跳到主要內容

臺灣博碩士論文加值系統

(18.97.14.91) 您好!臺灣時間:2025/02/19 18:57
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

我願授權國圖
: 
twitterline
研究生:官佳葳
研究生(外文):KUAN, CHIA-WEI
論文名稱:安寧緩和就醫提問單的發展與前驅測試
論文名稱(外文):Development and Pilot-test of a Question Prompt List for Hospice Palliative Care
指導教授:魏米秀魏米秀引用關係
指導教授(外文):WEI, MI-HSIU
口試委員:林季緯謝至鎠
口試委員(外文):LIN, CHI-WEIHSIEH, JYH-GANG
口試日期:2023-05-03
學位類別:碩士
校院名稱:慈濟大學
系所名稱:傳播學系碩士班
學門:教育學門
學類:其他教育學類
論文種類:學術論文
論文出版年:2023
畢業學年度:111
語文別:中文
論文頁數:99
中文關鍵詞:安寧緩和就醫提問單醫病溝通以病人為中心健康識能
外文關鍵詞:hospice palliative carequestion prompt listphysician-patient communicationpatient-centerednesshealth literacy
相關次數:
  • 被引用被引用:0
  • 點閱點閱:110
  • 評分評分:
  • 下載下載:4
  • 收藏至我的研究室書目清單書目收藏:0
進入到安寧緩和醫療的病人和家屬通常會有許多的疑問,但有許多的因素導致他們不知道如何向醫療人員討論。就醫提問單(以下簡稱QPL),是個簡便有效的溝通工具,可以協助病人、家屬和醫療人員促進討論。本研究旨在發展適用於安寧緩和情境下的QPL,並進行前驅測試瞭解病人或家屬使用成效。
研究方法採用混合研究法,共分成二階段,第一階段向4位家屬和6位醫療人員進行半結構式個別訪談與焦點團體訪談,確認適合納入QPL草稿的問題,再由相關領域專家進行審查,確認安寧緩和提問單內容,共7個類別、26個問題。第二階段於2022年12月至2023年3月在東部某醫院之安寧病房以方便取樣招募23位病人和家屬,進行QPL介入單組前後測前驅測試。以無母數統計方法進行統計檢定。
研究結果顯示在使用QPL後,安寧緩和自覺瞭解度(p=.001)、與醫療人員互動自我效能(p=0.18)、以病人為中心之照護感受(p=.037)和前測相比有提升者顯著比未提升者多;決策控制偏好在QPL使用前後沒有分佈上的差異。病人和家屬對使用QPL的感受,量性問卷結果對QPL的感受是相當正向的(M=4.33; SD=0.53);質性部分,病人和家屬指出使用QPL能幫助他們減少不安的情緒、提供思考提問的方向、讓其更認識安寧緩和。
QPL的介入提升了病人和家屬對安寧緩和的瞭解度、與醫療人員的溝通自我效能、以病人為中心的感知,並可讓病人和家屬更加瞭解自己的狀況,主動向醫療人員提出關心的議題,故在臨床實務上可使用QPL做為安寧緩和中醫病溝通的輔助工具,協肋病人和家屬在醫療過程中參與的主動性。建議未來可以針對QPL的使用成效做進一步研究。

Question Prompt List (QPL) is a simple and effective communication tool that can assist patients and family members in discussions with healthcare professionals. Patients and family members usually have many questions when they get into hospice palliative care (PC) but may not know how to discuss them with healthcare professionals. This study aimed to develop a QPL for palliative care and conduct a pilot test to determine its effectiveness and perceived usability from the patients and family members.
A mixed-methods design was used in this study, consisting of two phases. In the first phase, semi-structured individual interviews with four family members and focus group interviews with six healthcare professionals were conducted to confirm appropriate questions to include in the QPL draft. The content of the QPL, consisting of 7 categories and 26 questions, was then reviewed by relevant discipline experts. The second phase was a pre-post test of the QPL intervention pilot study conducted from December 2022 to March 2023. Twenty-three patients and family carers were recruited through convenience sampling from the palliative care unit of a hospital in Hualien.
