Effect of internet multiple linkage mode-based extended care combined with in-hospital comfort care on colorectal cancer patients undergoing colostomy

BACKGROUND Patients with colorectal cancer may need postoperative nursing to improve prognosis,and conventional nursing is not effective.Clinical research is needed to explore nursing methods that can more effectively improve postoperative conditions on colorectal cancer patients undergoing colostomy.AIM To explore the effect of internet multiple linkage mode-based extended care combined with in-hospital comfort care on colorectal cancer patients undergoing colostomy.METHODS Data from 187 patients with colostomy treated in our hospital from May 2019 to March 2022 were collected and divided into three groups,A(n=62),B(n=62)and C(n=63),according to different intervention methods.Group A received internet multiple linkage mode-based extended care combined with in-hospital comfort care.Group B received internet multiple linkage mode-based extended care.Group C received usual care intervention.Complications were compared among the three groups.The stoma self-efficacy scale,Hamilton Anxiety Scale,RESULTS The complication rate of group A,B and C(16.13%,20.97%and 60.32%,respectively)was significantly different(all P<0.05).The incidence of complications in groups A and B was lower than that in group C,and there was no significant difference between groups A and B(P>0.05).After intervention,the scores of ostomy care,social contact,diet choice,confidence in maintaining vitality,confidence in self-care of ostomy,confidence in sexual life,confidence in sexual satisfaction and confidence in physical labor in the three groups were all higher than before intervention,and the scores of groups A and B were higher than those of group C,with statistical significance(P<0.05).The Hamilton Anxiety Scale and Hamilton Depression Scale scores of the three groups after intervention were lower than those before intervention.The scores of groups A and B were lower than those of group C,and the score of group A was lower than that of group B,all with statistical significance(all P<0.05).There was a statist-ically significant difference in cancer-induced fatigue among the three groups(P<0.05).After intervention,the scores of physical health,psychological health,social health and mental health of the three groups were lower than before the intervention.The scores of group A and B were lower than that of group C;and the score of group A was lower than that of group B,all with statistical significance(all P<0.05).CONCLUSION Internet multiple linkage mode-based extended care combined with in-hospital comfort care can effectively improve self-efficacy,bad mood,cancer-related fatigue and life quality of colorectal cancer patients undergoing colostomy.

Effect of variable heat treatment modes on microstructures of Fe-Cr-Bcast iron alloy

The effect of heat treatment mode on the microstructure of Fe-Cr-B cast iron alloys was investigated inthis paper by comparing the difference of precipitation patterns of secondary particles after thermal cycling treatment(TCT) with those after normal heat treatment (NHT). No obvious differences were found in precipitation patterns ofsecondary particles between TCT and NHT when experimental temperature was below Ar1. However, whentemperature was over Ar1, there were significant differences, with secondary particles prominently segregated at thegrain boundaries under TCT, while the particles evenly distributed in the matrix under NHT. The reason for themicrostructure differences could be associated with the development of non-equilibrium segregation of boron duringTCT.

Impact of failure mode and effects analysis-based emergency management on the effectiveness of craniocerebral injury treatment

