基于ERAS理念的Steward评分法对骨科全身麻醉术后患儿早期进食及术后应激水平的影响

目的:探究基于快速康复外科理念(ERAS)的Steward评分法对骨科全身麻醉术后患儿早期进食及术后应激水平的影响。方法:选取医院2021年7月—2021年12月收治的120例骨科患儿作为研究对象,依据干预方式不同分为常规组和康复组,每组60例。常规组给予全身麻醉术后常规护理,术后6 h进食。康复组应用基于ERAS理念的Steward评分法行全身麻醉术后干预,术后清醒1~3 h进食。比较两组患儿围术期相关情况、术后恶心呕吐(PONV)、疼痛情况、口渴、饥饿情况及家属焦虑程度。结果:康复组患儿术后首次饮水时间、术后首次进食时间短于常规组(P<0.05);康复组患儿PONV情况优于常规组(P<0.05),Wong-Baker面部表情疼痛量表(FPS-R)评分低于常规组(P<0.05);康复组患儿口渴、饥饿发生率为15.00%,低于常规组的68.33%(P<0.05);康复组家属焦虑程度评分低于常规组(P<0.05)。结论:快速康复理念下Steward评分可调节骨科全身麻醉术后患儿围术期相关情况,改善PONV、疼痛情况,调节口渴、饥饿情况,减轻家属焦虑程度。

Steward动感平台体感仿真数值化算法研究

为实现六自由度Steward动感平台的姿态控制,实时模拟驾驶舱的运动姿态,选择Washout Filte的滤波方法作为体感模拟算法,推导Washout Filter的高通、低通滤波器的传递函数转换为差分方程的算法及纵向加速度倾斜策略、俯仰策略等,并用实例验证了算法的正确性.

基于BP神经网络的Steward平台运动学分析

位置正解是Steward平台机构应用的基础,探讨了人工神经网络在Steward平台机构位置正解求解中的应用。采用BP神经网络,利用位置逆解结果,通过训练学习,从而求得Steward平台机构运动学正解。经过验证,BP网络的求解精度满足精确控制的要求。

基于VEGA的Steward动感平台数字化建模方法研究

Steward平台因具有六自由度运动实现容易、结构简单和控制算法成熟等特点而被应用于飞行模拟器、汽车驾驶模拟器等众多领域.主要研究Steward动感平台结构及运动范围,建立动感平台的坐标系、变换矩阵,建立运动学方程,得到位置逆解计算公式,采用Vega Prime建模软件进行平台装配,建立了完整的Steward动感平台数字化模型.

Perceptions of Beach Stewards and Information Needs for Shorebird Stopover Sites Vary as a Function of Visitor Interests: Improving Stewardship Programs in Coastal Landscapes

Many studies have demonstrated that some of the activities of people can disturb nesting and foraging birds, particularly along coasts and estuaries. Some managers respond to human disturbance of sensitive species by closing beaches, but most have stewards monitor and restrict access to beaches or portions of beaches. Yet little is known about the type of visitor or their perceptions of beach stewards. This paper explores the general acceptance of beach stewards and their role in conservation of red knots (Calidris canutus rufa), other shorebirds, and horseshoe crabs (Limulus polyphemus) along the Delaware Bay (New Jersey) beaches by interviewing 279 visitors during the stopover period. While most people came to see the shorebird and horseshoe crab spectacle (60%), many came for the scenery, tranquility, and recreation. Just over half of the people interviewed said that the stewards were helpful (58%), although most of those that answered this question later said that they provided conservation value (86%), but only 40% said they relied on the stewards for information. On a Likert rating scale of 1 to 5 (the highest value), the mean rating for whether it was important for stewards to be present was 3.87 ± 0.09, and the rating for the presence of stewards who can provide information was 3.71 ± 0.11. In contrast, protection of shorebirds was rated a mean of 4.79 ± 0.04. There were significant visitor type differences in how important stewards were, but not in the importance of stewards who can provide information. Fishermen, recreationists, and people coming for scenery and tranquility rated the presence of stewards higher than those visitors who were interested in either shorebirds or crabs (or both). Ratings also differed significantly as a function of age and gender;older adults and females rated characteristics higher than did people under 30 years and males. Information needs identified by stewards are also discussed. These data can be used by the managers developing a strategy for conservation of shorebirds and other species sensitive to disturbance, and for the implementation of an effective stewardship program.

