European Journal of General Practice最新文献

{"title":"Democratising the design and delivery of large-scale randomised, controlled clinical trials in primary care: A personal view.","authors":"Christopher C Butler","doi":"10.1080/13814788.2023.2293702","DOIUrl":"10.1080/13814788.2023.2293702","url":null,"abstract":"<p><strong>Background: </strong>Rapid identification of effective treatments for use in the community during a pandemic is vital for the well-being of individuals and the sustainability of healthcare systems and society. Furthermore, identifying treatments that do not work reduces research wastage, spares people unnecessary side effects, rationalises the cost of purchasing and stockpiling medication, and reduces inappropriate medication use. Nevertheless, only a small minority of therapeutic trials for SARS-CoV-2 infections have been in primary care: most opened too late, struggled to recruit, and few produced actionable results. Participation in research is often limited by where one lives or receives health care, and trial participants may not represent those for whom the treatments are intended.</p><p><strong>Innovative trials: </strong>The ALIC4E, PRINCIPLE and the ongoing PANORAMIC trial have randomised over 40,500 people with COVID-19. This personal view describes how these trials have innovated in: <b>trial design</b> (by using novel adaptive platform designs); <b>trial delivery</b> (by complementing traditional site-based recruitment ('the patient comes to the research') with mechanisms to enable sick, infectious people to participate without having to leave home ('taking research to the people'), and by addressing the 'inverse research participation law,' which highlights disproportionate barriers faced by those who have the most to contribute, and benefit from, research, and; in <b>transforming the evidence base</b> by evaluating nine medicines to support guidelines and care decisions world-wide for COVID-19 and contribute to antimicrobial stewardship.</p><p><strong>Conclusion: </strong>The PRINCIPLE and PANORAMIC trials represent models of innovation and inclusivity, and exemplify the potential of primary care to lead the way in addressing pressing global health challenges.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"30 1","pages":"2293702"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10773679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139099234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Registration and management of children with overweight by general practitioners in The Netherlands.","authors":"Hevy Hassan, Jacoline van den Driest, Angeline Bosman, Bart Willem Koes, Patrick Jan Eugène Bindels, Marienke van Middelkoop","doi":"10.1080/13814788.2024.2425186","DOIUrl":"10.1080/13814788.2024.2425186","url":null,"abstract":"<p><strong>Background: </strong>General practitioners (GPs) form the gateway to healthcare in numerous European countries. Their role in addressing and managing overweight/obesity in children is crucial. In Dutch guidelines, GPs are encouraged to proactively address weight-related issues during patient consultations, regardless of the initial reason of the visit.</p><p><strong>Objective(s): </strong>To examine the frequency, management and follow-up of GP visits of children for overweight/obesity and the identification by GPs of these children presenting with other complaints.</p><p><strong>Methods: </strong>A retrospective cohort study. Health records from 2012-2021 in the Rijnmond Primary Care Database (RPCD) of children aged 2-18 with overweight/obesity who visited the GP were analysed. Children were categorised into two groups: those visiting for weight-related issues (group 1) and those visiting for other complaints but identified as overweight or obese by GPs (group 2). Data on patient demographics, reasons for contact, and management strategies were extracted.</p><p><strong>Results: </strong>From the 120,991 children, 3035 children with documented overweight or obesity were identified, 208 were excluded. The study population comprised 2827 individuals: 55% belonging to group 1, 45% to group 2. The frequency of first visits remained stable at approximately 0.5% visits per total person-years each year. Group 1 received more referrals (74%) and follow-up consultations (45.5%) than group 2 with 17% referrals and 19.7% follow-up consultations.</p><p><strong>Conclusion: </strong>This study highlights a concerning difference in the management of the two groups. Strategies for effective management of overweight in children and the GP's role, warrant further investigation. Especially when overweight is not the primary reason for visit.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"30 1","pages":"2425186"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11565679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Series: Public engagement with research. Part 3: Sharing power and building trust through partnering with communities in primary care research.","authors":"Jessica Drinkwater, Michelle Farr, Gary Hickey, Esther Van Vliet, Sophie Söderholm Werkö, Ingrid Klingmann, Steven Blackburn","doi":"10.1080/13814788.2024.2328707","DOIUrl":"10.1080/13814788.2024.2328707","url":null,"abstract":"<p><strong>Background: </strong>This article focuses on potential strategies to support primary care researchers in working in partnership with the public and healthcare professionals. Partnership working can potentially to improve the relevance and usefulness of research and ensure better research and health outcomes.