Research on the Application of Evidence-Based Quality Control Circle to Improve the Implementation Rate of Airway Management Measures in Adult Critically Ill Patients

Objective: To explore the effect of evidence-based quality control circle (QCC) in improving the implementation rate of airway management measures in adult critically ill patients. Methods: Based on the Joanna Briggs Institute (JBI) evidence-based health care model, the best evidence of airway management in adult critically ill patients was obtained and applied to the clinic. Results: The total implementation rate of airway management measures in adult critically ill patients increased from 23.62% before the implementation of quality control circle to 88.82%, and the pulmonary infection rate in critically ill patients decreased from 42.31% to 21.74%, with statistical significance between the two groups (P 0.05). Conclusion: Evidence-based quality control circle activities can standardize the practice standards of airway management in critically ill patients, reduce the occurrence of patients’ airway related complications, and improve clinical outcomes.

Safety of applying midazolam-ketamine-propofol sedation combination under the supervision of endoscopy nurse with patient-controlled analgesia pump in colonoscopy

AIM To compare the results of midazolam-ketaminepropofol sedation performed by an endoscopy nurse and anaesthetist during colonoscopy in terms of patient satisfaction and safety.METHODS American Statistical Association(ASA) Ⅰ-Ⅱ 60 patients who underwent colonoscopy under sedation were randomly divided into two groups: sedation under the supervision of an anaesthetist(SSA) and sedation under the supervision of an endoscopy nurse(SSEN). Both groups were initially administered 1 mg midazolam, 50 mg ketamine and 30-50 mg propofol. Continuation of sedation was performed by the anaesthetist in the SSAgroup and the nurse with a patient-controlled analgesia(PCA) pump in the SSEN group. The total propofol consumption, procedure duration, recovery times, pain using the visual analogue scale(VAS) and satisfaction score of the patients, and side effects were recorded. In addition, the patients were asked whether they remembered the procedure and whether they would prefer the same method in the case of re-endoscopy.RESULTS Total propofol consumption in the SSEN group was significantly higher(P < 0.05) than that in the SSA group. When the groups were compared in terms of VAS score, recovery time, patient satisfaction, recall of the procedure, re-preference for the same method in case of re-endoscopy, and side effects, there were no significant differences(P > 0.05) between the two groups. No long-term required intervention side effects were observed in either group.CONCLUSION Colonoscopy sedation in ASA Ⅰ-Ⅱ patients can be safely performed by an endoscopy nurse using PCA pump with the incidence of side effects and patient satisfaction levels similar to sedation under anaesthetist supervision.

Factors That Promote Autonomous and Controlled Motivation in Self-management Behavior of Hemodialysis Patients

This study examined the differences and primary factors from the impact of autonomous motivation and controlled motivation on the self-management behavior of hemodialysis patients.Anonymous,self-describing questionnaires were used for research on nine different dialysis facilities of 413 people who regularly visit.From using the primary factor results of multiple regression analysis,that took autonomous motivation and controlled motivation as the dependent variable,a path diagram was created that led to each motivation.The acknowledgement of autonomy support facilitated whether it was autonomous motivation or controlled motivation(The standardized coefficient was 0.385,0.346,p<0.0001).Positive evaluation coping skills were a primary factor that promoted autonomous motivation,while trait anxiety,disorders of social activities,and lack of motivation were primary factors that promoted controlled motivation.In order to raise the autonomous motivation to promote self-management behavior in patients with hemodialysis treatment,situations that easily cause amotivation and anxiety,as well as tendencies for depression should be assessed.Also the encouragement to attain positive evaluation coping skills to support patient autonomy appears to be effective.

