Intensive and Critical Care Nursing最新文献

{"title":"Prophylactic dressings to prevent sacral pressure injuries in adult patients admitted to intensive care units: A three-arm feasibility randomized controlled trial","authors":"Sharon Latimer ,&nbsp;Rachel M. Walker ,&nbsp;Wendy Chaboyer ,&nbsp;Lukman Thalib ,&nbsp;Fiona Coyer ,&nbsp;Jodie L. Deakin ,&nbsp;Brigid M. Gillespie","doi":"10.1016/j.iccn.2024.103746","DOIUrl":"https://doi.org/10.1016/j.iccn.2024.103746","url":null,"abstract":"<div><h3>Background</h3><p>Pressure injuries in intensive care patients are a safety issue. Specialized foam sacral prophylactic dressings prevent pressure injuries with several products available for clinicians to choose from.</p></div><div><h3>Objectives</h3><p>Assess the feasibility of conducting a multisite trial to test the effectiveness of two dressings versus usual care in preventing sacral pressure injuries in intensive care patients.</p></div><div><h3>Methods</h3><p>Using a three-arm pilot randomized trial design, adult intensive care unit patients at risk for pressure injuries were randomly allocated to the Mepilex® Sacrum dressing, the Allevyn™ Life Sacrum dressing or the control group. Daily pressure injury data were collected including a de-identified sacral photograph, which the blinded outcome assessor used to determine the study end point: a new sacral pressure injury. Pre-determined feasibility criteria were measured in terms of eligibility, recruitment, retention, intervention fidelity and missing data.</p></div><div><h3>Results</h3><p>From May-September 2021, we screened 602 intensive care unit adult patients for eligibility with 93 % (n = 558) excluded. Forty-four (7 %) were eligible, and all were recruited and randomized (100 %). After receipt of the intervention two participants withdrew from the study. Our final sample of 42 participants were randomly allocated to the Mepilex® (n = 12), Allevyn™ (n = 14) or control (n = 16) group. The interventions were delivered as intended and there were 11 (6 %) cases of missing outcome data. Five participants (12 %) developed a sacral pressure injury, four of whom received a sacral dressing.</p></div><div><h3>Conclusions</h3><p>A larger trial is feasible with minor refinement to the length of stay eligibility criterion.</p></div><div><h3>Implications for practice</h3><p>Prophylactic sacral dressings are recommended for pressure injury prevention. Determining the feasibility of a larger trial to test the effectiveness of two dressings versus usual care in preventing sacral pressure injuries in intensive care patients can provide evidence to aid clinicians, policy makers and managers make value-based care decisions.</p></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"84 ","pages":"Article 103746"},"PeriodicalIF":5.3,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0964339724001319/pdfft?md5=724a061e04a1d0eedeaec639000d7cec&pid=1-s2.0-S0964339724001319-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141424430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is it time to monitor the unmonitored?","authors":"Niels Van Regenmortel,&nbsp;Manu L.N.G. Malbrain,&nbsp;Xavier Monnet","doi":"10.1016/j.iccn.2024.103751","DOIUrl":"https://doi.org/10.1016/j.iccn.2024.103751","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"84 ","pages":"Article 103751"},"PeriodicalIF":5.3,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141424454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified frailty index effectively predicts adverse outcomes in sepsis patients in the intensive care unit","authors":"Xinya Li ,&nbsp;Yonglan Tang ,&nbsp;Xingwen Deng ,&nbsp;Fuling Zhou ,&nbsp;Xiaxuan Huang ,&nbsp;Zihong Bai ,&nbsp;Xin Liang ,&nbsp;Yu Wang ,&nbsp;Jun Lyu","doi":"10.1016/j.iccn.2024.103749","DOIUrl":"https://doi.org/10.1016/j.iccn.2024.103749","url":null,"abstract":"<div><h3>Background</h3><p>Frailty and sepsis have a significant impact on patient prognosis. However, research into the relationship between frailty and sepsis in the general adult population remains inadequate. This paper aims to investigate the association between frailty and adverse outcomes in this population.</p></div><div><h3>Method</h3><p>This retrospective analysis investigated sepsis patients who were initially admitted to the intensive care unit (ICU). The Modified Frailty Index (MFI) was derived by tracking patients’ International Classification of Diseases (ICD) codes during their hospitalization. Patients were classified into two groups based on their MFI scores: a frail group (MFI ≥ 3) and a non-frail group (MFI = 0–2). The key outcomes were mortality rates at 90 and 180 days, with secondary outcomes including the incidence of delirium and pressure injury.