International Journal of Orthopaedic and Trauma Nursing最新文献

{"title":"Does early or late discharge after total knee replacement affect the burden and stress of caregivers?","authors":"Özlem Fidan ,&nbsp;Nihal Buker ,&nbsp;Raziye Savkin ,&nbsp;Arife Sanlialp Zeyrek","doi":"10.1016/j.ijotn.2023.101036","DOIUrl":"10.1016/j.ijotn.2023.101036","url":null,"abstract":"<div><h3>Background</h3><p>Since patients may experience difficulties in their daily activities after total knee replacement<span> surgery, the role of the caregiver is important in supporting the daily needs of the patients. Caregivers are involved in the day-to-day care activities of the patient during the recovery process, managing their symptoms and providing support. All these factors can affect the burden and stress of caregivers.</span></p></div><div><h3>Methods</h3><p>It was aimed to compare the caregiver burden and stress of caregivers of total knee replacement patients who were discharged on the same day of surgery and at a later point. Data were collected from 140 caregivers by using the Bakas Caregiving Outcomes Scale, Zarit Caregiving Burden Scale, and Stress Coping Styles Scale.</p></div><div><h3>Results</h3><p>There was no significant difference between on the same day of surgery discharge and later discharge in terms of care burden and stress of caregivers (p &gt; 0.05). While the burden of care was mild to moderate (22.15 ± 13.76) on the same day of surgery discharge group, the burden of care in the later discharge group was very low (19.03 ± 13.65).</p></div><div><h3>Conclusion</h3><p>In order to reduce the care burden and stress levels of caregivers, it is important that nurses determine the problems related to caregiving and provide the necessary support.</p></div>","PeriodicalId":45099,"journal":{"name":"International Journal of Orthopaedic and Trauma Nursing","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9763716","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":"Level of implementation of pain management and early mobilization strategies to prevent delirium in geriatric trauma patients: A mixed-methods study","authors":"Maryline Beaudoin ,&nbsp;Etienne L. Belzile ,&nbsp;Céline Gélinas ,&nbsp;David Trépanier ,&nbsp;Marcel Émond ,&nbsp;Marc-Aurèle Gagnon ,&nbsp;Mélanie Bérubé","doi":"10.1016/j.ijotn.2023.101050","DOIUrl":"10.1016/j.ijotn.2023.101050","url":null,"abstract":"<div><h3>Background</h3><p><span>Pain management and </span>early mobilization strategies are recommended in clinical practice guidelines for the prevention of delirium in older adults. However, available data on the implementation of these strategies in trauma are limited.</p></div><div><h3>Aims</h3><p>To describe the use of pain management and early mobilization strategies in older adults at a level I trauma center, as well as the facilitators and barriers to their implementation.</p></div><div><h3>Methods</h3><p>A convergent mixed methods study was used. Quantitative data were collected from sixty medical records. Qualitative data was collected through a focus group with healthcare providers to explore their perspectives regarding the use of the target practices and on barriers and facilitators to their implementation. Descriptive statistics were calculated, and a thematic analysis using an inductive and deductive interpretative descriptive approach was undertaken.</p></div><div><h3>Results</h3><p>A question on the presence/absence of pain was the most frequently documented pain assessment method. Pain assessment was poorly documented. Frequencies of non-opioid and opioid administrations were similar, but non-pharmacological strategies were not widely used. The first mobilization was performed quickly and was most commonly to a chair. The focus group discussion confirmed many of the data collected in the medical records. Barriers to implementing the targeted strategies were primarily related to organizational context and facilitation processes.</p></div><div><h3>Conclusions</h3><p>Areas for improvement were identified including pain assessment, the use of non-pharmacological pain management strategies and ambulation as a mobilization strategy. Our findings will serve as a starting point for optimizing and adapting practices for geriatric trauma patients and evaluating their impact.</p></div>","PeriodicalId":45099,"journal":{"name":"International Journal of Orthopaedic and Trauma Nursing","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41239700","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":"Literature reviews","authors":"Mary Drozd,&nbsp;Carmen Queiros,&nbsp;Shareena Bibi Mohd Arif","doi":"10.1016/j.ijotn.2023.101058","DOIUrl":"10.1016/j.ijotn.2023.101058","url":null,"abstract":"","PeriodicalId":45099,"journal":{"name":"International Journal of Orthopaedic and Trauma Nursing","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136127692","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":"Sustainability in Orthopaedic and Trauma Nursing","authors":"Rebecca Jester","doi":"10.1016/j.ijotn.2024.101082","DOIUrl":"https://doi.org/10.1016/j.ijotn.2024.101082","url":null,"abstract":"","PeriodicalId":45099,"journal":{"name":"International Journal of Orthopaedic and Trauma