Effect of motivational interviewing on postoperative weight control in patients with obstructive sleep apnea-hypopnea syndrome

BACKGROUND Obesity is an important factor to cause the obstructive sleep apnea-hypopnea syndrome(OSAHS).Higher body mass index(BMI)often results in more severe OSAHS.Currently,the common measures for controlling the weight mainly include diet control,increase exercise and so on.Motivational interviewing(MI)could explore the patient’s internal state and make the patient realize his/her ambivalence,resulting in the change in his/her behavior.This process emphasizes respecting the patient’s autonomy.AIM To evaluate the effect of MI on the weight control of patients with OSAHS.METHODS A randomized controlled study was conducted in 100 obese OSAHS patients undergoing surgical treatment at Shengjing Hospital of China Medical University.The patients were divided into an intervention group and a control group,with 50 cases each.The control group was given routine health education after the operation;in addition to the regular health education,the intervention group was given MI according to a predetermined plan.Obesity-related indicators,postoperative complications,and the sleep status of both groups were evaluated before and 6 mo after the intervention.RESULTS Patients in the intervention group had significantly improved body weight,BMI,and waist and neck circumferences compared with patients in the control group(P<0.05).Regarding complications at 6 mo after operation,the incidence of cough and reflux in patients in the intervention group was significantly lower than that in the control group(P<0.05).In addition,the Epworth Sleepiness Scale and Self-Rating Scale of Sleep scores of patients in the intervention group were significantly lower than those in the control group,and the sleep status of patients in the intervention group was improved(P<0.05).CONCLUSION MI intervention has a significant advantage over postoperative routine health education.It can greatly change the lifestyle,further control the postoperative weight,reduce the occurrence of complications,improve the quality of sleep,and improve long-term postoperative efficacy in OSAHS patients.

Comparison of Oral Manifestations in Hospitalized COVID-19 Positive Patients and COVID-19 Negative Dental Outpatients. A Case Series Study and Literature Review

Background: The Coronavirus disease 2019 (COVID-19) is a respiratory infectious disease, also named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which can cause various systemic manifestations that pose a threat to human life. Oral lesions in patients with COVID-19 may appear during or after the illness and may or may not be a consequence of the viral infection. Objective: In this case series we compare the oral manifestations in hospitalized COVID-19 positive patients and COVID-19 negative dental outpatients. Methods: 60 hospitalized COVID-19 patients and 41 control patients, were examined for oral signs and symptoms. The controls were dental patients who visited the hospital for dental care without complaining of any problems related to the oral cavity itself. Results: We have observed a strong association between certain clinical findings and COVID-19, including alterations in taste (ageusia, dysgeusia, and hypogeusia), anosmia, hairy tongue, tongue imprints, red tongue, erythematous candidiasis, pseudomembranous candidiasis, and exfoliative cheilitis. A trend but not statistically significant association at the level of 5% was also noted for colored tongue, linea alba, and pale mucosa. On the contrary, fissured tongue and oral mucosa pigmentation were more frequent in the controls, statistically significant at the level of 5%. Conclusion: COVID-19 has been found to impact the oral cavity, resulting in various oral lesions that can be attributed to either the direct action of the virus or the patient’s immune response.

Utilization Management:Walking the Line Between Patient Needs and Healthcare Economics-Short Communication

Utilization management plays a crucial role in healthcare by optimizing resource allocation,improving patient outcomes,and effectively controlling costs.By balancing patient needs with economic considerations,healthcare institutions can ensure efficient and sustainable service delivery.Utilization management encompasses various strategies,including prior authorization,concurrent review,and clinical pathways,to enhance care quality,manage expenses,and streamline resource use.The benefits of utilization management include cost containment,improved care standards,and the implementation of consistent treatment guidelines,thereby increasing the overall efficiency and effectiveness of healthcare delivery.

Construction of a New Model of Contactless Medical Services for Outpatients Based on the Project-Achieving Quality Control Circle

Objective: To carry out empirical research on the role of project-achieving quality control circle (QCC) in constructing a new model of contactless medical service for outpatients. Methods: A QCC, consisting of information office members from a grade A tertiary hospital in Wenzhou, was established to conduct a research project with the theme “Constructing a new model of contactless medical service based on outpatients’ experience.” According to the ten steps and PDCA cycle, an analysis was carried out before and after the QCC activities, focusing on improving pre-consultation services, providing steward-like services, and facilitating post-consultation management. Results: After the QCC activities, the mobile appointment rate, missed appointment rate, the proportion of smart check-ins, and the average check-in time were 55.68%, 4.02%, 39.75%, and 8.24 ± 3.66 min, respectively;in contrast, before the activities, they were 32.00%, 7.88%, 0.00%, and 14.96 ± 4.98 min, respectively;the difference between the two groups was statistically significant (χ2 = 3480.112, 4994.496;Fisher’s exact probability = 963788.570;t = 5.323, P < 0.001). Many experts have also visited the hospital to learn about this system, thus rendering social and economic benefits. Conclusion: Project-achieving QCC activities are suitable for complex situations, such as constructing a new model of contactless medical service, and can significantly improve outpatient service quality, enhance patients’ experience, and improve the abilities of circle members.

