International Emergency Nursing最新文献

{"title":"The potential for Safewards to reduce restrictive interventions for people arriving to the emergency Department with police for a mental health assessment","authors":"Catherine Daniel ,&nbsp;Celene Y.L. Yap ,&nbsp;Jonathan C Knott ,&nbsp;Ashleigh Ryan ,&nbsp;Rebecca Brittliff ,&nbsp;Marie Gerdtz","doi":"10.1016/j.ienj.2024.101570","DOIUrl":"10.1016/j.ienj.2024.101570","url":null,"abstract":"<div><div>Safewards is a complex intervention developed to promote a therapeutic response to minimise conflict and containment in inpatient mental health settings. A pilot study was conducted to adapt Safewards for the emergency department (ED) setting to evaluate its impact on the use of restrictive interventions. This subgroup analysis focusses on patients transported to the ED by police for mental health assessment.</div></div><div><h3>Method</h3><div>A retrospective file audit was conducted using pre and post measures on the use of restrictive interventions following the implementation of Safewards. Demographic and restrictive interventions data were extracted from the hospital databases 12 months before and 6 months after Safewards was implemented. All patients transported to the ED by police for a mental health assessment were included in two regional emergency departments in Victoria, Australia, with over 122,000 presentations per year accredited by the Australasian College for Emergency Medicine.</div></div><div><h3>Results</h3><div>There were 1379 pre and 543 post attendances accompanied by police. Of these, 85.5% pre and 99.1% post were transported to the hospital under Section 351 of the MHA (2014). Post implementation, there were fewer code grey events (clinical and security responses to unarmed threat) that required restrictive interventions including mechanical or chemical restraint. The number of code grey events in which no restrictive intervention was applied increased from 76.7% to 86.6%. Staff assigned higher triage ratings following the introduction of Safewards.</div><div>There was a significant reduction in code grey events that used one restrictive intervention after implementing Safewards ED interventions (15.6% versus 7.2%<em>; p</em>=&lt;0.001). Significantly fewer sedative medications were administered to manage behaviour on arrival (20.6% pre versus 9.8% post, p=&lt;0.001).</div></div><div><h3>Conclusion</h3><div>The Safewards ED adaptation may have contributed to a reduction in the use of restrictive interventions in this high-risk subgroup of patients frequently subject to restrictive interventions in the ED. Further research is required to validate the findings from this subgroup analysis.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"78 ","pages":"Article 101570"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating the impact of nursing shift change audit on the safety of emergency department patients","authors":"Sina Kazemi ,&nbsp;Saeed Hashemi ,&nbsp;Ali Rahmani ,&nbsp;Hossein Mahmoudi","doi":"10.1016/j.ienj.2024.101551","DOIUrl":"10.1016/j.ienj.2024.101551","url":null,"abstract":"<div><h3>Introduction</h3><div>Nursing care is complex and critical, emphasizing the importance of standardized communication methods for conveying health information. Nurses working different shifts exchange treatment details and patient information during shift handover. By utilizing the SBAR method for shift handover, nurses can ensure that the receiving nurse has a comprehensive understanding of the patient’s condition. Conducting shift change audits allows for comparison of the current shift practices with standard protocols, enabling the identification and resolution of any issues. Implementing targeted reporting strategies during shift changes can help address challenges and improve the effectiveness of health information transfer.</div></div><div><h3>Objective</h3><div>The study was conducted to investigate the impact of auditing nursing shift changes on patient safety in the emergency department of a hospital in Tehran.</div></div><div><h3>Methods</h3><div>The present study is a semi-experimental study conducted on 35 nurses and 70 patients in a convenience sample before and after the intervention. The study took place in the emergency department of a hospital in Tehran during 2023–2024. Initially, nurses’ shift work, patient safety, and nurses’ satisfaction were assessed using a questionnaire. The current situation was then compared with the SBAR checklist, and an SBAR training program was developed for nurses. Interventions included theoretical training sessions on using the SBAR method during shift changes and the presentation of a training video. After completing the educational interventions, the materials were reviewed, problems were addressed, and nurses’ shift changes were evaluated using the SBAR checklist, along with completion of a patient safety questionnaire.</div></div><div><h3>Results</h3><div>The study found that the SBAR score significantly increased after the intervention (49.49) compared to before (21.31) (P &lt; 0.05). Additionally, patient safety scores significantly improved after the intervention (P &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>Implementing a targeted and integrated approach to shift work based on the SBAR method can help address challenges in nursing shift delivery, improve the nursing care process, and enhance patient safety.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"78 ","pages":"Article 101551"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792193","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}

