Journal of Hospice & Palliative Nursing最新文献_第3页

Clinical Recommendations for Improving Palliative Nursing Care for Patients With a Left Ventricular Assist Device. 改善左心室辅助装置患者姑息护理的临床建议。

IF 1.2 4区医学

Journal of Hospice & Palliative Nursing Pub Date : 2024-08-01 Epub Date: 2024-06-08 DOI: 10.1097/NJH.0000000000001039

Pierce K DiMauro

引用次数: 0

Community-Based Palliative Care: An APRN-Led Embedded Model for Advanced Lung Disease. 社区姑息关怀：以全科护士为主导的晚期肺病嵌入式模式。

IF 1.2 4区医学

Journal of Hospice & Palliative Nursing Pub Date : 2024-08-01 Epub Date: 2024-06-15 DOI: 10.1097/NJH.0000000000001041

Tracy Fasolino, Wayne Hollinger, Ahmad Boota, Cindy M Steeves

{"title":"Community-Based Palliative Care: An APRN-Led Embedded Model for Advanced Lung Disease.","authors":"Tracy Fasolino, Wayne Hollinger, Ahmad Boota, Cindy M Steeves","doi":"10.1097/NJH.0000000000001041","DOIUrl":"10.1097/NJH.0000000000001041","url":null,"abstract":"Community-based palliative care (CBPC) models address the growing needs of patients and caregivers with chronic and serious illnesses. From pediatrics to geriatrics, individuals prefer to receive care within their local community and at home. Delivering care at the community level and within the home improves health outcomes, reduces disparities, and supports local economic activity. Various models of CBPC have developed through partnerships with existing services, such as home health agencies, but ongoing challenges and barriers exist for further expansion of specialty palliative care. Advanced practice registered nurses increasingly manage chronic and serious illnesses and are essential for all health care teams, particularly for CBPC. As trusted providers within the community, advanced practice registered nurses create lasting relationships that allow for meaningful exchanges with patients and caregivers. This article reviewed the concept and features of CBPC offered within the United States and describes an advanced practice registered nurse-led embedded palliative care program for advanced lung disease.","PeriodicalId":54807,"journal":{"name":"Journal of Hospice & Palliative Nursing","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421843","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 Nurse Practitioner-Driven Palliative and Supportive Care Service in Nursing Homes: Evaluation of a Quality Improvement Project. 护理院中由执业护士驱动的姑息治疗和支持性护理服务：质量改进项目评估。

IF 1.2 4区医学

Journal of Hospice & Palliative Nursing Pub Date : 2024-08-01 Epub Date: 2024-03-25 DOI: 10.1097/NJH.0000000000001028

Joan G Carpenter, Julianne Murthi, Molly Langford, Ruth Palan Lopez

{"title":"A Nurse Practitioner-Driven Palliative and Supportive Care Service in Nursing Homes: Evaluation of a Quality Improvement Project.","authors":"Joan G Carpenter, Julianne Murthi, Molly Langford, Ruth Palan Lopez","doi":"10.1097/NJH.0000000000001028","DOIUrl":"10.1097/NJH.0000000000001028","url":null,"abstract":"This article describes a quality improvement project implemented by a national postacute long-term care organization aimed at enhancing the provision of palliative care to nursing home residents. The project focused on improving advance care planning, end-of-life care, symptom management, and care of people living with serious illness. Both generalist and specialist palliative care training were provided to nurse practitioners in addition to implementing a system to identify residents most likely to benefit from a palliative approach to care. To evaluate the nurse practitioner experiences of the program, survey data were collected from nurse practitioners (N = 7) involved in the project at 5 months after implementation. Nurse practitioners reported the program was well received by nursing home staff, families, and residents. Most nurse practitioners felt more confident managing residents' symptoms and complex care needs; however, some reported needing additional resources for palliative care delivery. Most common symptoms that were managed included pain, delirium, and dyspnea; most common diagnoses cared for were dementia and chronic organ failure (eg, cardiac, lung, renal, and neurological diseases). In the next steps, the project will be expanded throughout the organization, and person- and family-centered outcomes will be evaluated.","PeriodicalId":54807,"journal":{"name":"Journal of Hospice & Palliative Nursing","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11233246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140289687","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}

