Pub Date : 2022-03-15DOI: 10.1080/21548331.2022.2054633
E. Wake, C. Brandenburg, K. Heathcote, Kate Dale, Don Campbell, M. Cardona
ABSTRACT Objective Understanding the longitudinal patient experience outcomes following major trauma can promote successful recovery. A novel, hospital-led telephone follow-up program was implemented by a multi-disciplinary clinical trauma service team at a Level I trauma center. This process evaluation examined what factors promoted or impeded the program’s implementation. Methods A prospective convergent mixed-methods process evaluation design was used. Quantitative data included patient and injury demographics and program feasibility data such number of telephone calls attempted/completed and call duration. Qualitative data consisted of semi-structured interviews with program participants (staff, patients, and caregivers) who had participated in the program. Descriptive statistics and thematic analysis were applied to quantitative and qualitative data, respectively. Data were collected concurrently and merged in the results to understand and describe the implementation and sustainability of the program.274 major trauma patients (ISS ≥ 12) were eligible for follow-up. A response rate of over 75% was achieved, with nurses responsible for most of the calls. Limited time and competing clinical demands were identified as barriers to the timely completion of the calls. Results Participants valued the preexisting trauma service/patient relationship, and this facilitated program implementation. Clinicians were motivated to evaluate their patient’s recovery, whilst patients felt ‘cared for’ and ‘not forgotten’ post-hospital discharge. Teamwork and leadership were highly valued by the clinical staff throughout the implementation period as ongoing source of motivation and support. Staff spontaneously developed the program to incorporate clinical follow-up processes by providing guidance, advice, and referrals to patients who indicated ongoing issues such as pain or emotional problems. Conclusion Telephone follow-up within a clinical trauma service team is feasible, accepted by staff and valued by patients and families. Despite time constraints, the successful implementation of this program is reliant on existing clinical/patient relationships, staff teamwork and leadership support.
{"title":"Follow-up of severely injured patients can be embedded in routine hospital care: results from a feasibility study","authors":"E. Wake, C. Brandenburg, K. Heathcote, Kate Dale, Don Campbell, M. Cardona","doi":"10.1080/21548331.2022.2054633","DOIUrl":"https://doi.org/10.1080/21548331.2022.2054633","url":null,"abstract":"ABSTRACT Objective Understanding the longitudinal patient experience outcomes following major trauma can promote successful recovery. A novel, hospital-led telephone follow-up program was implemented by a multi-disciplinary clinical trauma service team at a Level I trauma center. This process evaluation examined what factors promoted or impeded the program’s implementation. Methods A prospective convergent mixed-methods process evaluation design was used. Quantitative data included patient and injury demographics and program feasibility data such number of telephone calls attempted/completed and call duration. Qualitative data consisted of semi-structured interviews with program participants (staff, patients, and caregivers) who had participated in the program. Descriptive statistics and thematic analysis were applied to quantitative and qualitative data, respectively. Data were collected concurrently and merged in the results to understand and describe the implementation and sustainability of the program.274 major trauma patients (ISS ≥ 12) were eligible for follow-up. A response rate of over 75% was achieved, with nurses responsible for most of the calls. Limited time and competing clinical demands were identified as barriers to the timely completion of the calls. Results Participants valued the preexisting trauma service/patient relationship, and this facilitated program implementation. Clinicians were motivated to evaluate their patient’s recovery, whilst patients felt ‘cared for’ and ‘not forgotten’ post-hospital discharge. Teamwork and leadership were highly valued by the clinical staff throughout the implementation period as ongoing source of motivation and support. Staff spontaneously developed the program to incorporate clinical follow-up processes by providing guidance, advice, and referrals to patients who indicated ongoing issues such as pain or emotional problems. Conclusion Telephone follow-up within a clinical trauma service team is feasible, accepted by staff and valued by patients and families. Despite time constraints, the successful implementation of this program is reliant on existing clinical/patient relationships, staff teamwork and leadership support.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"50 1","pages":"138 - 150"},"PeriodicalIF":0.0,"publicationDate":"2022-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46886323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-14DOI: 10.1080/21548331.2022.2052667
J. Gnanaraj, R. Kauffman, W. Khaliq
