Journal of Healthcare Quality Research最新文献

{"title":"Resultados del uso de Pulse Point Arrow como herramienta de lean healthcare en la gestión de la seguridad del paciente pediátrico en el área quirúrgica","authors":"A. Cervera Barajas ,&nbsp;L. López Rodríguez ,&nbsp;E. Pérez Fernández ,&nbsp;D. Moreno Borrego ,&nbsp;R.M. Romero Ruiz ,&nbsp;P. Bonachela Solás","doi":"10.1016/j.jhqr.2024.09.006","DOIUrl":"10.1016/j.jhqr.2024.09.006","url":null,"abstract":"<div><h3>Objective</h3><div>To improve the safety's management in the urology paediatric surgical process of the Ambulatory Major Surgery Unit (AMSU) through the use of this tool.</div></div><div><h3>Material and methods</h3><div>Observational study lasting 9 months divided into a PRE-period for collecting information on the safety indicators defined by the team and reflected in the Pulse Point Arrow, using the “Hoja de Ruta”, an intervention period and a POST collection stage of the same information.</div></div><div><h3>Results</h3><div>In both periods, a total of 1464 “Hojas de Ruta” were collected in the CMA unit, 55.8% of the total corresponding to the PRE-period, and the rest to the POST.</div><div>The selected indicators improved significantly, highlighting the correct placement of bracelets, bed assignment, allergy registration, and administration of preoperative treatment.</div></div><div><h3>Conclusions</h3><div>The use of new management tools in healthcare systems is essential for improving healthcare processes and achieving better health outcomes. In our experience the introduction of Pulse Point Arrow improved results of surgical safety of the paediatric patient.</div></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":"39 6","pages":"Pages 399-404"},"PeriodicalIF":1.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629625","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}

{"title":"Enhancing vaccine accessibility and efficacy through microneedle patches","authors":"V. Kumar ,&nbsp;N. Rai ,&nbsp;S. Sah ,&nbsp;M. Soni","doi":"10.1016/j.jhqr.2024.09.004","DOIUrl":"10.1016/j.jhqr.2024.09.004","url":null,"abstract":"","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":"39 6","pages":"Pages 343-345"},"PeriodicalIF":1.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629697","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}

{"title":"Relationship between adherence to oral antidiabetic drugs and control of type 2 diabetes mellitus","authors":"E. Esquivel-Prados ,&nbsp;E. Pareja-Martínez ,&nbsp;J.P. García-Corpas","doi":"10.1016/j.jhqr.2024.06.007","DOIUrl":"10.1016/j.jhqr.2024.06.007","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Poor adherence to oral antidiabetic drugs (Adh-OAD) is a risk factor for poor control of type 2 diabetes mellitus (T2DM). Therefore, it is necessary to quantify the Adh-OAD. This quantification is possible through electronic dispensing records from the community pharmacy.</div><div>The objective was to evaluate the influence of the Adh-OAD on the control of T2DM and the percentage of glycosylated hemoglobin (%HbA1c) in the patient.</div></div><div><h3>Materials and methods</h3><div>A cross-sectional descriptive observational study was conducted in 8 community pharmacies in Granada (Spain). Patients older than 18 years with T2DM and on oral antidiabetic drugs (OADs) for at least 6 months were included. The main study variables were the control of T2DM, %HbA1c, and the Adh-OAD considering three cut-off points (≥80%, ≥70%, ≥60%). This relationship was studied using multivariate binary logistic regression and multivariate linear regression, respectively.</div></div><div><h3>Results</h3><div>A total of 107 patients were included. The mean age was 70.5 years (SD: 9.7), and 54.2% were men. Eighty-five patients (79.4%) had well-controlled T2DM (mean %HbA1c: 6.5%; SD<!--> <!-->=<!--> <!-->0.6). Considering Adh-OAD<!--> <!-->≥<!--> <!-->80%, 13.1% (<em>n</em> <!-->=<!--> <!-->14) had a poor adherence and was related to the %HbA1c (<em>β</em> <!-->=<!--> <!-->0.742; <em>p</em> <!-->=<!--> <!-->0.007) and the control of T2DM (OR: 7.327; 95% CI: 1.302–41.241). Poor adherence was found in 9.3% (<em>n</em> <!-->=<!--> <!-->10) considering Adh-OAD<!--> <!-->≥<!--> <!-->70% and in 3.7% (<em>n</em> <!-->=<!--> <!-->4) considering Adh-OAD<!--> <!-->≥<!--> <!-->60%. In both cases, a statistically significant relationship was found between Adh-OAD and the %HbA1c and between Adh-OAD and the control of T2DM.</div></div><div><h3>Conclusions</h3><div>Adh-OAD influenced the %HbA1c in patients with T2DM and the control of their disease.</div></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":"39 6","pages":"Pages 346-355"},"PeriodicalIF":1.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141761487","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}

