Securing offshore resources development:A mathematical investigation into gas leakage in long-distance flexible pipes

Gas flexible pipes are critical multi-layered equipment for offshore oil and gas development.Under high pressure conditions,small molecular components of natural gas dissolve into the polymer inner liner of the flexible pipes and further diffuse into the annular space,incurring annular pressure build-up and/or production of acidic environment,which poses serious challenges to the structure and integrity of the flexible pipes.Gas permeation in pipes is a complex phenomenon governed by various factors such as internal pressure and temperature,annular structure,external temperature.In a long-distance gas flexible pipe,moreover,gas permeation exhibits non-uniform features,and the gas permeated into the annular space flows along the metal gap.To assess the complex gas transport behavior in long-distance gas flexible pipes,a mathematical model is established in this paper considering the multiphase flow phenomena inside the flexible pipes,the diffusion of gas in the inner liner,and the gas seepage in the annular space under varying permeable properties of the annulus.In addition,the effect of a variable temperature is accounted.A numerical calculation method is accordingly constructed to solve the coupling mathematical equations.The annular permeability was shown to significantly influence the distribution of annular pressure.As permeability increases,the annular pressure tends to become more uniform,and the annular pressure at the wellhead rises more rapidly.After annular pressure relief followed by shut-in,the pressure increase follows a convex function.By simulating the pressure recovery pattern after pressure relief and comparing it with test results,we deduce that the annular permeability lies between 123 and 512 m D.The results help shed light upon assessing the annular pressure in long distance gas flexible pipes and thus ensure the security of gas transport in the emerging development of offshore resources.

The Problematics of Transferred Parturient Women in Guinean Urban Areas: The Case of the Donka Maternity Ward at the University Hospital Centre (Chu) Conakry

Objectives: To describe the socio-demographic aspects of transferred parturient women;To identify the means of transport used by the evacuated parturient women to the Donka maternity ward at the University Hospital of Conakry;To describe the difficulties met;And to assess maternal and fetal prognosis. Methodology: It consisted of a prospective study over a period of 6 months from 01/02 to 31/07/2018. All patients transferred to the maternity ward of the Donka National Hospital of Conakry University Hospital. Results: The frequency of obstetric transfers was 13.79%. The epidemiological profile was that of a parturient woman of an average age of 25.7 years, married, and housewife, unschooled, who was on her first pregnancy and from the city of Conakry. The average distance covered was 16 km with extremes of 3 and 50 km. The transfer to the referral maternity clinic was not medicalized in 94% of cases. The venous route was not taken in 96% of cases. The parturient was not escorted by a health worker in 98% of cases. Bleeding was the most frequent reason for evacuation, followed by acute fetal sufferings. The average number of prenatal consultation was 2 with extremes of 0 and 9. The average length of stay was 3.6 days with extremes of 1 and 28 days. The majority of transferred women had a full-term pregnancy. The Cesarean section was 79.4%. The Retro placental hematoma was the most common complication found and was 29.4%. The counter-reference was not made in 97.79%. We recorded 8 maternal deaths, for a lethality rate of 1.77%. Possible interventions to reduce the dramatic situation of obstetric evacuations require first of all the decentralization of health care structures capable of performing a cesarean section. This approach should aim to create medical centers with a surgical antenna in all municipalities. These decentralized units would reduce the delay in case management and thus, limit the number of complications.

High-Performance Sodium Bose-Einstein Condensate Apparatus with a Hybrid Trap and Long-Distance Magnetic Transfer

We report on the production of large sodium Bose^Einstein condensates in a hybrid of magnetic quadrupole and optical dipole trap. With an optimized spin-flip Zeeman slower, 2 ~ 1010 sodium atoms are captured in the magneto-optical trap （MOT）. A long distance magnetic transfer setup moves the cold atom over 46cm from the MOT chamber to the UHV science chamber, which provides great optical access and long conservative trap lifetime. After evaporative cooling in the hybrid trap, we produce nearly pure condensates of 1 ~ 107 atoms with lifetime of 80 s in the optical dipole trap.

