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Preclinical testing of expired antivenoms and its uses in real-world experience: a systematic review. 过期抗蛇毒血清的临床前测试及其在实际经验中的应用:系统综述。
IF 2.7 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-08-21 DOI: 10.1136/emermed-2023-213707
Sutinee Soopairin, Chanthawat Patikorn, Suthira Taychakhoonavudh

Introduction: Limited access to antivenoms is a global challenge in treating snakebite envenoming. In emergency situations where non-expired antivenoms are not readily available, expired antivenoms may be used to save lives with the risk of deteriorating quality, efficacy and safety. Therefore, we aimed to systematically review and summarise the sparse preclinical evidence of neutralising efficacy of expired antivenoms and real-world experience of using expired antivenoms in humans.

Methods: We searched for articles published until 1 March 2023 in PubMed, Scopus, Web of Science and Embase. Studies demonstrating the preclinical studies evaluating expired antivenoms or studies describing the real-world experience of using expired antivenoms were included. Narrative synthesis was applied to summarise the evidence of expired antivenoms.

Results: Fifteen studies were included. Ten were preclinical studies and five were real-world experiences of using expired antivenoms in humans. The expired duration of antivenoms in the included studies ranged from 2 months to 20 years. The quality of expired antivenoms was evaluated in one study, and they met the standard quality tests. Five studies demonstrated that the expired antivenoms' immunological concentration and venom-binding activity were comparable to non-expired ones but could gradually deteriorate after expiration. Studies consistently exhibited that expired antivenoms, compared with non-expired antivenoms, were effective when stored in proper storage conditions. The safety profile of using expired antivenoms was reported in two included studies. However, it was inconclusive due to limited information.

Conclusion: Even though the quality and efficacy of expired antivenoms are comparable to non-expired antivenoms in preclinical studies, the information is limited in terms of real-world experiences of using expired antivenoms and their safety. Therefore, the use of expired antivenoms may be generally inconclusive due to scarce data. Further investigations may be needed to support the extension of antivenoms' expiration date according to their potential efficacy after expiration.

导言:抗蛇毒血清供应有限是治疗蛇咬伤的一个全球性挑战。在无法随时获得非过期抗蛇毒血清的紧急情况下,可以使用过期抗蛇毒血清来挽救生命,但过期抗蛇毒血清的质量、疗效和安全性可能会下降。因此,我们旨在系统地回顾和总结有关过期抗蛇毒血清中和功效的稀少临床前证据以及在人体中使用过期抗蛇毒血清的实际经验:我们在 PubMed、Scopus、Web of Science 和 Embase 中检索了 2023 年 3 月 1 日前发表的文章。其中包括展示评估过期抗蛇毒血清的临床前研究或描述使用过期抗蛇毒血清的实际经验的研究。结果:共纳入 15 项研究:结果:共纳入 15 项研究。结果:共纳入 15 项研究,其中 10 项为临床前研究,5 项为在人体中使用过期抗蛇毒血清的实际经验。纳入研究的抗蛇毒血清过期时间从 2 个月到 20 年不等。有一项研究对过期抗蛇毒血清的质量进行了评估,结果符合标准质量检测要求。五项研究表明,过期抗蛇毒血清的免疫浓度和毒液结合活性与未过期抗蛇毒血清相当,但过期后会逐渐变差。研究一致表明,与未过期的抗蛇毒血清相比,过期抗蛇毒血清在适当的储存条件下是有效的。有两项研究报告了使用过期抗蛇毒血清的安全性。结论:尽管过期抗蛇毒血清的质量和疗效都不尽如人意,但其安全性仍然值得关注:结论:尽管在临床前研究中,过期抗蛇毒血清的质量和疗效与非过期抗蛇毒血清相当,但在现实世界中使用过期抗蛇毒血清的经验及其安全性方面的信息却很有限。因此,由于数据稀少,过期抗蛇毒血清的使用总体上可能没有定论。可能需要进行进一步调查,以根据抗蛇毒血清过期后的潜在疗效来支持延长其有效期。
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引用次数: 0
Debate-Pro: manufacturers should assess the long-term stability of their antivenoms. Debate-Pro:制造商应评估其抗蛇毒血清的长期稳定性。
IF 2.7 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-08-21 DOI: 10.1136/emermed-2024-214173
Julien Potet
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引用次数: 0
Commentary: The RELIEF feasibility trial: topical lidocaine patches in older adults with rib fractures. RELIEF 可行性试验:肋骨骨折老年人的局部利多卡因贴片。
IF 2.7 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-08-21 DOI: 10.1136/emermed-2024-214244
Ceri Battle
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引用次数: 0
Debate-Con: Use of expired antivenoms: a flawed good idea. 辩-辩:使用过期抗蛇毒血清:一个有缺陷的好主意。
IF 2.7 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-08-21 DOI: 10.1136/emermed-2024-213923
Jean-Philippe François Chippaux
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引用次数: 0
Purulent lesion on a woman's hand. 一名妇女手部的化脓性病变。
IF 2.7 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-08-21 DOI: 10.1136/emermed-2024-213971
Rebecca Cavaliere, Claudio Dalla Vecchia, Carthage Carroll
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引用次数: 0
Qualitative study of new doctor induction and socialisation. 对新医生入职和社会化的定性研究。
IF 2.7 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-08-21 DOI: 10.1136/emermed-2022-212369
Keith Goodall, Adrian A Boyle, Rod MacKenzie

