Pain Management Nursing最新文献

{"title":"Auricular Acupressure Adjunct Treatment for Opioid Tapering: A Randomized Pilot Feasibility Study.","authors":"Heather J Jackson, Micaela Arseneau, Michelle Terrell, Kim Steanson, Mary S Dietrich","doi":"10.1016/j.pmn.2024.07.010","DOIUrl":"https://doi.org/10.1016/j.pmn.2024.07.010","url":null,"abstract":"<p><strong>Purpose: </strong>Opioid medications are necessary in the treatment of critically ill infants; however. prolonged use may lead to withdrawal syndrome. The purpose of this study was to assess feasibility of delivering an acupressure protocol for the treatment of iatrogenic withdrawal in a pediatric cardiac intensive care unit as well as impact and acceptance of acupressure as an adjunct treatment.</p><p><strong>Design: </strong>Randomized pilot feasibility trial.</p><p><strong>Methods: </strong>Acupressure stickers were applied and rotated to one ear every 1-3 days until withdrawal symptoms improved.</p><p><strong>Results: </strong>There were no serious adverse events, with only one reported incident of skin irritation. Recruiting benchmarks were exceeded. Weaning phases were significantly shorter in the acupressure group (medians 6.0 vs 22.0 respectively, p = .025, d = 0.90) and the control group used skin-to-skin contact as a comfort measure significantly more than the acupressure group (42.9% vs 6.3%, p = .18). Acupressure was accepted by parents, with an overall 96.2% rating their experience as positive, as measured by the Parent Client Satisfaction Questionnaire. The majority of health care providers (n = 19) were supportive, with 71.9% agreeing or completely agreeing acupressure is an acceptable adjunct for the treatment of withdrawal symptoms; 26.8% were neutral, as measured by the Acceptability of Intervention Measure, Intervention Appropriateness Measure, and Feasibility of Intervention Measure.</p><p><strong>Conclusions: </strong>Acupressure was found to be safe, feasible, and accepted by health care providers in a pediatric cardiac intensive care setting.</p><p><strong>Clinical implications: </strong>These findings support future research with larger sample sizes to improve clinical treatment of infants physically dependent on sedative medications.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142081146","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":"Application of Integrated Medical Care \"Cloud-Based Virtual Ward\" Management Model on Postoperative Analgesia: Based on Zigbee Technology.","authors":"Shaoru Chen, Hui Zhi, Hongmei Zhang, Jie Wang, Xin Li","doi":"10.1016/j.pmn.2024.07.011","DOIUrl":"https://doi.org/10.1016/j.pmn.2024.07.011","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to compare acute care postoperative patients monitored by standard care to those monitored through virtual ward technology by pain team to evaluate status in real-time.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>We included 72,240 and 68,424 postoperative patients who underwent the acute pain service model between January 2021 and April 2022 and the \"cloud-based virtual ward\" management model between May 2022 and September 2023, respectively. Patients were administered patient-controlled intravenous analgesia after surgery, and we collected perioperative data regarding the general condition, operation type, postoperative moderate-to-severe pain, nausea and vomiting, dizziness, hoarseness, and drowsiness of the patients.</p><p><strong>Results: </strong>The incidences of moderate-to-severe postoperative pain, postoperative nausea and vomiting, dizziness, drowsiness, hoarseness, resting pain, and activity pain were significantly reduced in the \"cloud-based virtual ward\" management model when compared with the acute pain service model.</p><p><strong>Conclusions: </strong>Compared to the acute pain service model, the \"cloud-based virtual ward\" management model can enhance pain management satisfaction and lower the frequency of moderate-to-severe postoperative pain and adverse effects.</p><p><strong>Clinical implications: </strong>The \"cloud-based virtual ward\" management model proposed in this study may improve the care of patients with acute postoperative pain. By reviewing the two pain management models for postoperative patients, we were able to compare the incidence of postoperative adverse reactions and use the standard process of the integrated medical care \"cloud-based virtual ward\" management model to optimize the management of postoperative patients and promote their health outcomes.