Adaptive neuro-fuzzy interface system for gap acceptance behavior of right-turning vehicles at partially controlled T-intersections

Gap acceptance theory is broadly used for evaluating unsignalized intersections in developed coun tries. Intersections with no specific priority to any move ment, known as uncontrolled intersections, are common in India. Limited priority is observed at a few intersections, where priorities are perceived by drivers based on geom etry, traffic volume, and speed on the approaches of intersection. Analyzing such intersections is complex because the overall traffic behavior is the result of drivers, vehicles, and traffic flow characteristics. Fuzzy theory has been widely used to analyze similar situations. This paper describes the application of adaptive neurofuzzy interface system （ANFIS） to the modeling of gap acceptance behavior of rightturning vehicles at limited priority Tintersections （in India, vehicles are driven on the left side of a road）. Field data are collected using video cameras at four Tintersections having limited priority. The data extracted include gap/lag, subject vehicle type, conflicting vehicle type, and driver＇s decision （accepted/rejected）. ANFIS models are developed by using 80 % of the extracted data （total data observations for major road right turning vehicles are 722 and 1,066 for minor road right turning vehicles） and remaining are used for model vali dation. Four different combinations of input variables are considered for major and minor road right turnings sepa rately. Correct prediction by ANFIS models ranges from 75.17 % to 82.16 % for major road right turning and 87.20 % to 88.62 % for minor road right turning. Themodels developed in this paper can be used in the dynamic estimation of gap acceptance in traffic simulation models.

Clinical Trial Protocol: Randomized Controlled Trial of Cancer Pain Monitoring System (CAPAMOS) in Patients with Advanced Cancer

Purpose: This randomized controlled trial (RCT) protocol was designed to evaluate the effectiveness of the Cancer Pain Monitoring System (CAPAMOS), a telenursing system designed to alleviate pain in ambulatory patients with advanced cancer. Methods: The study design involved a randomized controlled trial consisting of an intervention group using CAPAMOS and a control group that received usual care. At the time of enrollment, both groups will be given a questionnaire regarding issues, such as concerns related to cancer pain and self-management of opioid medication. Patients will then receive pain relief education based on the results of the questionnaire. Subjects in the control group will receive a pain diary and pain-relief pamphlet that acts as an educational tool. They could also call the outpatient clinic if they wanted to ask for a nursing consultation. The intervention group will be able to use CAPAMOS to manage their pain and receive video consultation with a telenurse, who is an oncology nursing specialist. Educational tools will be built into CAPAMOS. The study will be conducted for one month. The primary endpoint of this study was to calculate the Japanese Brief Pain Inventory score. The secondary endpoints were to assess the opioid medication self-management, Barriers Questionnaire, Japanese EuroQol 5-dimensions 5-level, and economic evaluation. Assessment items will be evaluated at registration and 2 and 4 weeks after registration. Conclusions: A RCT based on this protocol is expected to validate the efficacy of telenursing using CAPAMOS in patients with advanced cancer and pain.

