Wound management & prevention最新文献

{"title":"Negative pressure wound therapy with instillation in lower extremity wounds may contribute to cost-savings: 4 case reports.","authors":"R. Napolitano","doi":"10.25270/wmp.2023.2.22058","DOIUrl":"https://doi.org/10.25270/wmp.2023.2.22058","url":null,"abstract":"BACKGROUND\u0000Use of negative pressure wound therapy with instillation and dwell time (NPWTi-d) can assist with wound bed preparation for successful closure. The authors present their experience using NPWTi-d to manage lower extremity wounds in 4 patients and discuss the feasibility of improving cost efficiency.\u0000\u0000\u0000METHODS\u0000NPWTi-d involved instillation of normal saline with an 8-to 10 minute dwell time, followed by 3 to 3.5 hours of -125 mm Hg. Therapy continued for 6 to 7 days with dressing changes every 2 to 3 days.\u0000\u0000\u0000RESULTS\u0000Patients were all male, between the ages of 24 and 83 years old. Wound etiologies included chemical burn, deep tissue laceration, compartment syndrome with hematoma, and diabetic foot osteomyelitis. All wounds required cleansing. Prior to NPWTi-d, surgical debridement and antibiotics were administered as necessary. After NPWTi-d, the wounds exhibited healthy granulation and reduced in size, allowing for discharge to outpatient care. Upon follow-up 2 to 6 months later, no patients experienced wound complications or required readmission to the operating room, potentially saving on time and cost.\u0000\u0000\u0000CONCLUSION\u0000In these patients, use of NPWTi-d assisted in cleansing the wound surface and producing a positive healing outcome. Despite higher initial costs of NPWTi-d over standard dressings, a wound management protocol including NPWTi-d may help mitigate expenses incurred by delayed healing.","PeriodicalId":23741,"journal":{"name":"Wound management & prevention","volume":"69 2 1","pages":"32-38"},"PeriodicalIF":1.2,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49425452","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":"Textile composition, not number of layers, impacts interphase pressure and static stiffness index: A pragmatic, comparative analysis of the in vivo interphase pressure of 7 different 2-layer cohesive bandage kits in healthy volunteers.","authors":"S. Ehmann, Albert E. Ortega, H. Hettrick","doi":"10.25270/wmp.2023.2.22072","DOIUrl":"https://doi.org/10.25270/wmp.2023.2.22072","url":null,"abstract":"\"OBJECTIVE: The aim of the study was to comparatively evaluate the in vivo interphase pressure (IP) and statis stiffness index (SSI), upon initial application, of 7, 2-layer cohesive bandage kits when applied on healthy volunteers.\u0000\u0000\u0000METHOD\u0000Bandages were applied in random order, on non-consecutive days by a single experienced clinician. The IP at the time of application was measured on the right lower limb of 10 healthy volunteers at 2 different points (B1, C). Measurements were made in 2 positions, supine and standing. There were 2 consecutive applications and measurements made for each compression bandage set. Statistical analysis of the outcome data was performed, utilizing a repeated measures analysis of variance (ANOVA) to determine: the effects of the bandage type on IP and SSI for each of the measurement points and according to the subject's position. Post hoc analyses were performed by Tukey and Bonferroni test to identify significant differences. The dispersion of the recorded pressures within the study population (dispersion between subjects) was assessed by the coefficient of variations.\u0000\u0000\u0000RESULTS\u0000The in vivo IP measured at B1 in the supine position varied from 50.1 mmHg (±5.3) to 73.7 mmHg (±13.4). The in vivo IP measured at C in the supine position varied from 53.2 mmHg (±7.6) to 69.3 mmHg (±10.6). Bonferroni post hoc analyses demonstrated with a 95% confidence interval, there was a significant difference between wraps and placed them into 5 groups for the IP measured at B1, and 3 groups for measurements taken at C. A regression model including the main effects of the wrap and the subject with their interaction were similar for the IP observed at B1 and C in the supine position (r2 = 0.881). The in vivo SSI measured at B1 varied from 11.95 (±5.4) to 6.65 (±4.4). Post hoc analyses similarly demonstrated significant differences placing the wraps into 3 different groups. Statistical analysis of the variability of the IP observed at B1 and C showed there was a significant difference at B1 (P = .001), which was not observed at C (P = .347).