基于Reason模型的SIF-Q260型电子小肠镜故障原因分析

根据武汉大学中南医院内窥镜中心SIF-Q260型小肠镜故障率高且维修成本高的情况,应用Reason模型,从环境影响、不安全监督、不安全行为前兆及不安全行为4个层面分析造成SIF-Q260小肠镜故障的原因,针对各个层面故障原因,从定期培训以规范内窥镜的洗消及使用、设置专人管理内窥镜并定期对内窥镜使用洗消的规范性进行监督及评价、完善内窥镜监管系统3方面拟定改进措施,堵住系统“漏洞”,为内窥镜质量控制措施的制定提供依据,可预防和减少内窥镜故障的发生。

Challenges Experienced by Nurse Educators in Promoting Acquisition of Clinical Reasoning Skills by the Undergraduate Nursing Students: A Qualitative Exploratory Study

Background: Clinical reasoning is an essential skill for nursing students since it is required to solve difficulties that arise in complex clinical settings. However, teaching and learning clinical reasoning skills is difficult because of its complexity. This study, therefore aimed at exploring the challenges experienced by nurse educators in promoting acquisition of clinical reasoning skills by undergraduate nursing students. Methods: A qualitative exploratory research design was used in this study. The participants were purposively sampled and recruited into the study. Data were collected using semi-structured interview guides. Thematic analysis method was used to analyze the collected data The principles of beneficence, respect of human dignity and justice were observed. Results: The findings have shown that clinical learning environment, lacked material and human resources. The students had no interest to learn the skill. There was also knowledge gap between nurse educators and clinical nurses. Lack of role model was also an issue and limited time exposure. Conclusion: The study revealed that nurse educators encounter various challenges in promoting the acquisition of clinical reasoning skills among undergraduate nursing students. Training institutions and hospitals should periodically revise the curriculum and provide sufficient resources to facilitate effective teaching and learning of clinical reasoning. Nurse educators must also update their knowledge and skills through continuous professional development if they are to transfer the skill effectively.

Assessing the Levels of Clinical Reasoning Skills Using Self-Assessment of Clinical Reflection and Reasoning in Undergraduate Nursing Students: A Descriptive Comparative Study

Background: Clinical reasoning is a critical cognitive skill that enables undergraduate nursing students to make clinically sound decisions. A lapse in clinical reasoning can result in unintended harm to patients. The aim of the study was to assess and compare the levels of clinical reasoning skills between third year and fourth year undergraduate nursing students. Methods: The study utilized a descriptive comparative research design, based on the positivism paradigm. 410 undergraduate nursing students were systematically sampled and recruited into the study. The researchers used the Self-Assessment of Clinical Reflection and Reasoning questionnaire to collect data on clinical reasoning skills from third- and fourth-year nursing students while adhering to ethical principles of human dignity. Descriptive statistics were done to analyse the level of clinical reasoning and an independent sample t-test was performed to compare the clinical reasoning skills of the student. A p value of 0.05 was accepted. Results: The results of the study revealed that the mean clinical reasoning scores of the undergraduate nursing students were knowledge/theory application (M = 3.84;SD = 1.04);decision-making based on experience and evidence (M = 4.09;SD = 1.01);dealing with uncertainty (M = 3.93;SD = 0.87);reflection and reasoning (M = 3.77;SD = 3.88). The mean difference in clinical reasoning skills between third- and fourth-year undergraduate nursing students was not significantly different from an independent sample t-test scores (t = −1.08;p = 0.28);(t = −0.29;p = 0.73);(t = 1.19;p = 0.24);(t = −0.57;p = 0.57). Since the p-value is >0.05, the null hypothesis (H0) “there is no significantno significant difference in clinical reasoning between third year and fourth year undergraduate nursing students”, was accepted. Conclusion: This study has shown that the level of clinical reasoning skills of the undergraduate nursing students was moderate to low. This meant that the teaching methods have not been effective to improve the students clinical reasoning skills. Therefore, the training institutions should revise their curriculum by incorporating new teaching methods like simulation to enhance students’ clinical reasoning skills. In conclusion, evaluating clinical reasoning skills is crucial for addressing healthcare issues, validating teaching methods, and fostering continuous improvement in nursing education.

