Australasian Emergency Care最新文献_第10页

Shaping the future design of paramedicine: A knowledge to action framework to support paramedic system modernization 塑造护理人员的未来设计：支持护理人员系统现代化的知识到行动框架。

IF 1.8 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2023-03-15 DOI: 10.1016/j.auec.2023.03.002

Timothy Makrides , Madelyn P. Law , Linda Ross , Cameron Gosling , Joseph Acker , Peter O’Meara

Background

Over the past two decades, the demands placed on modern paramedic systems has changed. Paramedic services can no longer continue to operate on a traditional response model where more ambulances are deployed to meet the rising demand of patients calling for their health needs. Recent research has explored system design in paramedicine and its relationship with organizational performance. Two subsequent paramedic systems have been identified with one, the Professionally Autonomous paramedic system, being linked to higher performance. Yet, how to operationalize this model for system modernization continues to be a gap in practice.

Objective

To provide health leaders and policy makers with a framework from which to drive paramedic system modernization.

Methods

This study uses the Knowledge to Action framework to develop an implementation plan for systems that seek to modernize their service delivery model toward that of a Professionally Autonomous paramedic system.

Results

A detailed plan of the steps required to undertake system transformation are outlined. Whilst this framework outlines the components required for system modernization, it does not propose an in-depth outline of each of the steps required to achieve each component. Rather, end users are encouraged to develop individual implementation plans tailored to the local context using the comprehensive tools outlined within.

Conclusion

This knowledge to action framework provides health leaders and policy makers with a uniform roadmap for paramedic system modernization intended to improve health (clinical) outcomes as well as health system outcomes through the Professional Autonomous paramedicine model.

背景：在过去的二十年里，对现代护理系统的要求发生了变化。护理服务不能再继续以传统的响应模式运作，即部署更多的救护车来满足不断增长的患者需求。最近的研究探讨了辅助医疗系统的系统设计及其与组织绩效的关系。随后确定了两个护理系统，其中一个是专业自主护理系统，与更高的性能有关。然而，如何将这一模式用于系统现代化仍然是一个实践空白。目的：为卫生领导人和政策制定者提供一个推动护理系统现代化的框架。方法：本研究使用“知识到行动”框架为寻求将其服务提供模式现代化为专业自主护理系统的系统制定实施计划。结果：概述了进行系统转换所需步骤的详细计划。虽然本框架概述了系统现代化所需的组成部分，但并未对实现每个组成部分所需的每个步骤提出深入的概述。相反，鼓励最终用户使用其中概述的综合工具，根据当地情况制定单独的实施计划。结论：该知识到行动框架为卫生领导人和政策制定者提供了一个统一的护理系统现代化路线图，旨在通过专业自主护理人员模型改善卫生（临床）结果以及卫生系统结果。

{"title":"Shaping the future design of paramedicine: A knowledge to action framework to support paramedic system modernization","authors":"Timothy Makrides , Madelyn P. Law , Linda Ross , Cameron Gosling , Joseph Acker , Peter O’Meara","doi":"10.1016/j.auec.2023.03.002","DOIUrl":"10.1016/j.auec.2023.03.002","url":null,"abstract":"<div><h3>Background</h3><p>Over the past two decades, the demands placed on modern paramedic systems has changed. Paramedic services can no longer continue to operate on a traditional response model where more ambulances are deployed to meet the rising demand of patients calling for their health needs. Recent research has explored system design in paramedicine and its relationship with organizational performance. Two subsequent paramedic systems have been identified with one, the Professionally Autonomous paramedic system, being linked to higher performance. Yet, how to operationalize this model for system modernization continues to be a gap in practice.</p></div><div><h3>Objective</h3><p>To provide health leaders and policy makers with a framework from which to drive paramedic system modernization.</p></div><div><h3>Methods</h3><p>This study uses the Knowledge to Action framework to develop an implementation plan for systems that seek to modernize their service delivery model toward that of a Professionally Autonomous paramedic system.</p></div><div><h3>Results</h3><p>A detailed plan of the steps required to undertake system transformation are outlined. Whilst this framework outlines the components required for system modernization, it does not propose an in-depth outline of each of the steps required to achieve each component. Rather, end users are encouraged to develop individual implementation plans tailored to the local context using the comprehensive tools outlined within.</p></div><div><h3>Conclusion</h3><p>This knowledge to action framework provides health leaders and policy makers with a uniform roadmap for paramedic system modernization intended to improve health (clinical) outcomes as well as health system outcomes through the Professional Autonomous paramedicine model.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 4","pages":"Pages 296-302"},"PeriodicalIF":1.8,"publicationDate":"2023-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9188439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Gender-based differences in assessment and management of acute abdominal pain in the emergency department: A retrospective audit 急诊科急性腹痛评估和治疗中基于性别的差异：一项回顾性审计。

IF 1.8 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2023-03-11 DOI: 10.1016/j.auec.2023.03.001

Megan Hayes , Ana Hutchinson , Debra Kerr

Background

Previous research has identified gender-based differences in acute pain management in the emergency department [ED]. The aim of this study was to compare pharmacological management of acute abdominal pain in the ED by gender.

Methods

A retrospective chart audit was conducted at one private metropolitan ED including adult patients (18–80 years) who presented with acute abdominal pain in 2019. Exclusion criteria included: pregnancy, repeat presentation within the study period, pain-free at initial medical review or documented refusal of analgesia, and oligo-analgesia. Comparisons by gender included: (1) analgesia type and (2) time to analgesia. Bivariate analysis was undertaken using SPSS.