{"title":"Impact of multicomponent intervention on hospitalized clinical patient outcomes: A pre–post study in a university hospital","authors":"M.R.R. Falcetta ,&nbsp;F. Pivatto Júnior ,&nbsp;É.P. Cassol ,&nbsp;A. Boni ,&nbsp;T. Vaz ,&nbsp;F.M. da Costa ,&nbsp;D.F. do Canto ,&nbsp;L.M.G. Paskulin ,&nbsp;J.M. Dora","doi":"10.1016/j.jhqr.2024.06.003","DOIUrl":"10.1016/j.jhqr.2024.06.003","url":null,"abstract":"<div><h3>Background and objective</h3><div>Hospitalization significantly interferes with the individual's well-being and it occurs both during and after the hospitalization period. Different approaches to minimize morbidity related to hospitalization and the post-discharge period have been proposed, especially to those aimed at reducing readmission rates. The aim of this study is to evaluate the effect of multicomponent intervention (MI) on operational indicators and continuity of care outcomes.</div></div><div><h3>Materials and methods</h3><div>A quasi-experimental study conducted in a Brazilian university hospital in order to compare the impact of the intervention with usual care. The MI was the implementation of multidisciplinary rounds, the inclusion of the role of the navigator nurse, and care transition actions with half of the Internal Medicine teams in a clinical unit of a general hospital. Adult patients hospitalized were included in 2 periods and divided in 3 groups – Group A: before the intervention; Group B: after and with MI; Group C after and without MI.</div></div><div><h3>Results</h3><div>A total of 2333 hospitalizations were evaluated. There was a reduction in the rate of intensive care transfers to intensive care unit (ICU) and in the length of stay (LOS). LOS, discharge before noon, and transfers to ICU improved when comparing before and after the intervention, but were not different in post-intervention groups with and without MI.</div></div><div><h3>Conclusion</h3><div>These results reflect the improvement of care provided by MI, an effect that could be due to cross contamination also to teams without the intervention.</div></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":"39 6","pages":"Pages 365-372"},"PeriodicalIF":1.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141591640","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}

{"title":"Validación y fiabilidad de un instrumento para la evaluación de la calidad de servicios, adaptado a familiares, pacientes y personal de enfermería","authors":"A. Renghea ,&nbsp;S. Hernandez-Iglesias ,&nbsp;M.A. Cuevas-Budhart ,&nbsp;M.T. Iglesias López ,&nbsp;J.A. Sarrion-Bravo ,&nbsp;A. Crespo Cañizares ,&nbsp;M. Gómez del Pulgar García-Madrid","doi":"10.1016/j.jhqr.2024.07.003","DOIUrl":"10.1016/j.jhqr.2024.07.003","url":null,"abstract":"<div><h3>Aim</h3><div>To analyze the internal validity and reliability of the instrument for evaluating the quality of services adapted to three interest groups: patients, nurses, family members, and primary caregivers.</div></div><div><h3>Material and method</h3><div>Our research was conducted meticulously, employing a mixed methodology with two phases: qualitative, using the focus group for internal validation of the instrument, and quantitative. Subsequently, the survey was passed to the interest group of 430 patients, 525 relatives, and 298 nurses. Chronbac's alpha reliability analysis, the multiple linear regression model as a point estimator of the parameters, and exploratory factor analysis with a maximum likelihood factor using Kaiser-Meyer-Olkin to analyze the constructor and its indicators were performed to validate the adaptation. Finally, confirmatory factor analysis determines their respective measurement models’ unidimensionality, validity, and reliability.</div></div><div><h3>Results</h3><div>The result shows that the factor loading of each subconstruct is more significant than 0.5 in the three models, which indicates that the aptitude indices of the model were met. In addition, the model meets the discriminant validity criteria. The behavior of the SERVPERF questionnaire was analyzed in terms of consistency, Cronbach's alpha<!--> <!-->=<!--> <!-->0.94.</div></div><div><h3>Conclusion</h3><div>The scale items’ discrimination concerning the questions on global satisfaction is confirmed. This shows that the instrument is valid, reliable, and useful.</div></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":"39 6","pages":"Pages 381-390"},"PeriodicalIF":1.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141767528","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}