BACKGROUND Craniocerebral injuries encompass brain injuries,skull fractures,cranial soft tissue injuries,and similar injuries.Recently,the incidence of craniocerebral injuries has increased dramatically due to the increased numbers of traffic accidents and aerial work injuries,threatening the physical and mental health of patients.AIM To investigate the impact of failure modes and effects analysis(FMEA)-based emergency management on craniocerebral injury treatment effectiveness.METHODS Eighty-four patients with craniocerebral injuries,treated at our hospital from November 2019 to March 2021,were selected and assigned,using the random number table method,to study(n=42)and control(n=42)groups.Patients in the control group received conventional management while those in the study group received FMEA theory-based emergency management,based on the control group.Pre-and post-interventions,details regarding the emergency situation;levels of inflammatory stress indicators[Interleukin-6(IL-6),C-reactive protein(CRP),and procalcitonin(PCT)];incidence of complications;prognoses;and satisfaction regarding patient care were evaluated for both groups.RESULTS For the study group,the assessed parameters[pre-hospital emergency response time(9.13±2.37 min),time to receive a consultation(2.39±0.44 min),time needed to report imaging findings(1.15±4.44 min),and test reporting time(32.19±6.23 min)]were shorter than those for the control group(12.78±4.06 min,3.58±0.71 min,33.49±5.51 min,50.41±11.45 min,respectively;P<0.05).Pre-intervention serum levels of IL-6(78.71±27.59 pg/mL),CRP(19.80±6.77 mg/L),and PCT(3.66±1.82 ng/mL)in the study group patients were not significantly different from those in the control group patients(81.31±32.11 pg/mL,21.29±8.02 mg/L,and 3.95±2.11 ng/mL respectively;P>0.05);post-intervention serum indicator levels were lower in both groups than pre-intervention levels.Further,serum levels of IL-6(17.35±5.33 pg/mL),CRP(2.27±0.56 mg/L),and PCT(0.22±0.07 ng/mL)were lower in the study group than in the control group(30.15±12.38 pg/mL,3.13±0.77 mg/L,0.38±0.12 ng/mL,respectively;P<0.05).The complication rate observed in the study group(9.52%)was lower than that in the control group(26.19%,P<0.05).The prognoses for the study group patients were better than those for the control patients(P<0.05).Patient care satisfaction was higher in the study group(95.24%)than in the control group(78.57%,P<0.05).CONCLUSION FMEA-based craniocerebral injury management effectively shortens the time spent on emergency care,reduces inflammatory stress and complication risk levels,and helps improve patient prognoses,while achieving high patient care satisfaction levels.

Cone beam computed tomography-guided differences among registration methods for lung cancer and the effects of tumor position,treatment model,and tumor size on positioning errors

Objective To explore the differences in three different registration methods of cone beam computed tomography(CBCT)-guided down-regulated intense radiation therapy for lung cancer as well as the effects of tumor location,treatment mode,and tumor size on registration.Methods This retrospective analysis included 80 lung cancer patients undergoing radiotherapy in our hospital from November 2017 to October 2019 and compared automatic bone registration,automatic grayscale(t+r)registration,and automatic grayscale(t)positioning error on the X-,Y-,and Z-axes under three types of registration methods.The patients were also grouped according to tumor position,treatment mode,and tumor size to compare positioning errors.Results On the X-,Y-,and Z-axes,automatic grayscale(t+r)and automatic grayscale(t)registration showed a better trend.Analysis of the different treatment modes showed differences in the three registration methods;however,these were not statistically significant.Analysis according to tumor sizes showed significant differences between the three registration methods(P<0.05).Analysis according to tumor positions showed differences in the X-and Y-axes that were not significant(P>0.05),while the autopsy registration in the Z-axis showed the largest difference in the mediastinal and hilar lymph nodes(P<0.05).Conclusion The treatment mode was not the main factor affecting registration error in lung cancer.Three registration methods are available for tumors in the upper and lower lungs measuring<3 cm;among these,automatic gray registration is recommended,while any gray registration method is recommended for tumors located in the mediastinal hilar site measuring<3 cm and in the upper and lower lungs≥3 cm.

Investigation of AlGaN/GaN fluorine plasma treatment enhancement-mode high electronic mobility transistors by frequency-dependent capacitance and conductance analysis

This paper reports fluorine plasma treatment enhancement-mode HEMTs （high electronic mobility transistors） EHEMTs and conventional depletion-mode HEMTs DHEMTs fabricated on one wafer using separate litho-photography technology. It finds that fluorine plasma etches the AlGaN at a slow rate by capacitance-voltage measurement. Using capacitance-frequency measurement, it finds one type of trap in conventional DHEMTs with TT = （0.5 - 6） ms and DT ： （1 - 5）×10^13 cm^-2. eV^-1. Two types of trap are found in fluorine plasma treatment EHEMTs, fast with TW（f）= （0.2 - 2） μs and slow with TT（s） = （0.5 - 6） ms. The density of trap states evaluated on the EHEMTs is Dw（f） ： （1 - 3） × 10^12 cm^-2. eV^-1 and DT（s） =（2 - 6） × 10^12 cm-2. eV-1 for the fast and slow traps, respectively. The result shows that the fluorine plasma treatment reduces the slow trap density by about one order, but introduces a new type of fast trap. The slow trap is suggested to be a surface trap, related to the gate leakage current.