Higher cost of arthroplasty for hip fractures in patients transferred from outside hospitals vs primary emergency department presentation

BACKGROUND In 2016 Centers for Medicare and Medicaid Services proposed bundled payments for hip fractures to improve the quality and decrease costs of care.Patients transferred from other facilities may be imposing a financial risk on the hospitals that accept these patients.AIM To determine the costs associated with patients that either presented to the emergency department or were transferred from another hospital or skilled nursing facility(SNF)with the diagnosis of a hip fracture requiring operative intervention.METHODS A retrospective single institution review was conducted for all arthroplasty patients from 2010 to 2015.Inclusion criteria included a total or partial hip replacement for a hip fracture.Exclusion criteria included pathologic,periprosthetic,and fracture non-union.Data was collected to compare total observed costs for patients from the emergency department,patients from skilled nursing facilities,and patients from an outside hospital.RESULTS A total of 223 patients met the inclusion criteria.135(60.54%)of these patients presented primarily to the emergency department,58 patients(26.01%)were transferred from an outside hospital,and 30 patients(13.43%)were transferred from a SNF.Cost data analysis showed that outside hospital patients demonstrated significantly greater total cost for their hospitalization($43302)compared to emergency department patients($28875,P=0.000)and SNF patients($28282,P=0.000).CONCLUSION Patients transferred from an outside hospital incurred greater costs for their hospitalization than patients presenting from an emergency department or SNF.This is a strong argument for riskadjustment models when bundling payments for the care of hip fracture patients.

Knowledge Management Practices for Improvement of Brazilian Hospital Websites

This work aims to verify how the Web portals of Universities Hospital located in the northeast of Brazil are contributing to the expansion of knowledge of its users from the analysis of interactive features associated with the three mechanisms of knowledge management： knowledge access （KA）, knowledge creation （KC）, and knowledge transfer （KT）. The study is exploratory, descriptive, and qualitative type, such as a survey, developed through an adaptation of a relevant research, which involves the standardization of data collection instruments （questionnaires and interviews） applied directly to persons of a specific population, to assess knowledge management tools present in the University Hospital portals in the northeast region of Brazil. The results indicated that the resources from knowledge access were more prevalent than the others, ratifying the results found in research developed in Asian and North American Hospital portals.

Content of nursing discharge notes: Associations with patient and transfer characteristics

Background: In situations of care transfer of older people from hospital to home care at discharge, exchanging relevant and necessary information about the patient’s health status and individual needs are of importance to ensure continuity and appropriate nursing follow-up care. Objective: The objectives of the study were to: 1) examine the content of nurses’ discharge notes of older patients’ discharged from hospital to home care, and 2) investigate the association between the content of discharge notes and characteristics of patient and transfer. Methods: The nursing discharge notes of 70 older patients admitted to a geriatric unit and a general medicine ward at a local hospital in central Norway were analysed. The discharge notes were structured in accordance with the Well-being, Integrity, Prevention, and Safety (VIPS) model. Mean, standard deviations, and independent sample t-tests were performed to show and examine differences in use of VIPS keywords in relation to patient and transfer characteristics. To examine if use of VIPS keywords could be predicted by patient and transfer characteristics, linear multiple regression analyses were used. Results: Significant differences for mean scores on used VIPS keywords in the discharge note were found for gender, age, and medical department facility. While gender and medical department facility were significant predictors of mental related keywords in the discharge note, medical department facility was a significant predictor of physical related keywords. Conclusions: The result of this study indicate that documentation of patient status in the nursing discharge note of older patients transferred from hospital to home care is incomplete and are influenced by patient and transfer characteristics. In order to ensure continuity and appropriate nursing follow-up care, we emphasize the need for a more comprehensive approach to older patients, and that this must be reflected in the nursing discharge note.

Comparative Study on the Trans-Province Transfer of the Multiple Trauma Patients after Sichuan Earthquake