引用次数: 0

Instituting a Palliative Care Trigger in a Surgical Intensive Care Unit (SICU): Survey Results of SICU Team Members. 在外科重症监护病房（SICU）设立姑息关怀触发点：SICU 团队成员调查结果。

IF 1.2 4区医学

Journal of Hospice & Palliative Nursing Pub Date : 2024-08-01 Epub Date: 2024-04-15 DOI: 10.1097/NJH.0000000000001026

Michelle A McKay, Shawn Mangan, Eleanor Fitzpatrick, Holden Caplan, Gillian Love, Joshua A Marks, John Liantonio

{"title":"Instituting a Palliative Care Trigger in a Surgical Intensive Care Unit (SICU): Survey Results of SICU Team Members.","authors":"Michelle A McKay, Shawn Mangan, Eleanor Fitzpatrick, Holden Caplan, Gillian Love, Joshua A Marks, John Liantonio","doi":"10.1097/NJH.0000000000001026","DOIUrl":"10.1097/NJH.0000000000001026","url":null,"abstract":"Increasing palliative care presence in the intensive care unit (ICU) improves symptom management, increases goals-of-care discussion, and reduces unnecessary procedures in ICU patients. An interdisciplinary study team developed a palliative care trigger program in a 17-bed surgical ICU (SICU). Surgical ICU patients who met 3 triggers (ICU length of stay > 10 days, repeat ICU admission, and metastatic cancer) automatically received a palliative care consult. The purpose of the current study was to survey SICU health care professionals before and after the institution of the palliative care trigger program. Overall, the palliative care trigger program was viewed positively by interdisciplinary team members with increased team communication and decreased resistance for the inclusion of palliative care in the SICU plan of care. The palliative care trigger program was successfully developed and implemented in a SICU and was accepted by the interdisciplinary team members caring for SICU patients. Team member feedback is being used to expand the palliative care trigger program to improve care for SICU patients.","PeriodicalId":54807,"journal":{"name":"Journal of Hospice & Palliative Nursing","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140861667","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

Nurses' knowledge, Practice, and Associated Factors Towards Adult Palliative Care: A Cross-sectional Study. 护士对成人姑息治疗的认识、实践及相关因素：横断面研究。

IF 1.2 4区医学

Journal of Hospice & Palliative Nursing Pub Date : 2024-08-01 Epub Date: 2024-05-03 DOI: 10.1097/NJH.0000000000001035

Ayele Agena, Bizuayehu Atinafu Ataro, Eshetu Elfios Endrias, Belete Birhan, Yacob Abriham Borie, Gezahegn Bekele, Ezedin Molla, Tinbete Samuel, Tomas Yeheyis, Ayantu Melesse, Debora Banga

{"title":"Nurses' knowledge, Practice, and Associated Factors Towards Adult Palliative Care: A Cross-sectional Study.","authors":"Ayele Agena, Bizuayehu Atinafu Ataro, Eshetu Elfios Endrias, Belete Birhan, Yacob Abriham Borie, Gezahegn Bekele, Ezedin Molla, Tinbete Samuel, Tomas Yeheyis, Ayantu Melesse, Debora Banga","doi":"10.1097/NJH.0000000000001035","DOIUrl":"10.1097/NJH.0000000000001035","url":null,"abstract":"The demand for palliative care is increasing rapidly, but inadequate knowledge and practice remain a significant issue. This study aimed to assess nurses' knowledge, practice, and associated factors toward adult palliative care. A cross-sectional study was conducted including 277 randomly selected nurses from May through September 2021. The data related to knowledge were gathered using the Palliative Care Quiz for Nursing, and an observational checklist to assess the practice was used. EpiData and SPSS software were used for data entry and analysis, respectively. Descriptive statistics and bivariable and multivariable analyses were also applied. Depending on the value of the adjusted odds ratio with a 95% confidence level, statistical significance was declared at a P value of .05. Findings showed that 43.2% and 47% of nurses had good knowledge and practice in palliative care, respectively. The odds of trained nurses having good knowledge were 9.65 times higher than those who did not. There were 2.7 times more odds of practicing palliative care among nurses with good knowledge than those with poor knowledge. Overall, over half of the nurses have poor knowledge and practice in palliative care. To enhance their knowledge and practice, formal palliative care education and training will be beneficial.","PeriodicalId":54807,"journal":{"name":"Journal of Hospice & Palliative Nursing","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140877879","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