Is Nationwide Special Campaign on Antibiotic Stewardship Program Effective on Ameliorating Irrational Antibiotic Use in China? Study on the Antibiotic Use of Specialized Hospitals in China in 2011–2012

Summary： With dwindling number of new antibiotics and inappropriate use of antibiotics, the emergence and spread of antibiotics resistance occurs commonly in healthcare institutions worldwide. In China, antibiotics are commonly overprescribed and misused. This study is to assess the effect of the nationwide special campaign on antibiotic stewardship program （ASP） at specialized hospitals in China by investigating prescription information from 2011 to 2012. Data on the hospital consumption and prescription of systemic antibiotics were obtained from four specialized hospitals, including maternity, children＇s, stomatological and cancer hospitals. Systematic random sampling was used to select outpatient prescriptions and inpatient cases. A total of 105 specialized hospitals in 2011 and 121 specialized hospitals in 2012 were analysed. The defined daily doses （DDDs） per 100 inpatient days, the percentage of antibiotic use in outpatient prescriptions, and the percentage of antibiotic use in inpatient eases were used as measurements of antibiotic use. The overall antibiotic use density in the selected hospitals decreased between 2011 and 2012 from 39.37 to 26.54 DDD/100 inpatient days （P〈0.001）. The percentage of antibiotic use in outpatient prescriptions （range： 24.12%-18.71%, P=0.109） and inpatient cases （64.85%-60.10%, P=-0.006） also decreased within the two years. Significant changes were observed among regions and different hospitals within the two years. And antibiotic consumption was correlated with the type and size of specialized hospital in 2012, but not with the regions. This analysis of antibiotic consumption of specialized hospitals allows relevant comparisons for benchmarking and shows that national ASP has improved antibiotic rational use in China. The data will assist policymakers in formulating effective strategies to decrease antibiotic overuse and identify areas that require further work.

闭口掩鼻试验和Steward苏醒评分在儿童全麻后苏醒质量的对比观察

目的:比较闭口掩鼻试验和Steward苏醒评分评估患儿全麻后苏醒质量效果。方法:选取2014年1月至2018年7月于我院行全麻手术0~10岁的患儿156例为研究对象,随机分为对照组和观察组,每组78例。对照组采用Steward苏醒评分评估患儿苏醒质量,观察组采用闭口掩鼻试验评估患儿的苏醒质量,比较两组患儿评估所需时间、麻醉复苏室滞留时间、苏醒时间及不良反应发生情况。结果:观察组评估所需时间为7.86±1.04 s,明显低于对照组,麻醉室复苏滞留时间为35.16±7.27min,明显高于对照组,差异均有统计学意义(P<0.05);两组患儿苏醒时间无显著性差异(P>0.05);观察组舌后坠、喉痉挛、术后复睡、术后躁动等不良反应发生率为28.21%,明显低于对照组,差异有统计学意义(P<0.05)。结论:闭口掩鼻试验和Steward苏醒评分评估儿童全麻后苏醒效果各具优势,闭口掩鼻试验方法评估快速高效且术后不良反应发生率低,安全性高;Steward苏醒评分方法麻醉复苏室滞留时间短,复苏周转快,但评估效率较慢且安全性低。

