Pain Management Nursing最新文献

{"title":"Pain and Suffering: The Experience of Patients With Terminal Cancer.","authors":"Gerardo Rodríguez Aceves, Ana Leticia Salcedo Rocha, Elizabeth Sevilla","doi":"10.1016/j.pmn.2025.02.006","DOIUrl":"https://doi.org/10.1016/j.pmn.2025.02.006","url":null,"abstract":"<p><strong>Purpose/objectives: </strong>Analyze the meaning of pain and suffering experienced by patients with end-stage cancer from a systemic perspective.</p><p><strong>Design: </strong>Qualitative study based on General Systems Theory.</p><p><strong>Sample/participants: </strong>Ten patients with terminal stage cancer were interviewed.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted to understand the reasons for pain and suffering. From a systemic perspective, relationships and interrelationships between different categories, systems, and subsystems were established.</p><p><strong>Findings: </strong>More than a third of the patients identified the spiritual factor as the primary cause of their pain and suffering, above other factors (psychological, economic). They emphasized the importance of faith, religion, and beliefs during their illness.</p><p><strong>Implications for providers: </strong>Including training on aspects of spiritual care in the academic curricula of health professionals would enhance the quality of care for patients at the end of their lives.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143616761","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":"Positive Affect Moderates Walking's Impact on Depression in Fibromyalgia Patients.","authors":"Carmen Ecija, Patricia Catala, Lorena Gutierrez, Cecilia Peñacoba","doi":"10.1016/j.pmn.2025.02.002","DOIUrl":"https://doi.org/10.1016/j.pmn.2025.02.002","url":null,"abstract":"<p><strong>Background: </strong>Depression and pain have a dependent and complex relationship that increase pain-related barriers related to physical activity in patients with chronic pain. Moreover, positive affect and pain acceptance may also contribute to the development of lasting physical and cognitive resources that can support the maintenance of exercise behavior.</p><p><strong>Aim: </strong>The aim of this study has been to examine the impact of psychosocial variables (commitment to physical activity (walking), positive affect) on depression and activity acceptance among patients with Fibromyalgia (FM).</p><p><strong>Design: </strong>Cross-selectional correlational study.</p><p><strong>Method: </strong>Commitment to physical activity (walking), positive affect, depression and activity acceptance were evaluated in 132 FM women. Two models were tested to analyze mediation and a moderated mediation effects.</p><p><strong>Results: </strong>The mediating role of depression between walking and activity acceptance was corroborated regarding the subjective measure of walking. The moderated mediation model found that the effect of walking on activity acceptance was mediated by depression at medium (value: .19; ß = 2.50, [95% CI = 1.19/4.05]) and high levels (value: 9.87; ß =4.46, p < .001, [95% CI = 2.34/6.86]) of positive affect. The indirect effect of walking on activity acceptance via depression was stronger in individuals with higher positive affect.</p><p><strong>Conclusions: </strong>Different levels of positive affect played a contextual role when trying to prevent the effect of depression on activity acceptance in women that walked.</p><p><strong>Clinical implications: </strong>Positive affect is a key variable to prevent the effects of depression on activity acceptance in FM women that walk with the goal to exercise. Interventions from positive psychology, cognitive behavioural therapy and acceptance and commitment therapy can be very useful in this context.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605954","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":"Nurses' Readiness to Implement the Critical-Care Pain Observation Tool in the Intensive Care Unit-Instrument Adaptation and Psychometric Analysis.","authors":"Majid Alotni, Ritin Fernandez, Jenny Sim, Ginger Chu, Michelle Guilhermino","doi":"10.1016/j.pmn.2025.02.005","DOIUrl":"https://doi.org/10.1016/j.pmn.2025.02.005","url":null,"abstract":"<p><strong>Background: </strong>Ensuring effective pain assessment and management in intensive care units (ICUs) is crucial for promoting the well-being of patients.</p><p><strong>Purpose: </strong>To develop and investigate the psychometric properties of an instrument designed to measure nurses' readiness for implementing the Critical-Care Pain Observation Tool in ICUs in Saudi Arabia.</p><p><strong>Design: </strong>This study involved instrument adaptation and psychometric testing.</p><p><strong>Participants and settings: </strong>A convenience sample of 160 ICU nurses, head nurses, in-charge nurses, and nurse educators.</p><p><strong>Methods: </strong>This study comprised two phases. Phase 1 focused on modifying the Acceptability to Intervention (AIM) Intervention Appropriateness Measure (Williams et al.), and Feasibility Intervention Measure (FIM), measuring the content validity and pilot testing the modified tool. Phase 2 involved the psychometric testing of the modified tool and assessing the nurses' readiness for implementing pain assessment in the ICU.