Results

There were 192 participants: 61 (31.6 %) men and 131 (67.9 %) women. Men were more likely to get combined opioid and non-opioid medication as first line analgesia (men: 26.2 % n = 16; women: 14.5 % n = 19, p = .049). Median time from ED presentation to analgesia was 80 min for men (IQR: 60) versus 94 min for women (IQR: 58), (p = .119). Women (25.2 % n = 33) were more likely to receive their first analgesic after 90 min from ED presentation compared to men versus men (11.5 %, n = 7 p = .029). In addition, women waited longer before receiving second analgesia (women: 94, men: 30 min, p = .032).

Conclusion

Findings confirm there are differences in pharmacological management of acute abdominal pain in the ED. Larger studies are required to further explore differences observed in this study.

背景：先前的研究已经确定了急诊科急性疼痛管理中基于性别的差异[ED]。本研究的目的是按性别比较ED急性腹痛的药物治疗。方法：在一家私立大都市急诊室进行回顾性图表审计，包括2019年出现急性腹痛的成年患者（18-80岁）。排除标准包括：妊娠、研究期内重复出现、初次医学检查时无疼痛或有记录的拒绝镇痛和寡镇痛。性别比较包括：（1）镇痛类型和（2）镇痛时间。结果：共有192名参与者：男性61名（31.6%），女性131名（67.9%）。男性更有可能接受阿片类和非阿片类药物联合用药作为一线镇痛（男性：26.2%n=16；女性：14.5%n=19，p=0.049）。从ED出现到镇痛的中位时间男性为80分钟（IQR:60），女性为94分钟（IQR:58），（p=.119）。与男性相比，女性（25.2%n=33）更有可能在ED出现90分钟后接受第一次镇痛（11.5%，n=7 p=.029）。此外，女性在接受第二次镇痛前等待的时间更长（女性：94，男性：30分钟，p=0.032）。结论：研究结果证实ED中急性腹痛的药物治疗存在差异。需要进行更大规模的研究来进一步探索本研究中观察到的差异。

{"title":"Gender-based differences in assessment and management of acute abdominal pain in the emergency department: A retrospective audit","authors":"Megan Hayes , Ana Hutchinson , Debra Kerr","doi":"10.1016/j.auec.2023.03.001","DOIUrl":"10.1016/j.auec.2023.03.001","url":null,"abstract":"<div><h3>Background</h3><p><span>Previous research has identified gender-based differences in acute pain management in the </span>emergency department<span> [ED]. The aim of this study was to compare pharmacological management of acute abdominal pain in the ED by gender.</span></p></div><div><h3>Methods</h3><p>A retrospective chart audit<span> was conducted at one private metropolitan ED including adult patients (18–80 years) who presented with acute abdominal pain in 2019. Exclusion criteria included: pregnancy, repeat presentation within the study period, pain-free at initial medical review or documented refusal of analgesia, and oligo-analgesia. Comparisons by gender included: (1) analgesia type and (2) time to analgesia. Bivariate analysis was undertaken using SPSS.</span></p></div><div><h3>Results</h3><p>There were 192 participants: 61 (31.6 %) men and 131 (67.9 %) women. Men were more likely to get combined opioid and non-opioid medication as first line analgesia (men: 26.2 % n = 16; women: 14.5 % n = 19, <em>p</em> = .049). Median time from ED presentation to analgesia was 80 min for men (IQR: 60) versus 94 min for women (IQR: 58), (<em>p</em><span> = .119). Women (25.2 % n = 33) were more likely to receive their first analgesic after 90 min from ED presentation compared to men versus men (11.5 %, n = 7 </span><em>p</em> = .029). In addition, women waited longer before receiving second analgesia (women: 94, men: 30 min, <em>p</em> = .032).</p></div><div><h3>Conclusion</h3><p>Findings confirm there are differences in pharmacological management of acute abdominal pain in the ED. Larger studies are required to further explore differences observed in this study.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 4","pages":"Pages 290-295"},"PeriodicalIF":1.8,"publicationDate":"2023-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9104746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Public health messaging during disasters: A qualitative study of emergency department key informants 灾难期间的公共卫生信息：对急诊部门关键信息提供者的定性研究。

IF 1.8 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2023-03-03 DOI: 10.1016/j.auec.2023.02.005

Nicole M. Coombs, Joanne E. Porter, Michael Barbagallo

Background

Patient education is a professional obligation for all nurses. Public health messaging in emergency departments during disasters can help prevent further risk or illness for affected communities. In this study, Australian emergency nurse Key Informants share their perceptions and experiences of preventative messaging provided in their departments during disasters and the governance and processes in place to support this practice.

Methods

The qualitative phase of a mixed methods study, where semi structured interviews were utilised, and data analysed using a six step Thematic analysis.

Results

Three themes were identified: (1) Part of the Job; (2) It’s all in the delivery; and (3) Preparation is the key. These themes include concepts involving the confidence and competence of nurses providing messages, what, when and how messages are being given and how prepared both the department and staff are regarding patient education during disaster events.

Conclusions

Nurse confidence is a key factor in the delivery of preventative messages during disasters, potentially resulting from a lack of exposure, a junior workforce and minimal training. Leaders agree that departments are not preparing or supporting messaging practice, with an absence of specific training, formal guidelines, and patient education resources; and that improvement is needed.