Aim: Junior doctors joining EDs are required to rapidly acquire new knowledge and skills, but there is little research describing how this process can be facilitated. We aimed to understand what would make ED formal induction and early socialisation more effective.

Methods: Qualitative study; informal interviews of junior doctors, consultants and nursing staff and direct observation of clinical interactions, induction and training in a single ED in an English Emergency Department between August and October 2019. We used constant comparison to identify and develop themes.

Findings: New junior doctors identified that early socialisation should facilitate patient safety and a safe learning space, with much of this process dependent on consultant interactions rather than formal induction. Clear themes around helpful and unhelpful consultant support and supervision were identified. Consultants who acknowledged their own fallibility and maintained approachability produced a safe learning environment, while consultants who lacked interest in their juniors, publicly humiliated them or disregarded the junior doctors' suggestions were seen as unhelpful and unconstructive.

Conclusion: Effective socialisation, consistent with previous literature, was identified as critical. Junior doctors see consultant behaviours and interactions as key to creating a safe learning space.

目的:加入急诊科的初级医生需要快速掌握新的知识和技能,但关于如何促进这一过程的研究却很少。我们旨在了解如何才能使急诊科的正式入职培训和早期社会化更加有效:定性研究;对初级医生、顾问和护理人员进行非正式访谈,并于 2018 年 8 月至 10 月间在英国一家急诊科对临床互动、入职和培训进行直接观察。我们采用不断比较的方法来确定和发展主题:新入职的初级医生认为,早期社会化应促进患者安全和安全的学习空间,这一过程在很大程度上取决于顾问的互动,而不是正式的入职培训。围绕有帮助和无帮助的顾问支持和督导确定了明确的主题。那些承认自己有缺陷并保持平易近人的顾问会创造一个安全的学习环境,而那些对下级医生缺乏兴趣、公开羞辱下级医生或无视下级医生建议的顾问则被认为是无益和无建设性的:与以往文献一致,有效的社会化被认为是至关重要的。初级医生认为顾问的行为和互动是创造安全学习空间的关键。
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引用次数: 0
Best Evidence Topic report: Is a CT head required for patients who present to the emergency department with a first seizure? 最佳证据专题报告:首次癫痫发作的急诊患者是否需要进行头部 CT 检查?
IF 4.6 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-08-21 DOI: 10.1136/emermed-2024-214189
Callum Williams, Gregory Yates

A short systematic review was undertaken to assess whether adult patients presenting to the ED with a first seizure require a CT head scan to rule out emergent intracranial pathology. MEDLINE, EMBASE, Cochrane and Google Scholar databases were searched. Seven relevant papers were identified. Study information, patient characteristics, key results and methodological weaknesses were tabulated. Our results indicate that adults presenting with a first seizure are a high-yield group for CT with a number needed to scan (NNS) between 10 and 19 for findings that would change management in ED, such as haemorrhage, infarction and tumours. We believe that this NNS is sufficiently low to justify the routine use of neuroimaging for these patients in emergency care.