ABSTRACT Objective To evaluate prevalence of nonadherence to breast cancer screening guidelines after bedside educational intervention and informed individualized risk assessment score during an inpatient stay. Methods A prospective intervention study was conducted among 507 cancer-free (except skin cancer) women aged 50–75 years hospitalized to a general medicine service. Study intervention included one-on-one bedside education via handout and videos about breast cancer screening and informed individualized risk assessment using the Gail risk model to predict 5-year risk for breast cancer development. Study outcomes were measured using posthospitalization follow-up survey to determine if intervention resulted in improved adherence to breast cancer screening. Chi-square and unpaired t-tests were utilized to compare population characteristics. Results The mean age for the study population was 60.5 years (SD = 6.9), the mean 5-year Gail risk score was 1.77 (SD = 1), and 36% of women were African American. One hundred sixty nine (33%) hospitalized women were nonadherent to breast cancer screening recommendations. Only 15% of the nonadherent women were reachable for follow-up survey, and 42% of these women self-reported adherence to screening mammography after a mean follow-up period of 27 months. Conclusion This study provides evidence that most women who are nonadherent to breast cancer screening remain nonadherent after hospital discharge despite educational interventions. Our study intervention was only partially successful in enhancing breast cancer screening among hospitalized women who were overdue and at high risk. Further studies need to evaluate strategies to overcome the barriers and improve adherence whenever patients encounter health care system regardless of clinical locale.
{"title":"Effect of inpatient breast cancer education and risk assessment on mammography utilization among hospitalized women post discharge","authors":"J. Gnanaraj, R. Kauffman, W. Khaliq","doi":"10.1080/21548331.2022.2052667","DOIUrl":"https://doi.org/10.1080/21548331.2022.2052667","url":null,"abstract":"ABSTRACT Objective To evaluate prevalence of nonadherence to breast cancer screening guidelines after bedside educational intervention and informed individualized risk assessment score during an inpatient stay. Methods A prospective intervention study was conducted among 507 cancer-free (except skin cancer) women aged 50–75 years hospitalized to a general medicine service. Study intervention included one-on-one bedside education via handout and videos about breast cancer screening and informed individualized risk assessment using the Gail risk model to predict 5-year risk for breast cancer development. Study outcomes were measured using posthospitalization follow-up survey to determine if intervention resulted in improved adherence to breast cancer screening. Chi-square and unpaired t-tests were utilized to compare population characteristics. Results The mean age for the study population was 60.5 years (SD = 6.9), the mean 5-year Gail risk score was 1.77 (SD = 1), and 36% of women were African American. One hundred sixty nine (33%) hospitalized women were nonadherent to breast cancer screening recommendations. Only 15% of the nonadherent women were reachable for follow-up survey, and 42% of these women self-reported adherence to screening mammography after a mean follow-up period of 27 months. Conclusion This study provides evidence that most women who are nonadherent to breast cancer screening remain nonadherent after hospital discharge despite educational interventions. Our study intervention was only partially successful in enhancing breast cancer screening among hospitalized women who were overdue and at high risk. Further studies need to evaluate strategies to overcome the barriers and improve adherence whenever patients encounter health care system regardless of clinical locale.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"50 1","pages":"132 - 137"},"PeriodicalIF":0.0,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49320967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-06DOI: 10.1080/21548331.2022.2050649
K. Carlson, Tabatha Matthias, Justin R. Birge, Brady P Bulian, Sarah E Richards, Jason F. Shiffermiller
ABSTRACT Objectives To describe the structure and implementation of a model in which hospitalists focus on a particular hospital unit or area, referred to as ‘geographic rounding,’ and to analyze its effect on hospitalist efficiency, interruptions, after-hours work, and satisfaction. Methods The leadership of our academic hospital medicine group designed a geographic rounding intervention with the goal of improving provider satisfaction and mitigating burnout. Our quantitative analysis compared the pre-intervention and post-intervention time periods with regard to progress note completion time, after-hours progress note completion, secure messaging communication volume, and Mini-Z survey results. A post-intervention qualitative analysis was performed to further explore the relationship between geographic rounding and the drivers of burnout. Results Following the intervention, 97% of geographic rounders were localized to one or two geographic areas and 77% were localized to a single geographic area. Following the implementation of geographic rounding, progress notes were completed an average of 29 minutes earlier (p < 0.001). The proportion of progress notes completed after-hours decreased from 25.1% to 20% (p < 0.001). The volume of secure messages received by hospitalists decreased from 1.95 to 1.8 per patient per day (p < 0.001). The proportion of hospitalists reporting no burnout increased from 77.8% to 93% after implementing geographic rounding, a change that did not reach statistical significance (p = 0.1). Qualitative analysis revealed mixed effects on work environment but improvements in efficiency, patient-centeredness, communication with nurses, and job satisfaction. Conclusion Geographic rounding represents an organization-level change that has the potential to improve hospitalist career satisfaction.