{"title":"Enhancing emergency competencies in healthcare professionals via murder mystery games: Comment","authors":"Amnuay Kleebayoon,&nbsp;Viroj Wiwanitkit","doi":"10.1016/j.ienj.2024.101566","DOIUrl":"10.1016/j.ienj.2024.101566","url":null,"abstract":"","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"78 ","pages":"Article 101566"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878620","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}

{"title":"The effectiveness of using animal-themed vacutainers to reduce pain and fear in children during bloodletting","authors":"Nejla Canbulat Sahiner ,&nbsp;Selda Ates Besirik ,&nbsp;Alper Yusuf Koroglu ,&nbsp;Seda Dilay","doi":"10.1016/j.ienj.2024.101549","DOIUrl":"10.1016/j.ienj.2024.101549","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to compare the effects of vacutainers of three different animal characters on pain and fear in children during bloodletting.</div></div><div><h3>Methods</h3><div>This randomized controlled trial included 180 children between the ages of 4 and 7 years who required bloodletting for routine control. Children were randomized into two groups: experimental and control groups. Routine bloodletting procedure was applied to those in the control group. Animal characters (butterfly, peacock and rabbit) chosen by children in the experimental group was attached to the vacutainer, and then their blood was drawn. The data were obtained by face-to-face interviews with the child, parent and observer before and after the procedure. Children’s pain and fear/anxiety levels were evaluated using the Wong-Baker FACES Pain Scale and the Children’s Fear Scale, respectively.</div></div><div><h3>Results</h3><div>There was no statistically significant difference between the groups’ pre-test scores with respect to age, BMI, gender, fear/anxiety assessments of the child, parent, and observer. Children in the experimental group had significantly lower pain and fear/anxiety levels after the procedure compared to those in the control group(p &lt; 0.000).</div></div><div><h3>Conclusions</h3><div>Animal characters (butterfly, peacock and rabbit) attached to the vacutainer is effective in reducing both fear and pain levels in children during bloodletting.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"78 ","pages":"Article 101549"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773881","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}

{"title":"Video and booklet discharge instructions for mothers for childhood fever in pediatric emergency department: A randomized controlled trial","authors":"Aylin Kurt,&nbsp;Fatma Dinç,&nbsp;Emine Güneş Şan","doi":"10.1016/j.ienj.2024.101546","DOIUrl":"10.1016/j.ienj.2024.101546","url":null,"abstract":"<div><h3>Background</h3><div>Due to lack of knowledge and misunderstanding, parents may mismanage a fever and seek unnecessary medical attention.</div></div><div><h3>Aim</h3><div>The study aimed to determine the effectiveness of video and booklet discharge instructions for childhood fever in the pediatric emergency department.</div></div><div><h3>Methods</h3><div>This randomized controlled trial (NCT05929131) consisted of three groups: video (n = 48), booklet (n = 48), and verbal (n = 48) discharge instructions. Data were collected using the Introductory Information Form, Parent’s Childhood Fever Management, Post-Discharge Coping Difficulties Scale for Parents, and Post-Discharge Information Form.</div></div><div><h3>Results</h3><div>Within the first 3 days after receiving discharge instructions, parents in the video group had lower scores on the Parents’ Fever Management Scale (video: 20.29 ± 1.99, booklet: 20.65 ± 2.07, verbal: 28.41 ± 1.51; p &lt; 0.05) and the Post-Discharge Coping Difficulties Scale for Parents (video: 39.44 ± 3.91, verbal: 54.03 ± 9.12; p = 0.019) compared to the verbal group. After discharge, the number of hospital readmissions was lower in the video group of parents compared to the verbal group (video: 1.12 ± 0.44, verbal: 1.54 ± 0.96, p = 0.015).</div></div><div><h3>Conclusion</h3><div>Visual discharge instructions, such as booklets and videos to support discharge instructions, have been shown to be effective in improving mothers’ fever management skills and reducing their return to the emergency department.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"78 ","pages":"Article 101546"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786789","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}