背景：病人教育是所有护士的职业义务。灾害期间，应急部门的公共卫生信息有助于防止受影响社区面临进一步的风险或疾病。在这项研究中，澳大利亚急诊护士主要信息员分享了他们对灾难期间在其部门提供的预防性信息的看法和经验，以及支持这一做法的治理和流程。方法：混合方法研究的定性阶段，使用半结构化访谈，并使用六步主题分析对数据进行分析。结果：确定了三个主题：（1）工作的一部分；（2）一切都在交付中；（3）准备是关键。这些主题包括提供信息的护士的信心和能力，提供信息的内容、时间和方式，以及部门和工作人员在灾难事件期间对患者教育的准备情况。结论：护士的信心是在灾难期间传递预防信息的关键因素，这可能是由于缺乏接触、初级劳动力和最低限度的培训造成的。领导们一致认为，各部门没有准备或支持信息传递实践，缺乏具体的培训、正式的指导方针和患者教育资源；并且这种改进是需要的。

{"title":"Public health messaging during disasters: A qualitative study of emergency department key informants","authors":"Nicole M. Coombs, Joanne E. Porter, Michael Barbagallo","doi":"10.1016/j.auec.2023.02.005","DOIUrl":"10.1016/j.auec.2023.02.005","url":null,"abstract":"<div><h3>Background</h3><p>Patient education is a professional obligation for all nurses. Public health messaging in emergency departments during disasters can help prevent further risk or illness for affected communities. In this study, Australian emergency nurse Key Informants share their perceptions and experiences of preventative messaging provided in their departments during disasters and the governance and processes in place to support this practice.</p></div><div><h3>Methods</h3><p>The qualitative phase of a mixed methods study, where semi structured interviews were utilised, and data analysed using a six step Thematic analysis.</p></div><div><h3>Results</h3><p>Three themes were identified: (1) Part of the Job; (2) It’s all in the delivery; and (3) Preparation is the key. These themes include concepts involving the confidence and competence of nurses providing messages, what, when and how messages are being given and how prepared both the department and staff are regarding patient education during disaster events.</p></div><div><h3>Conclusions</h3><p>Nurse confidence is a key factor in the delivery of preventative messages during disasters, potentially resulting from a lack of exposure, a junior workforce and minimal training. Leaders agree that departments are not preparing or supporting messaging practice, with an absence of specific training, formal guidelines, and patient education resources; and that improvement is needed.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 4","pages":"Pages 284-289"},"PeriodicalIF":1.8,"publicationDate":"2023-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10837822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Improving care for older patients visiting emergency departments. Are they receiving falls prevention guideline care? 改善对急诊科老年病人的护理。他们是否接受预防跌倒指南护理?

IF 1.8 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2023-03-01 DOI: 10.1016/j.auec.2022.08.003

Melinda Williamson , Annette Barton , Deborah Edwards , Claire Morrisby , Angela Jacques , Kristie J. Harper

Background

The primary objective was to examine whether the Emergency Department (ED) treatment of older adults who fall in Australia is concordant with falls prevention and management clinical guideline care recommendations.

Methods

A retrospective medical records audit was completed for patients 65years and older, who attended the ED with a fall and were discharged home. An audit tool was developed from local, national, and international falls clinical guidelines.

Results

One thousand and twenty-seven patients presented following a fall throughout 2020. One hundred and seven patient medical records were audited. Assessment of cognition (94%), medication review (76%) and use of a falls risk screen (76%) were commonly completed. Under half of the patients had a documented gait evaluation (40%) and review of vision (18%). Concordance with guideline care was more likely for older patients (p = 0.042), with higher levels of comorbidity (p = 0.013), who required care assistance (p = 0.008) and received treatment from a multidisciplinary team (p < 0.001) in an observation ward (p < 0.001).

Conclusions

Older patients with increased comorbidities and higher care needs had more falls guideline care recommendations documented. This was likely to occur when patients were moved to the observation ward where more comprehensive care by a multidisciplinary team could occur.

背景主要目的是检查急诊科（ED）对澳大利亚老年人跌倒的治疗是否符合跌倒预防和管理临床指南护理建议。方法对65岁及以上的患者进行回顾性医疗记录审计，这些患者因跌倒到急诊室就诊并出院回家。审计工具是根据当地、国家和国际跌倒临床指南开发的。结果127名患者在2020年秋季就诊。对107份患者病历进行了审计。认知评估（94%）、药物审查（76%）和跌倒风险筛查（76%）的使用通常完成。不到一半的患者进行了步态评估（40%）和视力检查（18%）。老年患者更有可能与指南护理相一致（p=0.042），合并症水平较高（p=0.013），需要护理协助（p=0.008），并在观察病房接受多学科团队的治疗（p<；0.001）。结论合并症增加和护理需求增加的老年患者有更多跌倒指南护理建议。当患者被转移到观察病房时，可能会发生这种情况，在那里可以由多学科团队进行更全面的护理。