The results showed that after using the QPL, there was a significant improvement in patients' and family carers' perceived understanding of palliative care (p=.001), perceived efficacy in physician patient interactions (p=0.18), and perceived patient-centered care (p=.037) compared to pre-test, all of which reached statistical significance. There was no difference in the control preference role before and after using the QPL. Patients and family carers agreed that the QPL was helpful for them (M=4.33; SD=0.53). Most participants felt that using QPL helped them to reduce their anxiety, provide an overview and prepare for what was ahead, and improve their understanding of palliative care.
The QPL intervention can improve patients' and family carers' understanding of palliative care, communication self-efficacy with healthcare professionals, and patient-centered perception. It can also help patients and family carers better understand their own conditions and proactively raise concerns with healthcare professionals. Therefore, in clinical practice, QPL can be a supportive communication tool for patients and healthcare professionals in palliative care, facilitating patient and family involvement in the healthcare process. Future research is needed for its effectiveness and adoption.
中文摘要 i
英文摘要 ii
目錄 iv
圖目錄 vi
表目錄 vii
第一章 緒論 1
第一節 研究背景和動機 1
第二節 研究目的 2
第二章 文獻探討 4
第一節 安寧緩和醫療 4
第二節 民眾在安寧緩和醫療中可能的困難 5
第三節 就醫提問單 10
第四節 就醫提問單在安寧緩和臨床醫療的應用 14
第三章 研究方法 29
第一節 研究架構 29
第二節 研究步驟 30
第三節 發展安寧緩和提問單 30
第四節 安寧緩和提問單介入測試 34
第四章 研究結果 42
第一節 安寧緩和提問單發展 42
第二節 安寧緩和提問單介入測試 49
第五章 討論與結論 68
第一節 討論 68
第二節 研究限制 71
第三節 建議 71
第四節 結論 72
參考文獻 73
附錄 80
附錄一、安寧緩和提問單草稿內容 80
附錄二、專家效度名單 82
附錄三、前測問卷 83
附錄四、後測問卷 89
附件五、研究計畫許可書 95
附件六、研究計畫變更許可書 97
附錄七、安寧緩和提問單三折頁 98


古慧仙、古慧嬋、張彩秀(2007)。影響門診病患就醫忠誠度之相關因素探討。澄清醫護管理雜誌,3(1),36-45。https://doi.org/10.30156/ccmj.200701.0006
台灣安寧照顧基金會(2020)。安寧30愛不止息 30週年紀念特刊。安寧照顧會訊,98。
台灣安寧照顧基金會 (2022)。安寧療護的創設。https://www.hospice.org.tw/care
朱昭美、劉嘉仁、黃勝堅、翁林仲、陳淑廷、吳美慧、林軒璋、陳佩琳、黃遵誠(2015)。醫院員工社區安寧療護教育訓練之成效。北市醫學雜誌,12,86-108。https://doi.org/10.6200/tcmj.2015.12.Sp.09
李欣慈、鄭淑貞、黃川芳、吳郁梅、胡文郁(2015)。華人儒、釋、道文化觀點探討台灣護理之家老年住民簽署自身預立醫療指示文件的現況與困境。安寧療護雜誌,20(2),154-165。https://doi.org/10.6537/tjhpc.2015.20(2).5
李隆軍、胡中傑、黃曉峰、林鉅勝、張瑛瑛(2011)。癌症末期病人安寧居家的主要照顧議題分析。安寧療護雜誌,16(2),151-167。https://doi.org/10.6537/tjhpc.2011.16(2).2
林本炫(2007)。不同質性方法的資料分析比較。周平、楊弘編,質性研究方法的眾聲喧嘩。南華教社所。