The Effect of the Menstrual Cycle on Cognitive Performance: Spatial Reasoning, Visual & Numerical Memory

The menstrual cycle has been a topic of interest in relation to behavior and cognition for many years, with historical beliefs associating it with cognitive impairment. However, recent research has challenged these beliefs and suggested potential positive effects of the menstrual cycle on cognitive performance. Despite these emerging findings, there is still a lack of consensus regarding the impact of the menstrual cycle on cognition, particularly in domains such as spatial reasoning, visual memory, and numerical memory. Hence, this study aimed to explore the relationship between the menstrual cycle and cognitive performance in these specific domains. Previous studies have reported mixed findings, with some suggesting no significant association and others indicating potential differences across the menstrual cycle. To contribute to this body of knowledge, we explored the research question of whether the menstrual cycles have a significant effect on cognition, particularly in the domains of spatial reasoning, visual and numerical memory in a regionally diverse sample of menstruating females. A total of 30 menstruating females from mixed geographical backgrounds participated in the study, and a repeated measures design was used to assess their cognitive performance in two phases of the menstrual cycle: follicular and luteal. The results of the study revealed that while spatial reasoning was not significantly related to the menstrual cycle (p = 0.256), both visual and numerical memory had significant positive associations (p < 0.001) with the luteal phase. However, since the effect sizes were very small, the importance of this relationship might be commonly overestimated. Future studies could thus entail designs with larger sample sizes, including neuro-biological measures of menstrual stages, and consequently inform competent interventions and support systems.

Reason模型在肝癌介入术病人围术期护理安全管理中的应用分析

目的:探讨Reason模型在肝癌介入术病人围术期护理安全管理中的应用效果。方法:应用Reason模型对2020年6月-2021年6月22例次肝癌介入术病人围术期护理安全不良事件进行回顾性分析,从不安全行为、不安全性前提、不安全监督、组织管理4个方面分析原因并制定解决方案,比较方案实施前后护理安全不良事件发生率。结果:实施Reason模型后肝癌介入术病人围术期护理安全不良事件发生率为0.135%,显著低于实施前的0.586%(P<0.05)。结论:基于Reason模型的管理有利于深度挖掘护理管理问题,降低护理安全不良事件发生率,有助于改变医护人员对不良事件上报的态度,保障病人安全。

基于SHEL+Reason模型的住院药房药品调剂差错安全风险综合评价指标体系的建立

目的建立基于SHEL+Reason模型的住院药房药品调剂差错安全风险综合评价指标体系。方法通过SHEL+Reason模型对我院住院药房2019年7—12月期间的441076条医嘱进行分析,结合文献复习法形成药品调剂差错安全风险的专家咨询表,采取德尔菲法(Delphi Method)进行咨询,通过统计学分析对指标体系进行完善,运用综合评分法构建综合评价方程,抽取2021年1—6月期间的897条调剂差错医嘱进行评价研究,采用信度分析验证指标体系的可靠性,对综合评价结果采用X-σ_(X)、X、X+σ_(X)确定区分不同等级的界限,进行单因素方差分析(完全随机设计),验证通过综合评价方法获得的各分类间的差异是否有统计学意义。结果本指标体系包含4个一级指标,10个二级指标,进行了两轮专家咨询后专家权威性和指标体系内部一致性良好,利用抽取的医嘱验证了构建的综合评价指标体系具有良好的区分度。结论建立的住院药房药品调剂安全风险评价指标体系适用于医院住院药房的药品调剂差错管理,可为医院相关管理工作的开展提供参考。

如何理解菲尼斯的“practical reasonableness”?

“practical reasonableness”是菲尼斯自然法理论中的一个核心概念,也是晚近有关菲尼斯的讨论中最困扰学界的理解及翻译的概念。在汉语学界有关“practical reasonableness”的多种理解中,有着诸多混淆,把“practial reasonableness”与“practical reason”“practical reasoning”“practical intelligibility”区分开来对于恰切理解这个概念尤为必要。另外,菲尼斯所使用的“practical reasonableness”概念在很大程度上可追溯至阿奎那的“prudentia”概念,尽管其在一定程度上对阿奎那的理论进行了改造。通过区分及渊源上的考察,我们大体上可以界定菲尼斯的“practical reasonableness”概念所包含的基本含义:其一,它是一种整合性的和统合性的力量;其二,它的这种力量在根本意义上来源于理性,所以,它是实践理性活动的一种产物;其三,它是实践理性活动成功而达致的状态,因此它会对人的倾向、态度和行动提出要求。