{"title":"Improving care for older patients visiting emergency departments. Are they receiving falls prevention guideline care?","authors":"Melinda Williamson , Annette Barton , Deborah Edwards , Claire Morrisby , Angela Jacques , Kristie J. Harper","doi":"10.1016/j.auec.2022.08.003","DOIUrl":"10.1016/j.auec.2022.08.003","url":null,"abstract":"<div><h3>Background</h3><p>The primary objective was to examine whether the Emergency Department<span><span> (ED) treatment of older adults who fall in Australia is concordant with </span>falls prevention and management clinical guideline care recommendations.</span></p></div><div><h3>Methods</h3><p><span>A retrospective medical records </span>audit was completed for patients 65years and older, who attended the ED with a fall and were discharged home. An audit tool was developed from local, national, and international falls clinical guidelines.</p></div><div><h3>Results</h3><p>One thousand and twenty-seven patients presented following a fall throughout 2020. One hundred and seven patient medical records were audited. Assessment of cognition (94%), medication review (76%) and use of a falls risk screen (76%) were commonly completed. Under half of the patients had a documented gait evaluation (40%) and review of vision (18%). Concordance with guideline care was more likely for older patients (p = 0.042), with higher levels of comorbidity (p = 0.013), who required care assistance (p = 0.008) and received treatment from a multidisciplinary team (p < 0.001) in an observation ward (p < 0.001).</p></div><div><h3>Conclusions</h3><p>Older patients with increased comorbidities and higher care needs had more falls guideline care recommendations documented. This was likely to occur when patients were moved to the observation ward where more comprehensive care by a multidisciplinary team could occur.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 1","pages":"Pages 84-89"},"PeriodicalIF":1.8,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9344396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

The prehospital management of ambulance-attended adults who fell: A scoping review 在救护车救护下跌倒的成年人的院前管理:一项范围审查

IF 1.8 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2023-03-01 DOI: 10.1016/j.auec.2022.07.006

Paige Marie Watkins , Stacey Masters , Anne-Marie Hill , Hideo Tohira , Deon Brink , Judith Finn , Peter Buzzacott

Background

The ageing population is requiring more ambulance attendances for falls. This scoping review aimed to map and synthesise the evidence for the prehospital management of Emergency Medical Services (EMS) attended adult patients who fall.

Methods

The Joanna Briggs Institute methods for scoping reviews were used. Six databases were searched (Medline, Scopus, CINAHL, Cochrane, EMBASE, ProQuest), 1st August 2021. Included sources reported: ambulance attended (context), adults who fell (population), injuries, interventions or disposition data (concept). Data were narratively synthesised.

Results

One-hundred and fifteen research sources met the inclusion criteria. Detailed information describing prehospital delivered EMS interventions, transport decisions and alternative care pathways was limited. Overall, adults< 65 years were less likely than older adults to be attended repeatedly and/or not transported. Being male, falling from height and sustaining severe injuries were associated with transport to major trauma centres. Older females, falling from standing/low height with minor injuries were less likely to be transported to major trauma centres.

Conclusion

The relationship between patient characteristics, falls and resulting injuries were well described in the literature. Other evidence about EMS management in prehospital settings was limited. Further research regarding prehospital interventions, transport decisions and alternative care pathways in the prehospital setting is recommended.

背景老龄化的人口需要更多的救护车来照顾跌倒的人。这项范围界定审查旨在绘制和综合急诊医疗服务（EMS）护理的成年跌倒患者院前管理的证据。方法采用乔安娜·布里格斯研究所的范围界定审查方法。2021年8月1日，检索了六个数据库（Medline、Scopus、CINAHL、Cochrane、EMBASE、ProQuest）。报告的来源包括：救护车（背景）、跌倒的成年人（人群）、受伤、干预措施或处置数据（概念）。数据是叙述性合成的。结果115个研究来源符合入选标准。描述院前EMS干预、运输决策和替代护理途径的详细信息有限。总体而言，成年人<；与老年人相比，65岁的人不太可能被反复护理和/或不被运送。作为男性，从高处坠落和严重受伤与被送往主要创伤中心有关。年龄较大的女性从站立/低位坠落，受轻伤，被送往主要创伤中心的可能性较小。结论文献中充分描述了患者特征、跌倒和由此造成的损伤之间的关系。关于院前环境中EMS管理的其他证据有限。建议对院前干预、交通决策和院前环境中的替代护理途径进行进一步研究。

{"title":"The prehospital management of ambulance-attended adults who fell: A scoping review","authors":"Paige Marie Watkins , Stacey Masters , Anne-Marie Hill , Hideo Tohira , Deon Brink , Judith Finn , Peter Buzzacott","doi":"10.1016/j.auec.2022.07.006","DOIUrl":"10.1016/j.auec.2022.07.006","url":null,"abstract":"<div><h3>Background</h3><p>The ageing population is requiring more ambulance attendances for falls. This scoping review aimed to map and synthesise the evidence for the prehospital management of Emergency Medical Services (EMS) attended adult patients who fall.</p></div><div><h3>Methods</h3><p><span><span>The Joanna Briggs Institute methods for scoping reviews were used. Six databases were searched (Medline, Scopus, </span>CINAHL, Cochrane, EMBASE, ProQuest), 1st August 2021. Included sources reported: ambulance attended (</span><em>context</em>), adults who fell (<em>population</em>), injuries, interventions or disposition data (<em>concept</em>). Data were narratively synthesised.</p></div><div><h3>Results</h3><p>One-hundred and fifteen research sources met the inclusion criteria. Detailed information describing prehospital delivered EMS interventions, transport decisions and alternative care pathways was limited. Overall, adults< 65 years were less likely than older adults to be attended repeatedly and/or not transported. Being male, falling from height and sustaining severe injuries were associated with transport to major trauma centres. Older females, falling from standing/low height with minor injuries were less likely to be transported to major trauma centres.</p></div><div><h3>Conclusion</h3><p>The relationship between patient characteristics, falls and resulting injuries were well described in the literature. Other evidence about EMS management in prehospital settings was limited. Further research regarding prehospital interventions, transport decisions and alternative care pathways in the prehospital setting is recommended.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 1","pages":"Pages 45-53"},"PeriodicalIF":1.8,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10792799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3