{"title":"Emergency department crowding: An assessment of the potential impact of the See-and-Treat protocol for patient flow management at an Italian hospital","authors":"Pietro Verzelloni ,&nbsp;Giorgia Adani ,&nbsp;Alessandro Longo ,&nbsp;Silvio Di Tella ,&nbsp;Anna Laura Santunione ,&nbsp;Marco Vinceti ,&nbsp;Tommaso Filippini","doi":"10.1016/j.ienj.2024.101569","DOIUrl":"10.1016/j.ienj.2024.101569","url":null,"abstract":"<div><h3>Background</h3><div>Crowding and patient flow management are among the most relevant issues for emergency departments (EDs). This results in delayed treatment, adverse outcomes and increased costs. For these reasons, nurse-independent treatment protocols were developed aimed at managing non-emergency patients outside EDs thus improving patient flow. Our objective was to assess the potential impact of the implementation of the “<em>See-and-Treat</em>” protocol on eligible patients and related healthcare costs at an Italian ED.</div></div><div><h3>Methods</h3><div>We selected all minor access codes from 2022 at the ED of Sassuolo Hospital in Northern Italy. We only included subjects discharged to home, while we excluded those who required specialized medical care or had received “Fast-Track” treatment. We identify a list of medical conditions to identify subjects eligible for inclusion in the <em>See-and-Treat</em> protocol and calculate the related healthcare costs.</div></div><div><h3>Results</h3><div>Of 40,906 individual ED admissions, 2,607 (6.4%) qualified for <em>See-and-Treat</em> management. Limb injuries and pain were the leading conditions at presentation. Through cost analysis, we found that implementation of the <em>See-and-Treat</em> protocol may result in savings over €100,000/year at Sassuolo Hospital, and over €7 million if projected to the entire Emilia-Romagna Region.</div></div><div><h3>Conclusions</h3><div>Despite some limitations affecting protocol implementation, especially availability of highly-specialized and specifically-trained nurses, the study provided a foundation for a more comprehensive understanding of the implementation of the <em>See-and-Treat</em> protocol as a possible valid model with a view to both human and economic healthcare resources.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"78 ","pages":"Article 101569"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors correlating work engagement among Palestinian emergency nurses during Gaza war in the West Bank","authors":"Malakeh.Z. Malak ,&nbsp;Hisham Zahran ,&nbsp;Abdelrahman Swalmeh ,&nbsp;Haya Albana","doi":"10.1016/j.ienj.2024.101567","DOIUrl":"10.1016/j.ienj.2024.101567","url":null,"abstract":"<div><h3>Purpose</h3><div>Work engagement among emergency nurses is a critical issue that adversely affects the quality of patient care and productivity. Psychological reactions (e.g., stress, anxiety, and depression) and resilience correlated with work engagement. This study addresses the gap in understanding the factors correlating work engagement among.</div><div>emergency nurses in the West Bank during the Gaza War.</div></div><div><h3>Methods</h3><div>A descriptive correlational design was used. The data were collected from 378 emergency nurses from governmental and private hospitals in the West Bank using a self-reported questionnaire from December 2023 to February 2024. Depression Anxiety Stress Scales-21 (DASS-21), the Connor-Davidson Resilience Scale (CD-RISC), and the Utrecht Work Engagement Scale (UWES) were used to assess the study variables.</div></div><div><h3>Results</h3><div>The findings demonstrated that 71.7 %, 52.9 %, 42.5 %, 55.6 %, and 40.0 % of the emergency nurses reported severe to extremely severe stress, moderate to extremely severe levels of anxiety, severe to extremely severe levels of depression, low resilience, and low to extremely low levels of job engagement, respectively. A positive relationship existed between work engagement and age (r = 0.407, p &lt; 0.01), years of experience (r = 0.385, p &lt; 0.01), and resilience (r = 0.419, p &lt; 0.01). While, work engagement negatively correlated with stress (r = -0.486, p &lt; 0.01), anxiety (r = -0.616, p &lt; 0.01), and depression (r = -0.632, p &lt; 0.01).</div></div><div><h3>Conclusions</h3><div>The findings indicated that policymakers and healthcare professionals should promote initiatives that enhance nurses’ resilience and mitigate psychological responses to improve work engagement. Therapeutic programs should consider the situational variations of Palestinian society, encompassing resilience, coping mechanisms, and psychological management approaches.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"78 ","pages":"Article 101567"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967152","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}