基于知识图谱多跳推理的中文矿物知识问答方法与系统

已有相关矿物数据库用于存储和查询相关矿物知识,常用的搜索引擎也可以对矿物知识进行查询,但无法回答用自然语言进行提问的矿物问题,查询返回的答案需要进一步筛选。亦有基于知识图谱进行矿物知识问答的相关研究,但只能回答涉及知识图谱中一个三元组的简单问题,无法回答涉及多个三元组的多跳复杂问题。为此,本文提出基于知识图谱多跳推理的矿物复杂知识问答方法,采用ComplEx模型将矿物实体、关系和问句表示为复数向量,以更好地获取相互之间的语义及推理关系。输入矿物问句后,通过Bert-LSTM-CRF获取其中心词,采用基于编辑距离及分词的方法获得中心词的候选实体集合,然后采用全连接网络确定最相关的实体作为推理起点,与矿物问句拼接后通过全连接网络获得当前跳的最相关关系。根据当前跳的起始实体及最相关关系,在矿物知识图谱中获得另一实体作为下一跳的推理起点,并将下一跳的问句更新为原问句,与当前跳最相关关系拼接,以将当前跳的推理信息带入到下一跳推理中,直到获得的最相关推理关系为预定义的结束标识符,推理结束,返回最后一跳的实体为答案,并给出推理路径。采用Python语言,在Tensorflow框架下实现了本文提出的矿物复杂知识问答并与相关模型进行对比,证明了本文方法的有效性。采用前后端分离架构,使用RESTful API、React、Ajax、echarts和Flask等框架和技术,开发了基于知识图谱多跳推理的矿物复杂知识问答系统,为矿物知识获取及相关地质研究提供了平台和工具。

我院贝伐珠单抗生物类似药与原研药相关不良反应回顾性分析

目的分析某院贝伐珠单抗生物类似药与原研药相关药物不良反应(ADR)的发生情况,为临床合理用药提供数据支持。方法对江苏省肿瘤医院2022年1-12月上报的贝伐珠单抗生物类似药和原研药相关ADR报告进行回顾性分析。结果我院使用贝伐珠单抗的患者共6818人次,上报ADR报告136份,贝伐珠单抗生物类似药的ADR发生率显著高于原研药(2.18%vs.0.71%,P=0.004)。ADR报告中,治疗方案以贝伐珠单抗与其他肿瘤治疗药物的联合治疗方案为主(129人次);痊愈和好转的患者有118人次;一般ADR报告108份,严重ADR报告28份;ADR主要累及系统/器官以心血管系统为主,贝伐珠单抗生物类似药与原研药引起的高血压/血压升高、白细胞/血小板降低、腹泻和发热发生率比较,差异均无统计学意义。结论贝伐珠单抗生物类似药的相关ADR发生率明显高于原研药,但ADR临床表现无明显差异,临床医生可以根据患者及其家属意愿选择使用。

基于案例推理的隧道洞门智能设计方法研究

为将以往隧道案例的经验应用到新建隧道设计中,以解决传统设计方法工作量大且效率低下的问题,提出基于案例推理的隧道洞门智能设计方法。结合隧道洞门工程特点,选取影响洞门设计的主要因素,将影响因素划分为12个属性单元来表征工程案例,运用三角模糊数的层次赋权计算方法对各属性单元权重进行赋值,借助相似度理论建立隧道洞门设计方案相似决策模型。基于GIS技术开发了隧道洞门工程案例库,实现对既有工程的存储管理,同时利用SQL查询语言及Python计算脚本实现案例的属性特征值计算与最相似匹配,进一步修正后可实现隧道洞门修建方案的设计决策。以某山区隧道为例对智能设计方法进行验证,结果表明:根据属性单元特征值计算结果,在案例库中比选得出与拟建隧道相似度最高的既有工程为凤凰山隧道,且相似度为0.707。因此,设定阈值为0.7时能加快案例库的检索速率与匹配准确率,该方法吸取了既有工程案例的经验,能应用于隧道洞门施工方案的决策设计,可供今后隧道洞门方案的智能化设计参考。

论行政复议的适当性审查

合法性审查、适当性审查是行政复议机关审查被申请行政行为的两个审查标准。适当性审查与行政诉讼合理性审查表述不同但内容一致。合法性审查是形式合法性审查,适当性审查是实质合法性审查,因此,适当性审查与合法性审查构成了一种从“从形式违法到实质违法”的双阶审查方法。在形式合法性已经确认的前提下,针对被申请行政行为的内容,行政复议机关可以从合目的性、结果可接受性和利益权衡三个面向作适当性审查。