</p><p><strong>Discussion: </strong>We describe what we mean by partnership working and the importance of reflecting on power and building trusting relationships. To share power in partnership working, it is essential to critically reflect on the multiple dimensions of power, their manifestations, and your own power. Power can influence relationships and therefore, it is essential to build trust with partners. Next, we outline how the context of primary care research and decisions about who you work with and how to work together, are vital considerations that are imbued with power. Lastly, we suggest different ways of working in partnership to address different dimensions of power. We provide examples from primary care research across Europe regarding how to recognise, tackle, and challenge, invisible, hidden and visible power.</p><p><strong>Conclusion: </strong>We conclude by proposing three calls to actions to encourage researchers working in primary care to consider the multiple dimensions of power and move towards partnership working. First is to use participatory methods to improve the inclusivity of your research. Second is to include patients and the public in decisions about the design, delivery and development of research and its outcomes. Third is to address various systemic and institutional barriers which hinder partnership working.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"30 1","pages":"2328707"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10984225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140307893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Task shifting from general practitioners to other health professionals in out-of-hours primary care - a systematic literature review on content and quality of task shifting.","authors":"Katrine Bjørnshave Bomholt, Mette Amalie Nebsbjerg, Viola Burau, Anna Mygind, Morten Bondo Christensen, Linda Huibers","doi":"10.1080/13814788.2024.2351807","DOIUrl":"10.1080/13814788.2024.2351807","url":null,"abstract":"<p><strong>Background: </strong>Task shifting from general practitioners (GPs) to other health professionals could solve the increased workload, but an overview of the evidence is lacking for out-of-hours primary care (OOH-PC).</p><p><strong>Objectives: </strong>To evaluate the content and quality of task shifting from GPs to other health professionals in clinic consultations and home visits in OOH-PC.</p><p><strong>Methods: </strong>Four database literature searches were performed on 13 December 2021, and updated in August 2023. We included articles that studied content (patient characteristics, reason for encounter) and/or quality (patient satisfaction, safety, efficiency) of task shifting in face-to-face contacts at OOH-PC. Two authors independently screened articles for inclusion and assessed the methodological quality of included articles using the JBI critical appraisal checklist. Data was extracted and results were synthesised in a narrative summary.</p><p><strong>Results: </strong>The search identified 1,829 articles, resulting in the final inclusion of seven articles conducted in the UK or the Netherlands. Studies compared GPs with other health professionals (mainly nurses). These other health professionals saw patients with less urgent health problems, younger patients, and patients with less complex health problems than GPs. Most studies concluded that other health professionals provided safe and vastly efficient care corresponding to the level of GPs but findings about productivity were inconclusive.</p><p><strong>Conclusion: </strong>The level of safety and efficiency of care provided by other health professionals in OOH-PC seems like that of GPs, although they mainly see patients presenting with less urgent and less complex health problems.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"30 1","pages":"2351807"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11123461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141081864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changing of the Guard. A dialogue between the former and the new Editor-in-Chief.","authors":"Jelle Stoffers, Jako S Burgers","doi":"10.1080/13814788.2024.2373125","DOIUrl":"10.1080/13814788.2024.2373125","url":null,"abstract":"","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"30 1","pages":"2373125"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11249138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"German general practitioners' experiences of managing post-COVID-19 syndrome: A qualitative interview study.","authors":"Josefine Schulze, Lennart Lind, Alina Rojas Albert, Laura Lüdtke, Jens Hensen, Corinna Bergelt, Martin Härter, Nadine Janis Pohontsch","doi":"10.1080/13814788.2024.2413095","DOIUrl":"10.1080/13814788.2024.2413095","url":null,"abstract":"<p><strong>Background: </strong>The management of the long-term sequelae of coronavirus disease 2019 (COVID-19) infection, known as post-COVID-19 syndrome (PCS), continues to challenge the medical community, largely owing to a significant gap in the understanding of its aetiology, diagnosis and effective treatment.</p><p><strong>Aim: </strong>To examine general practitioners' (GPs) experiences of caring for patients with PCS and to identify unmet care needs and opportunities for improvement.</p><p><strong>Design and setting: </strong>This study follows a qualitative design, using in-depth semi-structured telephone interviews with GPs (<i>N</i> = 31) from across Germany.