Control effect of structured skin care plan of integrated Chinese and Western medicine in elderly patients with incontinence-associated dermatitis

Objective:The objective of this study is to explore the clinical effects of structured skin care plan of integrated Chinese and Western medicine in intervening elderly patients with incontinence-associated dermatitis(IAD).Materials and Methods:Totally,66 elderly patients with IAD were randomly divided into the experiment group(32 cases)and control group(34 cases).The control group was given routine nursing care,while the experiment group was given a structured skin care plan.The observational course was 2 weeks.The treatment efficiency and healing time were compared between the two groups.Results:After 2-week intervention,the total effective rate of the experiment group was higher than that of the control group(97.1%vs.78.1%,X^(2)=3.913,P=0.048).The skin assessment tool score of the experiment group was lower than that of the control group(0.56±1.58 vs.1.75±2.46,Z=−−2.401,P=0.016).The healing time of the experiment group was shorter than that of the control group(7.29±4.76 days vs.10.69±6.36 days,Z=−2.280,P=0.026).Conclusion:The structured skin care plan of integrated Chinese and Western medicine showed a good effect in elderly IAD patients,and provided a reference for clinical treatment and care of elderly patients with IAD.

Control study of short-term curative effect of minimally invasive total hip arthroplasty using metal-on-metal large-diameter femoral head for the elderly patients with femoral neck fractures

Objective To discuss the postoperative curative effects of two surgical techniques of minimally invasive total hip arthroplasty (THA) using metal-on-metal largediameter and conventional diameter femoral head for the elderly patients

Effects of a Nurse-Led Educational Intervention for Chinese Adult Patients with Psoriatic Arthritis: A Case-Control Study

The aim of this study was to evaluate the effect of an individual nurse-led educational intervention for patients with psoriatic arthritis (PsA). This was a case-control study. The case group consisted of six individual educational sessions delivered by a nurse. A total of 40 patients with PsA joined in this study: the case group (n = 20) and the control group (n = 18). After a 6-week intervention, the case group had significantly better management for the severity of arthritis symptoms (p < 0.05), better psychological well-being and significant lower levels of anxiety (p < 0.05), and depression score (p < 0.01), and reported better improvement of physical and psychological domain of quality of life (QOL) (both p values < 0.05) than the control group. In conclusion, this nurse-led individual education intervention has statistically significant benefits for the management of clinical symptoms of arthritis and for psychological well-being and QOL in patients with PsA.

Disease-specific health-related quality of life and its determinants in liver cirrhosis patients in Lithuania

AIM: To evaluate disease-specific quality of life (QOL) in liver cirrhosis patients and to compare it with those of a healthy population. Also an important objective was to assess whether QOL in liver cirrhosis patients differs by age and gender, by type and severity of disease. METHODS: The case group of 131 liver cirrhosis patients was selected. The control group of 262 was enrolled from a healthy population according to the scheme of case-control study. Clinical, demographic, laboratory data were collected. QOL was measured with a specific chronic liver disease questionnaire (CLDQ), which was translated and validated in Lithuanian. QOL scores were compared between groups by age, gender, type and severity of disease. Cronbach’s alpha statistics calculation was used for evaluation of internal consistency reliability. Student’s t test or ANOVA were used for evaluation hypothesis about probability equation. RESULTS: QOL was significantly lower in liver cirrhosis patients than in healthy population (59.5 ± 18.3 vs 85.3 ± 12.3, P < 0.001). The significant QOL differences between case and control groups were observed in domains of worry and abdominal symptoms, the smaller differences-in emotional functions and systematic symptom domains. Significantly worse QOL was in observed patients with increased clinical severity of the disease measured by Child-Pugh class. Age, gender and etiology of disease had an insignificant effect on QOL in cirrhotic patients. CONCLUSION: QOL was significantly impaired in all CLDQ domains in liver cirrhosis patients. Increase in severity of disease was the major factor associated with poorer QOL.

Facilities for Centralized Isolation and Quarantine for the Observation and Treatment of Patients with COVID-19