Background: Trans-province transfer of the patients has been successfully carried out and has greatly relieved the burden of the hospitals in Sichuan Province after Sichuan earthquake. The aim of the study was to retrospectively analyze the efficacy and feasibility of the trans-province transfer of the multiple trauma patients after Sichuan earthquake. Methods: A retrospective and descriptive analysis was conducted based on the medical records of the multiple trauma patients (ISS ≥ 16) transferred to the Grade 3A hospitals outside Sichuan province. The patients were divided into two groups based on the distance to Sichuan province, i.e., Group A (the seismic patients transferred to Chongqing) and Group B (the seismic patients transferred to the other provinces/ municipalities). A comparison was done in aspects of distance of transfer, time from injury to transfer, vital signs, the infection rates (at transfer and on discharge), injury severity and prognostic indices (cure rate, disability rate and mortality). Results: The distance between Chengdu and the other places was at a wide range of 313 - 1653 km, whereas the time from injury to transfer showed no statistical difference between groups (P > 0.05). There were no significant differences between both groups with respects to patient demographics, injury mechanism, time from injury to transfer, vital signs, infection rate and injury severity. The prognostic indices showed no significant difference, except for FIM scores (P < 0.05). Conclusions: The results of the study indicate that the different distance of the transfer of the multiple trauma patients does not aggravate the severity or deteriorate the prognosis, which proves that the medical supportive transfer system is acceptable, effective and worthy of further implementation in China, which may be ascribed to the advanced transportation system and high level of therapeutic capacity of the hospitals. In the meantime, attention should be paid to psychological intervention and functional rehabilitation during the treatment of the transferred seismic patients.

亚洲地区高校及医院科技成果转化模式分析及启示

科技成果转化是全球促进生物医药及卫生健康创新发展的关键途径。亚洲地区以新加坡、日本及以色列为代表,在科技成果转化方面成效显著,其高校与医院采取了不同策略。借鉴其经验,中国应搭建内部服务平台、设立技术转移机构、形成高校与附属医院联动效应、加大政策支持力度并优化转化考核评价体系,以提升科技成果转化效率与效果。

国际肿瘤专科医院2000年-2023年专利申请及转化运用情况分析

目的:回顾中国和美国一流肿瘤专科医院2000年-2023年的专利申报、授权、转化情况,为提升医院高水平知识产权管理和成果转化提供参考。方法:应用Incopat数据库收集整理2000年-2023年德克萨斯大学安德森癌症中心、哈佛大学丹娜法伯癌症研究所、斯隆·凯特琳癌症中心、中国医学科学院肿瘤医院、中山大学肿瘤防治中心、复旦大学附属肿瘤医院的专利申请趋势、专利研发布局、高价值专利申请热点、转让/许可情况等方面进行了综合比较。结果:安德森癌症中心虽然专利申请公开数量相比较少,但其专利质量非常高,高价值专利占比超过90%,专利转让许可占比接近50%。丹娜法伯癌症研究所和斯隆·凯特琳癌症中心的专利公开总数均相对其他医院优势非常明显,均超过1500项,高价值专利占比均在60%~80%之间,专利转化占比均在7%~10%之间。中山大学肿瘤防治中心和中国医学科学院肿瘤医院的发明专利公开数量近些年增长迅速,专利总数均超过500项,高价值专利占比均在60%左右,但是专利转化占比较低。美国医疗机构专家研究热点均集中在新型化合物和生物制品,国内三家医疗机构的申请重点集中在医疗器械。结论:国内医院的高价值数量和占比仍远低于美国两家医院。建议国家建立专利分级分类管理制度,构建全国层面的专利交互平台。医疗机构可以从高质量专利孵育、引导促进专利转化、加强知识产权培训、加强国际合作等多方面加强管理,提升医院专利质量,走好转化路径。

中医医院急危重症患者安全转运管理实践的应用与探讨

目的探讨中医医院临床支持中心(简称中心)在急危重症患者安全转运中的管理实践,分析其管理模式、安全转运工作量及满意度,为促进急危重症患者安全转运提供参考依据。方法总结重庆市中医院临床支持中心近10年在危急重症患者安全转运工作中的管理经验,回顾性分析2015年1月至2023年12月重庆市中医院临床支持中心120急诊急救组、重症转运组转运患者工作量。采用随机抽样法,使用自行设计的问卷调查医院急诊科、重症监护室以及相关临床科室500名医务工作者对中心工勤人员参与急危重症患者安全转运的满意度。结果中心参与转运急危重症患者达到323499总人次,未发生管道脱落、跌倒、坠床等意外责任事件。满意度调查显示,医务工作者对中心工勤人员的工作能力满意度为98%,服务态度满意度为96%,工作效率满意度为95%,职业素养满意度为80%。结论临床支持中心在大型三甲中医医院急危重症患者转运中发挥重要作用,为减轻临床医务人员的工作压力、安全转运危急重症患者提供有力的保障,在提高医务人员满意度方面起到了积极作用。今后中心可从员工激励制度、针对性培训、信息化建设3方面出发,进一步促进持续质量改进。