\u0000\u0000\u0000CONCLUSION\u0000Sub-bandage pressure measurements produced by the 7, '2-layer cohesive' compression box sets were not equivocal. IP and SSI varied by textile composition, clinically supporting the trial of alternative '2-layer cohesive' compression box set if the desired outcome (ie, wound healing, edema reduction) is not achieved. Additional study in patients with edema is warranted to allow an evidenced-based approached to the selection of a compression bandage set.","PeriodicalId":23741,"journal":{"name":"Wound management & prevention","volume":"69 2 1","pages":"14-25"},"PeriodicalIF":1.2,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42582939","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":"Therapeutic modalities of human β defensin-2 with prospective significance in diabetic wound treatment.","authors":"Vidyasrilekha. Yele, Bharat Kr Sanapalli","doi":"10.25270/wmp.2023.2.22084","DOIUrl":"https://doi.org/10.25270/wmp.2023.2.22084","url":null,"abstract":"BACKGROUND\u0000Diabetic Wounds (DW) are a debilitating complication of diabetes. Although various therapeutic strategies are available for DW management, none of them meet all the fundamentals due to the multifaceted pathophysiology of DW. Given the ever-present threat of DW, novel improved therapeutic strategies and the fortification of DW research deserve better prioritization.\u0000\u0000\u0000PURPOSE\u0000The current review aims to provide the detailed role of human β defensin-2 (HBD-2) in skin wounds with a prospective significance in DW treatment.\u0000\u0000\u0000METHODS\u0000This review was conducted through searches of relevant abstracts, research and review articles, and patents, in Scopus, Web of Science, PubMed, Google Scholar, and Clinical Trials databases of English language articles.\u0000\u0000\u0000RESULTS\u0000HBD-2 is a critical innate immune-response protein that defends the human body from infections. Recent reports also support the role of HBD-2 in suppressing inflammation and promoting proliferation and angiogenesis. Based on the literature, its therapeutic administration has been proposed to maintain the equilibrium of systemic homeostasis in DW.\u0000\u0000\u0000CONCLUSION\u0000It has been hypothesized that HBD-2 could be a crucial modulator for controlling chronic inflammation and size by promoting proliferation and angiogenesis, opening up new therapy options in DW.","PeriodicalId":23741,"journal":{"name":"Wound management & prevention","volume":"69 2 1","pages":"39-45"},"PeriodicalIF":1.2,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42042066","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 PechaKucha presentation about prevention of pressure injury on knowledge of elderly care department students: a randomized controlled study.","authors":"Hale T Damar,&nbsp;Sueda Gür","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>PechaKucha (PK) is a presentation technique that uses visual and narrative presentations consisting of 20 slides, each shown for 20 seconds.</p><p><strong>Purpose: </strong>The aim of this study was to evaluate the effects of the PK presentation on elderly care department students' knowledge about pressure injury prevention.</p><p><strong>Methods: </strong>This study used a single-blinded randomized control trial. Elderly care department students were randomized to the PK presentation technique (intervention group) and traditional PowerPoint presentations only (control group). The sample of the study consisted of 54 (intervention group = 28, control group = 26) elderly care department students. Data was collected using the Sociodemographic Form and the Pressure Ulcer Prevention Knowledge Assessment Instrument (PUPKAI). PUPKAI was administered before the presentations (pre-test), after the presentations (post-test 1), and 4 weeks after the presentations (post-test 2).</p><p><strong>Results: </strong>Following the presentations, the intervention group's PUPKAI mean score (47.23 ± 11.62) was significantly higher than the control group's mean score (36.64 ± 12.41) (P < .05). Four weeks after completing the education, the intervention group's mean PUPKAI score (43.11 ± 13.72) was significantly higher than the control group's mean score (36.46 ± 12.76) (P < .05).