</p><p><strong>Method: </strong>Interviews were audio-recorded, transcribed verbatim and analysed using qualitative content analysis.</p><p><strong>Results: </strong>GPs reported that they were often the first point of contact for patients with persistent symptoms following SARS-CoV-2 infection, with symptoms typically resolving within weeks. While ongoing symptomatic COVID-19 is perceived to be more common, the relevance of PCS to GP practices is considerable given its severe impact on patients' functioning, social participation and the substantial time required for patient care. GPs coordinate diagnosis and treatment but face challenges because of the unclear definition of PCS and difficulties in attributing symptoms, resulting in a cautious approach to ICD-10 coding. Interviewees highlight lengthy diagnostic pathways and barriers to accessing specialist care.</p><p><strong>Conclusion: </strong>The findings confirm the high functional limitations and psychosocial burden of PCS on patients, and the central role of GPs in their care. The study suggests a need for further research and health policy measures to support GPs in navigating diagnostic uncertainty, interprofessional communication and the limited evidence on effective treatments.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"30 1","pages":"2413095"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11494714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and potential solutions for collaboration between primary and secondary care in patients with persistent somatic symptoms and functional disorders: A nominal group technique study.","authors":"Nick Mamo, Judith G M Rosmalen, Denise J C Hanssen, Lineke M Tak, Tim C Olde Hartman","doi":"10.1080/13814788.2024.2413090","DOIUrl":"10.1080/13814788.2024.2413090","url":null,"abstract":"<p><strong>Background: </strong>Persistent somatic symptoms and functional disorders (PSS/FD) are complex conditions requiring collaboration between healthcare professionals. This is especially true at the interface between primary and secondary care interface. The current fragmentation of care is a major barrier to this, leading to poor experiences and outcomes and high costs for healthcare and society.</p><p><strong>Objectives: </strong>The aim is to identify barriers and possible solutions for collaboration between primary and secondary care in patients with PSS/FD.</p><p><strong>Methods: </strong>In two sessions, using the nominal group technique, a mix of primary and secondary care professionals identified barriers and possible solutions to collaboration between primary and secondary care in PSS/FD care. Barriers to collaboration were identified during session one, with potential solutions identified during session two in response to the top eight barriers. Each session ended with a voting round ranking the barriers and solutions.</p><p><strong>Results: </strong>A total of 102 healthcare professionals participated in two sessions. In the first session, 55 participants provided a list of 22 barriers, while in the second session, 47 participants provided 18 possible solutions. The top barriers related to shared language and protocols, referral quality, expectations and responsibilities between healthcare professionals and patients, and time pressure. The top solutions identified related to general practitioners using electronic consultations with specialists and shared terminology with patients.</p><p><strong>Conclusion: </strong>The identified barriers and possible solutions for collaboration between primary and secondary care need attention when considering collaboration in PSS/FD care and related settings, both in new and ongoing collaborations.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"30 1","pages":"2413090"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11485729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating sarcoidosis: Recognizing, managing, and supporting patients in primary care.","authors":"Marjolein Drent, Nellie Jans","doi":"10.1080/13814788.2024.2418307","DOIUrl":"10.1080/13814788.2024.2418307","url":null,"abstract":"<p><strong>Background: </strong>Sarcoidosis is a chronic multisystem inflammatory disease of unknown aetiology, characterised by noncaseating granulomas and a variable clinical presentation. Despite its global distribution, sarcoidosis is relatively rare, with the highest prevalence in northern Europe. This poses challenges for primary care physicians due to its broad spectrum of symptoms, from organ-specific manifestations to general complaints like fatigue and concentration difficulties.</p><p><strong>Objectives: </strong>This article aims to provide primary care physicians with practical tools for the early recognition and management of sarcoidosis, emphasising their role in monitoring disease progression and providing supportive care.</p><p><strong>Methods: </strong>Key strategies for diagnosis and management are reviewed, focusing on holistic patient care addressing both somatic and psychosocial aspects of the disease.</p><p><strong>Results: </strong>Early recognition, careful monitoring of disease progression, and individualised treatment plans are crucial. Pharmacotherapy is not always required and should be carefully balanced. The role of supportive, patient-centered counseling is illustrated with two cases.</p><p><strong>Conclusion: </strong>Primary care physicians play a critical role in managing sarcoidosis, particularly in early recognition and monitoring. Given the absence of standardised treatment protocols, a flexible, holistic approach that includes psychosocial support is essential. This article provides a practical framework for general practitioners to address the challenges of sarcoidosis management and improve patient outcomes.