基于“12345”热线转办的投诉分析及措施探讨

目的归纳总结“12345”热线转办投诉的情况,分析原因,提出处理措施。方法选取2020年1月—2022年12月“12345”热线转办的启东市中医院投诉763件进行分析,分析投诉类型,总结发生投诉的科室分布情况,同时总结引起投诉的相关原因,提出处理措施。结果763件投诉情况中,涉及院感防控方面的总计380件,占比49.80%,其他涉及医院诊疗服务、就医流程、医疗收费等情况。涉及投诉的科室包括门诊医技科室、病区、总务、药房、收费等。分析结果显示,院感防控是3年内引起投诉的主要原因;其次是医患沟通不到位、医疗质量问题、服务态度问题、收费不合理等。结合原因提出相应处理对策。结论通过“12345”热线能够一定程度使医院了解投诉信息,拓宽投诉通道,改进服务机制,提升服务质量,以建立和谐、融洽的医患关系。

快速反应团队在ECMO患者院际转运中的作用探究

探究快速反应团队在体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)患者院际转运中的作用.选取2020年3月-2023年3月贵州省人民医院收治的23例ECMO患者为研究对象,采用抽签法将患者分为参照组(n=13)和试验组(n=10),参照组以常规流程对患者开展转运管理干预,试验组建立快速反应团队对患者开展转运管理干预.比较两组患者干预效果.结果显示,干预后,试验组转运前、中、后各环节转运管理干预质量评分均较参照组更高(P<0.05).试验组转运反应时间、现场评估及救治时间均较参照组更短(P<0.05);试验组转运期间不良事件总发生率较参照组更低(P<0.05),转运管理干预总满意率较参照组更高(P<0.05).研究发现,在ECMO患者院际转运管理干预中,积极建立快速反应团队对提高各环节转运管理干预质量具有重要作用,可以进一步缩短患者转运时间,提高转运效率,有效减少转运期间不良事件的发生,提高患者的转运管理干预满意度.

脑卒中患者医院-家庭过渡期护理的研究进展

对过渡期护理的概念、脑卒中患者医院-家庭过渡期护理发展现状、我国脑卒中患者过渡期护理存在问题及顺利过渡的改善策略等进行综述,旨在为构建适合我国脑卒中患者的过渡期护理模式、护理方案提供依据,为更好地维护并促进脑卒中患者的康复和健康提供借鉴。

北京协和医院药学门诊服务模式探索与实践

目的:探索建立北京协和医院(以下称我院)药学门诊服务模式。方法:查阅国内外文献、开展调查研究,结合实践经验,归纳总结我院药学门诊服务管理制度、操作规程、服务内容和质控体系;分析药学门诊服务发展的挑战,提出促进药学门诊服务发展的建议。结果:初步搭建我院药学门诊服务模式,门诊类型包括线下药学门诊和互联网药学门诊,就诊途径包括患者自主挂号和医生院内转诊,覆盖专科包括妊娠哺乳期、糖尿病、冠心病、抗栓治疗、呼吸系统疾病、多重慢病、消化系统疾病、神经精神系统疾病、免疫系统疾病、肺癌抗肿瘤、营养药学、综合药学共12个方向的药物治疗管理,电子记录采用定制的药学门诊电子表单,既能满足药学门诊工作需求,又能实现与临床诊疗病历互查。截至2023年10月31日,线下药学门诊接诊患者426例,其中接收院内转诊病例92例,占比21.6%,药学门诊意见采纳率为87.8%;互联网药学门诊接诊患者543例,为临床患者切实解决了用药难题。结论:线上+线下药学门诊服务模式可以更好地满足患者的医疗需求,实现以患者为中心的药学服务转型。