</p></div><div><h3>Result</h3><p>Of the 21,338 patients who were recruited for this study (median age about 68 years, 41.8 % female), 5,507 were classified as frail and 15,831 were classified as non-frail. Frail patients were significantly more likely to have delirium (48.9 % vs. 36.1 %, p &lt; 0.001) and pressure injury (60.5 % vs. 51.4 %, p &lt; 0.001). After controlling for confounding variables, the multifactorial Cox proportional hazard regression analyses revealed a significantly elevated mortality rate at 90 days (adjusted HR: 1.58, 95 % CI: 1.24–2.02, p &lt; 0.001) and 180 days (adjusted HR: 1.47, 95 % CI: 1.18, 1.83, p &lt; 0.001) in the frail group compared to their non-frail counterparts.</p></div><div><h3>Conclusions</h3><p>Frailty independently predisposes adult sepsis patients in the ICU to adverse outcomes. Future investigations should concentrate on evaluating frailty and developing targeted interventions to improve patient prognosis.</p></div><div><h3>Implication for clinical practice</h3><p>The MFI provides a simple clinical assessment tool that can be integrated into electronic medical records for immediate calculation. This simplifies the assessment process and plays a key role in predicting patient outcomes.</p></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"84 ","pages":"Article 103749"},"PeriodicalIF":5.3,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141424431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a routine post-shift debriefing program in ICU aiming at quality-of-care improvement: A primary analysis of feasibility and impacts","authors":"Anne-Françoise Rousseau ,&nbsp;Michael Fontana ,&nbsp;Stéphanie Georis ,&nbsp;Bernard Lambermont ,&nbsp;Jonathan Cavalleri ,&nbsp;Marc Pirotte ,&nbsp;Gaëlle Tronconi ,&nbsp;Méryl Paquay ,&nbsp;Benoit Misset","doi":"10.1016/j.iccn.2024.103752","DOIUrl":"https://doi.org/10.1016/j.iccn.2024.103752","url":null,"abstract":"<div><h3>Objectives</h3><p>This report describes the implementation of a clinical debriefing (CD) program in intensive care units (ICU) and analyses its feasibility and its impact on staff well-being.</p></div><div><h3>Design</h3><p>Observational study.</p></div><div><h3>Setting</h3><p>From April to September 2023, post-shift CDs were run once a week in 2 out of 7 units in our department, using an adapted version of the DISCOVER-PHASE tool. CD sessions were performed face-to-face with volunteer members of the multidisciplinary ICU team.</p></div><div><h3>Main outcome measures</h3><p>After 6 months, a survey assessing the satisfaction of the debriefed teams was conducted. The impact of CD on staff well-being was assessed using three validated questionnaires (Maslach Burnout Inventory, Ways of Coping Checklist, Professional Quality of Life Scale) administered in the 7 units before and after the CD period.</p></div><div><h3>Results</h3><p>A total of 44 CDs were performed, lasting 15 (4–35) min. There were 6 (1–9) attendees per CD, mainly nurses (64.6%). Discussions focused mainly on basic problems related to dysfunctional material, communication and organization inside the team. The two debriefed teams were satisfied of the program and gave 9, 8 and 8 out of 10 on a visual analogical scale for the climate of confidence of the DC, their organisation, and their ability to improve working conditions and quality of care, respectively. Subscores at the three questionnaires assessing staff well-being before and after the CD period were similar, whether teams experienced CD or not.</p></div><div><h3>Conclusions</h3><p>Implementing of post-shift debriefings in our ICU was feasible and well accepted. More prolonged programs are probably needed to demonstrate benefits on staff well-being.</p></div><div><h3>Implications for clinical practice</h3><p>This report offers elements that other teams can use to successfully conduct post-shift debriefings and to plan future research on longer-term programs.</p></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"84 ","pages":"Article 103752"},"PeriodicalIF":5.3,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141424432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives for capillary refill time in clinical practice for sepsis","authors":"Weipeng Huang ,&nbsp;Yiyan Huang ,&nbsp;Li Ke ,&nbsp;Chang Hu ,&nbsp;Pengyu Chen ,&nbsp;Bo Hu","doi":"10.1016/j.iccn.2024.103743","DOIUrl":"https://doi.org/10.1016/j.iccn.2024.103743","url":null,"abstract":"<div><h3>Background</h3><p>Capillary refill time (CRT) is defined as the time taken for color to return to an external capillary bed after pressure is applied to cause blanching. Recent studies demonstrated the benefits of CRT in guiding fluid therapy for sepsis. However, lack of consistency among physicians in how to perform and interpret CRT has led to a low interobserver agreement for this assessment tool, which prevents its availability in sepsis clinical settings.