基于模糊神经网络的电网消防预警算法

针对传统基于阈值判别方法的电网火灾预警系统预测精度低、抗干扰能力弱的问题,提出了一种基于模糊神经网络的电网消防预警算法。该算法利用神经网络学习大规模电网数据,使用模糊逻辑推理算法来提升预测结果的推理能力,并通过结合神经网络对大规模数据的学习能力和模糊逻辑算法的推理能力来分析电网线路参数,从而提升电网消防预警系统的精度和抗干扰能力。实验与仿真结果表明,所提出方法能显著提升电网火灾的预警精度,且使用模糊逻辑推理可以得到更符合实际情况的电网火灾预警结果。

平台经济领域强化反垄断的正当性与合理限度

近些年来,国内外在平台经济领域开展了声势浩大的反垄断行动,尤其是欧盟出台的《数字市场法》和我国强调“强化反垄断和防止资本无序扩张”备受关注。基于平台经济竞争的鲜明特点和数字平台对经济社会的巨大影响,强化平台经济领域的反垄断有其理论上的正当性和现实的必要性。与此同时,平台经济创新发展的内在要求又决定了在平台经济领域的反垄断有其合理的边界和必要的限度。美国和欧盟等在平台经济领域反垄断上的差异性反映了国际竞争的现实情况,我国需要从国家利益最大化角度出发对平台经济领域反垄断策略做出理性选择,以促进我国平台经济规范健康持续发展。

行政复议变更决定的运用

2023年《行政复议法》修改的重要内容即构建了以变更决定为核心的行政复议决定体系。这一修改更加贴切行政复议的功能定位,行政复议也能够进一步避免程序空转,真正发挥出解决行政纠纷的“主渠道”作用。但是,抽象而出的规则面对复杂具体的个案,仍会存在诸多理解和适用上的不确定性,有必要对新法中的变更决定条款作出解释,进一步细化其实践运用。具体而言,在事证明确类案件中,行政复议机关可以基于两种理由作出变更决定,一是适用依据正确,但是行政行为内容不适当,包括明显不当和一般意义上的“不适当”,以是否具有规则性条款或者裁量基准,建立双重审查标准体系;二是未正确适用依据,包括违法和不当适用依据的情形。在事证瑕疵类案件中,行政机关原则上适用变更决定,但事实认定过程对专业性要求高以及案件事实疑难复杂的情形,可以适用撤销决定。

融合知识图谱和案例推理的燃气应急辅助决策研究

燃气事故发生时,应急处置人员基于文本资料查询应急处置方案难以满足处置科学性与快速性的需求。为此,提出了一种融合知识图谱和案例推理的燃气应急辅助决策方法。将已有燃气事故案例文本资料以知识图谱的形式存储与表示,利用案例推理的属性相似度与关系相似度加权计算方法,根据事故目标案例与源案例的综合相似度,检索出最佳相似源案例作为现场处置人员应急处置决策的重要参考,并将新的案例与处置措施存储于燃气应急处置知识图谱库中,实现处置措施的知识更新。通过案例相似度权重分配、属性权重分配、属性相似度方法选取,以及案例验证等,验证了本文方法的合理性与有效性。

Correlation between Reasons for Prescription and Karyotype Results in Patients Referred for Suspected Chromosomal Abnormalities

Karyotype prescription is based on clinical signs (or reasons for karyotype prescription) which are phenotypic manifestations associated with chromosomal abnormalities. The aim of this study was to establish a correspondence between karyotype indications and their results in patients. This was a retrospective study that was carried out in the Histology-Embryology-Cytogenetics laboratory of the University Hospital of Cocody-Abidjan from 2014 to 2019. 58 patient files were identified and included the indication or reason for prescribing a constitutional karyotype and the biological result obtained. An individual data sheet was used to collect the data. 17 reasons for prescription were identified and divided into 2 groups. Sexual ambiguity was the most frequent reason (29.3%). The first group (G1) represented the 10 reasons for which the karyotype results were normal. The second group (G2) corresponded of the 7 motives with normal or abnormal karyotype results. Several anomalies were listed according to these reasons: inversions, mosaics (anomalies of number and structure) and trisomy 21. The last was the most frequent chromosomal anomaly (69.24%). It was found in several reasons for karyotype prescription: malformations, neurological disorders, suspected trisomy and cardiac pathology. Several factors could explain these results, among which are the limits of the karyotype and the non-genetic causes that can induce these abnormal phenotypes. Complementary examinations to the karyotype are molecular cytogenetic techniques, notably fluorescence in situ hybridization (FISH) and array comparative genomic hybridization (Array-CGH).