我们进行了一项简短的系统性回顾,以评估因首次癫痫发作而到急诊室就诊的成人患者是否需要通过头部 CT 扫描来排除颅内病变的可能性。研究人员检索了 MEDLINE、EMBASE、Cochrane 和 Google Scholar 数据库。确定了七篇相关论文。研究信息、患者特征、主要结果和方法学缺陷均已列表。我们的研究结果表明,首次癫痫发作的成人是CT的高收益群体,其扫描所需次数(NNS)介于10至19次之间,扫描结果将改变急诊室的处理方式,如出血、梗塞和肿瘤。我们认为这个 NNS 值很低,足以证明在急诊护理中对这些患者常规使用神经成像是合理的。
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引用次数: 0
Tailored leadership training in emergency medicine: qualitative exploration of the impact of the EMLeaders programme on consultants and trainees in England. 急诊医学中量身定制的领导力培训:EMLeaders 计划对英格兰顾问和受训人员影响的定性探索。
IF 2.7 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-08-21 DOI: 10.1136/emermed-2023-213868
Rosie Kneafsey, Amanda Moore, Shea Palmer, Ala Szczepura, Gareth Hooper, Caroline Leech, Chris Turner, Aanika Khan, Bhupinder Pawar, Amanda Rodrigues Amorim Adegboye

Background: Emergency medicine (EM) consultants are expected to provide leadership to facilitate optimal clinical results, effective teamwork and learning. To foster leadership skills, the Emergency Medicine Leadership Programme (EMLeaders) was launched in 2018 by the Royal College of Emergency Medicine (RCEM), Health Education England and National Health Service England. A mixed-methods evaluation of EMLeaders was commissioned to assess the impact at the strategic, team and individual levels. This paper reports the qualitative evaluation component.

Methods: Qualitative data collected from 2021 to 2022 were drawn from an online survey of RCEM members in England, which included four open questions about leadership training. At the end of the survey, participants were asked to share contact details if willing to undertake an in-depth qualitative interview. Interviews explored perceptions of the programme and impact of curriculum design and delivery. Data were analysed thematically against the Kirkpatrick framework, providing in-depth understanding.

Results: There were 417 survey respondents, of whom 177 had participated in EMLeaders. Semistructured interviews were completed with 13 EM consultants, 13 trainees and 1 specialty and associate specialist doctor. EMLeaders was highly valued by EM consultants and trainees, particularly group interaction, expert facilitation and face-to-face practical scenario work. Consultant data yielded the themes: we believe in it; EM relevance is key; on a leadership journey; shaping better leaders; and a broken system. Challenges were identified in building engagement within a pressured workplace system and embedding workplace role modelling. Trainees identified behavioural shift in themselves following the programme but wanted more face-to-face discussions with senior colleagues. Key trainee themes included value in being together, storytelling in leadership, headspace for the leadership lens and survival in a state of collapse.

Conclusion: The development of leadership skills in EM is considered important. The EMLeaders programme can support leadership learning but further embedding is needed.