林家穗、王枝燦、賴維淑(2020)。華人傳統文化對國人善終選擇之影響。安寧療護雜誌,24(1),1-16。https://doi.org/10.6537/tjhpc.202003_24(1).01
林維君、黃文聰、廖純真、謝玉娟、邱智鈴、夏德瑛、曹朝榮(2003)。安寧病房中家屬照顧者的資訊需求。安寧療護雜誌,8(2),161-174。https://doi.org/10.6537/tjhpc.2003.8(2).4
姚建安、邱泰源、陳慶餘、吳英璋、林瑞雄(2003)。緩和醫療住院病人主要家屬照顧者的訊息需求與滿意度的研究。安寧療護雜誌,8(3),270-282。https://doi.org/10.6537/tjhpc.2003.8(3).3
洪小涵、邱玉蟬(2011)。民眾溝通特質與策略對醫師滿意與信任的影響。台灣公共衛生雜誌,30(6),582-593。https://doi.org/10.6288/TJPH2011-30-06-08
胡文郁、邱泰源、莊榮彬、陳慶餘、戴玉慈、陳月枝(1999)。居家緩和醫療家庭主要照顧者之需求與滿意度。台灣醫學雜誌,3(5),527-537。https://doi.org/10.6320/fjm.1999.3(5).04
胡幗英(2021)。探索主要家屬照護者對末期病人選擇安寧療護之經驗及決策過程 [未出版之碩士論文]。國立臺灣師範大學社會工作學研究所,台北市。取自https://hdl.handle.net/11296/2u3tuf。
張美娟、魏米秀、謝至鎠(2017)。健康識能友善教材評估指標使用指引。衛生福利部國民健康署。 https://health99.hpa.gov.tw/m3302
陳貞秀、劉滄梧、蔡來蔭、劉憶萍、徐翠霞、唐秀治(2006)。台灣非安寧照顧下末期癌症疼痛處置的適當性。中華民國癌症醫學會雜誌,22(1),1-29。https://doi.org/10.6588/jcos.2006.22.1.1
陳殷正、劉郁孚、蔡蕙珊、林玉書、范建得(2016)。安寧緩和醫療條例回顧與探討。醫學與健康期刊,5(1),25-34。
黃惠美、郭碧照、胡中傑、謝玉玲、黃曉峰(2005)。台中某社區民眾之安寧療護知識及其影響因素。安寧療護雜誌,10(4),371-383。https://doi.org/10.6537/tjhpc.2005.10(4).5
楊美玲、林佳靜、陳靜敏(2002)。居家安寧療護家屬主要照顧者照顧經驗之探討。志為護理-慈濟護理雜誌,1(3),48-56。https://doi.org/10.6974/tcnj.200209.0048
萬宣慶、周盈邑、張冠民、董鈺琪(2020)。癌症與非癌生命末期病人使用安寧療護對照護利用及費用的影響。台灣公共衛生雜誌,39(2),187-201。https://doi.org/10.6288/tjph.202004_39(2).108073
熊誼芳、賴允亮、蘇韋如(2014)。邁向安寧緩和醫療的新一頁。生命教育研究,6(2),99-118。https://doi.org/10.3966/207466012014120602004
趙可式(2009)。台灣安寧療護的發展與前瞻。護理雜誌,56(1),5-10。https://doi.org/10.6224/jn.56.1.5
劉梅英、李淑慧、王昭慧、劉雪娥(2021)。癌末接受「安寧緩和共同照護」病人之症狀與照顧措施的探討。護理雜誌,68(6),32-42。https://doi.org/10.6224/jn.202112_68(6).06
劉梅英、劉雪娥、王宏銘、蔡培癸、簡淑慧、林怡欣(2015)。安寧共同照顧模式對改善癌末主要照顧家屬照顧負荷之成效。Journal of Nursing & Healthcare Research,11(4),257-266。https://doi.org/10.6225/JNHR.11.4.257
衛生福利部(2021)。109年死因統計結果。https://www.mohw.gov.tw/cp-5017-61533-1.html
賴允亮(2004)。台灣之安寧緩和醫療。台灣醫學,8(5),653-656。https://doi.org/10.6320/fjm.2004.8(5).07
謝至鎠、王淑貞、王英偉(2013)。符合社區民眾預立醫療自主計劃文化觀點之介入模式-台灣花蓮地區之經驗。安寧療護雜誌,18(1),1-13。https://doi.org/10.6537/tjhpc.2013.18(1).1
魏米秀、王英偉、張美娟、謝至鎠(2017)。中文多面向健康識能量表(MMHLQ)之發展。台灣公共衛生雜誌,36(6),556-570。https://doi.org/10.6288/tjph201736106061
魏米秀、王英偉、張美娟、謝至鎠(2020a)。健康識能與就醫提問單。醫療品質雜誌,14(4),8-11。https://doi.org/10.3966/199457952020071404002
魏米秀、王英偉、張美娟、謝至鎠(2020b)。就醫提問單:促進醫病溝通的工具。台灣家庭醫學雜誌,30(4),185-195。https://doi.org/10.3966/168232812020123004001