</p></div><div><h3>Objective</h3><p>To give physicians a concise overview of CRT and explore recent evidence on its reliability and value in the management of sepsis.</p></div><div><h3>Research design</h3><p>A narrative review.</p></div><div><h3>Results</h3><p>This narrative review summarizes the factors affecting CRT values, for example, age, sex, temperature, light, observation techniques, work experience, training level and differences in CRT measurement methods. The methods of reducing the variability of CRT are synthesized. Based on studies with highly reproducible CRT measurements and an excellent inter-rater concordance, we recommend the standardized CRT assessment method. The threshold of normal CRT values is discussed. The application of CRT in different phases of sepsis management is summarized.</p></div><div><h3>Conclusions</h3><p>Recent data confirm the value of CRT in critically ill patients. CRT should be detected by trained physicians using standardized methods and reducing the effect of ambient-related factors. Its association with severe infection, microcirculation, tissue perfusion response, organ dysfunction and adverse outcomes makes this approach a very attractive tool in sepsis. Further studies should confirm its value in the management of sepsis.</p></div><div><h3>Implications for clinical practice</h3><p>As a simple assessment, CRT deserves more attention even though it has not been widely applied at the bedside. CRT could provide nursing staff with patient’s microcirculatory status, which may help to develop individualized nursing plans and improve the patient’s care quality and treatment outcomes.</p></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"84 ","pages":"Article 103743"},"PeriodicalIF":5.3,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141424456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in nursing care: The gap between research and the real world","authors":"Rafael Lima Rodrigues Carvalho,&nbsp;Daniela Ponce,&nbsp;Milena Soriano Marcolino","doi":"10.1016/j.iccn.2024.103747","DOIUrl":"https://doi.org/10.1016/j.iccn.2024.103747","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"84 ","pages":"Article 103747"},"PeriodicalIF":5.3,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141328836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Randomized feasibility trial for evaluating the impact of primary nursing on delirium duration during intensive care unit stay","authors":"Lars Krüger ,&nbsp;Armin Zittermann ,&nbsp;Thomas Mannebach ,&nbsp;Franziska Wefer ,&nbsp;Tobias Becker ,&nbsp;Sarah Lohmeier ,&nbsp;Anna Lüttermann ,&nbsp;Vera von Dossow ,&nbsp;Sebastian V. Rojas ,&nbsp;Jan Gummert ,&nbsp;Gero Langer","doi":"10.1016/j.iccn.2024.103748","DOIUrl":"10.1016/j.iccn.2024.103748","url":null,"abstract":"<div><h3>Objective</h3><p>We tested the feasibility of a randomized controlled trial for comparing primary nursing with standard care.</p></div><div><h3>Research Methodology</h3><p>Elective cardiac surgical patients were eligible for inclusion. Patients with an intensive care unit stay of ≥ 3 days were followed up until intensive care unit discharge. Recruitment period was one year.</p></div><div><h3>Setting</h3><p>Two intensive care units at a university hospital specialized in cardiovascular and diabetic diseases.</p></div><div><h3>Main Outcome Measures</h3><p>Primary outcomes were recruitment and delivery rate. Primary clinical outcome was duration of delirium, as assessed by the Confusion Assessment Method for Intensive Care Units. Secondary outcomes included the incidence of delirium, anxiety (10-point Numeric Rating Scale), and the satisfaction of patient relatives (validated questionnaire).</p></div><div><h3>Results</h3><p>Of 369 patients screened, 269 could be allocated to primary nursing (n = 134) or standard care (n = 135), of whom 46 patients and 48 patients, respectively, underwent an intensive care unit stay ≥ 3 days. Thus, recruitment and delivery rates were 73 and 26 %, respectively. During primary nursing and standard care, 18 and 24 patients developed a delirium, with a median duration of 32 (IQR: 14–96) and 24 (IQR: 8–44) hours (P = 0.10). The risk difference of delirium for primary nursing versus standard care was 11 % and the relative risk was 0.65 (95 % CI: 0.28–1.46; P = 0.29). The extent of anxiety was similar between groups (P = 0.13). Satisfaction could be assessed in 73.5 % of relatives, without substantial differences between groups.</p></div><div><h3>Conclusion</h3><p>Data demonstrate that a trial for comparing primary nursing with standard care is generally feasible. However, the incidence of delirium may be a better primary outcome parameter than delirium duration, both in terms of long-term patient outcome and robustness of data quality.