背景:急诊医学(EM)顾问应发挥领导作用,以促进最佳临床效果、有效的团队合作和学习。为培养领导技能,英国皇家急诊医学院(RCEM)、英格兰卫生教育署(Health Education England)和英格兰国民健康服务局(National Health Service England)于 2018 年推出了急诊医学领导力计划(EMLeaders)。为评估 EMLeaders 在战略、团队和个人层面的影响,委托开展了一项混合方法评估。本文报告了定性评估部分:从 2021 年到 2022 年收集的定性数据来自英格兰 RCEM 成员的在线调查,其中包括四个有关领导力培训的开放性问题。调查结束时,参与者被要求提供联系方式,如果愿意进行深入的定性访谈的话。访谈内容包括对课程的看法以及课程设计和实施的影响。根据柯克帕特里克框架对数据进行了专题分析,以提供深入的理解:共有 417 名调查对象,其中 177 人参加过 EMLeaders。对 13 名急诊科顾问、13 名受训人员和 1 名专科医生和副专科医生进行了结构化访谈。EMLeaders受到了急诊科顾问和学员的高度评价,尤其是小组互动、专家指导和面对面的实际情景模拟。顾问数据产生了以下主题:我们相信它;电磁相关性是关键;领导力之旅;塑造更好的领导者;以及破碎的系统。在压力重重的工作场所系统中建立参与感和树立工作场所榜样方面存在挑战。受训人员发现自己在课程结束后的行为发生了转变,但希望与资深同事进行更多面对面的讨论。受训人员的关键主题包括:在一起的价值、在领导力中讲故事、领导力视角的思考空间以及在崩溃状态下的生存:结论:在急诊科发展领导技能被认为是非常重要的。EMLeaders计划可以支持领导力学习,但还需要进一步的嵌入。
{"title":"Tailored leadership training in emergency medicine: qualitative exploration of the impact of the EMLeaders programme on consultants and trainees in England.","authors":"Rosie Kneafsey, Amanda Moore, Shea Palmer, Ala Szczepura, Gareth Hooper, Caroline Leech, Chris Turner, Aanika Khan, Bhupinder Pawar, Amanda Rodrigues Amorim Adegboye","doi":"10.1136/emermed-2023-213868","DOIUrl":"10.1136/emermed-2023-213868","url":null,"abstract":"<p><strong>Background: </strong>Emergency medicine (EM) consultants are expected to provide leadership to facilitate optimal clinical results, effective teamwork and learning. To foster leadership skills, the Emergency Medicine Leadership Programme (EMLeaders) was launched in 2018 by the Royal College of Emergency Medicine (RCEM), Health Education England and National Health Service England. A mixed-methods evaluation of EMLeaders was commissioned to assess the impact at the strategic, team and individual levels. This paper reports the qualitative evaluation component.</p><p><strong>Methods: </strong>Qualitative data collected from 2021 to 2022 were drawn from an online survey of RCEM members in England, which included four open questions about leadership training. At the end of the survey, participants were asked to share contact details if willing to undertake an in-depth qualitative interview. Interviews explored perceptions of the programme and impact of curriculum design and delivery. Data were analysed thematically against the Kirkpatrick framework, providing in-depth understanding.</p><p><strong>Results: </strong>There were 417 survey respondents, of whom 177 had participated in EMLeaders. Semistructured interviews were completed with 13 EM consultants, 13 trainees and 1 specialty and associate specialist doctor. EMLeaders was highly valued by EM consultants and trainees, particularly group interaction, expert facilitation and face-to-face practical scenario work. Consultant data yielded the themes: we believe in it; EM relevance is key; on a leadership journey; shaping better leaders; and a broken system. Challenges were identified in building engagement within a pressured workplace system and embedding workplace role modelling. Trainees identified behavioural shift in themselves following the programme but wanted more face-to-face discussions with senior colleagues. Key trainee themes included value in being together, storytelling in leadership, headspace for the leadership lens and survival in a state of collapse.</p><p><strong>Conclusion: </strong>The development of leadership skills in EM is considered important. The EMLeaders programme can support leadership learning but further embedding is needed.</p>","PeriodicalId":11532,"journal":{"name":"Emergency Medicine Journal","volume":" ","pages":"543-550"},"PeriodicalIF":2.7,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11347192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Frailty is associated with 30-day mortality: a multicentre study of Swedish emergency departments. 虚弱与 30 天死亡率相关:瑞典急诊科多中心研究。
IF 2.7 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-08-21 DOI: 10.1136/emermed-2023-213444
Samia Munir Ehrlington, Erika Hörlin, Rani Toll John, Jens Wretborn, Daniel Wilhelms