Arthur, J., Yennu, S., Zapata, K. P., Cantu, H., Wu, J., Liu, D., & Bruera, E. (2017). Perception of helpfulness of a question prompt sheet among cancer patients attending outpatient palliative care. J Pain Symptom Manage, 53(1), 124-130.e121. https://doi.org/10.1016/j.jpainsymman.2016.08.017
Arthur, J., Yennurajalingam, S., Williams, J., Tanco, K., Liu, D., Stephen, S., & Bruera, E. (2016). Development of a question prompt sheet for cancer patients receiving outpatient palliative care. J Palliat Med, 19(8), 883-887. https://doi.org/10.1089/jpm.2015.0545
Back, A. L. (2020). Patient-clinician communication issues in palliative care for patients with advanced cancer. J Clin Oncol, 38(9), 866-876. https://doi.org/10.1200/jco.19.00128
Bavelaar, L., Nicula, M., Morris, S., Kaasalainen, S., Achterberg, W. P., Loucka, M., Vlckova, K., Thompson, G., Cornally, N., Hartigan, I., Harding, A., Preston, N., Walshe, C., Cousins, E., Dening, K. H., De Vries, K., Brazil, K., & van der Steen, J. T. (2021). Developing country-specific questions about end-of-life care for nursing home residents with advanced dementia using the nominal group technique with family caregivers. Patient Education and Counseling, 105(4), 965-973. https://doi.org/https://doi.org/10.1016/j.pec.2021.07.031
Bouleuc, C., Savignoni, A., Chevrier, M., Renault-Tessier, E., Burnod, A., Chvetzoff, G., Poulain, P., Copel, L., Cottu, P., Pierga, J. Y., Brédart, A., & Dolbeault, S. (2021). A question prompt list for advanced cancer patients promoting advance care planning: a French randomized trial. J Pain Symptom Manage, 61(2), 331-341.e338. https://doi.org/10.1016/j.jpainsymman.2020.07.026
Clayton, J. M., Butow, P., Tattersall, M., Chye, R., Noel, M., Davis, J. M., & Glare, P. (2003). Asking questions can help: development and preliminary evaluation of a question prompt list for palliative care patients. Br J Cancer, 89(11), 2069-2077. https://doi.org/10.1038/sj.bjc.6601380
Clayton, J. M., Butow, P. N., Tattersall, M. H., Devine, R. J., Simpson, J. M., Aggarwal, G., Clark, K. J., Currow, D. C., Elliott, L. M., Lacey, J., Lee, P. G., & Noel, M. A. (2007). Randomized controlled trial of a prompt list to help advanced cancer patients and their caregivers to ask questions about prognosis and end-of-life care. J Clin Oncol, 25(6), 715-723. https://doi.org/10.1200/jco.2006.06.7827
Degner, L. F., Sloan, J. A., & Venkatesh, P. (1997). The control preferences scale. Can J Nurs Res, 29(3), 21-43.
