Journal of European CMEPub Date : 2022-11-29eCollection Date: 2022-01-01DOI: 10.1080/21614083.2022.2152941
Katie Stringer Lucero
{"title":"Net Promoter Score (NPS): What Does Net Promoter Score Offer in the Evaluation of Continuing Medical Education?","authors":"Katie Stringer Lucero","doi":"10.1080/21614083.2022.2152941","DOIUrl":"https://doi.org/10.1080/21614083.2022.2152941","url":null,"abstract":"<p><p>Net promoter Score (NPS) has been used in many fields, such as software, clinical care, and websites, as a measure of customer satisfaction since 2003. With a single question, NPS methodology is thought to determine brand loyalty and intent to act based on experiences with the brand or product. In the current study, accredited continuing medical education or continuing education (CME/CE) was the product. Providers of CME have utilised NPS rating (the individual score on a scale of 0 to 10) to collect data about the value of the experience a clinician has with CME activities, but there has been no research to examine what it actually is associated with. This study looked to understand - relative to other self-reported and assessment outcomes in CME, what does NPS at the activity level indicate? From 155 online CME programmes (29,696 target audience learners with complete data), potential outcomes of CME, including whether knowledge or competence improved via assessment score, mean post-confidence rating, and whether one intended practices changes and was committed to those changes, were examined as predictors of NPS. NPS is unique in that it cannot be calculated at the individual level; individual scores must be aggregated, and then the percentage who selected ratings of 0 to 5 is subtracted from the percentage who selected 9 or 10. Results showed that percentage of learners who are committed to change predicts 70% of the variance in NPS, which suggests NPS is a valid indicator of intention to act. These results have implications for how we might, as a field, incorporate the utilisation of a single standardised question to examine the potential impact of online CME and call for additional research on whether NPS predicts change in clinical practice.</p>","PeriodicalId":87300,"journal":{"name":"Journal of European CME","volume":"11 1","pages":"2152941"},"PeriodicalIF":0.0,"publicationDate":"2022-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b3/48/ZJEC_11_2152941.PMC9718547.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35255627","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}
Journal of European CMEPub Date : 2022-11-29eCollection Date: 2022-01-01DOI: 10.1080/21614083.2022.2153438
Herman Stoevelaar, Amit Bahl, Nicky Helsen, Nele R M Michels, Louis Smets, Mark J Speakman, Johan Stranne, Jaan Toelen, Frank Van der Aa, Luc Van Ruysevelt, Jessa Yperman, Thomas Zilli, Bertrand F Tombal, Martin C Michel
{"title":"Personalised versus non-individualised case-based CME: A randomised pilot study.","authors":"Herman Stoevelaar, Amit Bahl, Nicky Helsen, Nele R M Michels, Louis Smets, Mark J Speakman, Johan Stranne, Jaan Toelen, Frank Van der Aa, Luc Van Ruysevelt, Jessa Yperman, Thomas Zilli, Bertrand F Tombal, Martin C Michel","doi":"10.1080/21614083.2022.2153438","DOIUrl":"https://doi.org/10.1080/21614083.2022.2153438","url":null,"abstract":"<p><p>The PinPoint Case Platform (PPCP) offers independent online case-based CME. To align with personal learning needs, a functionality of needs assessments (\"QuickScan\") was developed, directing users to follow personalised case journeys. A randomised study was conducted, comparing its effectiveness, time efficiency and user experience with a format of non-individualised case-based learning. Forty-two residents in urology from five European countries were randomly assigned to follow non-individualised case-based learning (control group) or a needs assessment plus personalised case journeys on different topics in prostate cancer. After performing a pre- and post-assessment, both groups showed a similar increase in test scores (Mann-Whitney <i>U</i> = 247; p = .113), but the time needed for completing the learning exercise was significantly lower in the group with the personalised approach (median: 45 vs 90 minutes; Mann-Whitney <i>U</i> = 97.5; p = .0141). The quality of the two learning methods was similarly well received by both groups. In conclusion, learners who followed personalised case journeys learned similarly effective but more time efficient than non-individualised case-based learners. Future studies should determine if these findings can be extrapolated to board-certified physicians following CME activities.</p>","PeriodicalId":87300,"journal":{"name":"Journal of European CME","volume":"11 1","pages":"2153438"},"PeriodicalIF":0.0,"publicationDate":"2022-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/11/bc/ZJEC_11_2153438.PMC9718550.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35255628","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}
Journal of European CMEPub Date : 2022-11-17eCollection Date: 2022-01-01DOI: 10.1080/21614083.2022.2147288
Yann-Maël Bideau, Thomas Kearns