Nursing","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139548765","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 path analysis investigation into menopausal osteoporosis, sarcopenia risk, and their impact on sleep quality, depressive symptoms and quality of life","authors":"Hui-Ling Lai ,&nbsp;Chun-I Chen ,&nbsp;Yu-Ching Lin ,&nbsp;Liu-Chun Lu ,&nbsp;Chiung-Yu Huang","doi":"10.1016/j.ijotn.2023.101080","DOIUrl":"https://doi.org/10.1016/j.ijotn.2023.101080","url":null,"abstract":"<div><h3>Purpose</h3><p>The objective was to investigate the relationships among disease characteristics, sarcopenia risk, bone function, sleep quality, depressive symptoms, and health-related quality of life in menopausal women. Additionally, we also examined the potential mediating role of coping in the relationship between these factors and health outcomes for individuals with osteoporosis.</p></div><div><h3>Methods</h3><p>In a cross-sectional approach, 201 participants were referred by a physician from the Family Medicine<span><span> Department during their outpatient visits at a general hospital in Southern Taiwan. Data collection involved structured one-on-one interviews, and the analysis included descriptive and inferential statistics, along with a </span>structural equation modeling.</span></p></div><div><h3>Results</h3><p>The participants' bone function was strongly positively related to coping, physical and mental quality of life (QOL), and negatively related to sleep quality and depressive symptoms. The duration of osteoporosis was positively related to pain, sarcopenia risk, sleep quality, but negatively related to bone function, physical and mental QOL. This structural framework explains 36% of the variance in depressive symptoms, 25% in sleep disturbances, 54% in mental QOL, and 72% in physical QOL. The best-fit structural equation modeling showed that physical function, exercise, sarcopenia, pain, and coping were significant predictors of depressive symptoms, with coping acting as a mediator in these relationships.</p></div><div><h3>Conclusion</h3><p>Individuals who employed more active coping strategies exhibited fewer depressive symptoms, better sleep quality, and superior physical and mental QOL. Further, individuals with osteoporosis had lower pain levels, less sarcopenia risk, and higher engaged in exercise presentation improved physical and mental QOL. Future longitudinal research holds the promise of providing deeper insights into these complex relationships.</p></div>","PeriodicalId":45099,"journal":{"name":"International Journal of Orthopaedic and Trauma Nursing","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139433513","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":"Patient-reported outcomes the first thirty days after fast-track primary total hip arthroplasty. A prospective cohort study using a web-based registration tool for postoperative follow-up","authors":"Janne Kristin Hofstad ,&nbsp;Jomar Klaksvik ,&nbsp;Pål Klepstad ,&nbsp;Kari Hanne Gjeilo ,&nbsp;Kjeld Søballe ,&nbsp;Tina Strømdal Wik","doi":"10.1016/j.ijotn.2023.101079","DOIUrl":"10.1016/j.ijotn.2023.101079","url":null,"abstract":"<div><h3>Introduction</h3><p>The documentation on patient reported outcomes the first weeks at home following total hip arthroplasty (THA) is sparse. Length of hospital stay after THA is substantially reduced. Therefore, knowledge on whether patients are managing their own postoperative rehabilitation early after discharge is important, in order to give the patients realistic preoperative information, to modify expectations and enable patients to monitor their own rehabilitation process.</p></div><div><h3>Methods</h3><p>Eighty-two THA patients were included in a prospective cohort study. <u>Patient-reported outcomes</u> were collected twice a week thirty days postoperatively using a web-based registration tool. Numeric rating scales (0–10) for pain, function, and quality of life, EQ-5D, and the use of opioids were registered. Four weeks postoperatively a telephone interview were conducted. Pain, EQ5D and hip specific physical function score (HOOS-PS) were recorded preoperatively, at three- and twelve-months follow-up.</p></div><div><h3>Results</h3><p><u>Pain was maintained the first days after hospital discharge. From day 0 to day 30, p</u>ain decreased from 4.0 (SD 2.23) to 2.3 (SD 1.75), <u>function improved from 4.4 (SD 2.06) to 7 (SD 1.57), quality of life improved from 6.3 (SD 2.69) to 7.8 (SD 1.47), and EQ-5D improved from 0.4 to (SD 0.27) to 0.7 (SD 0.14). After 30 days, 32% still used opioids.</u> All patients completed the web-registration. <u>Pain, EQ-5D and HOOS-PS</u> improved substantially from preoperatively to twelve months follow-up.</p></div><div><h3>Conclusion</h3><p>Fast-track THA patients can expect continued postoperative pain and impaired quality of life the first week at home, before gradually improvement. After thirty days, 32 % of the patients still used opioids.