</p><p><strong>Results: </strong>The modified instrument was termed the Acceptability and Feasibility tool (mAFt). Academic and clinical expert panel feedback indicated satisfactory content validity. Exploratory factor analysis of the tool resulted in two factors: acceptability (10 items) and feasibility (5 items). The tool demonstrated high internal consistency with Cronbach's alpha values of 0.986 for acceptability and 0.951 for feasibility. The construct validity of the mAFt was supported as ICU nurses with higher education levels exhibited higher readiness scores.</p><p><strong>Conclusions: </strong>The results offer empirical support for the tool's credibility in gauging its readiness for implementation. However, further, psychometric assessments should be conducted with different nurse groups to validate the tool's effectiveness in diverse contexts.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605950","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":"Pain Acceptance: A Concept Analysis.","authors":"Yu Chen, Jie Sun, Yan Li, Wenji Xu, Shizheng Du","doi":"10.1016/j.pmn.2025.02.009","DOIUrl":"https://doi.org/10.1016/j.pmn.2025.02.009","url":null,"abstract":"<p><strong>Background: </strong>Chronic pain exhibits a high prevalence worldwide, placing a considerable burden on global health system. It is an urgent problem how to effectively manage chronic pain. As a notable component of positive psychology, pain acceptance plays an important role in promoting adaption to chronic pain. Pain acceptance has been studied for more than two decades, and different perspectives exist. It is warranted to clarify the concept of pain acceptance based on the most recent literature.</p><p><strong>Objective: </strong>To explore the concept of pain acceptance in the context of chronic pain and understand how it contributes to patients' well-being.</p><p><strong>Design: </strong>Concept analysis.</p><p><strong>Methods: </strong>The Walker and Avant's concept analysis strategy was utilized. Six databases of Pubmed, Web of Science, CINAHL, Science Direct, Springer Link and ProQuest were searched and 59 studies were eventually included and analyzed.</p><p><strong>Results: </strong>We found that the defining attributes of pain acceptance were pain coexistence, pain willingness and activity engagement. Antecedents were identified as demographic factors, pain condition, psychological or cognitive responses, personality traits or cultural background, behavior responses and social interactions. More importantly, pain acceptance prospectively predicts better physical function, mental well-being, social function, overall quality of life and lower medical consumption.</p><p><strong>Conclusions: </strong>The theoretical definition of pain acceptance is established in this study, which provides a reference to understand the role of pain acceptance in chronic pain management. This study may serve as a potential foundation for future research of pain acceptance, thereby adding scientific value for pain acceptance in nursing practice.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586636","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":"The Complexity of the Neonatal Pain Construct: A Commentary on Glenzel et al. (2023).","authors":"Alexandra Breton-Piette, Céline Gélinas, Marilyn Aita","doi":"10.1016/j.pmn.2025.02.007","DOIUrl":"https://doi.org/10.1016/j.pmn.2025.02.007","url":null,"abstract":"","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586637","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":"Factors Associated With Pain Among Hospitalized Older Adults Living With Dementia.","authors":"Barbara Resnick, Marie Boltz, Elizabeth Galik, Rachel McPherson, Ashley Kuzmik, Chris Wells, Luana Colloca, Shijun Zhu","doi":"10.1016/j.pmn.2025.01.012","DOIUrl":"https://doi.org/10.1016/j.pmn.2025.01.012","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to consider the factors associated with change in function, physical activity, behavioral symptoms and participation in function focused care among hospitalized older adults living with dementia.</p><p><strong>Design: </strong>This was a secondary data analysis using data from the Function Focused Care for Acute Care Using the Evidence Integration Theory (FFC-AC-EIT) study to increase physical activity among hospitalized older adults living with dementia.</p><p><strong>Methods: </strong>A total of 455 patients were recruited from 12 hospitals across two states. Hospitals were randomized to receive the FFC-AC-EIT intervention versus Education Only (EO). Structural Equation Modeling using the Amos statistical program was used to test the hypothesized model.</p><p><strong>Results: </strong>The mean age of the participants was 83.9 (SD = 8.3), the majority was female (63%) and White (65%). Tethering, exposure to FFC-AC-EIT, cognition, and nonpharmacologic interventions were associated with pain and pain mediated the relationship between these variables and change in function, behavioral symptoms and physical activity.