{"title":"The effect of geographic rounding on hospitalist work experience: a mixed-methods study","authors":"K. Carlson, Tabatha Matthias, Justin R. Birge, Brady P Bulian, Sarah E Richards, Jason F. Shiffermiller","doi":"10.1080/21548331.2022.2050649","DOIUrl":"https://doi.org/10.1080/21548331.2022.2050649","url":null,"abstract":"ABSTRACT Objectives To describe the structure and implementation of a model in which hospitalists focus on a particular hospital unit or area, referred to as ‘geographic rounding,’ and to analyze its effect on hospitalist efficiency, interruptions, after-hours work, and satisfaction. Methods The leadership of our academic hospital medicine group designed a geographic rounding intervention with the goal of improving provider satisfaction and mitigating burnout. Our quantitative analysis compared the pre-intervention and post-intervention time periods with regard to progress note completion time, after-hours progress note completion, secure messaging communication volume, and Mini-Z survey results. A post-intervention qualitative analysis was performed to further explore the relationship between geographic rounding and the drivers of burnout. Results Following the intervention, 97% of geographic rounders were localized to one or two geographic areas and 77% were localized to a single geographic area. Following the implementation of geographic rounding, progress notes were completed an average of 29 minutes earlier (p < 0.001). The proportion of progress notes completed after-hours decreased from 25.1% to 20% (p < 0.001). The volume of secure messages received by hospitalists decreased from 1.95 to 1.8 per patient per day (p < 0.001). The proportion of hospitalists reporting no burnout increased from 77.8% to 93% after implementing geographic rounding, a change that did not reach statistical significance (p = 0.1). Qualitative analysis revealed mixed effects on work environment but improvements in efficiency, patient-centeredness, communication with nurses, and job satisfaction. Conclusion Geographic rounding represents an organization-level change that has the potential to improve hospitalist career satisfaction.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"1 3","pages":"124 - 131"},"PeriodicalIF":0.0,"publicationDate":"2022-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41258114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-03DOI: 10.1080/21548331.2022.2049099
P. Ennezat, R. Guerbaai, Thierry H. LeJemtel, Morten Rix Hansen
Cardiology department, Service de cardiologie, Centre Hospitalier Universitaire Henri Mondor, Créteil, France; Medizinische Fakultät, Department Public Health (DPH), Universität Basel, Basel, Switzerland; University Heart and Vascular Institute, New Orleans, LA, USA; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
{"title":"Full transparency of ticagrelor trials in coronary artery disease should be warranted","authors":"P. Ennezat, R. Guerbaai, Thierry H. LeJemtel, Morten Rix Hansen","doi":"10.1080/21548331.2022.2049099","DOIUrl":"https://doi.org/10.1080/21548331.2022.2049099","url":null,"abstract":"Cardiology department, Service de cardiologie, Centre Hospitalier Universitaire Henri Mondor, Créteil, France; Medizinische Fakultät, Department Public Health (DPH), Universität Basel, Basel, Switzerland; University Heart and Vascular Institute, New Orleans, LA, USA; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"50 1","pages":"89 - 92"},"PeriodicalIF":0.0,"publicationDate":"2022-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41742846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-13DOI: 10.1080/21548331.2022.2050650
David Chaulk, Theresa Tran, Allison Neeley, A. Giardino
ABSTRACT Objective Hospital quality ratings are intended to guide patients and payers to the highest quality hospitals. Their success in achieving this goal has been limited by inconsistencies between ratings and questionable data collection methods. Despite these shortcomings, their popularity and importance are increasing. The purpose of this review is to identify the strengths and weaknesses of the US News and World Report (USNWR) Best Children’s Hospitals Report and Leapfrog Pediatric Care Survey and discuss improvement opportunities. Methods A structured literature review was performed analyzing hospital quality surveys. Previously published criteria were used to compare the USNWR Best Children’s Hospitals Report and Leapfrog Pediatric Care Survey. Results This narrative review highlights the strengths and weakness of both the USNWR Best Children’s Hospitals Report and the Leapfrog Pediatric Care Survey, including a letter grade comparison. Conclusion Existing children’s hospital rating systems are lacking. We suggest specific improvements that may better enable these reports to influence the quality of pediatric care.