{"title":"A European Approach to Micro-credentials for Lifelong Learning and Employability.","authors":"Yann-Maël Bideau, Thomas Kearns","doi":"10.1080/21614083.2022.2147288","DOIUrl":"https://doi.org/10.1080/21614083.2022.2147288","url":null,"abstract":"phenomenon of micro-credentials a new one. Small, short in duration, courses leading to different types of or are already domi-nant in many and training sectors, professions and labour market systems such as in diving instruction, and also very importantly in continuing professional development for health workers. Preliminary findings from the European Centre for the Development of Vocational Training’s (Cedefop) ongoing study on micro-credentials role in facilitating learning for employment shows that employer organisations in the in of","PeriodicalId":87300,"journal":{"name":"Journal of European CME","volume":" ","pages":"2147288"},"PeriodicalIF":0.0,"publicationDate":"2022-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3a/e1/ZJEC_11_2147288.PMC9677998.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40481947","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}
Journal of European CMEPub Date : 2022-11-15eCollection Date: 2022-01-01DOI: 10.1080/21614083.2022.2146372
Kathleen Regnier, Dimitra V Travlos, Daniel Pace, Sierra Powell, Allison Hunt
{"title":"Leading Change Together: Supporting Collaborative Practice through Joint Accreditation for Interprofessional Continuing Education.","authors":"Kathleen Regnier, Dimitra V Travlos, Daniel Pace, Sierra Powell, Allison Hunt","doi":"10.1080/21614083.2022.2146372","DOIUrl":"https://doi.org/10.1080/21614083.2022.2146372","url":null,"abstract":"<p><p>Interprofessional continuing education in support of team-based care is a critical component of healthcare quality and safety. In an effort to develop and advance the field of interprofessional continuing education (IPCE), the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) collaborated to launch Joint Accreditation for Interprofessional Continuing Education™, the first and only accrediting body in the world to offer the opportunity to be simultaneously accredited to provide CE activities for multiple healthcare professions through a single, unified application process, fee structure, and set of accreditation standards. To date, seven additional professions have joined Joint Accreditation: athletic trainers, dentists, dieticians, optometrists, physician associates/physician assistants (PAs), psychologists, and social workers. With this expansion, jointly accredited organisations can choose to offer IPCE for up to ten professions without needing to attain separate accreditations. Jointly accredited providers are able to offer education that is designed for single professions, multiple professions, and interprofessional teams, as long as 25% of the education is interprofessional. This innovation facilitates and incentivises IPCE which leads to improved healthcare delivery and better patient outcomes. To effectively integrate interprofessional collaborative practice throughout healthcare systems across the world, IPCE needs to become an integral part of lifelong learning for all health professions. There are several jointly accredited organisations that operate outside of the USA, and interest in Joint Accreditation and IPCE continues to grow.</p>","PeriodicalId":87300,"journal":{"name":"Journal of European CME","volume":" ","pages":"2146372"},"PeriodicalIF":0.0,"publicationDate":"2022-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f7/64/ZJEC_11_2146372.PMC9673784.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40699309","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}
Journal of European CMEPub Date : 2022-11-10eCollection Date: 2022-01-01DOI: 10.1080/21614083.2022.2142405
Suzanne Murray, Bente Langdahl, Enrique Casado, Keyla Brooks, Cesar Libanati, Livio Di Lecce, Patrice Lazure
{"title":"Preparing the Leaders of Tomorrow: Learnings from a Two-Year Community of Practice in Fragility Fractures.","authors":"Suzanne Murray, Bente Langdahl, Enrique Casado, Keyla Brooks, Cesar Libanati, Livio Di Lecce, Patrice Lazure","doi":"10.1080/21614083.2022.2142405","DOIUrl":"https://doi.org/10.1080/21614083.2022.2142405","url":null,"abstract":"<p><p>To facilitate the development of leadership competencies in a multidisciplinary group of 18 emerging bone experts from 6 European Countries and Brazil, to face future scenarios in the evolving field of fragility fractures, and to support secondary fracture prevention and improve patient outcomes. Changes brought by the COVID-19 pandemic have further highlighted this need. A 2.5-year community of practice (CoP) programme was established with two senior bone experts acting as mentors. The content was adapted during the COVID-19 pandemic. The education impact of the programme was assessed using an ethics-approved mixed-method design consisting of multiple sources of qualitative and quantitative data collected longitudinally. Quantitative data were analysed descriptively. Qualitative data underwent a thematic analysis. After participating in the programme, participants reported increased interprofessional collaboration and communication skills, better understanding of health economics and negotiation, application of adult learning principles to their work setting, development of competencies to critically appraise guidelines, enhanced abilities to facilitate behaviour change in others, and improved confidence leading their team through crisis situations. Although time was required for some physicians to get accustomed to the CoP concept and develop trust with other members, it was described as a beneficial real-world learning experience. An educational real-world CoP programme was effective in enhancing leadership competencies among future leaders in the bone field to improve care of fragility fracture patients. The results presented could guide the development of other CoPs in fragility fracture care as leadership competencies are increasingly required in that field.</p>","PeriodicalId":87300,"journal":{"name":"Journal of European CME","volume":" ","pages":"2142405"},"PeriodicalIF":0.0,"publicationDate":"2022-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/84/00/ZJEC_11_2142405.PMC9662001.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40709316","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}