</p></div>","PeriodicalId":45099,"journal":{"name":"International Journal of Orthopaedic and Trauma Nursing","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1878124123000837/pdfft?md5=550826b7d73d101b6f841737b4da7ec9&pid=1-s2.0-S1878124123000837-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139023310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of tramadol use with risk of hip fractures in patients with osteoarthritis: A systematic review and meta-analysis of observational studies","authors":"Mansour Bahardoust ,&nbsp;Sepideh Mousavi ,&nbsp;Javad Khaje Mozafari ,&nbsp;Zahra Deylami Moezi ,&nbsp;Meisam Haghmoradi ,&nbsp;Pouya Ebrahimi ,&nbsp;Homan Alipour ,&nbsp;Heeva Rashidi","doi":"10.1016/j.ijotn.2023.101078","DOIUrl":"https://doi.org/10.1016/j.ijotn.2023.101078","url":null,"abstract":"<div><h3>Objective</h3><p><span>Many studies have reported conflicting results for the use of tramadol with the risk of fractures, especially hip fractures. This </span>systematic review<span> and meta-analysis study aimed to evaluate the association of tramadol use versus codeine use with the risk of hip fracture for the first time.</span></p></div><div><h3>Methods</h3><p>PubMed, Scopus<span><span>, Google Scholar, and Web of Science databases were searched with specific keywords to find studies that examined the association of tramadol use with hip fracture risk in patients with </span>osteoarthritis up to May 2023. The risk of hip fracture secondary to tramadol versus codeine use was estimated based on age and sex. This systematic review was conducted based on the PRISMA checklist. Heterogeneity between studies was evaluated using Cochran's Q and I2 tests. Egger's test was used to check publication bias. The Newcastle-Ottawa Checklist (NOS) was used to assess the quality of the studies.</span></p></div><div><h3>Findings</h3><p>Ten studies with 1,939,293 participants were reviewed. The majority of participants were female. Based on the study evaluation checklist, most studies were of good quality. Tramadol use significantly increases the overall risk of hip fracture. (HR: 1.32, 95% CI: 1.14, 1.51, P: 0.001, I²:19.3%) Tramadol use significantly increases the risk of hip fracture in men (HR: 1.48, 95% CI: 1.24, 1.73, P: 0.001 I²:35%) and age ≤65 years (HR: 1.63, 95% CI: 1.45, 1.80, P: 0.001, I²:0%).</p></div><div><h3>Conclusion</h3><p>The use of tramadol significantly increases the risk of hip fracture. This increased risk of hip fracture was greater in males younger than 65 years.</p></div>","PeriodicalId":45099,"journal":{"name":"International Journal of Orthopaedic and Trauma Nursing","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138656512","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":"Risk prediction models for postoperative delirium in elderly patients with fragility hip fracture: A systematic review and critical appraisal","authors":"Bingqian Zhou ,&nbsp;Ai Wang ,&nbsp;Hong Cao","doi":"10.1016/j.ijotn.2023.101077","DOIUrl":"https://doi.org/10.1016/j.ijotn.2023.101077","url":null,"abstract":"<div><h3>Background</h3><p>Elderly patients with fragility hip fracture<span> continue to experience a high rate of postoperative delirium (POD), which has a significant negative impact on prognosis and imposes a huge economic burden. A number of risk prediction models have been developed to detect POD early. However, the risk of bias and clinical applicability of the models remain unclear. The aim of this study was to systematically evaluate risk prediction models for POD.</span></p></div><div><h3>Methods</h3><p><span><span>CNKI, WanFang DATA, Vip Database, SinoMed, PubMed, Web of Science, Embase, and the </span>Cochrane Library were searched for studies published by July 2023. The literature was screened independently by two investigators. The Checklist for Critical Appraisal and Data Extraction for </span>Systematic Reviews of Prediction Modeling Studies (CHARMS) and the Prediction Model Risk of Bias Assessment Tool (PROBAST) were respectively used for data extraction, risk of bias, and applicability assessment.</p></div><div><h3>Results</h3><p>A total of 16 studies on the construction of POD risk prediction models were included. The area under the ROC curve of the models ranges from 0.670 to 0.957. The most common predictors of POD included age, history of dementia, history of delirium, ASA<span> classification, preoperative waiting time, and preoperative albumin level. All models had a high risk of bias, mainly due to inadequate sample size, inappropriate handling of missing data, a lack of model performance evaluation, and overfitting of the models.</span></p></div><div><h3>Conclusions</h3><p>Overall, risk prediction models for POD in fragility hip fracture patients are still in the development stage. The majority of POD prediction models have substantial bias risks, attributable primarily to poor reporting of analysis and evaluation of model performance. In future research, it is recommended to conduct validation of the models or develop localized prediction models with demonstrated high performance, with the aim of benefiting POD screening.</p></div><div><h3>Systematic review registration</h3><p>PROSPERO CRD42023449153.