{"title":"Children’s hospital quality ratings: where are we and can we do better?","authors":"David Chaulk, Theresa Tran, Allison Neeley, A. Giardino","doi":"10.1080/21548331.2022.2050650","DOIUrl":"https://doi.org/10.1080/21548331.2022.2050650","url":null,"abstract":"ABSTRACT Objective Hospital quality ratings are intended to guide patients and payers to the highest quality hospitals. Their success in achieving this goal has been limited by inconsistencies between ratings and questionable data collection methods. Despite these shortcomings, their popularity and importance are increasing. The purpose of this review is to identify the strengths and weaknesses of the US News and World Report (USNWR) Best Children’s Hospitals Report and Leapfrog Pediatric Care Survey and discuss improvement opportunities. Methods A structured literature review was performed analyzing hospital quality surveys. Previously published criteria were used to compare the USNWR Best Children’s Hospitals Report and Leapfrog Pediatric Care Survey. Results This narrative review highlights the strengths and weakness of both the USNWR Best Children’s Hospitals Report and the Leapfrog Pediatric Care Survey, including a letter grade comparison. Conclusion Existing children’s hospital rating systems are lacking. We suggest specific improvements that may better enable these reports to influence the quality of pediatric care.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"49 1","pages":"405 - 412"},"PeriodicalIF":0.0,"publicationDate":"2021-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47592249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-13DOI: 10.1080/21548331.2022.2050112
A. Giardino, Tiffany Glasgow, Jill Sweney, David Chaulk
ABSTRACT Pediatrics is a field of medical specialty that focuses on children and their potential to successfully grow and develop into healthy adults. The articles in this special edition of Hospital Practice span a range of issues that affect children and their health care in the inpatient hospital setting, including equity and bias mitigation in health care, efficiency in patient rounding, using patient and family complaints to drive improvement efforts, the diagnostic process and avoiding fundamental diagnostic errors, pediatric palliative care, rapidly identifying and treating sepsis in children, the care and management of children on home ventilation, instituting a rapid response team in the pediatric environment, and quality rating systems for children’s hospitals.
{"title":"Pediatric inpatient hospital care","authors":"A. Giardino, Tiffany Glasgow, Jill Sweney, David Chaulk","doi":"10.1080/21548331.2022.2050112","DOIUrl":"https://doi.org/10.1080/21548331.2022.2050112","url":null,"abstract":"ABSTRACT Pediatrics is a field of medical specialty that focuses on children and their potential to successfully grow and develop into healthy adults. The articles in this special edition of Hospital Practice span a range of issues that affect children and their health care in the inpatient hospital setting, including equity and bias mitigation in health care, efficiency in patient rounding, using patient and family complaints to drive improvement efforts, the diagnostic process and avoiding fundamental diagnostic errors, pediatric palliative care, rapidly identifying and treating sepsis in children, the care and management of children on home ventilation, instituting a rapid response team in the pediatric environment, and quality rating systems for children’s hospitals.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"49 1","pages":"391 - 392"},"PeriodicalIF":0.0,"publicationDate":"2021-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47495525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Until workers can be effectively protected from the dusts, gases, and vapors that cause occupational lung diseases, clinicians must focus on careful history taking, precise diagnosis, and prompt therapy to relieve or reduce respiratory disability.
