doi.org/10.24884/2072-6716-2024-25-2-60-67","url":null,"abstract":"The purpose of the study is to improve the provision of assistance in the sudden cessation of the circulatory system when the victim is on the surface not suitable for the CPR. The objectives are to assess the possibility of using the manoeuvre of the victim for carrying out CPR from an inappropriate surface to the floor. Manoeuvre for the move of the victim — the patent for the invention RU 2803376 C2 was carried out by doctors and followed by statistical analysis of the anonymous questionnaire after the manoeuvre. The time of manoeuvre, simplicity, comfort in performance was analysed. Results. The manoeuvre time up to 3 seconds; the vast majority of participants rated the manoeuvre as simple and comfortable for execution. Conclusion. The manoeuvre of the victim gives the possibility of an immediate and effective CPR in the case of the victim with sudden cessation of circulation on the surface inappropriate for her to be conducted by CPR; suitable for rescuers with any level of training; easy to train.","PeriodicalId":517874,"journal":{"name":"EMERGENCY MEDICAL CARE","volume":" 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141832030","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}
Pub Date : 2024-03-04DOI: 10.24884/2072-6716-2024-25-1-64-67
M. Gavshchuk, V. I. Orel, G. О. Bagaturiya, O. V. Lisovskii, M. A. Protchenkov, A. A. Petrosyan, I. V. Karpatsky, F. M. Shermatov
The article presents the accumulated experience of using minimal gastrostomy through minilaparotomy, which allows us to consider these methods of forming a nutritious fistula as an alternative to puncture gastrostomy in conditions of import substitution and possible unavailability of the necessary imported consumables.
{"title":"Minimal gastrostomy via minilaparotomy as an alternative to puncture gastrostomy in the context of import substitution","authors":"M. Gavshchuk, V. I. Orel, G. О. Bagaturiya, O. V. Lisovskii, M. A. Protchenkov, A. A. Petrosyan, I. V. Karpatsky, F. M. Shermatov","doi":"10.24884/2072-6716-2024-25-1-64-67","DOIUrl":"https://doi.org/10.24884/2072-6716-2024-25-1-64-67","url":null,"abstract":"The article presents the accumulated experience of using minimal gastrostomy through minilaparotomy, which allows us to consider these methods of forming a nutritious fistula as an alternative to puncture gastrostomy in conditions of import substitution and possible unavailability of the necessary imported consumables.","PeriodicalId":517874,"journal":{"name":"EMERGENCY MEDICAL CARE","volume":"95 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140398198","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}
Pub Date : 2024-03-04DOI: 10.24884/2072-6716-2024-25-1-76-81
V. M. Shaytor, A. V. Emelianova, O. L. Yezhova, D. I. Shaytor, K. V. Sternlicht, A. I. Safronova, P. Y. Sivenkov
The article reveals the problem of diagnosing urgent pathology in childhood at the prehospital stage of emergency and emergency medical care. The revealed diagnostic errors make it possible to focus the attention of doctors on the most common discrepancies in the diagnoses of the prehospital and inpatient stages. The purpose of the work: to identify the structure of the discrepancy of diagnoses in the provision of SMP to children with the data of the reception department of a children’s hospital. Materials and methods:13957 case histories of children aged 0 to 17 years hospitalized by ambulance and emergency medical teams were analyzed. The frequency of discrepancies between the diagnoses of the prehospital stage and the reception department of the hospital, depending on the nosological variant of pathology and the age of children, was determined. The results of the study: The most frequent discrepancies in diagnoses were found in children of the first 7 years of life with acute respiratory pathology and infectious diseases. In children from 12 to 17 years of age, the differences in diagnoses were mainly due to cases of acute surgical pathology and were associated with over diagnosis and the complexity of assessing the child’s condition. Conclusion: Based on the results obtained, it is shown that there is a need for a more in-depth study of the features of the diagnosis of acute infectious diseases and respiratory pathology in children, as well as a differential approach in cases of urgent surgical pathology during advanced training and professional retraining of emergency and emergency physicians.