</p></div>","PeriodicalId":45099,"journal":{"name":"International Journal of Orthopaedic and Trauma Nursing","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138582200","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":"Nurse-led ultrasound-guided femoral nerve block: A randomised controlled trial of two different patient flow systems in an emergency department","authors":"Elin Saga ,&nbsp;Ragnhild S. Falk ,&nbsp;Pia C. Bing-Jonsson ,&nbsp;Kirsti I. Skovdahl ,&nbsp;Espen Lindholm","doi":"10.1016/j.ijotn.2023.101074","DOIUrl":"https://doi.org/10.1016/j.ijotn.2023.101074","url":null,"abstract":"<div><h3>Introduction</h3><p>Elderly with hip fractures present complex challenges. Effective pain management is crucial for recovery and quality of life. However, pain control can be difficult and requires customized care.</p></div><div><h3>Methods</h3><p>We conducted an unblinded, randomised controlled trial investigating the effects of ultrasound-guided femoral nerve block in patients with hip fracture performed by specially trained nurses (Group Nurse) compared to anaesthesiologists (Group Anaesthesiologist). The hypothesis was that a single shot ultrasound-guided femoral nerve block would result in a total summarized lower dynamic numeric rating scale score for pain intensity during the first 120 min after admission for patients in Group Nurse compared to Group Anaesthesiologist measured in five timepoints. The primary outcome was measured by a cumulative numeric rating scale score for dynamic pain (with flexion of the hip until maximum 30° from bed surface) during the first 120 min after admission to the emergency department.</p></div><div><h3>Results</h3><p>From February 2020 to June 2021, 263 patients were screened, of which 42 (16.0%) consented and were randomly allocated; 21 in each arm. The primary outcome was not different between groups (p = 0.24), and displayed no substantial superiority of specially trained nurses over anaesthesiologist. No complications or adverse effects were observed in either group. The use of systemic analgesics and the development of delirium was similar between the two groups. In the Nurse Group, patients were administered their ultrasound-guided femoral nerve block earlier.</p></div><div><h3>Conclusion</h3><p>Our study did not demonstrate a statistically significant beneficial effect of specially trained nurses over anaesthesiologist on cumulative pain in performing ultrasound-guided femoral nerve blocks, while no side-effects/complications or adverse effects were observed in either group.</p></div><div><h3>Clinicaltrial</h3><p>The trial was registered on October 31, 2019 at <span>Clinicaltrials.gov</span><svg><path></path></svg> (<span>NCT04145752</span><svg><path></path></svg>).</p></div>","PeriodicalId":45099,"journal":{"name":"International Journal of Orthopaedic and Trauma Nursing","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1878124123000783/pdfft?md5=470a20272fc985c38110ca3f0054e365&pid=1-s2.0-S1878124123000783-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138550217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SELF-CONCEPT development of school-aged children with congenital upper limb differences: A mixed-methods study","authors":"Sally Ann Martens ,&nbsp;Terry A. Badger","doi":"10.1016/j.ijotn.2023.101066","DOIUrl":"https://doi.org/10.1016/j.ijotn.2023.101066","url":null,"abstract":"<div><h3>Background</h3><p>School-aged children enter an essential phase of psychosocial development in which they begin to form their self-concept. Having a negative self-concept has a direct relationship on the gradual evolution of a child's personality which can influence academic and career success, peer interactions and relationships, generativity and life satisfaction and meaning. There is limited research examining self-concept in children with congenital upper limb differences.</p></div><div><h3>Objectives</h3><p>Describe self-concept in school-aged children with congenital upper limb differences (CULD).</p></div><div><h3>Methods</h3><p>In this convergent mixed methods study, we used the Piers Harris Children's Self-Concept Scale (PHCSCS) and modified photovoice methodology to explore self-concept in school aged children with CULD. The quantitative results from the PHCSCS were merged with the qualitative findings from the 63 photographs and 63 written descriptions provided by nine children.</p></div><div><h3>Results</h3><p>Mean self-concept was 51.22 (±10.43). Mean domain scores: behavioral adjustment 52 (±8.19), freedom from anxiety 48.56 (±10.42), happiness and satisfaction 49.44 (±10.73), intellectual and school status 54.78 (±10.31), and social acceptance 49.89 (±8.64). Nine participants described five themes of self-concept: emotions, sense of accomplishments, positive view of oneself and one's physical body, hobbies, and a sense of connection. Children defined their self-concept through expressions of self-efficacy, self-image, and social identity.</p></div><div><h3>Implications</h3><p>Results created a more comprehensive description of self-concept, and expanded understanding of the social identity of school-aged children with congenital upper limb difference. Future research is needed to examine the relationships between self-efficacy, self-image, and social identity to develop interventions promoting healthy self-concept development.</p></div>","PeriodicalId":45099,"journal":{"name":"International Journal of Orthopaedic and Trauma Nursing","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138480343","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}