Journal of the American Pharmacists Association最新文献

{"title":"2025 Pharmacy Quality Alliance Annual Meeting, May 19–21, 2025, Tampa, FL","authors":"","doi":"10.1016/j.japh.2025.102398","DOIUrl":"10.1016/j.japh.2025.102398","url":null,"abstract":"","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 3","pages":"Article 102398"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144099290","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":"Journal of the American Pharmacists Association reviewers—2024","authors":"","doi":"10.1016/j.japh.2025.102394","DOIUrl":"10.1016/j.japh.2025.102394","url":null,"abstract":"","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 3","pages":"Article 102394"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144099291","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":"Perioperative management of alpha-gal syndrome in bariatric surgery: A case study of venous thromboembolism prophylaxis","authors":"Kaelen Glaze,&nbsp;Sareidenn Ancayan,&nbsp;Susan Dodge","doi":"10.1016/j.japh.2025.102381","DOIUrl":"10.1016/j.japh.2025.102381","url":null,"abstract":"<div><h3>Background</h3><div>Alpha-gal syndrome (AGS) is a tick-borne allergic condition triggered by galactose-alpha-1,3-galactose, a carbohydrate found in mammalian products. This case report highlights the perioperative challenges of managing AGS in a patient undergoing Roux-en-Y gastric bypass, a common bariatric surgical procedure.</div></div><div><h3>Case summary</h3><div>A 53-year-old male with AGS was scheduled for robotic-assisted Roux-en-Y gastric bypass with potential hiatal hernia repair. The patient exhibited severe sensitivity to beef but lower reactivity to pork products, complicating the use of porcine-derived heparin for venous thromboembolism prophylaxis. After careful evaluation, low-molecular-weight heparin (enoxaparin) was selected as the anticoagulant, with 40 mg administered preoperatively. The patient underwent surgery without adverse reactions or bleeding complications.</div></div><div><h3>Practice implications</h3><div>This case underscores the complexities of AGS management in surgical settings, particularly regarding the selection of anticoagulants. While nonporcine alternatives exist, their safety and efficacy in bariatric surgery remain underexplored. The successful use of enoxaparin in this case suggests that a tailored approach, supported by multidisciplinary collaboration, can mitigate risks. This report highlights the need for further research to establish guidelines for anticoagulation in patients with AGS undergoing surgery. Enhanced awareness and individualized care are critical to ensuring optimal outcomes in this unique patient population.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 3","pages":"Article 102381"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532070","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":"Comparing in-person versus telephone Medicare counseling: Beneficiary satisfaction, cost-savings, and plan selection decisions from 2014 to 2021","authors":"Asia White,&nbsp;Nicholas McCormick,&nbsp;Yi Zhao,&nbsp;Kavon Diggs,&nbsp;Salisa C. Westrick,&nbsp;Lindsey Hohmann","doi":"10.1016/j.japh.2025.102350","DOIUrl":"10.1016/j.japh.2025.102350","url":null,"abstract":"<div><h3>Background</h3><div>A pharmacy school and a State Health Insurance Assistance Program developed a Medicare plan selection assistance program in 2013. In 2020, the program changed from in-person to telephone counseling.</div></div><div><h3>Objective</h3><div>To compare the impact of in-person vs. telephone Medicare counseling on beneficiary satisfaction, cost-savings, and plan selection decisions.</div></div><div><h3>Methods</h3><div>Outcomes were assessed via anonymous postcounseling survey, including the following: 1) program satisfaction (4-items); 2) annual cost-savings (2-items); and 3) plan selection decisions (1-item). Beneficiary satisfaction was measured using a Likert-type scale (1 = strongly disagree, 5 = strongly agree). Projected cost-savings was calculated as the difference between the total annual drug plus premium costs of the patient's current vs. newly selected plan (actual costs-savings) or least expensive plan option (potential cost-savings) for the next benefit year. Plan selection decision was measured via multiple-choice with response categories of “enrolled in or selected a new plan,” “undecided,” or “stayed with their current plan.” Differences in mean satisfaction scale scores, cost-savings, and plan selection decisions between in-person (2014–2019) and telephone counseling (2020–2021) were analyzed using Mann–Whitney U and Fisher's Exact tests. Predictors of plan selection decision were assessed via logistic regression.</div></div><div><h3>Results</h3><div>Beneficiaries (N = 632; in-person n = 564; telephone n = 68) were mostly female (59.8%), White (52.1%), and 69 years on average. The overall mean [SD] satisfaction scale score was higher among recipients of in-person (4.55[0.575]) vs. telephone counseling (4.30[0.645]; <em>P</em> = 0.002), but there was no statistically significant difference in mean projected annual cost-savings. Further, in-person vs. telephone counseling recipients more often enrolled in or selected a new plan (46.5% vs. 27.8%; <em>P</em> &lt; 0.05), while telephone vs. in-person recipients were more frequently undecided (37.0% vs. 24.4%; <em>P</em> &lt; 0.05). Overall satisfaction (adjusted odds ratio [aOR] = 11.548; <em>P</em> = 0.009) and potential cost-savings (aOR = 1.001; <em>P</em> = 0.020) predicted selection of a new plan.