{"title":"Diagnostic errors at the stage of providing emergency and emergency medical care to children","authors":"V. M. Shaytor, A. V. Emelianova, O. L. Yezhova, D. I. Shaytor, K. V. Sternlicht, A. I. Safronova, P. Y. Sivenkov","doi":"10.24884/2072-6716-2024-25-1-76-81","DOIUrl":"https://doi.org/10.24884/2072-6716-2024-25-1-76-81","url":null,"abstract":"The article reveals the problem of diagnosing urgent pathology in childhood at the prehospital stage of emergency and emergency medical care. The revealed diagnostic errors make it possible to focus the attention of doctors on the most common discrepancies in the diagnoses of the prehospital and inpatient stages. The purpose of the work: to identify the structure of the discrepancy of diagnoses in the provision of SMP to children with the data of the reception department of a children’s hospital. Materials and methods:13957 case histories of children aged 0 to 17 years hospitalized by ambulance and emergency medical teams were analyzed. The frequency of discrepancies between the diagnoses of the prehospital stage and the reception department of the hospital, depending on the nosological variant of pathology and the age of children, was determined. The results of the study: The most frequent discrepancies in diagnoses were found in children of the first 7 years of life with acute respiratory pathology and infectious diseases. In children from 12 to 17 years of age, the differences in diagnoses were mainly due to cases of acute surgical pathology and were associated with over diagnosis and the complexity of assessing the child’s condition. Conclusion: Based on the results obtained, it is shown that there is a need for a more in-depth study of the features of the diagnosis of acute infectious diseases and respiratory pathology in children, as well as a differential approach in cases of urgent surgical pathology during advanced training and professional retraining of emergency and emergency physicians.","PeriodicalId":517874,"journal":{"name":"EMERGENCY MEDICAL CARE","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140286089","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}
Pub Date : 2024-03-04DOI: 10.24884/2072-6716-2024-25-1-68-75
O. Shtegman, D. I. Yarushina, A. E. Butylchenkova, V. K. Kozhukhova
The main purpose of the study was to assess the quality and effectiveness of emergency medical care (EMC)in atrial fibrillation paroxysm (AF) at the prehospital stage. Materials and methods: the analysis included 111 patients who called an ambulance due to AF paroxysm. The patients were divided into groups depending on the recovery of sinus rhythm in the presence of a team. A telephone survey of patients was conducted 30 days after seeking medical help. Results: the sinus rhythm in the presence of the brigade was restored in 40% of cases. At the same time, the median recovery time of the rhythm was 32 minutes [Q1–Q3: 29–50]. 9% of patients were hospitalized. 53% of patients refused hospitalization. The probability of rhythm recovery increased with the help of a medical team and was not associated with the choice of an antiarrhythmic and the use of potassium and magnesium drugs. At the same time, in the next 30 days, complications (hospitalization, recurrence of AF and repeated call an ambulance) were observed more often among patients with restored rhythm (43% vs. 12%;p=0.00022). In 60.5% of patients who were trying to restore the rhythm, No anticoagulants were used, and in 7% 2 anticoagulants were used simultaneously. Conclusion. When providing EMC at the prehospital stage, rhythm restoration in the presence of a team is observed in 40% of cases, which is associated with a large number of complications in the next 30 days and a large percentage of errors associated with anticoagulant therapy.
