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Childhood Radiation Exposure Can Be Reduced Significantly Using EMR Decision Support

By MedImaging International staff writers
Posted on 19 May 2015

The results of a study to find ways to reduce the pediatric radiation burden have been published in the May 8, 2015, issue of the Journal of the American Board of Family Medicine.

The study included 115 physicians from 17 US military family medicine training programs, and aimed to find whether an existing clinical decision support system, and the order in which information was presented would impact physician imaging choices. The system included a number of decision enhancement tools in the clinical workflow.

The study was carried out by researchers at the US Uniformed Services University of the Health Sciences (USU; Bethesda, MD, USA), the Cincinnati Children’s Hospital Medical Center (Cincinnati, OH, USA), the US National Library of Medicine (NLM; Bethesda, MD, USA), and the Clemson University (Clemson, SC, USA).

According to the researchers up to 40% of Computed Tomography (CT) scans are unnecessary. When children are exposed to unnecessary ionizing radiation their lifetime malignancy risk increases significantly

Imaging guidelines and clinical decision support systems guiding physicians in the appropriate use of medical imaging are often adopted inconsistently, and are mostly unavailable for children.

To improve the physician’s understanding of radiation doses from common imaging modalities the researchers used American College of Radiology (ACR) Appropriateness Criteria for pediatric clinical scenarios, and looked at how decision support on estimated radiation dose and current imaging guidelines in the Electronic Medical Record (EMR) influenced the selection of pediatric imaging modalities.

The results of the study showed that decision support changed the physicians’ choice of imaging modality. As a result ultrasound, which has no ionizing radiation, became the initial imaging modality of choice for more than 70% of the physicians instead of CT, Magnetic Resonance Imaging (MRI), and multiple types of X-Ray systems.

US Air Force Major, Dr. Christopher W. Bunt, said, “Busy clinicians in the civilian sector or in the military welcome information that helps them make a quick, safe and evidence-based decision. This study provides them with evidence that the information helps save kids from unnecessary radiation exposure. As a parent, I want my kids to receive the imaging studies that they need to diagnose and treat illness or injury. Making sure that these decisions are supported by evidence and are safe for my children is extremely important.”

Related Links:
USU
Cincinnati Children’s Hospital Medical Center
US National Library of Medicine

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65 (72.002410888672): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

66 (488.9965057373): SELECT fid FROM jos_deeppockets WHERE id=294758740 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294758740 AND published='1' LIMIT 1

67 (47.922134399414): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=216 ORDER BY `ordering`

68 (38.862228393555): select jos_twitters.link from jos_twitters where cat=10

69 (33.140182495117): select jos_facebook.link from jos_facebook where cat=10

70 (29.087066650391): select jos_google_plus.link from jos_google_plus where cat=10

71 (29.087066650391): select jos_linkedin.link from jos_linkedin where cat=10

72 (30.994415283203): SELECT fid FROM jos_deeppockets WHERE id=294758740 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294758740 AND published='1' LIMIT 1

73 (30.040740966797): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=216 ORDER BY `ordering`

74 (314.95094299316): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294758740 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

75 (213.1462097168): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294758740 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

76 (38.14697265625): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

77 (53.167343139648): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (59.127807617188): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

90 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (84.161758422852): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294758740 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

92 (34.809112548828): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294758740 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

93 (33.140182495117): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

94 (48.160552978516): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

107 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

108 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294758740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294758740 AND published='1' LIMIT 1

109 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294758740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294758740 AND published='1' LIMIT 1

110 (50.067901611328): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294758740 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (44.822692871094): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294758740 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (70.810317993164): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294758740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294758740 AND published='1' LIMIT 1

113 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294758740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294758740 AND published='1' LIMIT 1

114 (44.107437133789): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294758740 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

115 (507.11631774902): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294758740 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

116 (960.8268737793): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

117 (391.96014404297): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

118 (114.20249938965): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294758740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294758740 AND published='1' LIMIT 1

119 (53.882598876953): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294758740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294758740 AND published='1' LIMIT 1

120 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294758740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294758740 AND published='1' LIMIT 1

121 (36.001205444336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294758740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294758740 AND published='1' LIMIT 1

122 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294758740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294758740 AND published='1' LIMIT 1

123 (36.954879760742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294758740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294758740 AND published='1' LIMIT 1

124 (313.99726867676): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

125 (!!!!! 22269.96421814): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

126 (110.86463928223): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294758740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294758740 AND published='1' LIMIT 1

127 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294758740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294758740 AND published='1' LIMIT 1

128 (498.05641174316): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294758740 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294758740 AND type='deeppockets_item' AND published='1' LIMIT 1

129 (!!!!! 429718.97125244): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

130 (97.036361694336): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

131 (40.054321289062): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

132 (29.802322387695): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

133 (37.908554077148): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

134 (31.948089599609): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

135 (27.894973754883): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

136 (27.894973754883): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

137 (491.85752868652): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294758740 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (395.05958557129): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294758740 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

139 (39.100646972656): SELECT name FROM jos_deeppockets WHERE id=216

140 (29.087066650391): SELECT name FROM jos_deeppockets WHERE id=216

141 (468.96934509277): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))216((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

142 (441.07437133789): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))216((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

143 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294758740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294758740 AND published='1' LIMIT 1

144 (48.87580871582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294758740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294758740 AND published='1' LIMIT 1

145 (!!!!! 8499.8607635498): TRUNCATE TABLE jos_trademed_module

146 (77.009201049805): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294758740 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (53.167343139648): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294758740 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

148 (787.01972961426): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294758740 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294758740 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

150 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294758740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294758740 AND published='1' LIMIT 1

151 (40.054321289062): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294758740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294758740 AND published='1' LIMIT 1

152 (!!!!! 1045.9423065186): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

153 (53.167343139648): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294758740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294758740 AND published='1' LIMIT 1

154 (40.054321289062): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294758740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294758740 AND published='1' LIMIT 1

155 (65.088272094727): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294758740 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294758740 AND type='deeppockets_item' AND published='1' LIMIT 1

156 (30.994415283203): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=216 or channel_id is null)

157 (25.98762512207): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=216 or channel_id is null)

158 (29.087066650391): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

159 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294758740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294758740 AND published='1' LIMIT 1

160 (43.153762817383): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294758740 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294758740 AND published='1' LIMIT 1

161 (38.862228393555): select jos_twitters.link from jos_twitters where cat=10

162 (30.994415283203): select jos_facebook.link from jos_facebook where cat=10

163 (31.948089599609): select jos_google_plus.link from jos_google_plus where cat=10

164 (30.994415283203): select jos_linkedin.link from jos_linkedin where cat=10

165 (257.01522827148): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

166 (!!!!! 1110.0769042969): insert into jos_banners_delta values (14615,'2025-05-01 09:37:17','3.145.116.193','view'),(14202,'2025-05-01 09:37:17','3.145.116.193','view'),(14203,'2025-05-01 09:37:17','3.145.116.193','view')

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