</p><p><strong>Conclusion: </strong>The knowledge level of the elderly care department students was found to be below the satisfactory level. It was determined that the PK presentation increased the knowledge level of the students regarding pressure injury prevention.</p>","PeriodicalId":23741,"journal":{"name":"Wound management & prevention","volume":"69 2","pages":"52-61"},"PeriodicalIF":1.2,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9594186","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":"Lessons Learned: A Disruption in Care Leads to Increased Rates of Proximal Amputations.","authors":"Justin Yu, Jai Joshi, Carmen Wong, Nafis Ahmed, Amit Rao, Timmy Li, Ammar Al Rubaiay, G. Landis, Alisha R. Oropallo","doi":"10.25270/wmp.2023.1.4957","DOIUrl":"https://doi.org/10.25270/wmp.2023.1.4957","url":null,"abstract":"BACKGROUND\u0000In March 2020, due to the COVID-19 pandemic, hospitalizations in New York state were restricted to emergency purposes. Non-COVID related cases involving lower extremity wounds were only admitted for acute infections and limb salvage. Patients with these conditions were placed at higher risk for eventual limb loss.\u0000\u0000\u0000PURPOSE\u0000To understand the impact of COVID-19 on amputation rates.\u0000\u0000\u0000METHODS\u0000A retrospective review of lower limb institution-wide amputations was conducted at Northwell Health from January 2020 to January 2021. The amputation rates during the COVID-19 shutdown period were compared to the pre-pandemic, post-shutdown, and reopening period.\u0000\u0000\u0000RESULTS\u0000The pre-pandemic period had 179 amputations, of which 8.38 % were proximal. 86 amputations were performed during shutdown, with a greater proportion being proximal (25.58 %, p=0.0009). Following the shutdown period, amputations returned to baseline. The proportion of proximal amputations during post-shutdown was 18.5 % and during reopening was 12.06 %. Patients had 4.89 times higher odds of undergoing a proximal amputation during the shutdown period.\u0000\u0000\u0000CONCLUSIONS\u0000The effect of COVID-19 on amputation rates demonstrates an increase in proximal amputation during the initial shutdown. This study suggests an indirect negative effect of COVID-19 hospital restrictions on surgeries during the initial shutdown period.","PeriodicalId":23741,"journal":{"name":"Wound management & prevention","volume":"69 1 1","pages":"49-57"},"PeriodicalIF":1.2,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44682477","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":"Lessons Learned: A Disruption in Care Leads to Increased Rates of Proximal Amputations.","authors":"Justin Yu,&nbsp;Jai Joshi,&nbsp;Carmen Wong,&nbsp;Nafis Ahmed,&nbsp;Amit Rao,&nbsp;Timmy Li,&nbsp;Ammar Al Rubaiay,&nbsp;Gregg Landis,&nbsp;Alisha Oropallo","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>In March 2020, due to the COVID-19 pandemic, hospitalizations in New York state were restricted to emergency purposes. Non-COVID related cases involving lower extremity wounds were only admitted for acute infections and limb salvage. Patients with these conditions were placed at higher risk for eventual limb loss.</p><p><strong>Purpose: </strong>To understand the impact of COVID-19 on amputation rates.</p><p><strong>Methods: </strong>A retrospective review of lower limb institution-wide amputations was conducted at Northwell Health from January 2020 to January 2021. The amputation rates during the COVID-19 shutdown period were compared to the pre-pandemic, post-shutdown, and reopening period.</p><p><strong>Results: </strong>The pre-pandemic period had 179 amputations, of which 8.38 % were proximal. 86 amputations were performed during shutdown, with a greater proportion being proximal (25.58 %, p=0.0009). Following the shutdown period, amputations returned to baseline. The proportion of proximal amputations during post-shutdown was 18.5 % and during reopening was 12.06 %. Patients had 4.89 times higher odds of undergoing a proximal amputation during the shutdown period.