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Lifetime of Work to Promote Health Equity in Pain Management: Honoring the Legacy of Dr. April H. Vallerand (1957-2024)","authors":"Anitha Saravanan Ph.D., M.S.N., APRN-BC ,&nbsp;Navdeep Singh Ph.D., AGACNP-BC ,&nbsp;Jinbing Bai Ph.D., M.S.N., R.N., FAAN","doi":"10.1016/j.pmn.2024.07.014","DOIUrl":"10.1016/j.pmn.2024.07.014","url":null,"abstract":"","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"25 5","pages":"Pages 433-435"},"PeriodicalIF":1.6,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009207","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":"Clinical Predictors of Medication Compliance in Patients With Acute Herpetic Neuralgia.","authors":"Hui Lyu, Ling-Yan Wang, Rui-Xia Wang, Han Sheng, Jian-Mei Xia, Jun-Ya Cheng","doi":"10.1016/j.pmn.2024.07.002","DOIUrl":"https://doi.org/10.1016/j.pmn.2024.07.002","url":null,"abstract":"<p><strong>Purpose: </strong>Pain is one of the most common and harmful symptoms experienced by individuals with acute herpetic neuralgia (AHN). In this population, studies to determine the causes that affect patients taking medications compliance are rare. This study aimed to construct a predictive model for medication compliance of patients with AHN and to verify its performance.</p><p><strong>Design and methods: </strong>In this prospective study of 398 patients with AHN who were discharged from a tertiary hospital with medications from July 2020 to October 2022, we used logistic regression analysis to explore the predictive factors of medication compliance of patients with AHN and to construct a nomogram. The area under the curve was used to evaluate the predictive effect of the model.</p><p><strong>Results: </strong>A predictive model of drug compliance of patients with AHN was constructed based on the following four factors: disease duration, pain severity before treatment, medication beliefs, and comorbidity of chronic diseases. The area under the curve of the model was 0.766 (95% confidence interval [0.713, 0.819]), with a maximum Youden's index of 0.431, sensitivity of 0.776, and specificity of 0.655. A linear calibration curve was found with a slope close to 1.</p><p><strong>Conclusions: </strong>The prediction model constructed in this study had good predictive performance and provided a reference for early clinical screening of independent factors that affected the medication compliance of patients with AHN.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141996263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Transcutaneous Electrical Nerve Stimulation on Patients with Total Knee Replacement: A Randomized Controlled Trial.","authors":"Nilgün Özbaş, Emre Ersoy, Murat Korkmaz, Hacı Ali Olçar","doi":"10.1016/j.pmn.2024.07.003","DOIUrl":"https://doi.org/10.1016/j.pmn.2024.07.003","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to determine the effect of transcutaneous electrical nerve stimulation (TENS) on pain, functionality, quality of life, and analgesic consumption in patients undergoing TKR.</p><p><strong>Design: </strong>A single center, randomized controlled trial.</p><p><strong>Methods: </strong>A total of 52 participants were randomly assigned to the intervention (n = 26) and control (n = 26) groups. The intervention group was exposed to conventional TENS. Data were collected with a Patient Identification Form, the Visual Analogue Scale (VAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Quality of Life Scale (SF-36), and the Analgesic Tracking Form.</p><p><strong>Results: </strong>VAS and WOMAC scores significantly decreased in the intervention group, over time, while they increased in the control group. SF-36 scores significantly increased in the intervention group over time. It was determined that analgesic consumption was significantly lower in the intervention group than in the control group.</p><p><strong>Conclusions: </strong>TENS significantly reduced pain and increased functionality and quality of life. Our findings suggest that TENS may be an effective adjunctive analgesic therapy in patients receiving TKR; however, more testing is needed in larger and more heterogeneous populations.</p><p><strong>Clinical implications: </strong>Nurses can provide effective postoperative pain control in patients undergoing TKR, increase functionality, accelerate the healing process, and improve their quality of life by using TENS, a non-pharmacological treatment method, in the perioperative period.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141996264","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":"Integrating Complementary Therapies in Managing Phantom Limb Pain: A Case Review.","authors":"Njood Y ALfaifi, Elizabeth J Winokur","doi":"10.1016/j.pmn.2024.07.007","DOIUrl":"https://doi.org/10.1016/j.pmn.2024.07.007","url":null,"abstract":"<p><strong>Objectives: </strong>This paper describes phantom limb pain (PLP), its impact on patients, and the various treatment options, including pharmacologic and complementary therapies. It investigates the efficacy of incorporating complementary and alternative therapies, both invasive and noninvasive, for amputees who have not achieved satisfactory results with pharmacologic treatments and suffer from adverse drug events. Furthermore, with the predicted increase in limb amputations, it is crucial for nurses, as frontline providers, to understand PLP, be prepared to manage persistent pain and associated psychological and functional issues and educate patients and families about alternative treatment options.