</p><p><strong>Conclusions: </strong>There are many factors associated with changes in function and behavioral symptoms among hospitalized patients with dementia. The findings from this study provide an important reminder about the critical importance of pain and support the use of nonpharmacologic interventions (e.g., physical activity, position changes and removing tethers) to optimize pain management and improve clinical outcomes among older hospitalized patients living with dementia.</p><p><strong>Clinical implications: </strong>The findings support use of nonpharmacologic interventions including physical activity, position changes and removing tethers as soon as it is clinically reasonable to do so to optimize pain management among older hospitalized patients living with dementia.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586633","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":"Effects of Mirror Therapy-Based Upper Extremity Exercises After Thoracotomy: A Randomized Controlled Trial.","authors":"Neriman Temel Aksu, Zeliha Başkurt, Hakan Keskin","doi":"10.1016/j.pmn.2025.02.003","DOIUrl":"https://doi.org/10.1016/j.pmn.2025.02.003","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the efficacy of mirror therapy-based upper extremity exercises on shoulder pain, shoulder functions, quality of life, and fear of re-injury.</p><p><strong>Design: </strong>Single-blind randomized controlled prospective study.</p><p><strong>Methods: </strong>This prospective randomized controlled study included patients who underwent surgery using the posterolateral-thoracotomy method. Patients were randomly divided into two groups as control (n = 40) and study group (n = 40). Patients were included in the pulmonary rehabilitation program 5 days a week for 4 weeks. In addition, the study group patients performed the upper extremity exercises in the rehabilitation program in front of a mirror. Pain, shoulder joint range of motion, shoulder muscle strength, shoulder function, quality of life, and kinesiophobia were evaluated before surgery and 4 weeks after the intervention.</p><p><strong>Results: </strong>A statistically significant improvement was observed in the study group when comparing shoulder flexion and abduction muscle strength before surgery (Median; 141; 119) with after 4 weeks (Median; 155; 138) (p = .027; p = .019). When the changes from baseline to 4 weeks were compared, there were statistically significant differences between the groups in all results except shoulder external rotation muscle strength (p < .050).</p><p><strong>Conclusions: </strong>Mirror therapy-based upper extremity exercises, which is added to the physiotherapy and rehabilitation program after thoracotomy, provides benefits such as pain relief, reduction of kinesiophobia, improvement of shoulder functions and improvement of quality of life.</p><p><strong>Clinical implications: </strong>Thoracotomy may cause shoulder pain and limitation of shoulder functions. Shoulder pain causes changes in the motor cortex and structural and functional changes that affect muscle activation. Central sensitization plays a role in events such as shoulder pain and dysfunction. Recently, mirror therapy has been used in the treatment program for upper extremity injuries and pain. Mirror therapy can provide consistent visual feedback when performing upper extremity exercises. Mirror therapy applied after thoracotomy can reduce shoulder pain and kinesiophobia. The study was registered at clinicaltrials.gov (NCT05962736).</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586630","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 Application of Intelligent Pain Management Program in Patients With Postherpetic Neuralgia Patients.","authors":"Huaxiu Xu, Liyun Kong, Huichen Yang, Ting Huang, Fenfen Liu, Lili Zhang, Fei Zheng, Zhiyong Wu, Xulin Wang, Xinhong Zhang","doi":"10.1016/j.pmn.2025.01.014","DOIUrl":"https://doi.org/10.1016/j.pmn.2025.01.014","url":null,"abstract":"<p><strong>Background: </strong>Effective pain management is crucial for treating and caring for individuals with postherpetic neuralgia (PHN). A systematic pain management program for this condition has not been established.</p><p><strong>Purpose: </strong>To assess the clinical effectiveness of an intelligent pain management (IPM) program for patients with postherpetic neuralgia (PHN).</p><p><strong>Methods: </strong>A randomized controlled trial was conducted, enrolling 92 PHN inpatients from January 2022 to January 2023. The control group (45 patients) received conventional pain management, while the experimental group (47 patients) underwent an IPM program. The study compared the impact of these approaches on clinical symptoms, sleep quality, and pain-catastrophizing cognition between the two groups.</p><p><strong>Results: </strong>In the experimental group, the Numerical Rating Scale (NRS) scores were, the Numerical Rating Scale (NRS) scores were significantly lower than those in the control group on the 7th and 10th days of hospitalization. The differences in NRS scores, both in terms of treatment effects and time effects, as well as the interaction effect between treatment and time, were statistically significant (p < .05). The experimental group also exhibited a lower average daily frequency of breakthrough pain, a higher total pain relief rate, and better sleep index scores compared to the control group, with statistically significant differences (p < .05). However, the pain catastrophizing scores in the experimental group were lower than those in the control group, but this difference was not statistically significant (p > 0.05).