Thoughts on the Innovative Design of the Integrated Service Mode of Pharmacies and Elderly Care Centers

Objective To evaluate the service model that integrates medical treatment and elderly care to provide a reference for the development of pharmacies and elderly care centers.Methods Through the literature investigation and case analysis,the domestic integrated medical treatment and elderly care service model was analyzed,and new ideas for the integration of pharmacies and elderly care centers were provided.Results and Conclusion The integrated service model of pharmacies and elderly care centers is designed and the integration mode of pharmacies,hospitals and elderly care centers is proposed by analyzing their advantages.The“pharmacy+elderly care”mode and the“pharmacy+medical treatment+elderly care”mode that integrates pharmacies,hospitals,and elderly care centers are put forward to predict its new development opportunities in the future.

垃圾渗滤液污水处理设备的臭氧投加复合抗扰控制

垃圾渗滤液污水处理设备中的臭氧投加系统具有大时滞、大惯性和多扰动的特点,导致难以实时调整臭氧投加量,从而影响后续设备出水水质。针对以上问题,在水流量比例的控制方面提出一种基于扰动观测器的改进型Smith预估器与滑模控制相结合的复合抗扰控制。其中,滑模控制为主控制器,扰动观测器用于估计出系统的集总扰动并反馈至前向通道消除扰动的不利影响,以便于Smith预估器更好地进行时滞补偿。仿真和实验结果表明,复合抗扰控制相较于PID控制和自抗扰控制具有更好的控制性能和抑制扰动的能力,能够有效提高垃圾渗滤液污水处理设备的出水水质。

快速反应团队工作模式对重症孕产妇抢救效率及救治结局的影响

目的:观察对重症孕产妇实施快速反应团队(RRT)工作模式的干预效果。方法:回顾性收集2021年10月-2022年10月开展常规护理模式的148例重症孕产妇临床资料纳入对照组,2022年11月-2023年11月开展RRT工作模式的152例重症孕产妇临床资料纳入观察组。比较两组抢救效率、救治结局、新生儿情况、重症孕产妇并发症。结果:观察组处理时间(22.6±4.0min)、抢救情况(10.5%)、剖宫产率(35.5%)、新生儿死亡率(0)、ICU入住率(2.0%)、住院时间(7.56±1.34d)、并发症总发生率(2.6%)均少于对照组(33.0±4.5min、18.9%、52.0%、4.1%、27.7%、10.86±3.33d、12.2%),预警情况(40.1%)、有效处理率(98.0%)、5minApagar评分(8.74±0.58分)、脐带血pH值(7.64±1.96)高于对照组(27.7%、81.8%、8.46±0.64分、4.96±1.34)(均P<0.05),两组孕产妇死亡率、新生儿1minApagar评分无差异(P>0.05)。结论:RRT工作模式可提高重症孕产妇的抢救效率,改善救治结局、新生儿情况。

经同侧大隐静脉入路髂静脉成型及支架植入术在日间治疗模式中的应用

目的:探讨髂静脉狭窄患者经同侧大隐静脉入路髂静脉成型及支架植入术在日间治疗模式中应用的可行性和近期疗效。方法:回顾性分析2017年2月至2022年3月经同侧大隐静脉入路实施髂静脉成型及支架植入术日间模式治疗的病例,共21例,男6例,女15例,年龄37~79岁[(62.5±10.2)岁]。髂静脉狭窄中单纯累及髂总静脉16例,单纯累及髂外静脉2例,同时累及髂总及髂外静脉3例,均通过同侧大隐静脉入路行髂静脉成型及髂静脉支架植入术,同时存在大隐静脉瓣膜功能不全的单纯髂静脉狭窄患者同期行大隐静脉射频闭合及曲张静脉硬化治疗术。术后规律直接口服抗凝药治疗及压力治疗,所有患者住院时间均于小于24 h。结果:所有21例患者手术均成功(手术成功率100%),术中无并发症,术后即刻并发症中穿刺点出血1例,加压包扎纱布被完全浸湿,经再次压迫止血5 min后渗血停止,所有患者住院时间均于小于24 h。随访结果:术后3个月随访率100%,其中绝对有效18例(18/21,85.7%),相对有效(术后仍有色素沉着,但范围减小)3例(3/21,14.3%)。髂静脉支架均通畅,同期行大隐静脉射频治疗患者射频治疗段大隐静脉主干均闭合良好。术后6个月随访率71.4%(15/21),其中绝对有效14例(14/15,93.3%),相对有效(术后仍有色素沉着,但范围减小)1例(1/15,6.7%)。髂静脉支架均通畅,同期行大隐静脉射频治疗患者射频治疗段大隐静脉主干均闭合良好。结论:经大隐静脉入路髂静脉狭窄的介入治疗技术在日间治疗模式中可行,有明确优势,近期疗效满意。