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"30 1","pages":"2418307"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11504428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the psychometric performance of the Spanish and Catalan versions of the patient reported experiences and Outcomes of Safety in Primary Care (PREOS-PC)-Compact questionnaire.","authors":"Maria A Fiol-deRoque, José M Valderas, Jorge Arias de la Torre, Maria J Serrano-Ripoll, Montserrat Gens-Barberà, Encarna Sánchez-Freire, Francisco M Martín-Luján, Antonio Olry de Labry, Ignacio Ricci-Cabello","doi":"10.1080/13814788.2023.2296573","DOIUrl":"10.1080/13814788.2023.2296573","url":null,"abstract":"<p><strong>Background: </strong>Patients provide a unique, irreplaceable, and essential perspective in evaluating patient safety. The suite of Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) tools are a notable exception to the scarcity of patient-reported patient safety measures. Full evaluation of their performance has only been attempted for the English version, thereby limiting its international applicability.</p><p><strong>Objectives: </strong>To assess the psychometric performance of the Spanish and Catalan versions of the PREOS-PC-Compact.</p><p><strong>Methods: </strong>Cross-sectional validation study. We used Classical Test Theory methods to examine scale score distribution, internal consistency, and construct validity; and Item Response Theory (IRT) methods to further explore construct validity.</p><p><strong>Results: </strong>3287 patients completed the Spanish version, and 1007 the Catalan version. Similar results were obtained for both versions. Confirmatory Factor Analysis supported a single construct for each scale. The correlations between PREOS-PC-Compact scales and known group analysis suggested adequate construct validity (inconclusive for known groups at the provider level). All four multi-item scales demonstrated adequate internal consistency reliability (α > 0.7), which was only confirmed for test-retest reliability for 'Practice activation.' A sample between 60-90 patients per practice was estimated sufficient to produce scores with reliability > 0.7 for all scales except for harm scales. IRT models showed disordered thresholds for 'Practice activation' and 'Harm burden' but showed excellent fit after reducing the response categories.</p><p><strong>Conclusion: </strong>The Spanish and Catalan versions of the PREOS-PC-Compact are broadly valid and reliable tools to measure patient safety in Spanish primary care centres; confirmation of lower-than-expected test-rest reliability merits further examination .</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"30 1","pages":"2296573"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10783822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139405138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The experiences of transgender and nonbinary adults in primary care: A systematic review.","authors":"Daisy Holland, Luka C J White, Marija Pantelic, Carrie Llewellyn","doi":"10.1080/13814788.2023.2296571","DOIUrl":"10.1080/13814788.2023.2296571","url":null,"abstract":"<p><strong>Background: </strong>Transgender and nonbinary (TNB) people face barriers to primary care, which remains the main entry point for accessing gender-affirming healthcare in the UK.</p><p><strong>Objectives: </strong>This systematic review aims to summarise the evidence regarding TNB people's experiences of primary care to inform improvements in service and patient outcomes.</p><p><strong>Methods: </strong>This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. A systematic literature search was conducted across articles from 2005 to April 2023 across Ovid Medline, Ovid Embase and PsychInfo using established keywords relating to gender identity, primary care and experiences. Qualitative data were thematically analysed and quantitative data were compiled using a descriptive narrative.</p><p><strong>Results: </strong>Following eligibility criteria, 16 articles were included in this review. This review identified both facilitators and limitations and barriers experienced by TNB people related to primary care provider knowledge; the patient-provider relationship, and healthcare settings. Quantitative findings reported up to 54.4% of participants were uncomfortable discussing TNB issues with their physician. Overall findings suggest TNB people face discrimination on a systemic level utilising primary care services, though positive healthcare encounters at a local level were reported. Participants expressed a desire for primary care-led gender-affirming healthcare services, with involvement from local TNB communities.</p><p><strong>Conclusion: </strong>This review demonstrates TNB people's mixed experiences of primary care alongside their recommendations for service improvement. This is the first systematically reviewed evidence on the topic, emphasising the need for clinicians and policymakers to centre the voices of the TNB community in service design and improvement.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"30 1","pages":"2296571"},"PeriodicalIF":3.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10783848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139405139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}