</p><p><strong>Approach: </strong>The review includes recent studies on pharmacologic interventions for PLP, case reports, and randomized clinical trials on non-pharmacologic complementary therapies, covering both invasive and noninvasive modalities. Studies from 2013 to 2022 were identified using the PubMed search engine with terms such as \"Amputation,\" \"phantom limb pain,\" \"invasive therapies,\" and \"non-invasive therapies.\"</p><p><strong>Results and conclusion: </strong>The pathogenesis of PLP remains unclear, complicating the identification of causes and the selection of targeted therapies for each patient. Uncontrolled PLP can severely impact the quality of life, causing psychological distress and loss of productivity. Traditional pharmacologic therapy often requires supplementation with other options due to PLP's refractory nature. A comprehensive, multimodal treatment plan, including non-pharmacologic therapies, can enhance rehabilitation and reduce complications. Incorporating these therapies can decrease reliance on medications, particularly opioids, and mitigate side effects. Although many potential PLP treatments exist, further clinical studies are needed to determine their effectiveness and establish protocols for optimizing patient outcomes.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988529","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":"Which Patients With Chronic Pain Do The Primary Care Refers to a Tertiary Hospital in a Developing Country? Experience From a University Hospital.","authors":"Guilherme Salcedo Areunete, Cláudia Zornoff Gavazza, Beatriz Fátima Alves de Oliveira, Nivaldo Ribeiro Villela","doi":"10.1016/j.pmn.2024.07.008","DOIUrl":"https://doi.org/10.1016/j.pmn.2024.07.008","url":null,"abstract":"<p><strong>Purpose: </strong>The study aimed to profile patients with uncontrolled chronic pain referred from primary care to a tertiary hospital in a developing country, and identify factors associated with pain intensity, interference, and its link with mental health.</p><p><strong>Design: </strong>Cross-sectional design.</p><p><strong>Methods: </strong>Data from 906 adult patients with nonmalignant chronic pain during their first visit to the multidisciplinary pain center at the State University of Rio de Janeiro in 2019 were used. The brief pain inventory and the Hospital Anxiety and Depression Scale questionnaire assessed pain intensity, its impact on daily activity, and symptoms of anxiety and depression.</p><p><strong>Results: </strong>The population was predominantly female (68.8%), over 50 (66.3%), with less than 11 years of education (86.5%), and 75.2% were overweight or obese. Most (81.9%) reported moderate or severe pain, significantly interfering with daily activities (>50%). The lower back was the most commonly affected site. Widespread pain was present in 43.6% of patients. High scores for anxiety (67.4%) and depression (52.2%) were observed. Severe pain was predominantly seen in middle-aged women and individuals with high levels of anxiety and depression.</p><p><strong>Conclusion: </strong>Patients with uncontrolled chronic pain referred from primary care to a tertiary hospital were predominantly female, overweight or obese, and exhibited a high prevalence of depression and anxiety. Their pain significantly interfered with daily activities.</p><p><strong>Clinical implications: </strong>The study provides valuable insight into the biopsychosocial characteristics of uncontrolled chronic pain patients in primary care, emphasizing the importance of implementing multidisciplinary approaches to manage chronic pain effectively within primary care settings.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141982971","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":"Comparison of the Efficacy of Propranolol Versus Valsartan in the Prevention of Migraine: A Randomized Controlled Trial.","authors":"Arash Mosarrezaii, Danial Tahazadeh, Hussein Soleimantabar, Pegah Panahi","doi":"10.1016/j.pmn.2024.07.001","DOIUrl":"https://doi.org/10.1016/j.pmn.2024.07.001","url":null,"abstract":"<p><strong>Background: </strong>Migraine is a prevalent episodic headache that affects approximately 14%-15% of the global population. Since valsartan is an antihypertensive drug, it is hypothesized that taking valsartan can prevent migraine attacks in patients with the condition. This study aimed to determine the efficacy of propranolol versus valsartan in preventing migraine attacks.</p><p><strong>Material and methods: </strong>This randomized controlled trial was conducted on 56 patients with migraine from a neurology clinic. Patients were divided into two equal groups of 28 individuals, after providing informed consent. The patients then received either propranolol or valsartan treatment. The intensity and frequency of migraines were compared before and after treatment in both study groups.</p><p><strong>Results: </strong>The patients' mean age was 32.78 years old (±6.9 SD), and 64% of the patients were female. After a 1-month treatment period, the results showed that valsartan patients experienced significantly fewer severe migraine attacks compared to propranolol patients.