</p><p><strong>Conclusion: </strong>IPM programs can enhance patient pain outcomes and improve sleep quality. Nevertheless, the effect on pain catastrophizing cognition did not reach statistical significance.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531767","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":"Effects of Ethnic Medicinal Plant Extracts Versus Nonsteroidal Anti-Inflammatory Drugs on Menstrual Pain in Women With Primary Dysmenorrhea: A Systematic Review and Meta-Analysis Study.","authors":"Ying-Yu Zhong, He Wang, Yue-Yun Wang","doi":"10.1016/j.pmn.2025.01.006","DOIUrl":"https://doi.org/10.1016/j.pmn.2025.01.006","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to compare the pain reduction effects of ethnic medicinal plant extracts and nonsteroidal anti-inflammatory drugs (NSAIDs) in women with primary dysmenorrhea.</p><p><strong>Methods: </strong>The following databases were searched: CNKI, Wanfang Data Knowledge Service Platform (Wanfang), VIP Chinese Journal Service Platform (VIP), SinoMed, PubMed, and Web of Science. The retrieval period was from the time of database construction to December 2023.Randomized controlled trials (RCTs) that compared the treatment of pain in women with primary dysmenorrhea using NSAIDs in the control group and plant extracts in the intervention group were identified. The literature was independently screened by two researchers, and the quality of the literature were evaluated using Cochrane's RCT Risk Assessment Manual for Bias. The evaluation includes several aspects including random sequence generation, assignment hiding, blind method and result data reporting. Meta-analysis was conducted using RevMan 5.4 software.</p><p><strong>Results: </strong>A total of 12 literature were included. Meta-analysis showed that there was no significant difference between ethnic medicinal plant extracts and NSAIDs in reducing the Visual Analog Scale (VAS) pain scores for primary dysmenorrhea (SMD = 0.32, 95% CI (-0.14, 0.78), p = .17). However, ethnic medicinal plant extracts were more effective than NSAIDs in reducing the proportion of people with pain, with a slight difference (OR = 1.75, 95% CI (1.02, 3.02), p < .05).</p><p><strong>Conclusion: </strong>Ethnic medicinal plant extracts can effectively reduce the VAS pain scores in women with primary dysmenorrhea and the proportion of people with pain. The effect is comparable to or even better than that of NSAIDs, with fewer side effects. Therefore, ethnic medicinal plant extracts can be considered as a clinical option to alleviate menstrual pain.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524115","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":"Romancing With Pain: A Survey Study of Young Adults With Chronic Pain.","authors":"Paula Forgeron, Pam Qualter, Abbie Jordan, Holly Saron, Bernie Carter","doi":"10.1016/j.pmn.2025.01.008","DOIUrl":"https://doi.org/10.1016/j.pmn.2025.01.008","url":null,"abstract":"<p><strong>Background: </strong>Developing and maintaining romantic relationships is a hallmark of entry to adulthood. Studies suggest that young people with chronic pain often experience social challenges engaging in romantic intimacy, but these studies are limited as they (1) combined participants who were and were not in romantic relationships and (2) focused solely on heterosexual romantic relationships. It is unknown how young adults with chronic pain, inclusive of diverse genders and sexual orientations, perceive themselves on romantic relationship factors.</p><p><strong>Purpose: </strong>To determine how pain-related factors are associated with romantic relationship factors when young adults with chronic pain are actively in a romantic relationship.</p><p><strong>Design: </strong>An online cross-sectional survey using validated questionnaires assessed chronic pain characteristics, romantic relationship factors, social well-being, and demographics. A social media campaign recruited 72 young adults (18-25 years) who were in a romantic relationship regardless of sexual orientation or gender identification.</p><p><strong>Results: </strong>Pain characteristics, not demographics, explained 23.6% of the variance in romantic relationship anxiety, suggesting that pain contributed to concerns about an individual needing their partner's approval and distress when their partner is unresponsive to their needs. Pain characteristics did not impact participants' present relationship satisfaction, but negatively impacted loneliness. Interestingly, loneliness was negatively associated with romantic relationship factors.</p><p><strong>Conclusions: </strong>Nurses and members of the interprofessional team should reassure young adults with chronic pain that pain is not necessarily a limiting factor in romantic relationship satisfaction. Additionally, clinical staff should also assess loneliness as romantic relationships alone are insufficient in decreasing loneliness within this population.</p>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516282","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}