{"title":"The results of emergency medical care for patients with paroxysmal atrial fibrillation","authors":"O. Shtegman, D. I. Yarushina, A. E. Butylchenkova, V. K. Kozhukhova","doi":"10.24884/2072-6716-2024-25-1-68-75","DOIUrl":"https://doi.org/10.24884/2072-6716-2024-25-1-68-75","url":null,"abstract":"The main purpose of the study was to assess the quality and effectiveness of emergency medical care (EMC)in atrial fibrillation paroxysm (AF) at the prehospital stage. Materials and methods: the analysis included 111 patients who called an ambulance due to AF paroxysm. The patients were divided into groups depending on the recovery of sinus rhythm in the presence of a team. A telephone survey of patients was conducted 30 days after seeking medical help. Results: the sinus rhythm in the presence of the brigade was restored in 40% of cases. At the same time, the median recovery time of the rhythm was 32 minutes [Q1–Q3: 29–50]. 9% of patients were hospitalized. 53% of patients refused hospitalization. The probability of rhythm recovery increased with the help of a medical team and was not associated with the choice of an antiarrhythmic and the use of potassium and magnesium drugs. At the same time, in the next 30 days, complications (hospitalization, recurrence of AF and repeated call an ambulance) were observed more often among patients with restored rhythm (43% vs. 12%;p=0.00022). In 60.5% of patients who were trying to restore the rhythm, No anticoagulants were used, and in 7% 2 anticoagulants were used simultaneously. Conclusion. When providing EMC at the prehospital stage, rhythm restoration in the presence of a team is observed in 40% of cases, which is associated with a large number of complications in the next 30 days and a large percentage of errors associated with anticoagulant therapy.","PeriodicalId":517874,"journal":{"name":"EMERGENCY MEDICAL CARE","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140398237","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}
Pub Date : 2024-03-03DOI: 10.24884/2072-6716-2024-25-1-33-42
A. M. Schikota, S. A. Gumenyuk, V. I. Yarema, A. B. Fedin, S. M. Zeinieva
Purpose: review and systematisation of publications in scientific medical literature devoted to ultrasound examination of trauma patients at the prehospital stage. Materials and methods: a search in scientific databases SCOPUS, Cochrane, PubMed, Russian Science Citation Index (RSCI) by key words: polytrauma, haemorrhage, evacuation of victims, ultrasound examination (US) was carried out. We analysed 46 literature sources — 2 domestic and 44 foreign, including data of meta ‑ analyses and systematic reviews; 23 studied articles were published in the last 5 years. Results: according to a number of scientific studies, ultrasound examination can be successfully used in patients with polytrauma at the prehospital stage, including during air ambulance evacuation on board a helicopter. Ultrasound examination according to the FAST protocol reduces the time to surgical intervention by 64–76%, reduces the need for radiation exposure, the incidence of complications after injury and the duration of the patient’s hospital stay. According to some authors, the sensitivity, specificity, positive and negative predictive value of the method in detecting intra–abdominal injuries and haemorrhage are 28–76%, 83–97%, 87–96% and 37–94%, respectively, which makes it an important tool for examination of an urgent patient, especially with unstable haemodynamics, influencing the treatment tactics. For the paediatric population in the diagnosis of haemoperitoneum, according to a meta‑analysis, the specificity of US leaves 95%, sensitivity — 66%. The method can be successfully applied in the work of aeromedical teams on board an air ambulance helicopter: according to a systematic review and meta‑analysis, the overall sensitivity of ultrasound in the diagnosis of pneumothorax during air ambulance evacuation is 61%, specificity — 99%. Conclusion: considering the analysed data from large randomised trials, meta‑analyses and systematic reviews, the use of ultrasound allows to make the right decisions regarding the tactics of treatment of the urgent patient, its transportation and choice of hospital, reduces the number of examinations, shortens the time to get the patient to the operating room and the duration of hospital stay, positively affects the outcome of the disease.
