基于德尔菲法的医疗过错标准化评估体系构建研究

目的构建医疗过错标准化评估体系,为医疗机构及相关领域评估医疗行为的违法性提供参考。方法在文献回顾的基础上,初步构建医疗过错评估体系。采用德尔菲法邀请31名专家对医疗过错评估体系各条目的重要性、可行性作出评价,并提出修改建议。结果两轮专家函询有效回收率分别为83.9%、96.8%,专家权威系数分别为0.902、0.887,各级条目Kendall’s W检验差异均有统计学意义(P<0.001)。最终构建的医疗过错评估体系包括依法执业、知情告知、诊疗技术、病历文书、医院管理5个一级条目和10个二级条目、20个三级条目、47个四级条目,各条目重要性和可行性评分均值均大于4、标准差均小于1、变异系数均小于0.2。结论医疗过错标准化评估体系科学可靠,具有一定的创新性和适用性。

基于Z-score模型的废水排放总量与浓度综合分析研究

污染物排放数量与环境质量、经济发展息息相关,综合分析污染物排放的总量和浓度,对明确污染物排放状况,改善环境质量和制定可持续发展战略很必要。研究基于Z-score标准化模型,基于中国2005-2014年废水污染物数据,对废水排放总量和废水中污染物浓度进行综合分析研究。分析结果表明：废水排放总量和污染物浓度综合分析的结果与单一排放总量或者排放浓度的分析结果有出入,以2005年废水排放总量和污染物浓度为例,综合分析的结果为环境污染中等,而单独就废水排放总量而言环境污染最轻,就浓度数据而言,环境污染较严重。指出总量和浓度的综合分析相对于单一指标的分析更能反映污染的实际状况,能为客观、科学的环境质量评价,制定环境管理法规政策提供定量依据。

以循证思维为导向的微课程联合CBL教学法在ICU规培护士临床思维能力培养中的应用

目的 探讨以循证思维为导向的微课程联合案例为基础的教学法(case-based learning,CBL)在重症监护病房(intensive care unit,ICU)规培护士临床思维能力培养中的应用效果,为临床提供一种新的教学方法。方法 选取2021年11月至2023年10月在本院ICU轮转的72名规培护士为研究对象,将2021年11月至2022年10月在本院ICU轮转的36名规培护士设为对照组,将2022年11月至2023年10月在本院ICU轮转的36名规培护士设为试验组。对照组采用CBL教学法,试验组采用以循证思维为导向的微课程与CBL教学法。教学前后比较两组护士临床思维能力评分,理论考核和临床技能考核评分,两组规培护士对教学的满意度。结果 培训后试验组规培护士临床思维能力的总分及其批判性思维能力、系统性思维能力、循证思维能力3个维度评分均高于对照组,理论考核与临床技能考核成绩均高于对照组,教学形式、教学方式、学习氛围满意度均优于对照组,两组比较,差异有统计学意义(均P<0.05)。结论 采用以循证思维为导向的微课程联合CBL教学法能有效提高ICU规培护士的临床思维能力、理论与技能水平。

Methodology for Extraction of Tunnel Cross-Sections Using Dense Point Cloud Data

Tunnel deformation monitoring is a crucial task to evaluate tunnel stability during the metro operation period.Terrestrial Laser Scanning(TLS)can collect high density and high accuracy point cloud data in a few minutes as an innovation technique,which provides promising applications in tunnel deformation monitoring.Here,an efficient method for extracting tunnel cross-sections and convergence analysis using dense TLS point cloud data is proposed.First,the tunnel orientation is determined using principal component analysis(PCA)in the Euclidean plane.Two control points are introduced to detect and remove the unsuitable points by using point cloud division and then the ground points are removed by defining an elevation value width of 0.5 m.Next,a z-score method is introduced to detect and remove the outlies.Because the tunnel cross-section’s standard shape is round,the circle fitting is implemented using the least-squares method.Afterward,the convergence analysis is made at the angles of 0°,30°and 150°.The proposed approach’s feasibility is tested on a TLS point cloud of a Nanjing subway tunnel acquired using a FARO X330 laser scanner.The results indicate that the proposed methodology achieves an overall accuracy of 1.34 mm,which is also in agreement with the measurements acquired by a total station instrument.The proposed methodology provides new insights and references for the applications of TLS in tunnel deformation monitoring,which can also be extended to other engineering applications.

标准化病人介导的案例教学法在护生临床综合能力训练中的应用

目的评价以标准化病人介导的案例教学法在护理本科实习生(以下简称护生)临床综合能力训练中的应用效果。方法采用便利抽样的方法,选取2020年7月至2021年6月在本院外科实习的护生150名为对照组,实施传统的综合训练,包括典型护理案例的课堂教学、床边见习与实习;2021年7月至2022年6月在本院外科实习的护生135名为观察组,在对照组基础上实施标准化病人介导的案例教学法,两组护生均分5批,每批26~32名,每批实习8w。实习结束前对两组护生临床综合能力进行考核并了解观察组护生对教学方法的评价。结果观察组护生综合能力总分为(91.20±7.29)分高于对照组(89.52±2.94)分,差异有统计学意义(P<0.05)。有96.3%以上护生认为,标准化病人介导的案例教学法可提升评估问诊、沟通、健康宣教、应变能力及操作技能水平,同时认为教学方法形象、生动、有趣。结论标准化病人介导的案例教学法能有效提高护生的临床综合能力,其教学效果获得护生的一致认可。

采暖建筑实际耗热量的测试方法与评价

为了完成天津建委下达的对节能小区的评价任务，我们对建筑耗热量指标的测方法、红外测温仪表的标定进行了探讨，建立了实验台，并在现场进行了对比试验．

Standardization in laboratory medicine: Adoption of common reference intervals to the Croatian population

Considering the fact that the results of laboratory tests provide useful information about the state of health of patients, determination of reference value is considered an intrinsic part in the development of laboratory medi-cine. There are still huge differences in the analytical methods used as well as in the associated reference intervals which could consequently significantly affect the proper assessment of patient health. In a constant effort to increase the quality of patients' care, there are numerous international initiatives for standardiza-tion and/or harmonization of laboratory diagnostics in order to achieve maximum comparability of laboratory test results and improve patient safety. Through the standardization and harmonization processes of analytical methods the ability to create unique reference intervals is achieved. Such reference intervals could be applied globally in all laboratories using methods traceable to the same reference measuring system and analysing the biological samples from the populations with similar socio-demographic and ethnic characteristics. In this review we outlined the results of the harmonization processes in Croatia in the field of population based reference intervals for clinically relevant blood and serum constituents which are in accordance with ongoing activity for worldwide standardization and harmonization based on traceability in laboratory medicine.

熔敷金属中扩散氢测定方法标准化现状与分析

文中首先对国内外现行的、具有代表性和权威性的熔敷金属扩散氢测定标准进行了系统的梳理和总结。并从试验用试块状态及精度、焊接工艺参数要求、试件焊接的操作要点和焊后的处理要求、各种收集方法的优缺点等角度对各标准之间的差异性进行了对比分析。最后,针对标准中推荐的具体试验方法,明确了具体操作时应注意的细节。结果表明,标准之间的一致性、差异性有助于实际工作中对标准的选择和使用,有利于标准化工作的持续改进。