</p></div><div><h3>Implications for clinical practice</h3><p>A randomized clinical trial regarding nursing organization during intensive care unit stay requires detailed planning of patient recruitment, data evaluation, and power calculation.</p></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"84 ","pages":"Article 103748"},"PeriodicalIF":5.3,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0964339724001332/pdfft?md5=ccb2c7d4075faa78d2d54d9d30cdb436&pid=1-s2.0-S0964339724001332-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141322192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The metronome as a resuscitator support tool during “Compressions-Only” cardiopulmonary resuscitation. A quasi-experimental study","authors":"Breogán Carballo Álvarez ,&nbsp;Jorge Alcántara Espinosa ,&nbsp;Sandra Vidal Martínez","doi":"10.1016/j.iccn.2024.103745","DOIUrl":"10.1016/j.iccn.2024.103745","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"84 ","pages":"Article 103745"},"PeriodicalIF":5.3,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141322193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Skin lesions in infant compared to adult ICU patients: Is it any different?","authors":"Jan Kottner ,&nbsp;Ulrike Blume-Peytavi","doi":"10.1016/j.iccn.2024.103730","DOIUrl":"https://doi.org/10.1016/j.iccn.2024.103730","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"84 ","pages":"Article 103730"},"PeriodicalIF":5.3,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0964339724001150/pdfft?md5=10bbe20160dbab1e1c46e1542d955046&pid=1-s2.0-S0964339724001150-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141302751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of peri-intubation non-pharmacological interventions on postoperative laryngeal symptoms: A systematic review with meta-analysis and meta-regression","authors":"Sevilay Senol Celik ,&nbsp;Athanasios Chalkias ,&nbsp;Seda Sariköse ,&nbsp;Hande Nur Arslan ,&nbsp;Ali Bahramifar ,&nbsp;Farshid Rahimi-Bashar ,&nbsp;Ali Ait Hssain ,&nbsp;Saeed Hashemi ,&nbsp;Amir Vahedian-Azimi","doi":"10.1016/j.iccn.2024.103728","DOIUrl":"https://doi.org/10.1016/j.iccn.2024.103728","url":null,"abstract":"<div><h3>Objectives</h3><p>To evaluate the effectiveness of <em>peri</em>-intubation non-pharmacological interventions in reducing postoperative sore throat (POST), cough (PEC), and hoarseness in surgical patients.</p></div><div><h3>Design</h3><p>A systematic review with <em>meta</em>-analysis and <em>meta</em>-regression.</p></div><div><h3>Setting</h3><p>Elective surgery under general anesthesia in operating rooms.</p></div><div><h3>Main Outcome Measures</h3><p>Evaluate the impact of non-pharmacological interventions, including pre-intubation (gargling with Sodium Azulene Sulfonate, licorice, or using Strepsils tablets of honey and lemon lozenge), during-intubation (inflating the TT cuff with normal saline and softening the ETT cuff with warm normal saline), and post-intubation (cold vapor therapy, gargling with honey lemon water, and using green tea gargle), on the occurrence of POST, PEC, and hoarseness.</p></div><div><h3>Results</h3><p>Nineteen trials with 2,136 participants were included. Pre-intubation intervention significantly reduced POST immediately after extubation (n = 861; OR: 0.28, 95 % CI: 0.20–0.38, P &lt; 0.001), and 24 h post-extubation (n = 1006; OR: 0.21, 95 % CI: 0.16–0.28, P &lt; 0.001). During-intubation intervention did not show significant effects on POST. Pre-intubation intervention also reduced POST-associated pain score at 24 h post-extubation (n = 440; MD: −0.50, 95 % CI: −0.81 to −0.18, P &lt; 0.001). Post-intubation interventions were effective in reducing POST-associated pain scores at different time points post-extubation (P &lt; 0.05). Pre-intubation intervention significantly reduced PEC (OR: 0.13, 95 % CI: 0.02–0.70, P = 0.02) and hoarseness (OR: 0.36, 95 %CI: 0.15–0.86, P = 0.02) at 24 h post-extubation. However, during-intubation interventions did not reduce hoarseness at 24 h post-extubation.</p></div><div><h3>Conclusion</h3><p>Pre-intubation non-pharmacological interventions were found to be the most effective in reducing the incidence and severity of POST, PEC, and hoarseness.</p></div><div><h3>Implications for Clinical Practice</h3><p>Implementing pre-intubation non-pharmacological interventions can be beneficial for bedside nurses and healthcare professionals in reducing postoperative complications and nurses can contribute to improving patient comfort and recovery outcomes following surgery.</p></div><div><h3>Systematic Review Protocol</h3><p>The protocol was registered in the PROSPERO international prospective register of systematic reviews on 2 January 2024 (CRD42023492813).</p></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"84 ","pages":"Article 103728"},"PeriodicalIF":5.3,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141302750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}