{"title":"Results of ultrasonic examination of patients with internal bleeding and multiple injury at the prehospital stage: a literature review","authors":"A. M. Schikota, S. A. Gumenyuk, V. I. Yarema, A. B. Fedin, S. M. Zeinieva","doi":"10.24884/2072-6716-2024-25-1-33-42","DOIUrl":"https://doi.org/10.24884/2072-6716-2024-25-1-33-42","url":null,"abstract":"Purpose: review and systematisation of publications in scientific medical literature devoted to ultrasound examination of trauma patients at the prehospital stage. Materials and methods: a search in scientific databases SCOPUS, Cochrane, PubMed, Russian Science Citation Index (RSCI) by key words: polytrauma, haemorrhage, evacuation of victims, ultrasound examination (US) was carried out. We analysed 46 literature sources — 2 domestic and 44 foreign, including data of meta ‑ analyses and systematic reviews; 23 studied articles were published in the last 5 years. Results: according to a number of scientific studies, ultrasound examination can be successfully used in patients with polytrauma at the prehospital stage, including during air ambulance evacuation on board a helicopter. Ultrasound examination according to the FAST protocol reduces the time to surgical intervention by 64–76%, reduces the need for radiation exposure, the incidence of complications after injury and the duration of the patient’s hospital stay. According to some authors, the sensitivity, specificity, positive and negative predictive value of the method in detecting intra–abdominal injuries and haemorrhage are 28–76%, 83–97%, 87–96% and 37–94%, respectively, which makes it an important tool for examination of an urgent patient, especially with unstable haemodynamics, influencing the treatment tactics. For the paediatric population in the diagnosis of haemoperitoneum, according to a meta‑analysis, the specificity of US leaves 95%, sensitivity — 66%. The method can be successfully applied in the work of aeromedical teams on board an air ambulance helicopter: according to a systematic review and meta‑analysis, the overall sensitivity of ultrasound in the diagnosis of pneumothorax during air ambulance evacuation is 61%, specificity — 99%. Conclusion: considering the analysed data from large randomised trials, meta‑analyses and systematic reviews, the use of ultrasound allows to make the right decisions regarding the tactics of treatment of the urgent patient, its transportation and choice of hospital, reduces the number of examinations, shortens the time to get the patient to the operating room and the duration of hospital stay, positively affects the outcome of the disease.","PeriodicalId":517874,"journal":{"name":"EMERGENCY MEDICAL CARE","volume":"76 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140286140","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}
Pub Date : 2024-03-02DOI: 10.24884/2072-6716-2024-25-1-27-32
V. V. Masljakov, S. A. Sidel’nikov, Y. E. Barachevskij, V. Gorbelik, N. V. Dmitriev, A. A. Pimenova, D. A. Polikarpov, M. A. Polidanov
Purpose of the study. Assess the knowledge of medical professionals providing assistance to victims with traumatic injuries to the facial skull, obtained in the context of road accidents. Materials and methods. For the study, a special questionnaire was developed, including 11 questions. The annotation involved 100 medical professionals working in emergency medical teams. Of these, 50 (50%) people with higher education, the corresponding certificate and holding the positions of doctors providing medical care in the city, another 50 (50%) people who had secondary medical education and worked as a paramedic providing medical care in rural conditions. Results. As a result of the study, the following results were obtained: most specialists working in emergency medical teams have sufficient knowledge of medical care for injuries to the facial skull, at the same time, most specialists do not have a specialized education in dentistry, which does not in all cases help to provide correct and competent care for such sufficiently specific injuries. This can lead to the choice of wrong tactics, which ultimately affects the treatment results of such victims. In this regard, pretexts to develop and introduce into practice specialized courses on the improvement of specialists working in emergency medical teams, which would be conducted by specialists in maxillofacial surgery, as well as disaster medicine. In our opinion, this will reduce the number of errors arising in the provision of medical care to such victims.