发达国家地膜应用及回收处理

本研究采用数据资料分析的方法,系统梳理了欧盟和日本地膜产品和相关标准、地膜应用与回收处理的做法和成效。结果显示:欧盟和日本使用的地膜产品以传统有色地膜为主,厚度多≥0.02 mm,是我国地膜厚度的两倍以上,相关标准要求也高于我国;欧盟和日本地膜多用于蔬菜等园艺作物上,收集处理系统完善,地膜回收率多在80%以上,基本不存在地膜残留污染问题;欧盟大部分国家和日本有较完善的废弃物管理立法,没有专门针对地膜的法律条文;由于地膜的回收率高、含杂率低,回收回来的地膜多可得到合理再利用;地膜全产业链有很好的设计与应用,值得我国学习。

肺癌多学科综合诊治现状及未来方向

尽管肺癌多学科诊疗(multidisciplinary team,MDT)模式能够提高患者的生活质量和生存预后,为何没有达到MDT诊疗模式所预期的目标呢?主要原因是肺癌MDT诊治模式相对滞后于各种治疗手段的进步。分析国内外肺癌MDT诊治最新研究成果,结合四川大学华西医院肺癌中心肺癌MDT诊治经验,本文将从以下几个方面对肺癌MDT的进展及未来发展方向进行讨论和总结:(1)肺癌MDT诊治模式的内涵和外延需要转变并适应新的诊治手段;(2)肺癌MDT诊治临床决策应当从“多学科会诊(multidisciplinary consultation,MDC)”向“MDT”转变;(3)肺癌MDT诊治过程要从“消防队模式”转向“防火墙模式”,并最终实行“个体化全程管理模式”;(4)肺癌MDT诊治路径要从“临时召集模式”向“肺癌单病种中心制模式”转变。

多学科团队协作诊疗引导下的团队教学模式应用在干燥综合征临床教学实践中的效果

目的分析多学科团队协作诊疗(MDT)引导下的团队教学模式应用在干燥综合征临床教学实践中的效果。方法选取2023年4月至2024年6月于福建中医药大学附属第二人民医院实习的72名风湿内分泌科中医学及中西医结合临床专业本科实习生为研究对象,按随机数字表法分为观察组和对照组,各36名。对照组以常规教学进行带教,观察组以MDT引导下的团队教学模式带教,对比两组实习生对干燥综合征知识的掌握情况、考核结果以及对带教模式的满意度和实习参与度等。结果观察组对人际关系、学习行为、学习意识、学习策略以及自我评价等知识掌握度高于对照组(均P<0.05);观察组干燥综合征理论知识、干燥综合征诊疗要点、干燥综合征诊疗技能成绩高于对照组(均P<0.05);观察组实习支持、积极行为、合作交流、收获自评等参与度评分高于对照组(均P<0.05);观察组带教满意度高于对照组(P<0.05)。结论MDT引导下的团队教学模式在干燥综合征临床教学中效果显著,能够提升实习生对疾病知识的掌握程度、考核成绩、参与度以及对带教模式的满意度。