燃气管道泄漏爆炸应急救援物资需求及救援点优化选址研究

为研究燃气管道泄漏爆炸后的应急救援物资需求量和最佳救援点选址,采用案例推理方法,建立了燃气管道泄漏爆炸事故应急资源需求模型。以某化工园区发生燃气管道泄漏爆炸为案例,运用MATLAB编程对应急资源需求进行数值计算;利用ArcGIS可视化、地图数据分析功能,建立网络空间数据集,获得该案例工业园区6个应急救援点。结果表明,可通过化工园区应急救援历史数据获得事故应急资源需求量,利用ArcGIS建立位置分配点和确定救援点数量,可获得优化的应急救援选址。

The Reasons for Admission of Elderly Subjects in Intensive Care at the CHU Ignace Deen

Objective: To determine the reasons for admission of elderly subjects and the prognosis in general intensive care. Patients and Methods: Observational descriptive and analytical study with prospective collection of data over a period of one year from January 1 to December 31, 2021. Patients aged 65 or over were included. Abstract: During the study period, 223 cases were collected out of 587 patients admitted, giving a prevalence of 37.9%. The average age was 74.127.39 ± years with extremes of 65 and 96 years and a male predominance (58.7%). The comorbidities were dominated by arterial hypertension (71.3%). The patients were: transferred from medical and surgical emergencies (75.8%). The average admission time was 48.8 ± 29.8 hours. One hundred and eight patients had a Glasgow score between 3 and 7. The reasons for admission were dominated by vascular causes (51.6%). Strokes of any type accounted for 43.9% of these reasons for admission. The average time for carrying out the biological assessments and imaging was 41.8 ± 27.3 hours with the extremes of 3 and 89 hours, 37.2% had a complete assessment within 24 hours. The average duration of hospitalization was 7.10 ± 8.87 days with extremes of 1 and 72 days. The mortality rate was 71.7%. Conclusion: This study has made it possible to take stock of the reasons for the admission of elderly subjects to intensive care. It appears that vascular causes are the main reasons for admission with heavy comorbidities which results in high mortality.

行贿犯罪案件的司法证明问题——对《刑法修正案(十二)》的证据法思考

《刑法修正案(十二)》体现了“受贿行贿一起查”的精神,但是行贿犯罪案件的无被害人犯罪、无可勘验的犯罪现场和大多数案件无目击证人的“三无”特点,决定了行贿案件的司法证明面临较大难题:一对一证据、主要依靠言词证据定案、非法证据较难排除、司法证明错误难以被检验、受贿案件的事实认定对行贿案件具有较强的证明力等五个方面。缓解证明困难,主要从11个方面进行论述:一是注重收集《刑法修正案(十二)》规定的行贿犯罪“从重”处罚的证据;二是利用认罪认罚提供的制度空间,对行贿人进行激励,换取其认罪认罚;三是注重收集客观化证据;四是对“再生证据”的创造和运用;五是注意录像固定言词证据;六是关键证人应当出庭作证,其证言内容须接受法庭检验;七是行贿人和受贿人均予否认情况下的事实认定问题;八是行贿人与受贿人供述不一致情况下的事实认定问题;九是行贿人翻供的事实认定问题;十是对行贿犯罪案件不能适用推定降低证明标准,受贿案件证明中运用的是推理而非推定;十一是经验法则在行贿案件证明中的运用问题。

应用伦理学的方法论

作为方法体系的应用伦理学,主要包含两个方面的内容:它是一个技术层面上的“方法组合”,是各种原则、规范、推理技巧和分析框架的应用组合;它也是一种“做伦理学”的方法论。应用伦理学的早期范式是一种原则主义,即运用普遍原则判断特殊事例的道德推理。当代应用伦理学的研究范式则是一个“转化”和“应用”多元知识解决道德困境的综合判断决策系统,它有两个重要的方法路径:权衡伦理原则和细化伦理规则。规则的权衡和细化是应用伦理学对道德推理不断开发的过程,是两种具有基础意义的应用伦理学分析方法。应用伦理学不仅打开了一个可适度无限开放的问题域,也催生着一个开放的学科知识交互系统和一个综合判断决策系统。但也应认识到,应用伦理学无法解决所有的道德困境,因此不能对它抱有不合理的预期。