改良Aldrete量表和Steward量表用于评估接受麻醉胃肠镜检查儿童复苏效果的回顾性分析

目的探究Steward量表和改良Aldrete量表用于评估接受全身麻醉胃肠镜检查儿童患者复苏效果的有效性及安全性。方法采用回顾性病例对照研究,分析2022年7—12月在浙江大学医学院附属儿童医院接受非插管全身麻醉下胃肠镜检查的患儿199例,将患儿根据年龄分为学龄前组36例、低学龄组75例及高学龄组88例。同时进行Steward量表和改良Aldrete量表麻醉苏醒评估,记录患儿的生命体征及达标所需时间,对比2个量表的评分效率及安全性。结果患儿Steward量表达标所需时间(17.5±9.3)min,显著低于改良Aldrete量表的(20.8±12.6)min,两者比较差异有统计学意义(t=2.97,P<0.01)。低学龄组在达到改良Aldrete量表出室标准时血氧饱和度(0.989±0.010)高于Steward量表的(0.980±0.015),两者比较差异有统计学意义(t=2.17,P<0.05)。Steward量表达标时间与患儿年龄呈负相关(r=-0.385,P<0.01)。改良Aldrete量表达标时间与患儿年龄无显著相关(r=-0.089,P>0.05)。结论在全身麻醉胃肠镜检查儿童麻醉复苏评估中,Steward量表虽比改良Aldrete量表评估效率高,但改良Aldrete量表比Steward量表安全性更高,更有利于保障患儿的生命安全。

靶控输注在前列腺电切中的应用

目的:探讨靶控输注(TCI)在前列腺电切中的应用价值。方法:选取2020年2月至2023年2月在医院行前列腺电切手术的80例患者,按照随机数字表法分为两组,各40例。对照组采用常规麻醉干预,观察组采用TCI技术。记录两组围术期相关指标,对比不同时间点[麻醉诱导前(T0)、气管插管(T1)、术后2 h(T2)、术后12 h(T3)、术后24 h(T4)]血清C反应蛋白(CRP)、视觉模拟评分(VAS)、镇静(Ramsay)评分、Steward苏醒评分,统计术后并发症。结果:观察组苏醒、拔管及麻醉恢复时间均较对照组短(P<0.05)。术后两组VAS评分随时间推移均逐渐降低,Ramsay评分随时间推移均逐渐升高,且观察组术后12 h、24 h、48 h时VAS评分均低于对照组,Ramsay评分高于对照组(P<0.05)。两组术后Steward苏醒评分降低(P<0.05);观察组术后Steward苏醒评分比对照组高(P<0.05)。两组SBP、DBP水平随T1~T4推移逐渐降低,且观察组均低于对照组(P<0.05)。两组CRP水平随T1~T3推移均逐渐增加,且观察组T1~T4时点的CRP水平均低于对照组(P<0.05)。观察组麻醉并发症发生率比对照组低(P<0.05)。结论:对行前列腺电切手术患者实行TCI技术,能有效促进术后恢复,提高镇静、镇痛效果,降低炎性因子表达,且安全性较高。

Aldrete评分、Steward评分、OAA/S评分在日间胸腔镜手术全麻术后苏醒的应用价值对比

目的探究Aldrete评分、Steward评分、警觉与镇静(Observer’s Assessment of Alterness/Sedation,OAA/S)评分在日间胸腔镜手术患者全麻术后苏醒延迟中的临床诊断效能。方法选取2020年1月至2021年6月在上海市肺科医院行全麻下日间胸腔镜手术患者600例,依据苏醒延长时间判定苏醒延迟情况,将患者纳入苏醒时间延迟组(200例)和苏醒时间未延迟组(400例)。采用单因素分析评价日间胸腔镜手术患者苏醒时间延迟在临床资料上的差异,多因素Logistic回归分析日间胸腔镜手术患者苏醒时间延迟的影响因素,分别采用Aldrete评分、Steward评分、OAA/S评分对患者苏醒情况进行评估,对比两组患者评分差异,绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析3项评分评估日间胸腔镜手术患者苏醒时间延迟的临床效能。结果日间胸腔镜手术患者的苏醒时间延迟在年龄、低体温、低血压、低血糖、高碳酸血症、手术时间及出血量情况上差异有统计学意义(P<0.001)。低血糖、低血压、出血量≥200 ml、手术时间≥4 h、高碳酸血症、年龄≥60岁、低体温是日间胸腔镜手术患者苏醒时间延迟的危险因素。与苏醒时间未延迟组比较,苏醒时间延迟组患者的Aldrete评分、Steward评分、OAA/S评分均明显降低(P<0.05)。Aldrete评分、Steward评分、OAA/S评分评估苏醒时间延迟的曲线下面积(area under curve,AUC)分别为0.966、0.855和0.720。结论低血糖、低血压、出血量≥200 ml、手术时间≥4 h、高碳酸血症、年龄≥60岁、低体温是全麻下日间胸腔镜手术患者术后苏醒延迟的危险因素,Aldrete评分在评估麻醉术后苏醒时间中的临床效能高于Steward评分、OAA/S评分。