病例讨论在口腔全科住院医师规范化培训中的作用探究

随着口腔分级诊疗的逐步普及和口腔科标准化规模的不断扩大,对口腔全科住院医师的需求日益增加。病例讨论作为一种经典的教学方法,能够有效激发学员从单纯的理论知识上升到系统的临床诊疗思维。作为口腔全科医师,是否具有全局观念、拥有单种疾病多角度治疗的思维模式、以及灵活运用口腔各专科知识解决临床问题的能力是衡量住院医师规范化培训成功与否的关键。文章首先论述口腔医学国际化进程的推进对培养更多的诊疗思维全面、操作技能娴熟并具有可持续性发展潜能的口腔全科医师的具体需求。而后分析基于临床,结合理论、经验和新科技等解决现实问题的病例讨论方式在口腔全科住院医师全面诊疗思维培养和临床技能提高中所发挥的作用,以期为进一步提升口腔全科住培教学质量提供一定的参考。

基于改进FMEA的污水厂设备故障风险评估模型

为保障污水处理厂正常运行,预防厂内设备发生故障,提出一种改进的故障模式与影响分析(FMEA)的风险评估模型。首先采用FMEA法识别污水厂设备故障模式,并结合毕达哥拉斯模糊集(PFS)刻画不确定评估信息;其次利用逐步权重评估比率分析法(SWARA)和最大偏差法计算主客观权重,通过博弈论组合权重计算3个风险因子的综合权重;然后采用多目标优化比率分析法(MOORA)对设备故障模式进行风险排序。最后以长春市Z污水厂设备故障风险评估为例,并将所提模型与传统FMEA、毕达哥拉斯模糊(PF)-优劣解距离法(TOPSIS)和PF-妥协折衷排序法(PF-VIKOR)等方法对比,验证该模型的有效性。结果表明:污水厂设备故障模式前3位是除砂机抽取的砂浆所含有机物过多、膜片脱落或破裂和大块异物进入水泵。

在线多模式教学在疼痛诊疗学实践教学中的应用

目的探讨在线多模式教学在疼痛诊疗学实践教学中的应用效果。方法选取我校五年制2018级麻醉本科学生48名作为研究对象。按照随机数字表法分为实验组和对照组,每组24名。在疼痛诊疗学实践教学中,实验组采用提前预习并利用视频观摩操作、病例汇报平台、计算机网络平台进行在线多模式教学,对照组按传统教学方式授课。实习结束后,比较分析两组学生的基础理论和知识应用能力考核成绩。结果实验组实习生的基础理论和知识应用能力考核成绩均高于对照组,差异均有统计学意义(t分别=2.71、2.42,P均<0.05)。结论在线多模式教学在疼痛诊疗学实践教学中对于提高学生对疼痛诊疗的理解和掌握具有重大意义。

医药联合门诊在老年患者合理用药管理中的工作模式探讨及成效分析

目的介绍南京医科大学第二附属医院老年患者医药联合门诊的工作模式与成效,分析优点与不足,以期为其他药学门诊的建立提供参考。方法选取2019年7月至2022年7月年于该门诊就诊并建立完整随访档案的680例患者,统计分析其一般情况、疾病及用药情况、药物治疗相关问题、药学服务内容等。结果680例患者中53.82%患有高血压,51.91%患者同时患有3种及以上慢性疾病,43.82%患者同时使用4~6种药物。680例患者中有441例存在854个药物治疗问题,平均1.94个/人。其中类型最多的是用药依从性问题,占38.17%。药师干预后患者依从性评分显著提高(P<0.05)。结论药师通过建立医药联合门诊,参与老年患者慢性病药物治疗管理,显著改善患者依从性,提高药物治疗有效性和安全性,进一步促进合理用药。

多学科协作诊疗模式对前置胎盘伴胎盘植入产妇妊娠结局的影响

目的探讨多学科协作(MDT)诊疗模式在改善前置胎盘伴胎盘植入母儿结局中的临床价值。方法回顾性分析2017年1月至2022年12月于江西省妇幼保健院分娩的281例前置胎盘伴胎盘植入产妇的临床资料,根据剖宫产术前是否进行MDT诊疗进行分组,其中MDT组152例,非MDT组129例。比较两组的剖宫产术前胎盘植入部位诊断准确性、术前预处理情况及母儿妊娠结局。结果MDT组术前胎盘植入部位的诊断符合率高于非MDT组,MDT组的腹主动脉球囊阻断率及输尿管置管率均高于非MDT组,且MDT组的术中出血量、出血>2000 ml率、输红细胞量及子宫切除率均低于非MDT组,差异有统计学意义(P<0.05)。结论MDT诊疗模式可以提高前置胎盘伴胎盘植入部位的术前诊断准确性,利于术者制定个体化的精准治疗方案,能有效减少胎盘植入患者术中出血量、输血量,降低子宫切除率,在改善母儿妊娠结局中具有一定临床价值。