Hospital presentations with diabetic ketoacidosis: A retrospective review 糖尿病酮症酸中毒的医院表现:回顾性回顾

IF 1.8 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2023-03-01 DOI: 10.1016/j.auec.2022.06.001

Steven James , Kylie Annetts , Thuy Frakking , Marc Broadbent , John Waugh , Lin Perry , Julia Lowe , Sean Clark

Background

Diabetic ketoacidosis (DKA) is a significant source of preventable episodes of care and cost. This study aimed to describe the demographic and clinical characteristics of people with type 1 diabetes (T1D) presenting to the Emergency Department (ED) with DKA in an area of socio-economic deprivation in metropolitan Queensland, Australia, and to describe factors associated with hospital admission and re-presentation in this population.

Methods

This was a retrospective descriptive analysis of routine healthcare record data for January 2015-December 2019. People with T1D were identified through hospital discharge codes.

Results

More than half (n = 165) the estimated local T1D population (n = 317) experienced an index ED presentation for DKA; mean±SD age at ED presentation was 31.1 + /− 19.3 years, 126 (76.4%) were aged ≥ 16 years and 20 (12.1%) were newly diagnosed. Index DKA presentation was significantly associated with female sex (p = 0.04) but no other demographic or geographic variables. More than half the presentations (n = 92, 55.8%) occurred outside regular business hours. Twenty-three representations occurred within 90 days, associated with older age (p = 0.045) and lower residential socio-economic score (p = 0.02).

Conclusion

Findings highlight the frequent problem of DKA and the importance of socio-economic influences. This flags the need and opportunity to improve support to people with T1D to promote diabetes self-care.

背景糖尿病酮症酸中毒（DKA）是可预防的护理和费用的重要来源。本研究旨在描述澳大利亚昆士兰大都市社会经济贫困地区急诊科就诊的1型糖尿病（T1D）患者的人口统计学和临床特征，并描述该人群中与入院和再次就诊相关的因素。方法对2015年1月至2019年12月的常规医疗记录数据进行回顾性描述性分析。T1D患者通过出院代码进行识别。结果超过一半（n=165）的估计本地T1D人群（n=317）经历了DKA的指数ED表现；ED出现时的平均±SD年龄为31.1+/-19.3岁，126人（76.4%）年龄≥16岁，20人（12.1%）为新诊断。DKA指数表现与女性显著相关（p=0.04），但没有其他人口统计学或地理变量。超过一半的演示（n=92，55.8%）发生在正常工作时间之外。23个表征发生在90天内，与年龄较大（p=0.045）和居住社会经济得分较低（p=0.02）有关。结论研究结果突出了DKA的常见问题和社会经济影响的重要性。这标志着需要和机会改善对T1D患者的支持，以促进糖尿病自我护理。

{"title":"Hospital presentations with diabetic ketoacidosis: A retrospective review","authors":"Steven James , Kylie Annetts , Thuy Frakking , Marc Broadbent , John Waugh , Lin Perry , Julia Lowe , Sean Clark","doi":"10.1016/j.auec.2022.06.001","DOIUrl":"10.1016/j.auec.2022.06.001","url":null,"abstract":"<div><h3>Background</h3><p><span>Diabetic ketoacidosis (DKA) is a significant source of preventable episodes of care and cost. This study aimed to describe the demographic and clinical characteristics of people with </span>type 1 diabetes<span> (T1D) presenting to the Emergency Department (ED) with DKA in an area of socio-economic deprivation in metropolitan Queensland, Australia, and to describe factors associated with hospital admission and re-presentation in this population.</span></p></div><div><h3>Methods</h3><p>This was a retrospective descriptive analysis of routine healthcare record data for January 2015-December 2019. People with T1D were identified through hospital discharge codes.</p></div><div><h3>Results</h3><p>More than half (n = 165) the estimated local T1D population (n = 317) experienced an index ED presentation for DKA; mean±SD age at ED presentation was 31.1 + /− 19.3 years, 126 (76.4%) were aged ≥ 16 years and 20 (12.1%) were newly diagnosed. Index DKA presentation was significantly associated with female sex (p = 0.04) but no other demographic or geographic variables. More than half the presentations (n = 92, 55.8%) occurred outside regular business hours. Twenty-three representations occurred within 90 days, associated with older age (p = 0.045) and lower residential socio-economic score (p = 0.02).</p></div><div><h3>Conclusion</h3><p>Findings highlight the frequent problem of DKA and the importance of socio-economic influences. This flags the need and opportunity to improve support to people with T1D to promote diabetes self-care.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 1","pages":"Pages 1-6"},"PeriodicalIF":1.8,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10802601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A novel study of situational awareness among out-of-hospital providers during an online clinical simulation 在在线临床模拟过程中，院外提供者的情境意识的一项新研究

IF 1.8 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2023-03-01 DOI: 10.1016/j.auec.2022.08.005

Justin Hunter , Michael Porter , Brett Williams

Background

Out-of-hospital providers must be situationally aware in order to maintain safety for themselves, their patients, the public, and their crew. They must be able to recognize situations, interpret them, and predict how those situations may unfold in the future.