</div></div><div><h3>Conclusion</h3><div>In-person counseling resulted in a greater proportion of beneficiaries selecting a new plan whereas telephone counseling resulted in greater decision inertia.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 3","pages":"Article 102350"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415865","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":"Impact of a targeted recruitment approach for a medication adherence packaging program","authors":"Alex William Middendorf,&nbsp;Christopher B. Robbins,&nbsp;Deidra Van Gilder,&nbsp;Erin Miller,&nbsp;Nicholas Elgersma,&nbsp;Sharrel Pinto","doi":"10.1016/j.japh.2025.102359","DOIUrl":"10.1016/j.japh.2025.102359","url":null,"abstract":"<div><h3>Background</h3><div>Medication synchronization and packaging services have been shown to positively impact patient adherence, however lack of robust mechanisms to recruit and enroll patients can present barriers to their utilization.</div></div><div><h3>Objectives</h3><div>To assess the effectiveness of a systematically targeted approach to patient recruitment into a medication packaging program.</div></div><div><h3>Practice description</h3><div>An upper midwest pharmacy chain, Lewis Drug, provides these services through 2 programs called SmartSync and SmartPack. Historically, there has been no targeted method for recruiting patients, leading to variable success of the programs.</div></div><div><h3>Practice innovation</h3><div>A targeted recruitment strategy was implemented identifying patients through pharmacy records including prescribed medications, adherence, and PioneerRx risk score, a composite score from 0 to 100 representing patient risk for hospitalization or medication therapy issues. Lead pharmacists from each of the 8 intervention sites were provided patient lists for recruitment with recruitment instructions. Untargeted recruitment approaches continued to facilitate comparisons.</div></div><div><h3>Evaluation methods</h3><div>Patient data were described using counts, percentages, measures of central tendency, and data dispersion. Analyses for enrollment growth were conducted using an interrupted time series analysis, and within-group comparisons with Wilcoxon signed-rank test. Chi-square analysis was used to test associations between groups and categorical variables.</div></div><div><h3>Results</h3><div>A total of 272 patients were identified. Of the patients with contact documented, 40% were enrolled. Of those enrolled, 81.4% were retained at 12 months. For risk scoring, statistically significant differences at 12 months compared to baseline were noted in recruited patients both for mean risk score reductions and shifts to lower risk categories. Adherence metrics remained high.</div></div><div><h3>Conclusion</h3><div>Overall, the targeted approach was successful in enrolling and retaining patients. Additionally, enrollment from untargeted recruitment approaches increased during the intervention, indicating the positive indirect effects targeted approaches can have on cumulative enrollment. Other pharmacy organizations may benefit from developing systematically targeted recruitment strategies for medication packaging programs.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 3","pages":"Article 102359"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434142","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":"Over-the-counter naloxone availability: Insights from rural community pharmacists in the Southern United States","authors":"Emily Gravlee,&nbsp;Carolanne Wartman,&nbsp;Meagen Rosenthal","doi":"10.1016/j.japh.2025.102357","DOIUrl":"10.1016/j.japh.2025.102357","url":null,"abstract":"<div><h3>Background</h3><div>Previous work has found that naloxone availability without a prescription in the Southern United States is highly varied, with 37% of Mississippi pharmacies and 53% of North Carolina pharmacies having naloxone available without a prescription in 2022 and 2024, respectively. The United States Food and Drug Administration approved Narcan nasal spray for over-the-counter (OTC) availability in 2023. However, limited information exists on the uptake of OTC naloxone across the United States, especially in rural spaces across the Southern United States.</div></div><div><h3>Objectives</h3><div>This study aimed to describe the availability and cost of OTC naloxone at rural community pharmacies across the Southern U.S. Secondary outcomes included pharmacists' perceived barriers to OTC naloxone for both pharmacists and patients.</div></div><div><h3>Methods</h3><div>This study employed a cross-sectional survey study design of community pharmacists enrolled in the Rural Research Alliance of Community Pharmacies practice-based research network. Data were descriptively analyzed using IBM SPSS Statistics.</div></div><div><h3>Results</h3><div>There were <em>N</em> = 47 responses to the survey, yielding a response rate of 34.8%. Of the responding community pharmacists, 40% indicated that their pharmacy carried OTC naloxone at the time of the survey (<em>n</em> = 18/47, 38.3%). Among these pharmacies, the median cost of OTC naloxone was $50.00 (interquartile range $46.25–$64.25, range $43.00–$123.20).