{"title":"Evaluation of the degree of implementation of zero projects in critical care units of Galicia (Spain) through internal audits","authors":"I. Losada-Castillo,&nbsp;M.O. Roca-Bergantiños,&nbsp;R. Vázquez-Mourelle,&nbsp;Group of Auditors for Zero Projects in Critical Units in Galicia","doi":"10.1016/j.jhqr.2024.06.008","DOIUrl":"10.1016/j.jhqr.2024.06.008","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this study was to assess the implementation of Zero Projects in Critical Care Units (CCUs) through Internal Audits (IA).</div></div><div><h3>Materials and methods</h3><div>Design: Real-time observational safety analysis. A questionnaire was developed with defined items to ensure objectivity. After IAs, a survey was conducted with the auditors. Scope: 11 CCUs in hospitals of the Servizo Galego de Saúde and Ribera-POVISA. Patients or participants: 24 auditors in 9 teams composed of medical, nursing, and quality personnel from health areas and 34 patients were assessed. Main variables of interest: Compliance with the quality standard (≥60% of items), strengths, areas for improvement, auditor's interest in IA, conformity with the organization and items.</div></div><div><h3>Results</h3><div>100% CCUs met the quality standard. 18.03% of items were fulfilled by all CCUs. Strengths: staff motivation, positive reception of auditors, and use of computer tools in some CCUs. Areas for improvement: deficit of automatic systems for controlling endotracheal tube cuff pressure (compliance rate in 9.1% of CCUs), training needs, communication issues, and not using checklists (45.5% of the reports). Auditors found IA very interesting, and 19% suggested improving organization and items.</div></div><div><h3>Conclusions</h3><div>All CCUs met the previously agreed-upon quality standard. Numerous improvement opportunities were identified and communicated to the audited CCUs. For greater homogeneity and objectivity, a review of previously agreed items and definitions is required.</div></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":"39 6","pages":"Pages 356-364"},"PeriodicalIF":1.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876239","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}

{"title":"Spanish adolescent patients with cancer and main caregivers: Using perceptions of care to drive change in healthcare","authors":"A. Molina-Prado ,&nbsp;A. Pérez de Albéniz ,&nbsp;G. Medin ,&nbsp;V. Pérez-Alonso ,&nbsp;E. Carceller ,&nbsp;B. Huguet-Rodríguez ,&nbsp;C. Garrido-Colino","doi":"10.1016/j.jhqr.2024.07.002","DOIUrl":"10.1016/j.jhqr.2024.07.002","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine whether there are differences in care experience of adolescent cancer patients and their main caregiver, treated in Adolescent Cancer Units (ACUs), compared to those treated in Non-Adolescent Cancer Units (NACUs), including the COVID-19 pandemic period.</div></div><div><h3>Method</h3><div>Measurement of Reported Experience in adolescent oncology patients (12–19 years old) and caregivers through ad hoc surveys. The responses of the study group of patients and caregivers treated in Adolescent Units were compared with the group not treated in them.</div></div><div><h3>Results</h3><div>It is noted that many respondents consider that they have not been affected by the COVID-19 pandemic. Significant differences were seen in communication, with better perception by the group of patients treated in ACU (87.1%) and caregivers of ACU (97.3%) compared to patients and caregivers of NACU (53.3% and 68.2% respectively). Regarding information received about the side effects, a better perception was observed among patients treated in the ACU than in the NACU (<em>p</em> <!-->=<!--> <!-->0.247). In the transmission of information and the possibility of fertility preservation, a significant difference was observed in favour of ACU in patients and direct caregivers (<em>p</em> <!-->=<!--> <!-->0.010 and <em>p</em> <!-->=<!--> <!-->0.018).</div></div><div><h3>Conclusions</h3><div>ACU represents an improvement in the quality perceived by patients and main caregiver on key points in the comprehensive care of the adolescent with cancer such as information, participation in the process and decision making, approach to side effects, psychological care and help in returning to normal life. However, fertility and strategies for talking about the cancer experience, were identified as areas for future improvement.</div></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":"39 6","pages":"Pages 373-380"},"PeriodicalIF":1.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753008","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}

{"title":"Determinants of citizens’ choice between public and private hospitals","authors":"S. Parrado ,&nbsp;J. Rama ,&nbsp;A.-M. Reynaers","doi":"10.1016/j.jhqr.2024.09.001","DOIUrl":"10.1016/j.jhqr.2024.09.001","url":null,"abstract":"<div><h3>Objective</h3><div>This study assesses what factors determine citizens’ preferences for a public or private hospital (assuming the choice is free of charge) according to the severity of the disease.</div></div><div><h3>Material and method</h3><div>A web-based discrete choice experiment was carried out with 1777 individuals distinguishing between a control group (posed with a simple choice for each health condition) and added information for respondents of the treatment groups (distance, waiting time, advice from the family doctor, and recommendations from the social context). The relevance of these factors in relation to the severity of one's illness is investigated. The outcome variable is the choice of a public versus a private hospital for the treatment of a health issue of a different severity.</div></div><div><h3>Results</h3><div>The severity of the health issue has a moderator effect on the additional information for the treatment groups. Waiting time has a direct positive impact on the patient's preferred choice for a private hospital both for severe and non-severe health issues. Distance to the hospital and the family doctor's recommendation positively impact the preferred choice for a private hospital for non-severe health issues but not for severe health issues. Covariates like gender and age are not relevant in explaining the effects of the treatments, and educational level has a positive impact on one of the treatments: advice from the patient's environment. Satisfaction with public hospitals has a positive impact on all treatments.</div></div><div><h3>Conclusions</h3><div>Results indicate that waiting time is a key factor in choosing a private hospital against the majority-stated preference for a public hospital.</div></div>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":"39 6","pages":"Pages 391-398"},"PeriodicalIF":1.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378417","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}