Dimoska, A., Tattersall, M. H. N., Butow, P. N., Shepherd, H., & Kinnersley, P. (2008). Can a "prompt list" empower cancer patients to ask relevant questions? Cancer, 113(2), 225-237. https://doi.org/10.1002/cncr.23543
Eggly, S., Hamel, L. M., Foster, T. S., Albrecht, T. L., Chapman, R., Harper, F. W. K., Thompson, H., Griggs, J. J., Gonzalez, R., Berry-Bobovski, L., Tkatch, R., Simon, M., Shields, A., Gadgeel, S., Loutfi, R., Ali, H., Wollner, I., & Penner, L. A. (2017). Randomized trial of a question prompt list to increase patient active participation during interactions with black patients and their oncologists. Patient Education and Counseling, 100(5), 818-826. https://doi.org/https://doi.org/10.1016/j.pec.2016.12.026
Faller, H., Koch, U., Brähler, E., Härter, M., Keller, M., Schulz, H., Wegscheider, K., Weis, J., Boehncke, A., Hund, B., Reuter, K., Richard, M., Sehner, S., Szalai, C., Wittchen, H. U., & Mehnert, A. (2016). Satisfaction with information and unmet information needs in men and women with cancer. J Cancer Surviv, 10(1), 62-70. https://doi.org/10.1007/s11764-015-0451-1
Hebert, R. S., Schulz, R., Copeland, V. C., & Arnold, R. M. (2009). Pilot testing of a question prompt sheet to encourage family caregivers of cancer patients and physicians to discuss end-of-life issues. Am J Hosp Palliat Care, 26(1), 24-32. https://doi.org/10.1177/1049909108324360
Henselmans, I., Brugel, S. D., de Haes, H. C. J. M., Wolvetang, K. J. A., de Vries, L. M., Pieterse, A. H., Baas-Thijssen, M. C. M., de Vos, F. Y. F., van Laarhoven, H. W. M., & Smets, E. M. A. (2019). Promoting shared decision making in advanced cancer: development and piloting of a patient communication aid. Patient Educ Couns, 102(5), 916-923. https://doi.org/10.1016/j.pec.2018.12.018
Holmström, I., & Röing, M. (2010). The relation between patient-centeredness and patient empowerment: a discussion on concepts. Patient Educ Couns, 79(2), 167-172. https://doi.org/10.1016/j.pec.2009.08.008
Institute of Medicine. (2004). Health literacy: a prescription to end confusion. The National Academies Press. https://doi.org/10.17226/10883
Janz, N. K., Wren, P. A., Copeland, L. A., Lowery, J. C., Goldfarb, S. L., & Wilkins, E. G. (2004). Patient-physician concordance: preferences, perceptions, and factors influencing the breast cancer surgical decision. J Clin Oncol, 22(15), 3091-3098. https://doi.org/10.1200/jco.2004.09.069
Katz, M. G., Jacobson, T. A., Veledar, E., & Kripalani, S. (2007). Patient literacy and question-asking behavior during the medical encounter: a mixed-methods analysis. J Gen Intern Med, 22(6), 782-786. https://doi.org/10.1007/s11606-007-0184-6
Langbecker, D., Janda, M., & Yates, P. (2012). Development and piloting of a brain tumour-specific question prompt list. Eur J Cancer Care (Engl) 21(4), 517-526. https://doi.org/10.1111/j.1365-2354.2012.01328.x
Lewis, E. T., Harrison, R., Cardona, M., Hanly, L., Hillman, K., Psirides, A., Zammit, A., McFarland, K., Dawson, A., & Barr, M. (2019). End‐of‐life priorities of older adults with terminal illness and caregivers: a qualitative consultation. Health Expectations, 22(3), 405-414. https://doi.org/10.1111/hex.12860
Maly, R. C., Frank, J. C., Marshall, G. N., DiMatteo, M. R., & Reuben, D. B. (1998). Perceived efficacy in patient-physician interactions (PEPPI): validation of an instrument in older persons. J Am Geriatr Soc, 46(7), 889-894. https://doi.org/10.1111/j.1532-5415.1998.tb02725.x
Menendez, M. E., van Hoorn, B. T., Mackert, M., Donovan, E. E., Chen, N. C., & Ring, D. (2017). Patients with limited health literacy ask fewer questions during office visits with hand surgeons. Clin Orthop Relat Res, 475(5), 1291-1297. https://doi.org/10.1007/s11999-016-5140-5
Negarandeh, R., Yazdani, Z., Ramtin, S., & Janani, L. (2021). Impact of using question prompt list on shared decision-making in the cancer patient: a systematic review. Nursing Practice Today, 8(3), 179-193. https://doi.org/10.18502/npt.v8i3.5933
Nutbeam, D. (2000). Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health promotion international, 15(3), 259-267. https://doi.org/10.1093/heapro/15.3.259
Nutbeam, D. (2008). The evolving concept of health literacy. Soc Sci Med, 67(12), 2072-2078. https://doi.org/10.1016/j.socscimed.2008.09.050