</div></div><div><h3>Conclusion</h3><div>Despite OTC Narcan nasal spray being available in pharmacies as of September 2023, availability of this life-saving medication remains less than ideal in rural and Southern pharmacies. These findings emphasize the need for further educational and policy interventions to improve naloxone availability.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 3","pages":"Article 102357"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434191","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":"Dare 2 Discuss social media campaign: An educational initiative to improve opioid use disorder discussions between the pharmacist and patient","authors":"Oliver Frenzel,&nbsp;Isaiah Ratz,&nbsp;Anna Skarphol,&nbsp;Amy Werremeyer","doi":"10.1016/j.japh.2025.102343","DOIUrl":"10.1016/j.japh.2025.102343","url":null,"abstract":"<div><h3>Background</h3><div>Opioid use disorder (OUD) is a chronic substance use disorder that currently results in significant morbidity and mortality within the United States. The Opioid and Naloxone Education program is a pharmacy-centered opioid risk screening process to identify patients at risk for OUD and opioid overdose. Three years after inception, data indicated patients screened as high-risk for OUD were receiving opioid safety interventions; however the evaluation noted a lack of OUD education with patients.</div></div><div><h3>Objective</h3><div>To describe and assess an educational initiative for pharmacists which is delivered via social media for the improvement of pharmacist-patient communication surrounding OUD education.</div></div><div><h3>Methods</h3><div>The initiative was named ‘Dare 2 Discuss’ and video content was developed to align with prior research citing challenges to health care provider-patient OUD education. Data to evaluate pharmacist interventions/education delivered to patients was collected by a pharmacy services documentation platform and social media performance was captured by each respective social media dashboard.</div></div><div><h3>Results</h3><div>The first video was posted on October 1, 2022 and the last video was posted on April 10, 2023. Each video took approximately 2.5 hours to create and averaged 42 seconds in length (17–168 seconds). On average, videos received 233 Facebook views (55–489 views) and 527 Instagram views (232–1434 views). The postintervention phase indicated that patient receipt of OUD education by the pharmacist increased by 23% and patient receipt of community support services information increased by 68%.</div></div><div><h3>Conclusion</h3><div>‘Dare 2 Discuss’ campaign may have improved pharmacist self-efficacy with subsequent adjustment of patient education techniques when addressing OUD conversations. These findings highlight the feasibility of a social media-delivered educational initiative to have a potential impact on factors associated with the opioid crisis and risk-reduction education by pharmacists. Creating relevant and easy-to-digest educational materials for health professionals is an important step in advancing practice and improving patient care. Results from the Dare 2 Discuss campaign suggest that this educational initiative may be an effective method to reach a broad number of pharmacists to improve patient interactions.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 3","pages":"Article 102343"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416010","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":"Cannabis at a crossroads: Pharmacist care considerations in the context of a changing cannabis regulatory landscape","authors":"Shreni Sheth,&nbsp;Megan Maroney,&nbsp;Mary Barna Bridgeman","doi":"10.1016/j.japh.2025.102361","DOIUrl":"10.1016/j.japh.2025.102361","url":null,"abstract":"<div><div>The debate over whether cannabis should be handled as a vilified substance or potential therapeutic entity has persisted over the past 50 years, coupled with or supported by a changing state-level regulatory landscape in the United States. Pharmacists must be aware of potential health implications and keep abreast of regulatory implications likely to result from potential state and national regulation changes. In this commentary, we highlight key considerations for pharmacists in the evolving cannabis regulatory landscape, including historical perspectives, current regulations, and future implications. Special attention to vulnerable populations is outlined, given the potential health consequences that must be considered if cannabis is rescheduled. The substantive public health implications associated with adult cannabis use (e.g., substance use/misuse, driving, lung health) are outside the scope of this commentary.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 3","pages":"Article 102361"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517140","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":"Assessing the behavioral health and social determinants of health training needs of Pennsylvania pharmacy personnel","authors":"Kelvin M. Lu,&nbsp;Oluwatoyin Fadeyibi,&nbsp;Andrew M. Peterson","doi":"10.1016/j.japh.2025.102363","DOIUrl":"10.1016/j.japh.2025.102363","url":null,"abstract":"<div><h3>Background</h3><div>Over one-third of Americans live in areas without access to mental health resources. Pharmacy personnel are a trusted and accessible resource in the community, allowing them to be a point of contact for individuals with behavioral health (BH) or social determinants of health (SDOH) needs. However, pharmacy personnel may not have the training or the confidence to provide that support.