基于信息平台的发热门诊就诊模式优化实践

通过医院信息化建设整合患者诊疗数据,并用于智能服务设备、信息自动采集、信息区域共享。实现基于医院信息平台的发热门诊就诊模式,优化资源配置,减少患者候诊时长,提高患者满意度,同时强化发热门诊在新型病毒监测方面的哨点作用。该模式为发热门诊的整体诊疗流程提供了有力的支持,在改善患者就医体验、节约医院成本、院感防控方面均具有一定意义。

奥瑞姆自我护理模式应用于脑动脉瘤介入治疗患者的效果及价值

目的 探讨进行脑动脉瘤介入治疗的患者应用奥瑞姆自我护理的效果及价值。方法 选取该院2021年2月至2022年2月收治的94例脑动脉瘤介入治疗患者作为研究对象,使用随机数字表法分为对照组和研究组,每组47例,分别实施常规护理、奥瑞姆自我护理干预,对比2组的自我护理能力、神经功能缺损、运动功能、生存质量及并发症发生情况。结果 2组护理前的自我概念、自我责任感、健康知识、自我护理技能比较差异无统计学意义(P>0.05);2组护理后各项自我护理能力均有明显升高,且研究组显著高于对照组,差异有统计学意义(P<0.05)。2组护理前的美国国立卫生研究所卒中量表(NIHSS)、Fugl-Meyer运动功能量表(FMA)、改良Rankin量表(MRS)比较,差异均无统计学意义(P>0.05);2组护理后NIHSS、FMA、MRS评分均有明显变化,且研究组的NIHSS、MRS评分显著低于对照组,FMA评分显著高于对照组,差异均有统计学意义(P<0.05)。研究组的颅内感染、脑血管痉挛、脑积水、动脉瘤再出血、肺部感染并发症发生率为2.1%(1/47),显著低于对照组[12.8%(6/47)],差异有统计学意义(P<0.05)。结论 对脑动脉瘤介入治疗患者应用奥瑞姆自我护理模式能取得良好的临床效果,价值显著,可有效提升患者自我护理能力,改善神经功能缺损、运动功能、生存质量,降低并发症发生风险,对疾病康复和预后有积极作用。

多学科诊疗模式与专科门诊在肺结节患者系统随访诊治中的应用

目的探讨多学科诊疗模式(MDT)与专科门诊在肺结节患者系统随访诊治中的应用。方法选取2019年6月至2021年10月于北京市顺义区医院就诊的200例肺结节患者作为研究对象,将就诊于呼吸内科和心胸外科门诊患者作为专科组(n=128),就诊于MDT门诊的患者作为MDT组(n=72)。比较两组不同门诊方式诊断结果及建议、治疗情况和病理情况。结果专科组浸润性腺癌23例,原位腺癌28例,腺瘤样增生15例,良性结节62例;建议复查62例,建议手术66例。MDT组患者浸润性腺癌10例,原位腺癌15例,腺瘤样增生7例,良性结节40例;建议复查40例,建议手术32例。专科组药物治疗66例,手术治疗37例,继续随访25例;MDT组药物治疗31例,手术治疗28例,继续随访13例。专科组37例手术治疗患者中浸润性腺癌15例,原位腺癌6例,腺瘤样增生9例,合计早期肺癌30例;MDT组28例手术治疗患者中浸润性腺癌12例,原位腺癌5例,腺瘤样增生9例,合计早期肺癌26例。两组诊断结果及建议、治疗情况、病理情况比较差异无统计学意义。结论对于肺结节患者的随访诊治,专科门诊与MDT诊疗相当。