Dyspnea and Palliative Care in Advanced Chronic Obstructive Pulmonary Disease: A Rapid Review. 晚期慢性阻塞性肺病中的呼吸困难和姑息治疗：快速回顾。

IF 1.2 4区医学

Journal of Hospice & Palliative Nursing Pub Date : 2024-08-01 Epub Date: 2024-06-19 DOI: 10.1097/NJH.0000000000001042

Sarah N Miller, Elizabeth Higgins, Joan Cain, Patrick Coyne, Robert Peacock, Ayaba Logan, Tracy Fasolino, Kathleen Oare Lindell

{"title":"Dyspnea and Palliative Care in Advanced Chronic Obstructive Pulmonary Disease: A Rapid Review.","authors":"Sarah N Miller, Elizabeth Higgins, Joan Cain, Patrick Coyne, Robert Peacock, Ayaba Logan, Tracy Fasolino, Kathleen Oare Lindell","doi":"10.1097/NJH.0000000000001042","DOIUrl":"10.1097/NJH.0000000000001042","url":null,"abstract":"Dyspnea is the most common and activity-limiting symptom for those with chronic obstructive pulmonary disease (COPD). Treatment is complex, palliative care (PC) dyspnea relief interventions are poorly understood, and PC remains underutilized in COPD despite national guidelines and recommendations. The purpose of this rapid review was to explore the concept of dyspnea and role of PC through the lens of providers, caregivers, and patients with COPD. A systematic approach for synthesis was used to identify 13 articles published between January 2018 and October 2023. Team members compared data via visualization and theme clustering to identify key conclusions describing operationalization of dyspnea, management, and PC implications. Dyspnea operationalization was challenging, with inconsistent measurement and terminology. Dyspnea was a significant burden in COPD and contributed to complexity of treatment. Opioids were used most often to treat dyspnea, but provider perspectives and biases can influence treatment decisions and perceptions of opioid therapy by the patient and caregiver. Evidence-based clinical practice guidelines and policies are needed to clarify the use of opioid therapy for dyspnea management to reduce stigmatization and barriers to treatment. Provider education should emphasize a multipronged approach to treatment of dyspnea in COPD with integration of PC early in the care continuum.","PeriodicalId":54807,"journal":{"name":"Journal of Hospice & Palliative Nursing","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141433406","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

My Partner Is My Family: Engaging and Advocating for Lesbian, Gay, Bisexual, Transgender, Queer+ Patients in Goals of Care Conversations. 我的伴侣就是我的家人：让女同性恋、男同性恋、双性恋、变性人和同性恋+患者参与到护理目标对话中并为他们进行宣传。

IF 1.2 4区医学

Journal of Hospice & Palliative Nursing Pub Date : 2024-08-01 Epub Date: 2024-04-26 DOI: 10.1097/NJH.0000000000001030

Korijna Valenti, Katherine Doyon, Brianne Morgan, Gwendolyn Quinn, David Bekelman