The coronavirus disease 2019(COVID-19)pandemic increased the burden on many healthcare systems and in the process,exposed the need for medical resources and physical space.While few studies discussed the efficient utilization of medical resources and physical space so far.Therefore,this study aimed to summarize experiences related to facilities used for centralized isolation for medical observation and treatment during the COVID-19 pandemic in China and to provide suggestions to further improve the management of confirmed cases,suspected cases,and close contacts.In China,three types of facilities for centralized isolation(Fangcang shelter hospitals,refitted non-designated hospitals,and quarantine hotels)underwent retrofitting for the treatment and isolation of confirmed and suspected cases.These facilities mitigated the immediate high demand for space.Moreover,in order to minimize infection risks in these facilities,regulators and governmental agencies implemented new designs,management measures,and precautionary measures to minimize infection risk.Other countries and regions could refer to China’s experience in optimally allocating social resources in response to the COVID-19 pandemic.As a conclusion,government should allocate social resources and construct centralized isolation and quarantine facilities for an emergency response,health authorities should issue regulations for centralized isolation facilities and pay strict attention to the daily management of these facilities,a multidisciplinary administration team is required to support the daily operation of a centralized isolation facility,in-depth studies and international collaboration on the centralized isolation policy are encouraged.

Where is the rudder of a fish?:the mechanism of swimming and control of self-propelled fish school

Numerical simulation and control of self- propelled swimming of two- and three-dimensional biomimetic fish school in a viscous flow are investigated. With a parallel computational fluid dynamics package for the two- and three-dimensional moving boundary problem, which combines the adaptive multi-grid finite volume method and the methods of immersed boundary and volume of fluid, it is found that due to the interactions of vortices in the wakes, without proper control, a fish school swim with a given flap- ping rule can not keep the fixed shape of a queue. In order to understand the secret of fish swimming, a new feedback con- trol strategy of fish motion is proposed for the first time, i,e., the locomotion speed is adjusted by the flapping frequency of the caudal, and the direction of swimming is controlled by the swinging of the head of a fish. Results show that with this feedback control strategy, a fish school can keep the good order of a queue in cruising, turning or swimming around circles. This new control strategy, which separates the speed control and direction control, is important in the construction of biomimetic robot fish, with which it greatly simplifies the control devices of a biomimetic robot fish.

Dynamics and adaptive control of a dual-arm space robot with closed-loop constraints and uncertain inertial parameters

A dynamics-based adaptive control approach is proposed for a planar dual-arm space robot in the presence of closed-loop constraints and uncertain inertial parameters of the payload. The controller is capable of controlling the po- sition and attitude of both the satellite base and the payload grasped by the manipulator end effectors. The equations of motion in reduced-order form for the constrained system are derived by incorporating the constraint equations in terms of accelerations into Kane＇s equations of the unconstrained system. Model analysis shows that the resulting equations perfectly meet the requirement of adaptive controller design. Consequently, by using an indirect approach, an adaptive control scheme is proposed to accomplish position/attitude trajectory tracking control with the uncertain parameters be- ing estimated on-line. The actuator redundancy due to the closed-loop constraints is utilized to minimize a weighted norm of the joint torques. Global asymptotic stability is proven by using Lyapunov＇s method, and simulation results are also presented to demonstrate the effectiveness of the proposed approach.

Deformation behaviors of 21-6-9 stainless steel tube numerical control bending under different friction conditions

For contact dominated numerical control(NC) bending process of tube, the effect of friction on bending deformation behaviors should be focused on to achieve precision bending forming. A three dimensional(3D) elastic-plastic finite element(FE) model of NC bending process was established under ABAQUS/Explicit platform, and its reliability was validated by the experiment. Then, numerical study on bending deformation behaviors under different frictions between tube and various dies was explored from multiple aspects such as wrinkling, wall thickness change and cross section deformation. The results show that the large friction of wiper die-tube reduces the wrinkling wave ratio η and cross section deformation degree ΔD and increases the wall thinning degree Δt. The large friction of mandrel-tube causes large η, Δt and ΔD, and the onset of wrinkling near clamp die. The large friction of pressure die-tube reduces Δt and ΔD, and the friction on this interface has little effect on η. The large friction of bending die-tube reduces η and ΔD, and the friction on this interface has little effect on Δt. The reasonable friction coefficients on wiper die-tube, mandrel-tube, pressure die-tube and bending die-tube of 21-6-9(0Cr21Ni6Mn9N) stainless steel tube in NC bending are 0.05-0.15, 0.05-0.15, 0.25-0.35 and 0.25-0.35, respectively. The results can provide a guideline for applying the friction conditions to establish the robust bending environment for stable and precise bending deformation of tube bending.

