Objective: To test a multifaceted collaborative quality improvement intervention designed to promote evidence based surfactant treatment for preterm infants of 23-29 weeksgestation. Design: Cluster randomised contro...Objective: To test a multifaceted collaborative quality improvement intervention designed to promote evidence based surfactant treatment for preterm infants of 23-29 weeksgestation. Design: Cluster randomised controlled trial Setting and participants: 114 neonatal intensive care units (which treated 6039 infants of 23-29 weeks gestation born in 2001). Main outcome measures: Process of care measures: proportion of infants receiving first surfactant in the delivery room, proportion receiving first surfactant more than two hours after birth, and median time from birth to first dose of surfactant Clinical outcomes: death before discharge home, and pneumothorax. Intervention: Multifaceted collaborative quality improvement advice including audit and feedback, evidence reviews, an interactive training workshop, and ongoing faculty support via conference calls and email. Results: Compared with those in control hospitals, infants in intervention hospitals were more likely to receive surfactant in the delivery room (adjusted odds ratio 5.38 (95%confidence interval 2.84 to 10.20)), were less likely to receive the first dose more than two hours after birth (adjusted odds ratio 0.35 (0.24 to 0.53)), and received the first dose of surfactant sooner after birth (median of 21 minutes vs 78 minutes, P < 0.001). The intervention effect on timing of surfactant was larger for infants born in the participating hospitals than for infants transferred to a participating hospital after birth. There were no significant differences in mortality or pneumothorax. Conclusion: A multifaceted intervention including audit and feedback, evidence reviews, quality improvement training, and follow up support changed the behaviour of health professionals and promoted evidence based practice.展开更多
The Jianpudong No. 4 tunnel is a shallow tunnel, which belongs to Shaoshan County scenic highway in Hunan province, China and whose surrounding rock is weak. According to its characteristics, the field monitoring test...The Jianpudong No. 4 tunnel is a shallow tunnel, which belongs to Shaoshan County scenic highway in Hunan province, China and whose surrounding rock is weak. According to its characteristics, the field monitoring tests and numerical analysis were done. The mechanical characteristics of shallow tunnels under weak surrounding rock and the stress-strain rule of surrounding rock and support were analyzed. The numerical analysis results show that the settlement caused by upper bench excavating accounts for 44% of the total settlement, and the settlement caused by tunnel upper bench supporting accounts for 56% of the total settlement. The maximum axial force of shotcrete lining is 177.2 k N, which locates in hance under the secondary lining. The maximum moment of shotcrete lining is 5.08 k N·m, which locates in the arch foot. The stress curve of steel arch has three obvious stages during the tunnel construction. The maximum axial force of steel arch is 297.4 k N, which locates in tunnel vault. The axial forces of steel arch are respectively 23.5 k N and-21.8 k N, which is influenced by eccentric compression of shallow tunnel and locates in hance. The results show that there is larger earth pressure in tunnel vault which is most unfavorable position of steel arch. Therefore, the advance support should be strengthened in tunnel vault during construction process.展开更多
文摘Objective: To test a multifaceted collaborative quality improvement intervention designed to promote evidence based surfactant treatment for preterm infants of 23-29 weeksgestation. Design: Cluster randomised controlled trial Setting and participants: 114 neonatal intensive care units (which treated 6039 infants of 23-29 weeks gestation born in 2001). Main outcome measures: Process of care measures: proportion of infants receiving first surfactant in the delivery room, proportion receiving first surfactant more than two hours after birth, and median time from birth to first dose of surfactant Clinical outcomes: death before discharge home, and pneumothorax. Intervention: Multifaceted collaborative quality improvement advice including audit and feedback, evidence reviews, an interactive training workshop, and ongoing faculty support via conference calls and email. Results: Compared with those in control hospitals, infants in intervention hospitals were more likely to receive surfactant in the delivery room (adjusted odds ratio 5.38 (95%confidence interval 2.84 to 10.20)), were less likely to receive the first dose more than two hours after birth (adjusted odds ratio 0.35 (0.24 to 0.53)), and received the first dose of surfactant sooner after birth (median of 21 minutes vs 78 minutes, P < 0.001). The intervention effect on timing of surfactant was larger for infants born in the participating hospitals than for infants transferred to a participating hospital after birth. There were no significant differences in mortality or pneumothorax. Conclusion: A multifaceted intervention including audit and feedback, evidence reviews, quality improvement training, and follow up support changed the behaviour of health professionals and promoted evidence based practice.
基金Projects(51408060,51208063)supported by the National Natural Science Foundation of China
文摘The Jianpudong No. 4 tunnel is a shallow tunnel, which belongs to Shaoshan County scenic highway in Hunan province, China and whose surrounding rock is weak. According to its characteristics, the field monitoring tests and numerical analysis were done. The mechanical characteristics of shallow tunnels under weak surrounding rock and the stress-strain rule of surrounding rock and support were analyzed. The numerical analysis results show that the settlement caused by upper bench excavating accounts for 44% of the total settlement, and the settlement caused by tunnel upper bench supporting accounts for 56% of the total settlement. The maximum axial force of shotcrete lining is 177.2 k N, which locates in hance under the secondary lining. The maximum moment of shotcrete lining is 5.08 k N·m, which locates in the arch foot. The stress curve of steel arch has three obvious stages during the tunnel construction. The maximum axial force of steel arch is 297.4 k N, which locates in tunnel vault. The axial forces of steel arch are respectively 23.5 k N and-21.8 k N, which is influenced by eccentric compression of shallow tunnel and locates in hance. The results show that there is larger earth pressure in tunnel vault which is most unfavorable position of steel arch. Therefore, the advance support should be strengthened in tunnel vault during construction process.