Background: Older patients living with frailty have an increased risk for adverse events. The Clinical Frailty Scale (CFS) is a 9-point frailty assessment instrument that has shown promise to identify frail emergency department (ED) patients at increased risk of adverse outcomes. The aim of this study was to investigate the association between CFS scores and 30-day mortality in an ED setting when assessments are made by regular ED staff.

Method: This was a prospective multicentre observational study carried out between May and November 2021 at three EDs in Sweden, where frailty via CFS is routinely assessed by ED staff. All patients ≥65 years of age were eligible for inclusion. Mortality at 7, 30 and 90 days, admission rate, ED and hospital length of stay (LOS) were compared between patients living with frailty (CFS≥5) and robust patients. Logistic regression was used to adjust for confounders.

Results: A total of 1840 ED visits of patients aged ≥65 years with CFS assessments done during the study period were analysed, of which 606 (32.9%) were patients living with frailty. Mortality after the index visit was higher in patients living with frailty at 7 days (2.6% vs 0.2%), 30 days (7.9% vs 0.9%) and 90 days (15.5% vs 2.4%). Adjusted ORs for mortality for those with frailty compared with more robust patients were 9.9 (95% CI 2.1 to 46.5) for 7-day, 6.0 (95% CI 3.0 to 12.2) for 30-day and 5.7 (95% CI 3.6 to 9.1) 90-day mortality. Patients living with frailty had higher admission rates, 58% versus 36%, a difference of 22% (95% CI 17% to 26%), longer ED LOS, 5 hours:08 min versus 4 hours:36 min, a difference of 31 min (95% CI 14 to 50), and longer in-hospital LOS, 4.8 days versus 2.7 days, a difference of 2.2 days (95% CI 1.2 to 3.0).

Conclusion: Patients living with frailty, had significantly higher mortality and admission rates as well as longer ED and in-hospital LOS compared with robust patients. The results confirm the capability of the CFS to risk stratify short-term mortality in older ED patients.

Trial registration number: NCT04877028.

背景年老体弱的患者发生不良事件的风险更高。临床虚弱程度量表(CFS)是一种 9 分虚弱程度评估工具,已被证明可用于识别不良后果风险增加的急诊科(ED)虚弱患者。本研究的目的是调查在急诊室环境中,由急诊室正式员工进行评估时,CFS评分与30天死亡率之间的关系:这是一项前瞻性多中心观察研究,于 2021 年 5 月至 11 月期间在瑞典的三家急诊室进行,急诊室工作人员通过 CFS 对虚弱程度进行常规评估。所有年龄≥65 岁的患者均符合纳入条件。比较了体弱患者(CFS≥5)和健康患者的 7 天、30 天和 90 天死亡率、入院率、急诊室和住院时间(LOS)。采用逻辑回归调整混杂因素:研究分析了在研究期间接受 CFS 评估的 1840 名年龄≥65 岁的急诊患者,其中 606 人(32.9%)为体弱患者。体弱患者在就诊 7 天(2.6% 对 0.2%)、30 天(7.9% 对 0.9%)和 90 天(15.5% 对 2.4%)后的死亡率较高。与体质较好的患者相比,体弱患者7天、30天和90天的死亡率调整后OR分别为9.9(95% CI 2.1-46.5)、6.0(95% CI 3.0-12.2)和5.7(95% CI 3.6-9.1)。体弱患者的入院率较高,为58%对36%,相差22%(95% CI为17%至26%);急诊室LOS较长,为5小时08分钟对4小时36分钟,相差31分钟(95% CI为14至50);院内LOS较长,为4.8天对2.7天,相差2.2天(95% CI为1.2至3.0):与体格健壮的患者相比,体弱患者的死亡率和入院率明显更高,急诊室和住院时间也更长。研究结果证实了CFS对老年急诊患者短期死亡率进行风险分层的能力:试验注册号:NCT04877028。
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引用次数: 0
Reduced noise in the emergency department: the impact on staff well-being and room acoustics. 降低急诊室的噪音:对工作人员健康和室内声学的影响。
IF 2.7 3区 医学 Q1 EMERGENCY MEDICINE Pub Date : 2024-08-21 DOI: 10.1136/emermed-2023-213471
Sofie Hendriks, Claudia M Vernooij, Rory D O'Connor, Kim E Jie