CO_2-triggered gelation for mobility control and channeling blocking during CO_2 flooding processes

CO2 flooding is regarded as an important method for enhanced oil recovery （EOR） and greenhouse gas control. However, the heterogeneity prevalently dis- tributed in reservoirs inhibits the performance of this technology. The sweep efficiency can be significantly reduced especially in the presence of ＂thief zones＂. Hence, gas channeling blocking and mobility control are important technical issues for the success of CO2 injection. Normally, crosslinked gels have the potential to block gas channels, but the gelation time control poses challenges to this method. In this study, a new method for selectively blocking CO2 channeling is proposed, which is based on a type of CO2-sensitive gel system （modified polyacry- lamide-methenamine-resorcinol gel system） to form gel in situ. A CO2-sensitive gel system is when gelation or solidification will be triggered by CO2 in the reservoir to block gas channels. The CO2-sensitivity of the gel system was demonstrated in parallel bottle tests of gel in N2 and CO2 atmospheres. Sand pack flow experiments were con- ducted to investigate the shutoff capacity of the gel system under different conditions. The injectivity of the gel system was studied via viscosity measurements. The results indi- cate that this gel system was sensitive to CO2 and had good performance of channeling blocking in porous media. Advantageous viscosity-temperature characteristics were achieved in this work. The effectiveness for EOR in heterogeneous formations based on this gel system was demonstrated using displacement tests conducted in double sand packs. The experimental results can provide guideli- nes for the deployment of theCO2-sensitive gel system for field applications.

The Popularization and Application of Cold Storage Red Blood Cells or Whole Blood at -80 ℃ of the Rh(D) Negative Patients in Surgical Operation

Summary: The efficiency of cold storage red blood cells (CSRBC) or whole blood at -80 ℃ used in 27 Rh(D) negative patients during surgical operation was reported. The Rh(D) negative patients received the transfusion of CSRBC or whole blood stored at -80 ℃ for 180 to 360 days. The changes in the indexes, such as blood TB, DB, K +, Na +, BUN, Cr, urine protein (URPO), UOB, Hb, HCT, serum total protein, relative to hemolytic reaction and blood volume before and after transfusion were observed. The results showed that after transfusion of CSRBC or whole blood 27 cases were negative for urine protein and UOB, and the levels of BUN and Cr were normal (P>0.05). Blood TB, DB, Hb, and HCT were increased, while pH, blood K + and blood Na + was normal with the difference being not significant before and after operation (P>0.05). Plasma protein was decreased, but there was no significant difference before and after operation (P>0.05). It was suggested that CSRBC or whole blood at -80 ℃ could be safely infused to the Rh(D) negative patients without side effects during the surgical operation.

Factors Analysis Related towards Behavior of Nosocomial Infection Control on Family Waiting Patient

World Health Organization(WHO)predicted 1.4 million people infected Health Associated Infection(HAIs).One of the risk factors caused is behavior of nosocomial infection control on patient watcher.The purpose is to know relation behavior of nosocomial infection control on patient watcher patient in Semarang hospital and the number of participants was 61 people.Research method was observation with cross sectional approach.Sampling technique was purposive sampling.Data analysis used univariate and bivariate analysis with Pearson correlation test and chi-square test.Result showed a half of them,mean age of the participants was 45.56.Minimum-maximum values were 20-62 with standard deviation 11.114,gender in the research,most of them was female(83.6%),last education was junior high school(34,4%),most of them worked as maids(45.9%).Category of behavior of nosocomial infection control:less(44.3%),moderate(34.4%),and good(21.3%).There is a meaningful relation between behavior of nosocomial infection control behavior with age(p=0.000),education(p=0.000),and occupation(p=0.000).There is no meaningful relation between behavior of nosocomial infection control with gender(p=0.186).Conclusion:there is a meaningful relation between behavior of nosocomial infection control on patient watcher with age,education,and job,while gender does not have a meaningful relation with behavior of nosocomial infection control.Based on this research,it is recommended to be done as intervention which is able to increase behavior of nosocomial infection control on patient watcher by improving nursing service.