</div></div><div><h3>Objective</h3><div>The purpose of this study was to identify the BH/SDOH training gaps of Pennsylvania pharmacy personnel.</div></div><div><h3>Methods</h3><div>An electronic needs survey was distributed to members of the Pennsylvania Pharmacists Association. Survey items elicited respondents' self-reported comfort in providing certain BH/SDOH services, self-reported access to related resources, and knowledge on true-false assessment questions. Demographic information (area of practice setting, type of community practice, job title, prior training) was selected <em>a priori</em> to determine if there were differences within the subcategories. Chi-squared tests were performed to determine statistical significance; α was set at 0.05.</div></div><div><h3>Results</h3><div>A total of 140 respondents completed the survey, with 54% identifying as pharmacists and 52% practicing in a suburban setting. Forty-one percent of respondents reported feeling comfortable assessing an individual for risk of suicide or harm and 32% reported being able to refer patients to local homeless shelters. A minority of respondents answered all Mental Health First Aid-related assessment questions correctly (43%). A statistically significant higher percentage of pharmacists were comfortable providing information on BH compared to nonpharmacist personnel (64% vs. 41%, <em>P</em> = 0.01) but not for other services. There was no statistically significant difference in reported comfort by area of practice setting or by type of community practice.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that pharmacy personnel have some level of experience and comfort with providing BH/SDOH services, but gaps remain. We expect that with additional training, pharmacy personnel can become advocates to help care for patients with BH/SDOH needs.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 3","pages":"Article 102363"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525188","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":"Implementation and evaluation of a pharmacist-led glucagon-like peptide-1 receptor agonist titration service in two primary care clinics","authors":"Kristel Miller,&nbsp;Erin Carson,&nbsp;Kimber Boothe,&nbsp;Bethanne Brown","doi":"10.1016/j.japh.2025.102385","DOIUrl":"10.1016/j.japh.2025.102385","url":null,"abstract":"<div><h3>Background</h3><div>People with type 2 diabetes are increasingly prescribed glucagon-like peptide-1 receptor agonists (GLP-1 RAs) which require frequent follow-up for tolerability and dose optimization. To prevent clinical inertia, ambulatory care pharmacists are well-positioned to provide titration services to reduce prescriber burden.</div></div><div><h3>Objectives</h3><div>The objective of this study was to describe the implementation and evaluation of a pharmacist-led GLP-1 RA titration service.</div></div><div><h3>Practice description</h3><div>The 2 clinics included in this study are part of a community-based health system serving northern Illinois.</div></div><div><h3>Practice innovation</h3><div>Included clinics are staffed by an ambulatory care pharmacist working under a delegation protocol. Initial encounters address medication accessibility and education. Follow-up visits evaluate tolerability, blood glucose control, and dose optimization.</div></div><div><h3>Evaluation methods</h3><div>The primary endpoint was the absolute change in hemoglobin A1c (HbA1c) from baseline to 3-6 months post-titration. Paired t-tests were used for statistical comparisons.</div></div><div><h3>Results</h3><div>From September 2022 to May 2023, 120 patients met inclusion criteria; 8 patients stopped therapy. Mean baseline HbA1c was reduced by −1.8% (<em>P</em> &lt; 0.001) at 3-6 months post-titration. Average change in weight was −8.1 kg (N = 107) (<em>P</em> &lt; 0.001). The number of diabetic medications decreased from an average of 2.5 to 2.1 medications. The percentage of patients meeting Healthcare Effectiveness Data and Information Set measures for diabetes after pharmacist intervention were 97.3% for blood pressure under 140/90 mm Hg, 95.5% for HbA1c under 8%, 100% for serum creatinine tested in last 12 months, and 90.2% for urine microalbumin/creatine ratio tested in last 12 months. The average patient required 6.5 encounters and 91 total pharmacist minutes to achieve GLP-1 RA optimization. Approximately 0.1 full-time equivalents of pharmacist coverage were required over 13 months to manage 120 patients.</div></div><div><h3>Conclusions</h3><div>Ambulatory care pharmacists can effectively optimize GLP-1 RAs to improve clinical outcomes, meet quality-based metrics, and reduce prescriber burden.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 3","pages":"Article 102385"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568696","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}