Method

A mixed-methods explanatory sequential design where out-of-hospital providers in Oklahoma, USA, participated in an 18-minute online simulation and then had their situational awareness (SA) measured. Upon completion, participants provided feedback during scheduled interviews.

Results

A total of 156 out-of-hospital providers participated. Participants were not situationally aware. While not statistically significant, those with higher education had higher SA scores. Participants perceived that the simulation processes were beneficial to their ongoing care in the field, and were satisfied with the online simulation environment.

Conclusions

Out-of-hospital providers are not situationally aware during an online clinical simulation. While they are focused intently on the surroundings of the scene, they do not put that same focus on the patient. With the appropriate technology and setup, the use of the Situational Awareness Global Assessment Technique (SAGAT) during online simulation is feasible and could enhance clinical performance. Further studies are needed to determine if overall education or years of clinical experience play a role in out-of-hospital SA.

背景医院外服务提供者必须具有情境意识，以维护自身、患者、公众和工作人员的安全。他们必须能够识别情况，解释情况，并预测这些情况在未来会如何发展。方法采用混合方法解释性顺序设计，美国俄克拉何马州的院外提供者参与了18分钟的在线模拟，然后测量了他们的情景感知（SA）。完成后，参与者在预定的访谈中提供反馈。结果共有156名院外服务提供者参与。参与者没有情境意识。虽然没有统计学意义，但受过高等教育的人SA得分更高。参与者认为模拟过程有利于他们在现场的持续护理，并对在线模拟环境感到满意。结论在在线临床模拟过程中，医院外的提供者没有情境意识。虽然他们专注于场景的周围环境，但他们并没有把同样的注意力放在患者身上。通过适当的技术和设置，在在线模拟过程中使用态势感知全球评估技术（SAGAT）是可行的，可以提高临床性能。需要进一步的研究来确定整体教育或多年的临床经验是否在院外SA中发挥作用。

{"title":"A novel study of situational awareness among out-of-hospital providers during an online clinical simulation","authors":"Justin Hunter , Michael Porter , Brett Williams","doi":"10.1016/j.auec.2022.08.005","DOIUrl":"10.1016/j.auec.2022.08.005","url":null,"abstract":"<div><h3>Background</h3><p>Out-of-hospital providers must be situationally aware in order to maintain safety for themselves, their patients, the public, and their crew. They must be able to recognize situations, interpret them, and predict how those situations may unfold in the future.</p></div><div><h3>Method</h3><p>A mixed-methods explanatory sequential design where out-of-hospital providers in Oklahoma, USA, participated in an 18-minute online simulation and then had their situational awareness (SA) measured. Upon completion, participants provided feedback during scheduled interviews.</p></div><div><h3>Results</h3><p>A total of 156 out-of-hospital providers participated. Participants were not situationally aware. While not statistically significant, those with higher education had higher SA scores. Participants perceived that the simulation processes were beneficial to their ongoing care in the field, and were satisfied with the online simulation environment.</p></div><div><h3>Conclusions</h3><p>Out-of-hospital providers are not situationally aware during an online clinical simulation. While they are focused intently on the surroundings of the scene, they do not put that same focus on the patient. With the appropriate technology and setup, the use of the Situational Awareness Global Assessment Technique (SAGAT) during online simulation is feasible and could enhance clinical performance. Further studies are needed to determine if overall education or years of clinical experience play a role in out-of-hospital SA.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 1","pages":"Pages 96-103"},"PeriodicalIF":1.8,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9344831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

New Zealand emergency nurses’ perspectives and experiences of professional joy in clinical practice: An exploratory qualitative study 新西兰急诊护士在临床实践中对专业快乐的看法与体会:一项探索性质的研究

IF 1.8 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2023-03-01 DOI: 10.1016/j.auec.2022.07.008

Caroline M. Leaf, Jacqui M. Murray

Background

Nursing is becoming an increasingly stressful occupation, identified by high rates of burnout, compounded by a worldwide nursing shortage. Differing solutions to combat burnout have not provided long-term positive outcomes. This research explored emergency nurses’ perspectives and experiences of one potential solution, known as joy in work, or professional joy.

Methods

A qualitative, descriptive design was used to conduct semi-structured interviews with six registered nurses from two New Zealand emergency departments. Thematic analysis techniques were used.

Findings

Professional joy was frequently experienced, despite the difficulties faced in the emergency environment. Joy was identified as being like a spark which provided an uplift. The experience of joy positively impacted the nurse, and beyond, and potentially provided a buffer that assisted with mitigating the daily challenges. Recalling or sharing experiences of joy evoked a sense of wellbeing in the nurse, which in turn provided motivation to keep on nursing. This research identified a link between nurse wellbeing, joy and the importance of a healthy work environment.

Conclusion

While this study was relatively small, the findings highlight the significant positive impact the experience of joy had on these nurses. Further research is recommended to gain greater understanding of this important topic.