Journal of European CMEPub Date : 2022-09-02eCollection Date: 2022-01-01DOI: 10.1080/21614083.2022.2116193
Erin Keely, Rhea Mitchell, Sheena Guglani, Douglas Archibald, Amir Afkham, Clare Liddy
{"title":"Benefits of Providing Feedback and Utilisation Metrics to Specialists on Their Participation in eConsult.","authors":"Erin Keely, Rhea Mitchell, Sheena Guglani, Douglas Archibald, Amir Afkham, Clare Liddy","doi":"10.1080/21614083.2022.2116193","DOIUrl":"https://doi.org/10.1080/21614083.2022.2116193","url":null,"abstract":"<p><p>Our study evaluates the impact of feedback sent to specialists participating in eConsult services. eConsult Specialists from two eConsult services in Ontario, Canada, received feedback on their use of eConsult via bi-annual specialist reports. An 11-item survey was developed to evaluate the impact, content, and distribution process of these specialist reports. We distributed 742 specialist reports in March 2021 and surveyed the specialists in July 2021. Our findings show that specialists largely felt that the feedback received validated their efforts (83%) and that receiving the report made them more likely to continue to participate in the eConsult service (59%). Most did not feel judged (74%) or distressed (79%) by the reports, and 72% said that reporting the median self-reported billing time did not impact their own billing times. Overall, eConsult services can capture, report and aggregate data valuable to specialists and is useful for Continuing Professional Development. Benefits and lack of risk implementing this type of feedback should encourage other services to consider similar processes.</p>","PeriodicalId":87300,"journal":{"name":"Journal of European CME","volume":"11 1","pages":"2116193"},"PeriodicalIF":0.0,"publicationDate":"2022-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ca/02/ZJEC_11_2116193.PMC9448361.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33454310","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}
Journal of European CMEPub Date : 2022-07-18eCollection Date: 2022-01-01DOI: 10.1080/21614083.2022.2101703
Ilaria Leggeri, Marina Tarrus Barberillo, Maria Dutarte, Begonya Nafria Escalera, Esther Murphy, Silvia Scalabrini, Patrocinio Ariza-Vega, Celine Carrera
{"title":"The Role of Patients in Health Education.","authors":"Ilaria Leggeri, Marina Tarrus Barberillo, Maria Dutarte, Begonya Nafria Escalera, Esther Murphy, Silvia Scalabrini, Patrocinio Ariza-Vega, Celine Carrera","doi":"10.1080/21614083.2022.2101703","DOIUrl":"https://doi.org/10.1080/21614083.2022.2101703","url":null,"abstract":"Public Affairs and Stakeholder Relations, EIT Health, Munich, Germany; Unit for Scientific Outreach and Innovation, Barcelona Institute for Global Health (Isglobal), Barcelona, Spain; Secretariat, European Patients' Academy on Therapeutic Innovation (EUPATI), Amsterdam, The Netherlands; Patients Engagement in Research, Institut de Recerca, Sant Joan de Deu, Barcelona, Spain; Robotics & Innovation Lab, School of Engineering, Trinity College Dublin, Dublin, Ireland; Department of Physiotherapy, Faculty of Health Sciences, Universidad de Granada, ibs. Granada, Granada, Spain; Education, EIT Health, Munich, Germany","PeriodicalId":87300,"journal":{"name":"Journal of European CME","volume":" ","pages":"2101703"},"PeriodicalIF":0.0,"publicationDate":"2022-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a7/d3/ZJEC_11_2101703.PMC9302006.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40645841","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}
Journal of European CMEPub Date : 2022-07-13eCollection Date: 2022-01-01DOI: 10.1080/21614083.2022.2095786
Ron Murray
{"title":"Report on Proceedings of the Fourteenth Annual European CME Forum, Studio Hybrid from Manchester UK, November, 2021.","authors":"Ron Murray","doi":"10.1080/21614083.2022.2095786","DOIUrl":"https://doi.org/10.1080/21614083.2022.2095786","url":null,"abstract":"ABSTRACT In a departure from the increasingly familiar virtual meetings conducted via collaboration apps the Fourteenth Annual European CME Forum (#14ECF) took place between 3 and 5 November 2021 using a blended model that relied mainly on a studio-based hub. A small group of faculty hosted plenary sessions in the studio with participation by attendees, panellists and workshop leaders via an interactive online meeting platform. The theme of the meeting was “The 3-legged stool: Achieving balance for effective CME. The plenaries focused on three linked topics, Rules and Regulations, Educational Design and Outcomes, and Funding and Independence. These were broadcast in high definition whilst interaction among participants, workshop leaders, and poster authors was achieved using an avatar-based conferencing platform. The breakout workshops covered topics including digital literacy, international collaboration, artificial intelligence, and diversity and inclusion. The meeting format was well accepted by participants and will form the basis for more hybrid-type meetings for future meetings. Graphical Abstract","PeriodicalId":87300,"journal":{"name":"Journal of European CME","volume":" ","pages":"2095786"},"PeriodicalIF":0.0,"publicationDate":"2022-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a3/22/ZJEC_11_2095786.PMC9291652.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40609483","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}