</p><p><strong>Conclusions: </strong>The effect of COVID-19 on amputation rates demonstrates an increase in proximal amputation during the initial shutdown. This study suggests an indirect negative effect of COVID-19 hospital restrictions on surgeries during the initial shutdown period.</p>","PeriodicalId":23741,"journal":{"name":"Wound management & prevention","volume":"69 1","pages":"49-57"},"PeriodicalIF":1.2,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9316154","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 Wound Debridement Pressures With Updated Tests.","authors":"S. Fisher","doi":"10.25270/wmp.2023.1.2631","DOIUrl":"https://doi.org/10.25270/wmp.2023.1.2631","url":null,"abstract":"BACKGROUND\u0000Wound debridement is one of the key treatment methods for chronic and acute wounds. Various tools are used to perform debridement, but the force applied to the tissue by these different instruments has been poorly documented in a limited number of past research efforts.\u0000\u0000\u0000PURPOSE\u0000The aim of this study was to provide insight into the actual amount of pressure exerted on wound tissue.\u0000\u0000\u0000METHODS\u0000We used a digital force transducer to measure the pressure applied by multiple combinations of angiocatheter needles (catheters), syringes, and other common debridement tools. The data obtained were compared with the pressure measurements reported by previous studies. The common standard used in research is a 35-mL syringe with a 19-gauge catheter with a pressure of 7 to 8 pounds per square inch (psi), which is regarded as the most effective for wound care.\u0000\u0000\u0000RESULTS\u0000Many of the instruments measured in this experiment closely reflected the pressure measurements previously published in the research literature and are safe to use to properly irrigate wounds. However, some discrepancies were also found, ranging from a small psi variability to several psi. Further studies and testing may be beneficial to confirm the results of this experiment.\u0000\u0000\u0000CONCLUSION\u0000Certain tools produced higher pressures that were not suitable for routine wound care. Findings from this study can also be used by clinicians to choose appropriate tools and to monitor pressure when they use various common irrigation tools.","PeriodicalId":23741,"journal":{"name":"Wound management & prevention","volume":"69 1 1","pages":"26-31"},"PeriodicalIF":1.2,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47646129","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":"Early Skin Temperature Characteristics of the Kennedy Lesion (Kennedy Terminal Ulcer).","authors":"K. Kennedy-Evans, Deanna M. Vargo, L. Ritter, D. Adams, Suzanne Koerner, Ellen Duell","doi":"10.25270/wmp.2023.1.1424","DOIUrl":"https://doi.org/10.25270/wmp.2023.1.1424","url":null,"abstract":"BACKGROUND\u0000Pressure injuries are associated with skin temperature changes, but little is known about skin temperature characteristics of the Kennedy Lesion (KL).\u0000\u0000\u0000PURPOSE\u0000The purpose of this study was to describe early skin temperature changes in KLs using long-wave infrared thermography.\u0000\u0000\u0000METHODS\u0000KLs were identified from chart review in 10 ICU patients. Skin assessments were performed within 24 hours of new skin discoloration. Temperature measurements were performed using a long-wave infrared thermography imaging system. Relative Temperature Differential (RTD) between the discolored area and a selected control point was calculated. RTDs of > +1.2 degrees C and < -1.2 degrees C were considered abnormal. Demographic data and observable characteristics of the KL were collected when available. Descriptive statistics (Mean plus/minus SD; % ) were used.\u0000\u0000\u0000RESULTS\u0000The major finding of this study was that there were no early skin temperature differences between the KLs and surrounding skin.\u0000\u0000\u0000CONCLUSION\u0000The early stage of the KL may be limited to microvascular injury which results in a normal skin temperature. More studies are needed to verify this finding and to ascertain whether KL skin temperature changes over time. The study also supports the bedside use of thermography in skin temperature assessment.","PeriodicalId":23741,"journal":{"name":"Wound management & prevention","volume":"69 1 1","pages":"14-24"},"PeriodicalIF":1.2,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47727294","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 Management With Topical Ibuprofen in Partial-Thickness Burn Wounds and Effects on Wound Healing: A Prospective Randomized Clinical Study.","authors":"A. Akgun, Merve Alkin","doi":"10.25270/wmp.2023.1.3248","DOIUrl":"https://doi.org/10.25270/wmp.2023.1.3248","url":null,"abstract":"BACKGROUND\u0000Pain management is important for patient comfort in the treatment of partial-thickness burn wounds. The topical application of ibuprofen provides analgesic and anti-inflammatory effects.