背景护理正成为一种压力越来越大的职业，其特点是高倦怠率，再加上全球护理短缺。对抗倦怠的不同解决方案并没有带来长期的积极结果。这项研究探讨了急诊护士对一种潜在解决方案的看法和经验，即工作中的快乐或职业快乐。方法采用定性、描述性设计，对新西兰两个急诊科的6名注册护士进行半结构化访谈。使用了专题分析技术。发现尽管在紧急情况下面临困难，但人们还是经常体验到职业上的快乐。快乐被认为是一个火花，它提供了一种提升。快乐的体验对护士和其他人产生了积极影响，并可能提供一种缓冲，有助于减轻日常挑战。回忆或分享快乐的经历会唤起护士的幸福感，这反过来又为继续护理提供了动力。这项研究确定了护士的幸福感、快乐感和健康工作环境的重要性之间的联系。结论虽然这项研究规模相对较小，但研究结果突出了快乐体验对这些护士的显著积极影响。建议进行进一步的研究以更好地了解这一重要主题。

{"title":"New Zealand emergency nurses’ perspectives and experiences of professional joy in clinical practice: An exploratory qualitative study","authors":"Caroline M. Leaf, Jacqui M. Murray","doi":"10.1016/j.auec.2022.07.008","DOIUrl":"10.1016/j.auec.2022.07.008","url":null,"abstract":"<div><h3>Background</h3><p>Nursing is becoming an increasingly stressful occupation, identified by high rates of burnout, compounded by a worldwide nursing shortage. Differing solutions to combat burnout have not provided long-term positive outcomes. This research explored emergency nurses’ perspectives and experiences of one potential solution, known as <em>joy in work</em>, or <em>professional joy.</em></p></div><div><h3>Methods</h3><p>A qualitative, descriptive design was used to conduct semi-structured interviews with six registered nurses<span> from two New Zealand emergency departments. Thematic analysis techniques were used.</span></p></div><div><h3>Findings</h3><p>Professional joy was frequently experienced, despite the difficulties faced in the emergency environment. Joy was identified as being like a spark which provided an <em>uplift</em>. The experience of joy positively impacted the nurse, and beyond, and potentially provided a buffer that assisted with mitigating the daily challenges. Recalling or sharing experiences of joy evoked a sense of wellbeing in the nurse, which in turn provided motivation to keep on nursing. This research identified a link between nurse wellbeing, joy and the importance of a healthy work environment.</p></div><div><h3>Conclusion</h3><p>While this study was relatively small, the findings highlight the significant positive impact the experience of joy had on these nurses. Further research is recommended to gain greater understanding of this important topic.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 1","pages":"Pages 59-65"},"PeriodicalIF":1.8,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10796652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effect of real-time feedback device compared to use or non-use of a checklist performance aid on post-training performance and retention of infant cardiopulmonary resuscitation: A randomized simulation-based trial 实时反馈装置与使用或不使用检查表对训练后婴儿心肺复苏表现和保留的影响:一项随机模拟试验

IF 1.8 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2023-03-01 DOI: 10.1016/j.auec.2022.07.005

Daniel Aiham Ghazali , Raphaëlle Rousseau , Cyril Breque , Denis Oriot

Introduction

This study aims to determine the best method for achieving optimal performance of pediatric cardiopulmonary resuscitation (CPR) during simulation-based training, whether with or without a performance aid.

Methods

In this randomized controlled study, 46 participants performed simulated CPR in pairs on a Resusci Baby QCPR™ mannequin, repeated after four weeks. All participants performed the first simulation without performance aids. For the second simulation, they were randomly assigned to one of three groups with stratification based on status: throughout CPR, Group A (n = 16) was the control group and did not use a performance aid; Group B (n = 16) used the CPR checklist; Group C (n = 14) used real-time visualization of their CPR activity on a feedback device. Overall performance was assessed using the QCPR™.

Results

All groups demonstrated improved performance on the second simulation (p < 0.01). Use of the feedback device resulted in better CPR performance than use of the CPR checklist (p = 0.02) or no performance aid (p = 0.04). Additionally, participants thought that the QCPR™ could effectively improve their technical competences.

Conclusions

Performance aid based on continuous feedback is helpful in the learning process. The use of the QCPR™, a real-time feedback device, improved the quality of resuscitation during infant CPR simulation-based training.

引言本研究旨在确定在基于模拟的训练中实现儿童心肺复苏（CPR）最佳性能的最佳方法，无论是否使用性能辅助。方法在这项随机对照研究中，46名参与者在Resusci Baby QCPR上进行了模拟心肺复苏™ 人体模型，四周后重复。所有参与者在没有表演辅助的情况下进行了第一次模拟。在第二次模拟中，他们被随机分配到三组中的一组，并根据状态进行分层：在整个心肺复苏过程中，A组（n=16）是对照组，不使用性能辅助；B组（n=16）采用心肺复苏检查表；C组（n=14）在反馈设备上使用他们的CPR活动的实时可视化。使用QCPR评估总体绩效™.结果所有组在第二次模拟中都表现出了更好的表现（p＜0.01）。使用反馈设备比使用CPR检查表（p＝0.02）或没有表现辅助（p＝0.04）能带来更好的CPR表现。此外，参与者认为QCPR™ 可以有效地提高他们的技术能力。结论基于持续反馈的绩效辅助对学习过程有帮助。QCPR的使用™, 实时反馈设备改进了在基于婴儿CPR模拟的训练期间的复苏质量。