基层医院护士院际转运急性心肌梗死同质化培训的效果分析

目的:制定基层医院护士院际转运急性心肌梗死同质化培训方案,并分析培训效果,为基层医院护士院际转运急救水平的提高提供参考依据。方法:采用便利抽样方法,选取2022年12月—2023年10月昆山医联体内9家基层医院58名参与院际转运的护士为研究对象,对其进行急性心肌梗死患者转运的同质化培训,比较护士培训前后的理论知识得分、急救技能得分、对培训的满意度及转运过程中意外事件发生情况。结果:同质化培训后,护士基础理论知识和急救技能培训考核成绩均高于培训前,转运过程中发生意外事件发生率低于培训前,差异均有统计学意义(P<0.05)。58名护士对培训条目满意度均在90%及以上,对院际转运同质化护理培训总体满意度达97.8%。结论:基层医院护士院际转运急性心肌梗死同质化培训有利于提高院际转运护士理论知识水平、急救技能水平及转运能力,降低意外事件发生率,提高转运质量。

山东省某大型综合医院科技成果转化探索与实践SWOT分析

采用管理学SWOT模型,分析山东省某大型综合医院科技成果转化工作的优势(S)、劣势(W)、机遇(O)和挑战(T),依照矩阵形式排列形成四类战略,利用内部优势把握机遇的SO战略,发挥内部优势抵抗外部威胁的ST战略,利用外部机遇克服内部劣势的WO战略和克服内部劣势避免外部威胁的WT战略,探讨推动大型综合医院科技成果转化的有效策略。

浅析医院平均住院日的计算方法

随着医院综合化程度的日益提高,为考核各临床专科的工作效率,在计算平均住院日时,需考虑转科因素。平均住院日为衡量医院医疗服务效率、工作开展质量水平的重要指标,直接反映了医院资源利用情况及医疗服务整体开展质量水平。当前随着医疗改革的不断深入及医疗需求不断增加,准确计算每位患者的住院日已成为提升医院竞争力、优化医疗资源配置的关键。基于此,本文综述了平均住院日的计算方法、影响因素以及在医院管理中的应用,旨在为医院管理提供参考。

电动垂直起降飞行器发展现状及其在航空医疗救援中的应用展望

介绍了电动垂直起降飞行器的基本概念、发展历程、分类方式、特点及优势,从时间、空间、运送能力和安全性等4个维度分析了电动垂直起降飞行器在航空医疗救援中应用的可行性,指出了电动垂直起降飞行器在院前急救、院际转运和应急医疗救援等方面具有较好的应用前景。

转科出科首页数据在科室“国考”和DRG指标评价中的应用

目的探索将转科出科首页数据结合出院病案首页数据应用于临床科室三级公立医院绩效考核和疾病诊断相关分组(DRG)主要指标评价。方法收集贵州省某三级甲等综合医院2022年1—8月HIS中转科出科首页和出院病案首页数据,对转科患者住院期间在不同临床科室的诊疗数据进行分段统计,结合出院病案首页数据,重新计算各科室“国考”和DRG主要指标。结果有98.00%(49/50)的临床科室发生转科行为;与出院病案首页数据相比,通过转科出科首页数据统计该院不同科室间四级手术和微创手术台(人)次数、手术患者并发症发生例数有明显变化,增加的主要为外科,减少的主要为内科;总权重变化的有37个科室,增加最多的是重症医学一科(增长39.41%),减少最多的是介入科(减少18.00%);病例组合指数(CMI)有变化的共36个科室。结论通过转科出科首页数据,可更加准确、合理地计算发生转科行为的病人在不同科室的“国考”和DRG主要指标,有利于客观反映医院各科室工作量、技术难度和医疗质量。

急危重症患者院间转运评估分级的最佳证据总结

目的总结评价并整合急危重症患者院间转运评估分级的最佳证据,为临床实践提供依据。方法按照证据资源“6S”模型系统检索国内外专业指南网、协会网以及数据库中有关急危重症患者院间转运评估分级的指南、证据总结、系统评价、临床决策、最佳实践、专家共识,检索时限为建库至2024年1月3日。由循证小组进行文献质量评价及证据提取。结果共纳入11篇文献,其中指南5篇、专家共识4篇、系统评价2篇,形成了5个类别的27条证据,包括实施评估及分级的人员、实施评估的工具、实施评估的时机、评估及分级的项目(病情评估、转运相关事项评估、风险评估、分级项目)、评估及分级的记录。结论该研究总结了急危重症患者院间转运评估分级的最佳证据,为临床开展院间转运实践提供依据。