\u0000\u0000\u0000PURPOSE\u0000To evaluate the efficacy of ibuprofen-containing foam dressing in partial-thickness burns.\u0000\u0000\u0000METHODS\u0000The study included 50 patients with superficial second-degree burn wounds. Ibuprofen-containing foam dressing was used in 25 patients and paraffin gauze dressing in 25 patients as controls. The visual analogue score (VAS) was evaluated 30 min after dressing. On the 90th day following wound healing, the Vancouver scar scale (VSS) was administered to the patients to evaluate healing and scar formation.\u0000\u0000\u0000RESULTS\u0000The rate of wound healing significantly increased in the study (ibuprofen-containing foam dressing) group compared to control group (8.84±2.97 vs 11.32±4.39, P = 0.010), and the frequency of dressing change significantly decreased in the study group vs control group (1.36±0.49 vs 5.68±2.07, P = 0.000). The oral analgesic needs and VAS scores of the patients were also found to be statistically significantly lower in the study group (5.04 ± 2.44) than for the control group (8.64 ± 1.29, P = 0.000). In the evaluation of the VSS, the total score was lower in the study group, but no statistically significant difference was observed.\u0000\u0000\u0000CONCLUSION\u0000The use of ibuprofen-containing foam dressing in patients with superficial second-degree burns eligible for outpatient follow-up provides effective pain management and increases patient comfort. It does not have a negative effect on wound healing. We consider that ibuprofen-containing foam dressing can be safely used in partial-thickness burns.","PeriodicalId":23741,"journal":{"name":"Wound management & prevention","volume":"69 1 1","pages":"32-48"},"PeriodicalIF":1.2,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43387103","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 Wound Debridement Pressures With Updated Tests.","authors":"Stacy Fisher","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Wound debridement is one of the key treatment methods for chronic and acute wounds. Various tools are used to perform debridement, but the force applied to the tissue by these different instruments has been poorly documented in a limited number of past research efforts.</p><p><strong>Purpose: </strong>The aim of this study was to provide insight into the actual amount of pressure exerted on wound tissue.</p><p><strong>Methods: </strong>We used a digital force transducer to measure the pressure applied by multiple combinations of angiocatheter needles (catheters), syringes, and other common debridement tools. The data obtained were compared with the pressure measurements reported by previous studies. The common standard used in research is a 35-mL syringe with a 19-gauge catheter with a pressure of 7 to 8 pounds per square inch (psi), which is regarded as the most effective for wound care.</p><p><strong>Results: </strong>Many of the instruments measured in this experiment closely reflected the pressure measurements previously published in the research literature and are safe to use to properly irrigate wounds. However, some discrepancies were also found, ranging from a small psi variability to several psi. Further studies and testing may be beneficial to confirm the results of this experiment.</p><p><strong>Conclusion: </strong>Certain tools produced higher pressures that were not suitable for routine wound care. Findings from this study can also be used by clinicians to choose appropriate tools and to monitor pressure when they use various common irrigation tools.</p>","PeriodicalId":23741,"journal":{"name":"Wound management & prevention","volume":"69 1","pages":"26-31"},"PeriodicalIF":1.2,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9316153","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}