{"title":"Тhe level of knowledge of medical workers providing assistance to victims with traumatic injuries of the facial skull received as a result of road accidents","authors":"V. V. Masljakov, S. A. Sidel’nikov, Y. E. Barachevskij, V. Gorbelik, N. V. Dmitriev, A. A. Pimenova, D. A. Polikarpov, M. A. Polidanov","doi":"10.24884/2072-6716-2024-25-1-27-32","DOIUrl":"https://doi.org/10.24884/2072-6716-2024-25-1-27-32","url":null,"abstract":"Purpose of the study. Assess the knowledge of medical professionals providing assistance to victims with traumatic injuries to the facial skull, obtained in the context of road accidents. Materials and methods. For the study, a special questionnaire was developed, including 11 questions. The annotation involved 100 medical professionals working in emergency medical teams. Of these, 50 (50%) people with higher education, the corresponding certificate and holding the positions of doctors providing medical care in the city, another 50 (50%) people who had secondary medical education and worked as a paramedic providing medical care in rural conditions. Results. As a result of the study, the following results were obtained: most specialists working in emergency medical teams have sufficient knowledge of medical care for injuries to the facial skull, at the same time, most specialists do not have a specialized education in dentistry, which does not in all cases help to provide correct and competent care for such sufficiently specific injuries. This can lead to the choice of wrong tactics, which ultimately affects the treatment results of such victims. In this regard, pretexts to develop and introduce into practice specialized courses on the improvement of specialists working in emergency medical teams, which would be conducted by specialists in maxillofacial surgery, as well as disaster medicine. In our opinion, this will reduce the number of errors arising in the provision of medical care to such victims.","PeriodicalId":517874,"journal":{"name":"EMERGENCY MEDICAL CARE","volume":"55 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140398484","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}
Pub Date : 2024-03-01DOI: 10.24884/2072-6716-2024-25-1-20-26
S. S. Moskvina, I. B. Kulikova, N. A. Pavlyuts, E. A. Tsebrovskaya, V. Teplov
The article presents an analysis of the staffing of the ambulance service in various regions of the Russian Federation. The problems of personnel shortage are outlined and possible ways of their solution are presented. The purpose of the study was to analyze the staffing of the ambulance service in the constituent entities of the Russian Federation. Methods. A retrospective analysis of the reporting forms of federal statistical observation No. 30 «Information on a medical organization» was carried out on the availability, staffing and part ‑time ratio of doctors working in emergency medical care in the Russian Federation, in federal districts and their subjects for the full period from 2016 to 2021. Results. According to the results of the analysis, a trend of aggravation of the personnel shortage in various regions of the Russian Federation was revealed. One of the solutions to this problem was to change the curriculum for 5th and 6th year students, after which an increase in students’ interest in emergency medicine was revealed. Another solution to this problem was proposed by the department of the Ivanovo region — to increase the financial support of full ‑time employees of the ambulance service through various programs. Thanks to these changes, it was possible to increase the staffing of medical personnel by 20% in the period from 2021 to 2023. Conclusion. To address the staffing shortage issue, various solutions are possible, including increasing the interest of young professionals through changes in curricula and increasing the salaries of emergency medical staff through various funding programs.
{"title":"Analysis of the staffing of the ambulance service in the constituent entities of the Russian Federation: problems and solutions","authors":"S. S. Moskvina, I. B. Kulikova, N. A. Pavlyuts, E. A. Tsebrovskaya, V. Teplov","doi":"10.24884/2072-6716-2024-25-1-20-26","DOIUrl":"https://doi.org/10.24884/2072-6716-2024-25-1-20-26","url":null,"abstract":"The article presents an analysis of the staffing of the ambulance service in various regions of the Russian Federation. The problems of personnel shortage are outlined and possible ways of their solution are presented. The purpose of the study was to analyze the staffing of the ambulance service in the constituent entities of the Russian Federation. Methods. A retrospective analysis of the reporting forms of federal statistical observation No. 30 «Information on a medical organization» was carried out on the availability, staffing and part ‑time ratio of doctors working in emergency medical care in the Russian Federation, in federal districts and their subjects for the full period from 2016 to 2021. Results. According to the results of the analysis, a trend of aggravation of the personnel shortage in various regions of the Russian Federation was revealed. One of the solutions to this problem was to change the curriculum for 5th and 6th year students, after which an increase in students’ interest in emergency medicine was revealed. Another solution to this problem was proposed by the department of the Ivanovo region — to increase the financial support of full ‑time employees of the ambulance service through various programs. Thanks to these changes, it was possible to increase the staffing of medical personnel by 20% in the period from 2021 to 2023. Conclusion. To address the staffing shortage issue, various solutions are possible, including increasing the interest of young professionals through changes in curricula and increasing the salaries of emergency medical staff through various funding programs.","PeriodicalId":517874,"journal":{"name":"EMERGENCY MEDICAL CARE","volume":"52 25","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140400300","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}
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