Riedl, D., & Schüßler, G. (2017). The influence of doctor-patient communication on health outcomes: a systematic review. Zeitschrift für Psychosomatische Medizin und Psychotherapie, 63(2), 131-150. https://doi.org/10.13109/zptm.2017.63.2.131
Roberts, K. J. (1999). Patient empowerment in the United States: a critical commentary. Health Expect, 2(2), 82-92. https://doi.org/10.1046/j.1369-6513.1999.00048.x
Roodbeen, R. T. J., Noordman, J., Boland, G., & van Dulmen, S. (2021). Shared decision making in practice and the perspectives of health care professionals on video-recorded consultations with patients with low health literacy in the palliative phase of their disease. MDM Policy Pract, 6(1), 23814683211023472. https://doi.org/10.1177/23814683211023472
Sanjo, M., Morita, T., Miyashita, M., Sato, K., Kamibeppu, K., Tsuneto, S., & Shima, Y. (2018). Are bereaved family members satisfied with information provision about palliative care units in Japan? Am J Hosp Palliat Care, 35(2), 275-283. https://doi.org/10.1177/1049909117729805
Satteson, E. S., Roe, A. K., Eppler, S. L., Yao, J., Shapiro, L. M., & Kamal, R. N. (2020). Development and testing of a question prompt list for common hand conditions: an exploratory sequential mixed-methods study. J Hand Surg Am, 45(11), 1087.e1081-1087.e1010. https://doi.org/10.1016/j.jhsa.2020.05.015
Schulte-Vieting, T., Siegle, A., Jung, C., Villalobos, M., & Thomas, M. (2021). Developing a question prompt list for the oncology setting: A scoping review. Patient Educ Couns. https://doi.org/10.1016/j.pec.2021.10.006
Seow, H., Guthrie, D. M., Stevens, T., Barbera, L. C., Burge, F., McGrail, K., Chan, K. K. W., Peacock, S. J., & Sutradhar, R. (2021). Trajectory of end-of-life pain and other physical symptoms among cancer patients receiving home care. Curr Oncol, 28(3), 1641-1651. https://doi.org/10.3390/curroncol28030153
Stewart, M. A. (1995). Effective physician-patient communication and health outcomes: a review. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 152(9), 1423-1433.
Street, R. L., Makoul, G., Arora, N. K., & Epstein, R. M. (2009). How does communication heal? Pathways linking clinician–patient communication to health outcomes. Patient Educ Couns, 74(3), 295-301. https://doi.org/10.1016/j.pec.2008.11.015
Walczak, A., Butow, P. N., Tattersall, M. H., Davidson, P. M., Young, J., Epstein, R. M., Costa, D. S., & Clayton, J. M. (2017). Encouraging early discussion of life expectancy and end-of-life care: a randomised controlled trial of a nurse-led communication support program for patients and caregivers. Int J Nurs Stud, 67, 31-40. https://doi.org/10.1016/j.ijnurstu.2016.10.008
Walczak, A., Henselmans, I., Tattersall, M. H. N., Clayton, J. M., Davidson, P. M., Young, J., Bellemore, F. A., Epstein, R. M., & Butow, P. N. (2015). A qualitative analysis of responses to a question prompt list and prognosis and end-of-life care discussion prompts delivered in a communication support program. Psycho-Oncology, 24(3), 287-293. https://doi.org/10.1002/pon.3635
Walczak, A., Mazer, B., Butow, P. N., Tattersall, M. H., Clayton, J. M., Davidson, P. M., Young, J., Ladwig, S., & Epstein, R. M. (2013). A question prompt list for patients with advanced cancer in the final year of life: development and cross-cultural evaluation. Palliat Med, 27(8), 779-788. https://doi.org/10.1177/0269216313483659
World Health Organization (2016). Planning and implementing palliative care services: a guide for programme managers. World Health Organization. https://doi.org/10.37774/9789275322871
Zetzl, T., Mann, D., Gruner, S., Schuler, M., Jentschke, E., Neuderth, S., Roch, C., & van Oorschot, B. (2020). Question prompts to empower cancer patients: results of a randomized controlled trial. Support Care Cancer, 28(6), 2571-2579. https://doi.org/10.1007/s00520-019-05036-0
Zhao, H., Luo, W., RC, M., Liu, J., Lee, J., & Cui, Y. (2016). Validation of the Chinese version 10-item perceived efficacy in patient-physician interactions scale in patients with osteoarthritis. Patient Prefer Adherence, 10, 2189-2195. https://doi.org/https://doi.org/10.2147/PPA.S110883

電子全文 電子全文(網際網路公開日期:20250601)
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
無相關期刊