{"title":"Workforce research priorities for emergency nurses in Australia","authors":"Nicholas McIntyre ,&nbsp;Julia Crilly ,&nbsp;Grace Xu ,&nbsp;Julia Morphet ,&nbsp;Bronwyn Griffin ,&nbsp;Jaimi Greenslade ,&nbsp;Elizabeth Elder","doi":"10.1016/j.ienj.2024.101539","DOIUrl":"10.1016/j.ienj.2024.101539","url":null,"abstract":"<div><h3>Background</h3><div>The current nursing shortage is a critical issue facing healthcare systems. Workforce research priorities for<!--> <!-->emergency nurses are limited.<!--> <!-->This study aimed to identify, collate, and prioritise areas of workforce research for emergency nursing in Australia.</div></div><div><h3>Methods</h3><div>This priority-setting study was conducted with ED nurses from September 2022 to August 2023 and comprised: i) an initial survey, ii) face-to-face group discussions, and iii) a prioritisation survey.</div></div><div><h3>Results</h3><div>A total of 318 ED nurses responded to the initial survey. Staffing (<em>n</em> = 245), workload (<em>n</em> = 112), access block (<em>n</em> = 63) and burnout (<em>n</em> = 54) were nominated as workforce concerns. Responses were grouped into three overarching categories: person, department, and organisation. These categories informed the face-to-face group discussions. A total of 30 ED nurses participated in one of three face-to-face group discussions. Sub-themes, including resilience, workload, and well-being emerged. From the prioritisation survey completed by 163 ED nurses, the highest-ranked workforce research priorities pertained to turnover and retention.</div></div><div><h3>Conclusions</h3><div>The research priorities identified reflect important and contemporary workforce issues for emergency nurses. Efforts to progress research in these priority workforce areas should be encouraged and supported.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"78 ","pages":"Article 101539"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parents’ perspective on unplanned return visits to the pediatric emergency department: A cross-sectional study","authors":"Fatma Dinç ,&nbsp;Aylin Kurt ,&nbsp;Dilek Yıldız","doi":"10.1016/j.ienj.2024.101568","DOIUrl":"10.1016/j.ienj.2024.101568","url":null,"abstract":"<div><h3>Background</h3><div>The aim of this study was to investigate the factors leading to more than one time visit to the pediatric emergency department within 72 h, parental wishes and experiences with emergency nurses from the parents’ perspective.</div></div><div><h3>Material and methods</h3><div>A cross-sectional study was conducted between April 15, 2023 and April 14, 2024 with 596 parents of children aged between 0 and 18 years who had return visits to the pediatric emergency department of a gynaecology and pediatrics hospital in the Western Black Sea Region of Türkiye within 72 h after the first visit. Following the acquisition of written informed consent from the parents, the data were collected using the Descriptive Characteristics of Children and Experiences of Parents Information Form.</div></div><div><h3>Results</h3><div>From the perspective of the parents, the most common reasons for an unplanned return visit to the pediatric emergency department were that the child’s health had deteriorated (24.1%), the child required further tests (23.8%), and the child had developed a different health condition (18.7%). During the first visit to the pediatric emergency department, parents most frequently wished to be allowed to be with the child (24.2%), to touch the child during the procedures (20.5%), to receive up-to-date information about the child’s condition (20.2%).</div></div><div><h3>Conclusions</h3><div>In line with these results, it is thought that the frequency of unplanned return visits to pediatric emergency departments can be reduced by implementing adequate, accurate and effective planned discharge training in pediatric emergency departments. Pediatric emergency nurses can benefit from the perspectives of parents in their professional practices to improve the quality of care and reduce the number of unplanned return visits to the emergency department.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"78 ","pages":"Article 101568"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957190","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}

{"title":"“I want him to know that I’m on his side…” understanding the nature of suicide care from the perspectives of emergency department nurses","authors":"Figen Şengün İnan ,&nbsp;Erkan Ünsal ,&nbsp;Tuğba Bolak","doi":"10.1016/j.ienj.2024.101563","DOIUrl":"10.1016/j.ienj.2024.101563","url":null,"abstract":"<div><h3>Introduction</h3><div>This study was aimed at understanding emergency department (ED) nurses’ experiences of caring for people who attempted suicide. ED nurses provide care to a great number of patients who have attempted suicide. EDs are accepted as an important environment to prevent repeat suicidal behavior and the importance of initiating interventions to prevent repeated attempts is emphasized.</div></div><div><h3>Method</h3><div>This study was a descriptive qualitative study. The study was conducted with 15 ED nurses who provided care to individuals who attempted suicide in two university hospitals in Turkey. Data were collected through face-to-face, semi-structured in-depth interviews. The data were analyzed using content analysis. Consolidated criteria for reporting qualitative studies (COREQ) were used to ensure the comprehensive reporting of this qualitative study protocol.</div></div><div><h3>Results</h3><div>The data were categorized under the following four themes: elements of current care, barriers to effective care, dimensions that should be improved in providing care, and needs.</div></div><div><h3>Conclusion</h3><div>Biomedical approaches constitute the basic elements of nurses’ care provided to a suicidal patient, and nurses have difficulty in providing emotional support. Caring for a suicidal patient creates an emotional burden for nurses. Nurses stated that they were faced with barriers related to emotional burden, stigma, lack of time, knowledge gaps, and unsuitable physical environment.</div></div>","PeriodicalId":48914,"journal":{"name":"International Emergency Nursing","volume":"78 ","pages":"Article 101563"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872639","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}