{"title":"[A practical model to implement the patient participation in tertiary hospitals (ICE model)].","authors":"Ana Martí, Clara Grau, Emmanuel Giménez, Karla Salas-Gama, Marta Aguayo, Antonio Román, Albert Salazar","doi":"10.1016/j.jhqr.2024.09.003","DOIUrl":"https://doi.org/10.1016/j.jhqr.2024.09.003","url":null,"abstract":"<p><strong>Objective: </strong>Democratise healthcare and research through a model that ensures the participation of patients and professionals.</p><p><strong>Method: </strong>Weaknesses are analysed and corrections are articulated with a model through biweekly meetings between the hospital's citizen attention and healthcare management.</p><p><strong>Results: </strong>The resulting model is proactive in nature, deployed between November-2021 and December-2023 and had three elements: Information, Co-creation and Strategy (ICE). The Information is materialized with: an Association Attention Office (AAO) and an Easy Reading Commission (ERC). Co-creation is organized through Stable Work Commissions (SWC) formed by professional-patient. The Strategy that is materialized through a Strategic Plan for institutional participation and a Strategic Committee for participation. The AAO has registered 304 entities and managed 112 projects. The ERC has evaluated 41 documents in 2023. 13SWCs related to therapeutic areas were generated where 108 professionals and 101 patient representatives participated and 42 objectives were agreed upon, working on templates for informative documents, guides or organizing informative days. The Strategic Participation Plan is translated into 8lines with objectives and actions, creating the Strategic Participation Committee as the governing body.</p><p><strong>Conclusions: </strong>The ICE-VH model is a replicable opportunity to implement patient and professional participation in any hospital and improve person-centered care by incorporating the values and preferences of all stakeholders.</p>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476740","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}

{"title":"[Integrated social value generated in a specialized hospital for chronic patients].","authors":"José Antonio González-Gutiérrez, Iker Apraiz-Sánchez, Arantxa Picón-Santamaría, María Begoña de la Fuente-Martínez, Sendoa Ballesteros-Peña","doi":"10.1016/j.jhqr.2024.09.002","DOIUrl":"https://doi.org/10.1016/j.jhqr.2024.09.002","url":null,"abstract":"<p><strong>Introduction: </strong>Measuring social value has always been a challenge for organizations that generate such value, including foundations, NGOs, social enterprises, and governmental entities. Often, the benefits of these initiatives are perceived as intangible or long-term, making them difficult to quantify. Assessing social value demonstrates the impact of investments and accountability to stakeholders.Healthcare organizations should be evaluated from a broad perspective, where the quality of healthcare services is an integral part of the social value with multiple beneficiaries.This study aims to determine the economic and social impact of Hospital Santa Marina on the Bizkaia (Basque Country) population in 2023, as well as to evaluate the evolution of the hospital's social value from 2018 to 2023.</p><p><strong>Materials and methods: </strong>The study was conducted from the multifaceted perspective of social accounting (stakeholder theory), utilizing the Social Return on Investment (SROI) tool. The economic value of the hospital (both direct and indirect) and the hospital's specific social value were calculated based on areas identified by stakeholders. Subsequently, the hospital's integrated social value and socio-emotional value were determined.</p><p><strong>Results: </strong>The hospital contributed €34,696,178.20 to society in Direct and Indirect Market Social Value (SROI), and the Non-Market Social Value amounted to €119,758,230.71. This generated an integrated social value of the hospital of €154,454,408.91, which, considering the satisfaction index for the year 2023 was 0.9805, leads to a socio-emotional value of €211,998,238.76.</p><p><strong>Conclusions: </strong>Hospital Santa Marina generates significant economic value for the society, beyond its direct contribution to the population's health. These findings underscore the importance of adopting a broader perspective on health and highlight the role of healthcare institutions as drivers of sustainable development.</p>","PeriodicalId":37347,"journal":{"name":"Journal of Healthcare Quality Research","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476741","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}