目的探讨课题研究型品管圈在构建基于加速康复外科(enhanced recovery after surgery,ERAS)理念下膝关节置换围手术期管理模式中的应用。方法成立“膝望圈”及圈外专家咨询团,依据课题研究型品管圈操作步骤,从人员、制度、方法、信息、...目的探讨课题研究型品管圈在构建基于加速康复外科(enhanced recovery after surgery,ERAS)理念下膝关节置换围手术期管理模式中的应用。方法成立“膝望圈”及圈外专家咨询团,依据课题研究型品管圈操作步骤,从人员、制度、方法、信息、设备5个层面分析现状,明确6大攻坚点,多方拟定对策并加以筛选判断,从组建多学科“环抱式”围手术期安全管理模式、建立五位一体“动无忧”康复安全策略、建立“智信行”膝关节置换临床路径信息化管理网络等方面改进。结果构建了基于ERAS理念下膝关节置换围手术期管理模式,优化了膝关节置换术临床路径。与改善前相比,康复风险评估落实率(41%提升至100%)及术后屈曲功能相关指标显著提升,患者术后首次下床时间[(16.5±0.41)h降至(9.6±1.11)h]、膝关节屈曲达标时间[(147.4±17.6)h降至(86.9±10.1)h]、改善后临床路径完成时间、均次康复费用以及均次住院费用均显著下降。结论课题研究型品管圈活动可有效推进基于ERAS理念下膝关节置换围手术期管理模式的构建,对规范临床诊疗行为,提高医疗质量,有积极促进作用,值得在医疗服务的现代化发展中推广应用。展开更多
In this paper, the fuzzy-set-based structural possibility theory is investigated, and this theory can be used to deal with the subjective uncertainties in the design of engineering structures. Furthermore, a comprehen...In this paper, the fuzzy-set-based structural possibility theory is investigated, and this theory can be used to deal with the subjective uncertainties in the design of engineering structures. Furthermore, a comprehensive model of structural safety assessment, which can merge subjective uncertainties with objective uncertainties, is presented. In this model, the fuzziness of stress-strength inference model, safety margin functions of single or multiple limit-state, structural failure state and the final assessment result are taken into account. This continuous model can be transformed into an equivalent model of probability-based and solved by the present structural reliability analysis method and parallel algorithm. An example is given to show the main idea of the method presented in this paper.展开更多
There are more and more researches on heat transfer characteristics and prediction of supercritical CO_(2).The method of adding adiabatic section before and after heating section is usually adopted in these researches...There are more and more researches on heat transfer characteristics and prediction of supercritical CO_(2).The method of adding adiabatic section before and after heating section is usually adopted in these researches to ensure that the fluid entering the heating section is no longer affected by boundary layer,but the appropriate length range of adiabatic section and the influence of entrance effect are not discussed.However,some studies show that the entrance effect would affect the heat transfer in mini tubes.This paper uses the commercial CFD code FLUENT 19.0 to numerically study the heat transfer of supercritical CO_(2) in a mini tube under different working conditions(such as Re_(in),P_(in),q_(w) and flow direction)and the lengths of the adiabatic section(l_(as)/d).The entrance effects on heat transfer is more pronounced when Re_(in) is within the transition state and wall heat flux is relatively high,the resulting heat transfer deterioration causes T_(w,x) and h_(w,x) to rise sharply.As the adiabatic section increases,the location at which the heat exchange deteriorates moves to the entrance of the heating section and eventually leaves.The buoyancy effect and flow acceleration effect caused by the sharp change of physical properties are analyzed,and the dimensionless velocity distribution at the inlet of the heating section in different adiabatic sections is compared.It is proved that the entrance effect has an influence on the convection heat transfer of supercritical CO_(2) in mini tubes.The interaction reflected by wall shear stress between boundary layer development and drastic changes in physical properties is the cause of heat transfer deterioration.展开更多
文摘目的探讨课题研究型品管圈在构建基于加速康复外科(enhanced recovery after surgery,ERAS)理念下膝关节置换围手术期管理模式中的应用。方法成立“膝望圈”及圈外专家咨询团,依据课题研究型品管圈操作步骤,从人员、制度、方法、信息、设备5个层面分析现状,明确6大攻坚点,多方拟定对策并加以筛选判断,从组建多学科“环抱式”围手术期安全管理模式、建立五位一体“动无忧”康复安全策略、建立“智信行”膝关节置换临床路径信息化管理网络等方面改进。结果构建了基于ERAS理念下膝关节置换围手术期管理模式,优化了膝关节置换术临床路径。与改善前相比,康复风险评估落实率(41%提升至100%)及术后屈曲功能相关指标显著提升,患者术后首次下床时间[(16.5±0.41)h降至(9.6±1.11)h]、膝关节屈曲达标时间[(147.4±17.6)h降至(86.9±10.1)h]、改善后临床路径完成时间、均次康复费用以及均次住院费用均显著下降。结论课题研究型品管圈活动可有效推进基于ERAS理念下膝关节置换围手术期管理模式的构建,对规范临床诊疗行为,提高医疗质量,有积极促进作用,值得在医疗服务的现代化发展中推广应用。
文摘In this paper, the fuzzy-set-based structural possibility theory is investigated, and this theory can be used to deal with the subjective uncertainties in the design of engineering structures. Furthermore, a comprehensive model of structural safety assessment, which can merge subjective uncertainties with objective uncertainties, is presented. In this model, the fuzziness of stress-strength inference model, safety margin functions of single or multiple limit-state, structural failure state and the final assessment result are taken into account. This continuous model can be transformed into an equivalent model of probability-based and solved by the present structural reliability analysis method and parallel algorithm. An example is given to show the main idea of the method presented in this paper.
文摘There are more and more researches on heat transfer characteristics and prediction of supercritical CO_(2).The method of adding adiabatic section before and after heating section is usually adopted in these researches to ensure that the fluid entering the heating section is no longer affected by boundary layer,but the appropriate length range of adiabatic section and the influence of entrance effect are not discussed.However,some studies show that the entrance effect would affect the heat transfer in mini tubes.This paper uses the commercial CFD code FLUENT 19.0 to numerically study the heat transfer of supercritical CO_(2) in a mini tube under different working conditions(such as Re_(in),P_(in),q_(w) and flow direction)and the lengths of the adiabatic section(l_(as)/d).The entrance effects on heat transfer is more pronounced when Re_(in) is within the transition state and wall heat flux is relatively high,the resulting heat transfer deterioration causes T_(w,x) and h_(w,x) to rise sharply.As the adiabatic section increases,the location at which the heat exchange deteriorates moves to the entrance of the heating section and eventually leaves.The buoyancy effect and flow acceleration effect caused by the sharp change of physical properties are analyzed,and the dimensionless velocity distribution at the inlet of the heating section in different adiabatic sections is compared.It is proved that the entrance effect has an influence on the convection heat transfer of supercritical CO_(2) in mini tubes.The interaction reflected by wall shear stress between boundary layer development and drastic changes in physical properties is the cause of heat transfer deterioration.