{"title":"Occupational lung diseases.","authors":"H. Weill","doi":"10.1201/9781003064800","DOIUrl":"https://doi.org/10.1201/9781003064800","url":null,"abstract":"Until workers can be effectively protected from the dusts, gases, and vapors that cause occupational lung diseases, clinicians must focus on careful history taking, precise diagnosis, and prompt therapy to relieve or reduce respiratory disability.","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"16 4 1","pages":"65-80"},"PeriodicalIF":0.0,"publicationDate":"2020-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47767436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-21DOI: 10.1542/9781610024358-part03-ch10
J. Klein
Research on the postcoital use of contraceptive steroids began in the 1960s. The first oral regimen, which used a widely available brand of combined estrogen–progestin oral contraceptive pills, was published in 1974 (7). Research on progestin-only regimens for occasional postcoital use by women having infrequent sexual intercourse also began at approximately the same time (8). Data regarding the use of IUDs as emergency contraceptives were initially published in the 1970s and, more recently, selective progesterone receptor modulators were introduced. The most commonly used oral emergency contraceptive regimen is the progestin-only pill, which consists of 1.5 mg of levonorgestrel (Table 1). This product can be purchased over the counter and is available without age restriction as of 2013. The product using two levonorgestrel doses of 0.75 mg has fallen out of use in favor of the simpler one-dose regimen, which is at least as effective as the two-dose product (9, 10). The levonorgestrel regimen is labeled for use for up to 72 hours after unprotected sex but is best used as soon as possible after unprotected sex (10–14) (Table 1). A second dedicated emergency contraceptive, a pill containing 30 mg of ulipristal acetate, was approved by the FDA in 2010 and requires a prescription. This selective progesterone receptor modulator, or antiprogestin, has demonstrated effectiveness up to 120 hours after unprotected sex (14) (Table 1). Combined estrogen–progestin emergency contraceptive regimens are no longer sold as a dedicated product. Emergency Contraception
{"title":"Emergency contraception.","authors":"J. Klein","doi":"10.1542/9781610024358-part03-ch10","DOIUrl":"https://doi.org/10.1542/9781610024358-part03-ch10","url":null,"abstract":"Research on the postcoital use of contraceptive steroids began in the 1960s. The first oral regimen, which used a widely available brand of combined estrogen–progestin oral contraceptive pills, was published in 1974 (7). Research on progestin-only regimens for occasional postcoital use by women having infrequent sexual intercourse also began at approximately the same time (8). Data regarding the use of IUDs as emergency contraceptives were initially published in the 1970s and, more recently, selective progesterone receptor modulators were introduced. The most commonly used oral emergency contraceptive regimen is the progestin-only pill, which consists of 1.5 mg of levonorgestrel (Table 1). This product can be purchased over the counter and is available without age restriction as of 2013. The product using two levonorgestrel doses of 0.75 mg has fallen out of use in favor of the simpler one-dose regimen, which is at least as effective as the two-dose product (9, 10). The levonorgestrel regimen is labeled for use for up to 72 hours after unprotected sex but is best used as soon as possible after unprotected sex (10–14) (Table 1). A second dedicated emergency contraceptive, a pill containing 30 mg of ulipristal acetate, was approved by the FDA in 2010 and requires a prescription. This selective progesterone receptor modulator, or antiprogestin, has demonstrated effectiveness up to 120 hours after unprotected sex (14) (Table 1). Combined estrogen–progestin emergency contraceptive regimens are no longer sold as a dedicated product. Emergency Contraception","PeriodicalId":75913,"journal":{"name":"Hospital practice","volume":"33 10 1","pages":"26"},"PeriodicalIF":0.0,"publicationDate":"2020-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44791481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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