{"title":"My Partner Is My Family: Engaging and Advocating for Lesbian, Gay, Bisexual, Transgender, Queer+ Patients in Goals of Care Conversations.","authors":"Korijna Valenti, Katherine Doyon, Brianne Morgan, Gwendolyn Quinn, David Bekelman","doi":"10.1097/NJH.0000000000001030","DOIUrl":"10.1097/NJH.0000000000001030","url":null,"abstract":"In goals of care conversations and through the care trajectory, to avoid insensitive or discriminatory care, it is vital clinicians recognize lesbian, gay, bisexual, transgender, queer+ patients' values and wishes. In clinical settings, implicit bias operating within unconscious awareness may challenge the commitment to equitable care, negatively affecting patient outcomes. In this composite case, during a conversation with a social worker/nurse team, a cisgender woman repeatedly expressed her wishes for her female partner to be her decision maker instead of her biological family. The conversation stalled during the patient's attempts to identify her partner as her most valued and trusted person. Interviewer follow-up responses based on motivational interviewing techniques, which do not include strategies for lesbian, gay, bisexual, transgender, queer+ interactions, inaccurately reflected the patient's needs. Two ethical issues emerged, (1) autonomy and (2) beneficence. Clinicians should approach all patients using nongendered language, and allow patients to self-identify and decide which people are in their support system. Lack of inclusivity training has significant potential to affect the patient experience and decrease clinician/patient trust. Clinicians should not assume the decision maker is a cisgender, heterosexual partner or a biological family member. When patients speak about their partners, it is imperative clinicians use the patient's language and not avoid or redirect responses.","PeriodicalId":54807,"journal":{"name":"Journal of Hospice & Palliative Nursing","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140873855","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

Exploring Holistic Cancer Care and Survivorship in India Through the Kerala Model of Palliative Care: Role of Community Nurse and Outpatient Meetings. 通过喀拉拉邦姑息治疗模式探索印度的整体癌症护理和生存期：社区护士和门诊会议的作用。

IF 1.2 4区医学

Journal of Hospice & Palliative Nursing Pub Date : 2024-08-01 Epub Date: 2024-05-09 DOI: 10.1097/NJH.0000000000001036

Prema Naittee George, M P Ganesh

{"title":"Exploring Holistic Cancer Care and Survivorship in India Through the Kerala Model of Palliative Care: Role of Community Nurse and Outpatient Meetings.","authors":"Prema Naittee George, M P Ganesh","doi":"10.1097/NJH.0000000000001036","DOIUrl":"10.1097/NJH.0000000000001036","url":null,"abstract":"Support groups and meetings are self-help gatherings that provide a unique sense of community, unconditional acceptance, and information on cancer and its treatment. This cross-sectional study examined 12 outpatient meetings within the Kerala model of palliative care, a community-based service provided to patients irrespective of disease, stage, or prognosis starting from the time of diagnosis. The study focused on the pivotal role of community nurses in facilitating these meetings, with participants including cancer patients and survivors. Using in-depth interviews (n = 52) and participant observations, this research used a qualitative approach and explored the dynamics and outcomes of outpatient meetings. Findings highlight the indispensable contributions of these community nurses serving as linchpins in providing support, guiding discussions, and offering crucial education. Outpatient meetings effectively addressed psychosocial concerns, combatted stigmas associated with cancer, and promoted informed decision making in cancer care. The study emphasizes the need for recognizing the role played by community nurses in improving psychosocial support and diminishing stigma, and ultimately the quality of life of patients and survivors through the palliative cancer care within the Kerala model. We also underscore the need for policy initiatives, resource allocation, and training programs tailored to support these frontline health care providers effectively.","PeriodicalId":54807,"journal":{"name":"Journal of Hospice & Palliative Nursing","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140900288","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

An Age Group Comparison of Concurrent Hospice Care: A Cost-Effectiveness Analysis. 同时提供安宁疗护的年龄组比较：成本效益分析

IF 1.2 4区医学

Journal of Hospice & Palliative Nursing Pub Date : 2024-08-01 Epub Date: 2024-05-14 DOI: 10.1097/NJH.0000000000001037