{"title":"Effect of real-time feedback device compared to use or non-use of a checklist performance aid on post-training performance and retention of infant cardiopulmonary resuscitation: A randomized simulation-based trial","authors":"Daniel Aiham Ghazali , Raphaëlle Rousseau , Cyril Breque , Denis Oriot","doi":"10.1016/j.auec.2022.07.005","DOIUrl":"10.1016/j.auec.2022.07.005","url":null,"abstract":"<div><h3>Introduction</h3><p>This study aims to determine the best method for achieving optimal performance of pediatric cardiopulmonary resuscitation (CPR) during simulation-based training, whether with or without a performance aid.</p></div><div><h3>Methods</h3><p>In this randomized controlled study, 46 participants performed simulated CPR in pairs on a Resusci Baby QCPR™ mannequin, repeated after four weeks. All participants performed the first simulation without performance aids. For the second simulation, they were randomly assigned to one of three groups with stratification based on status: throughout CPR, Group A (n = 16) was the control group and did not use a performance aid; Group B (n = 16) used the CPR checklist; Group C (n = 14) used real-time visualization of their CPR activity on a feedback device. Overall performance was assessed using the QCPR™.</p></div><div><h3>Results</h3><p>All groups demonstrated improved performance on the second simulation (p < 0.01). Use of the feedback device resulted in better CPR performance than use of the CPR checklist (p = 0.02) or no performance aid (p = 0.04). Additionally, participants thought that the QCPR™ could effectively improve their technical competences.</p></div><div><h3>Conclusions</h3><p>Performance aid based on continuous feedback is helpful in the learning process. The use of the QCPR™, a real-time feedback device, improved the quality of resuscitation during infant CPR simulation-based training.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 1","pages":"Pages 36-44"},"PeriodicalIF":1.8,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10785438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Triage and length of stay in emergency department visits due to alcohol intoxication: A retrospective chart review 酒精中毒患者急诊分诊和住院时间:回顾性图表回顾

IF 1.8 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care

Pub Date : 2023-03-01 DOI: 10.1016/j.auec.2022.08.004

Sunmi Lee , Hyunjin Oh

Background

Patients with alcohol intoxication are screened and treated at emergency departments (EDs), at the cost of alcohol-related ED visit resource consumption. The purposes of this study were to identify characteristics of patients with alcohol intoxication, in terms of triage, blood alcohol concentration (BAC), and ED length of stay (LOS) and to compare these characteristics by homelessness status.

Methods

We conducted a retrospective chart review of all visits and referrals to one drunken center in an ED between January and December 2019. Adults aged over 18 years admitted to the drunken center with a blood alcohol concentration (BAC) of 100 mg/dl or higher were included.

Results

Approximately 89 % were male, around 30.4 % of the patients with acute alcohol intoxication were homeless. Approximately 46 % of patients were Medicaid or non-insured. Approximately 74.2 % of the patients were classified as KTAS 4 (less urgent) and 5 (nonurgency) upon initial KTAS evaluation. Both BAC and ED LOS were significantly higher in the homeless group.

Conclusions

About half of alcohol intoxicated patients who visited ED were vulnerable, and they visited the ED due to the problem of less urgent or non-urgent status of triage. Sobering places, not ED, and connecting patients with social work programs is important.

背景酒精中毒患者在急诊科接受筛查和治疗，费用为酒精相关急诊就诊资源的消耗。本研究的目的是确定酒精中毒患者在分诊、血液酒精浓度（BAC）和ED住院时间（LOS）方面的特征，并根据无家可归状况对这些特征进行比较。方法我们对2019年1月至12月期间ED中一家醉酒中心的所有就诊和转诊进行了回顾性图表审查。纳入了血液酒精浓度（BAC）为100mg/dl或更高的18岁以上进入醉酒中心的成年人。结果约89%为男性，约30.4%的急性酒精中毒患者无家可归。大约46%的患者是医疗补助或非保险患者。在最初的KTAS评估中，约74.2%的患者被分为KTAS 4（不太紧急）和5（非紧急）。无家可归者组的BAC和ED LOS均显著升高。结论约有一半的酒精中毒患者就诊于急诊科，他们就诊于急诊室是由于分诊状态不太紧急或不紧急的问题。清醒的地方，而不是急诊室，并将患者与社会工作项目联系起来是很重要的。

{"title":"Triage and length of stay in emergency department visits due to alcohol intoxication: A retrospective chart review","authors":"Sunmi Lee , Hyunjin Oh","doi":"10.1016/j.auec.2022.08.004","DOIUrl":"10.1016/j.auec.2022.08.004","url":null,"abstract":"<div><h3>Background</h3><p><span>Patients with alcohol intoxication are screened and treated at emergency departments (EDs), at the cost of alcohol-related ED visit resource consumption. The purposes of this study were to identify characteristics of patients with alcohol intoxication, in terms of triage, </span>blood alcohol concentration (BAC), and ED length of stay (LOS) and to compare these characteristics by homelessness status.</p></div><div><h3>Methods</h3><p>We conducted a retrospective chart review of all visits and referrals to one drunken center in an ED between January and December 2019. Adults aged over 18 years admitted to the drunken center with a blood alcohol concentration (BAC) of 100 mg/dl or higher were included.</p></div><div><h3>Results</h3><p>Approximately 89 % were male, around 30.4 % of the patients with acute alcohol intoxication were homeless. Approximately 46 % of patients were Medicaid or non-insured. Approximately 74.2 % of the patients were classified as KTAS 4 (less urgent) and 5 (nonurgency) upon initial KTAS evaluation. Both BAC and ED LOS were significantly higher in the homeless group.</p></div><div><h3>Conclusions</h3><p>About half of alcohol intoxicated patients who visited ED were vulnerable, and they visited the ED due to the problem of less urgent or non-urgent status of triage. Sobering places, not ED, and connecting patients with social work programs is important.</p></div>","PeriodicalId":55979,"journal":{"name":"Australasian Emergency Care","volume":"26 1","pages":"Pages 90-95"},"PeriodicalIF":1.8,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10785464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0