</p><p><strong>Conclusion: </strong>According to the results of the present study, valsartan may be at least as effective as propranolol and perhaps more effective on some measures.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141982969","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":"Association Between Pain During Pregnancy and Postpartum Depressive Symptoms in Adolescent and Adult Women.","authors":"Bárbara Brenda de Araújo Faria, Sabrina Gabrielle Gomes Fernandes Macêdo, Catherine M Pirkle, Saionara M A Câmara","doi":"10.1016/j.pmn.2024.06.014","DOIUrl":"https://doi.org/10.1016/j.pmn.2024.06.014","url":null,"abstract":"<p><strong>Issue: </strong>Postpartum depressive symptoms may be more prevalent and/or severe in vulnerable populations.</p><p><strong>Background: </strong>Postpartum depression represents a serious mental health problem associated with maternal suffering. Despite the relevance and clinical implications of investigating pain during pregnancy and the association with postpartum depression, there is limited research on this topic.</p><p><strong>Aim: </strong>We evaluated the association between pain during pregnancy and postpartum depression symptoms in adolescent and adult women.</p><p><strong>Methods: </strong>This study included 86 pregnant women (42 adolescents aged 13 to 18 years and 44 adults aged 23 to 28 years) from Trairi region, Northeastern Brazil. The evaluation of pain intensity and postpartum depression symptoms was conducted using the validated instruments of the Pelvic Pain Assessment Form and Edinburgh Postnatal Depression Scale (EPDS), respectively. Mann-Whitney and Kruskal-Wallis tests compared depressive symptoms in relation to pain status.</p><p><strong>Findings: </strong>Overall, pregnant women reporting moderate to intense pain presented more depressive symptoms, with emphasis to \"deep pain with intercourse\" (p = .09), \"burning vaginal pain after sex\" (p = .01), \"pelvic pain lasting hours or days after intercourse\" (p = .06), and \"pain with urination\" (p = .09). When stratified by age group, significant associations were found only for the adolescents.</p><p><strong>Discussion: </strong>Our results suggest that women reporting pain in different daily situations have higher EPDS scores.</p><p><strong>Conclusion: </strong>Pain during pregnancy is associated with postpartum depression symptoms, mainly among adolescents. Adequate screening and pain management during pregnancy may improve women's quality of life.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141982968","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":"Non-Pharmacological Pain and Stress Management (N-PPSM) in Pediatric Wards: A Nurses' Perspective","authors":"Idyatul Hasanah PhD ,&nbsp;Nursalam Nursalam PhD ,&nbsp;Ilya Krisnana PhD ,&nbsp;Yuni Sufyanti Arief PhD ,&nbsp;Nuzul Qur'aniati PhD ,&nbsp;Zikrul Haikal MD ,&nbsp;Ririn Afrian Sulistyawati MKep ,&nbsp;Tita Rohita PhD","doi":"10.1016/j.pmn.2024.07.005","DOIUrl":"10.1016/j.pmn.2024.07.005","url":null,"abstract":"<div><h3>Purpose</h3><p>To describe the nurses’ use of non-pharmacological pain and stress management (N-PPSM) in pediatric wards and their perceptions of the benefits and perceived barriers that encourage and limited their use of these methods.</p></div><div><h3>Methods</h3><p>This was a descriptive cross-sectional study involving 125 nurses working in the pediatric ward of an Indonesian hospital. Data collection utilized modified non-pharmacological method questionnaires, and data analysis involved t-tests and ANOVA.</p></div><div><h3>Results</h3><p>The most widely used N-PPSM by nurses are cognitive methods such as providing education (48%), physical methods by positioning (40%), emotional support (36%), environmental support (45%), and family support (60%). Nurses stated that N-PPSM had few side effects (50.4%), were inexpensive (49.6%), could be performed independently (51.2%), and were easy to use (52.8%). However, during its implementation, there were several obstacles including lack of experience (42.4%), lack of training (48%), lack of equipment (45.6%), nurse belief (36.8%), lack of time (44%), patient unwilling (47.2%), and patient belief (41.6%). Work experience influences the overall utilization of N-PPSM (<em>p</em>-value = .043).</p></div><div><h3>Conclusion</h3><p>The findings from this research emphasize the significance of enhanced training for nurses working in the utilization of N-PPSM in pediatric wards.</p></div><div><h3>Clinical Implications</h3><p>Findings from this study can enhance nurses' knowledge and competence in using N-PPSM in pediatric wards, thus improving patient care. Hospitals may consider implementing new policies, education, training, and infrastructure to support N-PPSM. Educational institutions can also incorporate these methods into nursing curricula, increasing nurses' awareness and skills in using N-PPSM in pediatric patients.</p></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"25 5","pages":"Pages 510-517"},"PeriodicalIF":1.6,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141982970","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}