Radion Svynarenko, Melanie J Cozad, Lisa C Lindley

{"title":"An Age Group Comparison of Concurrent Hospice Care: A Cost-Effectiveness Analysis.","authors":"Radion Svynarenko, Melanie J Cozad, Lisa C Lindley","doi":"10.1097/NJH.0000000000001037","DOIUrl":"10.1097/NJH.0000000000001037","url":null,"abstract":"This study aimed to examine the cost-effectiveness of concurrent hospice care compared with standard care among pediatric patients of different age groups. Using a national Medicaid database of 18 152 pediatric patients enrolled in hospice care between 2011 and 2013, this study calculated and analyzed incremental cost-effectiveness ratios (ICERs) for concurrent care versus standard hospice care for children of 4 age categories: <1 year, 1 to 5 years, 6 to 14 years, and 15 to 20 years. The results indicated that the total Medicaid cost of hospice care was $3229 per patient per month (PPPM; SD, $8709) for those younger than 1 year, $4793 PPPM (SD, $8178) for those aged 1 to 5 years, $5411 PPPM (SD, $7456) for those aged 6 to 14 years, and $5625 PPPM (SD, $11459) for those aged 15 to 20 years. Incremental cost-effectiveness ratio values across all age groups showed that children enrolled in concurrent care had fewer live discharges but at a higher Medicaid cost of care as compared with those enrolled in standard hospice care. Concurrent hospice care was the most cost-effective in the age groups of <1 year and 1 to 5 years, with ICERs equal to $45 (95% confidence interval [CI], $23-$66) and $49 (95% CI, $8-$76), respectively. For the other older age groups, benefits of enrollment in concurrent care came at a much higher cost: in the age group of 6 to 14 years, ICER was equal to $217 (95% CI, $129-$217), and in the age group of 15 to 20 years, it was $107 (95% CI, $82-$183). Concurrent hospice is an effective way to reduce live discharges but has a higher total Medicaid cost than standard hospice care.","PeriodicalId":54807,"journal":{"name":"Journal of Hospice & Palliative Nursing","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11233226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946420","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}

引用次数: 0

An Evolutionary Concept Analysis of the "Fighter" in the Intensive Care Unit. 重症监护室 "战斗机 "的演变概念分析。

IF 1.8 4区医学

Journal of Hospice & Palliative Nursing Pub Date : 2024-06-01 Epub Date: 2024-02-09 DOI: 10.1097/NJH.0000000000001017

Laura Tycon Moreines, Abraham A Brody, Komal Patel Murali

{"title":"An Evolutionary Concept Analysis of the \"Fighter\" in the Intensive Care Unit.","authors":"Laura Tycon Moreines, Abraham A Brody, Komal Patel Murali","doi":"10.1097/NJH.0000000000001017","DOIUrl":"10.1097/NJH.0000000000001017","url":null,"abstract":"The purpose of this article was to analyze the concept of \"the fighter in the intensive care unit (ICU)\" per the scientific literature and the impact this mentality has on care administered in the ICU. A literature review and a concept analysis based on Rodger's evolutionary method were performed to identify surrogate terms, antecedents, attributes, and consequences pertaining to the \"fighter\" in the ICU. Thirteen articles with a focus on \"the fighter\" were included in this analysis. There is a strong desire to remain optimistic and maintain high spirits as a coping mechanism in the face of extreme prognostic uncertainty. Themes that emerged from the literature were the need to find inner strength and persist in the face of adversity. The concept of \"the fighter in the ICU\" can serve as either adaptive or maladaptive coping, depending on the larger clinical picture. Patient experiences in the ICU are fraught with physical and psychological distress. How the patient and family unit cope during this anxiety-provoking time is based on the individual. Maintaining optimism and identifying as a fighter can be healthy ways to adapt to the circumstances. This concept analysis highlights the importance of holistic care and instilling hope particularly as patients may be nearing the end of life.","PeriodicalId":54807,"journal":{"name":"Journal of Hospice & Palliative Nursing","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139725063","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