Journal of European CMEPub Date : 2022-06-12eCollection Date: 2022-01-01DOI: 10.1080/21614083.2022.2087397
Malke Asaad, Rami Elmorsi, Andrew M Ferry, Aashish Rajesh, Renata S Maricevich
{"title":"Interviewing Amidst a Pandemic: Perspectives of US Residency Program Directors on the Virtual Format.","authors":"Malke Asaad, Rami Elmorsi, Andrew M Ferry, Aashish Rajesh, Renata S Maricevich","doi":"10.1080/21614083.2022.2087397","DOIUrl":"10.1080/21614083.2022.2087397","url":null,"abstract":"<p><p>COVID-19 imposed significant limitations upon the 2021 U.S. National Resident Matching Program (NRMP), most important of which is the replacement of traditional in-person interviews with a virtual format. To determine the strengths, limitations, and overall utility of virtual interviews (VIs) for residency applicant selection, a 14-question electronic survey was administered to programme directors (PDs) of all American Council for Graduate Medical Education (ACGME)-accredited residency programmes, from December 2020 through March 2021. PDs were asked about their experience with VIs and the ability to assess residency applicants using the virtual format. A total of 1123 PDs (30% response rate) representing 30 different specialities responded to our survey. Compared to in-person interviews, VIs made it more challenging to assess applicants' fit with the programme, emotional intelligence, commitment to speciality, and ability to function as a resident physician. Overall, only 15% of PDs believed that VIs were better than in-person interviews. Once travel restrictions are lifted and in-person interviews are possible, 67% of PDs plan on hosting dual-format residency interviews, while 26% and 5% of PDs will exclusively host in-person interviews and VIs, respectively. This result was significantly different between surgical and non-surgical programmes [35% of surgical PDs suggested they would offer in-person interviews exclusively, compared to 21% of non-surgical PDs, p < 0.0001]. Although proven to be cost and time-efficient, VIs were challenging in evaluating certain qualities of residency applicants. While this study was focused on U.S. residency matching, it provides important insights about the future of VIs in medical recruitment as a whole.</p>","PeriodicalId":87300,"journal":{"name":"Journal of European CME","volume":" ","pages":"2087397"},"PeriodicalIF":0.0,"publicationDate":"2022-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9196818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45224028","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}
Journal of European CMEPub Date : 2022-06-12eCollection Date: 2022-01-01DOI: 10.1080/21614083.2022.2085011
Ina Weisshardt, Ivo Vlaev, Trishna Chauhan, Eva Hofstädter-Thalmann
{"title":"Learnings from the forced transition of an industry supported educational programme for young experts in urology and oncology from face-to-face to digital during the COVID-19 pandemic.","authors":"Ina Weisshardt, Ivo Vlaev, Trishna Chauhan, Eva Hofstädter-Thalmann","doi":"10.1080/21614083.2022.2085011","DOIUrl":"10.1080/21614083.2022.2085011","url":null,"abstract":"<p><p>When the COVID-19 pandemic caused face-to-face meetings to be cancelled, an industry-sponsored educational programme, designed to develop skills and expand knowledge of young experts in oncology and urology, was forced to partially move from face-to-face setting to virtual meetings. In our outcomes analysis, we aimed to better understand what drives behavioural change following a series of educational interventions based on the physical or virtual formats. Therefore, we performed a structured outcomes evaluation for each educational intervention, including the perspectives of the learner and the teaching faculty. Our main findings were that \"relevance\" is the strongest driver of recall, satisfaction and behavioural change. Social interactions amongst learners and between faculty and learners are possible in the digital world, and we observed a trend of the young learners in favour of digital learning, especially with improved technical platforms enabling social interaction. Other findings were that new skills are required by the teaching faculty and that hybrid formats were identified by all participants as the model of the future. When developing future educational programmes, these specific needs of learners and faculty need to be considered and offer opportunities to develop more personalised programmes in order to increase learning impact.</p>","PeriodicalId":87300,"journal":{"name":"Journal of European CME","volume":" ","pages":"2085011"},"PeriodicalIF":0.0,"publicationDate":"2022-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9196841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47236040","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}