Background and introduction: The ED is often perceived as noisy. Excessive noise has deleterious effects on health and productivity. This study evaluated if a package of noise-reducing interventions altered workload, physical complaints, productivity and room acoustics.

Methods: This was an observational pre-post implementation study. It was performed in our non-academic ED in the Netherlands from July 2021 to April 2022. Our primary objective was to determine if a combination of technical, acoustical and behavioural interventions was associated with improved staff well-being, and the secondary objective was to evaluate if these interventions resulted in better room acoustics. Moreover, the correlation of noise sensitivity with staff well-being and its effect on interventions were evaluated. All ED staff that were sufficiently exposed to the interventions received questionnaires to assess their well-being before and after the interventions. Room acoustics before and after interventions were expressed in reverberation time (seconds) and participant ratings are reflected as the mean of the sum of their Likert scale ratings.

Results: 43 participants were included. At baseline, individual noise sensitivity was significantly correlated with physical complaints (r=0.409, p=0.006) and productivity (r=0.399, p=0.008). After the interventions, a reduction in reverberation time was reached in the central ED area (0.49 s, SD 0.06 s vs 0.39 s, SD 0.05; p<0.001). Participants experienced significantly less noise disturbance during work (sum score 7.28 vs 3.19; p<0.001). Productivity and physical complaints improved significantly (sum score 4.81 vs 2.70; p<0.001 and sum score -3.74 vs -8.14; p<0.001, respectively). Participants also showed a perceived change in behaviour (sum score -2.00 vs -4.70; p<0.001). There was no confounding by noise sensitivity nor age.

Conclusion: The package of behavioural, acoustical and technical interventions was associated with increased staff well-being, reflected by decreased perception of noise, increased productivity, decreased physical complaints and observable changes in behaviour. Furthermore, the interventions positively influenced the room acoustics.

背景和引言:人们通常认为急诊室噪音很大。过度的噪音会对健康和工作效率产生有害影响。本研究评估了一揽子降噪干预措施是否会改变工作量、身体不适、工作效率和室内声学效果:这是一项实施前-实施后的观察性研究。研究于 2021 年 7 月至 2022 年 4 月在荷兰的非学术性急诊室进行。我们的首要目标是确定技术、声学和行为干预措施的结合是否与员工健康状况的改善有关,次要目标是评估这些干预措施是否能改善室内声学效果。此外,还评估了噪音敏感度与员工健康的相关性及其对干预措施的影响。所有充分接触到干预措施的急诊室工作人员都接受了问卷调查,以评估他们在干预措施前后的健康状况。干预前后的室内声学以混响时间(秒)表示,参与者的评分以其李克特量表评分总和的平均值表示:共纳入 43 名参与者。基线时,个人噪音敏感度与身体不适(r=0.409,p=0.006)和工作效率(r=0.399,p=0.008)显著相关。采取干预措施后,ED 中心区域的混响时间有所缩短(0.49 秒,SD 0.06 秒 vs 0.39 秒,SD 0.05;p 结论:行为、声学和技术方面的一揽子干预措施提高了工作人员的幸福感,这体现在对噪音的感知降低、工作效率提高、身体不适减少以及行为上的明显变化。此外,干预措施还对室内声学效果产生了积极影响。
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引用次数: 0
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