六自由度Stewart并联平台的参数优化及公差分配

并联机器人的基础设计工作主要涉及两个方面:基本参数设计与公差分配。从机器人可达工作空间进行了推广,引申出广义的可达工作空间,将机器人姿态与位置同时考虑。以广义可达工作空间为优化目标,对6-SPS型Stewart平台进行基本参数的优化,通过粒子群算法(PSO)获得了一组具有更大的位置,姿态可达空间的并联机器人参数。另外,以更低的机器人制造成本为目标,在尺寸公差与形位公差满足机器人设计目标的约束下,对各基本尺寸的公差进行优化分配。通过分析尺寸公差与形位公差对末端精度的影响,建立了大概的公差-精度关系模型。

Steward与Aldrete苏醒评分法对麻醉复苏效果影响的比较

目的 探讨分析Steward与Aldrete苏醒评分法对麻醉复苏效果的影响.方法 选取2019年1月~2020年5月在笔者医院行全身麻醉的49例患者作为研究对象,随机分为两组:观察组24例患者,采用Aldrete苏醒评分;对照组25例患者,采用Steward苏醒评分.结果 和对照组相比,观察组入PACU即刻、30min、60min、90min的苏醒评分更高,出室所需时间更长,入PACU30min和60min的MAP更低,入PACU30min的SpO2更高(P<0.05).结论 Steward评分比Aldrete评分复苏周转时间短,但Aldrete评分比Steward评分的生命体征指标更加平稳,并发症发生率更低,安全性更高,更适合作为麻醉复苏的离室标准.

城市固废资源化利用情景下的“环保管家”服务——以上海市老港生态环保基地为例

随着社会生产力的不断发展以及人们环境保护意识的不断提高,“环保管家”服务模式应运而生。本文以上海老港基地为研究对象,从政府“环保管家”视角,研究城市固废资源化利用基地建设及运行过程中,环境治理方案及治理措施的实践成果,以期在技术层面提升“环保管家”技术认知、拓宽行业限制,达到“环保管家”整体技术实力提升的目的。

环保管家在排污许可领域的应用探索

在排污许可制背景下,企业需要构建完善的环境管理体系,以便做到按证排污、自证守法。本文分析了排污许可执法检查中的常见问题和目前企业环境管理中遇到的难点,并针对性地提出了“环保管家”的服务思路和服务内容,旨在为环保管家助力企业落实主体责任方面提供参考。

Curriculum Development for FAIR Data Stewardship

The FAIR Guidelines attempts to make digital data Findable, Accessible, Interoperable, and Reusable(FAIR). To prepare FAIR data, a new data science discipline known as data stewardship is emerging and, as the FAIR Guidelines gain more acceptance, an increase in the demand for data stewards is expected. Consequently, there is a need to develop curricula to foster professional skills in data stewardship through effective knowledge communication. There have been a number of initiatives aimed at bridging the gap in FAIR data management training through both formal and informal programmes. This article describes the experience of developing a digital initiative for FAIR data management training under the Digital Innovations and Skills Hub(DISH) project. The FAIR Data Management course offers 6 short on-demand certificate modules over 12 weeks. The modules are divided into two sets: FAIR data and data science. The core subjects cover elementary topics in data science, regulatory frameworks, FAIR data management, intermediate to advanced topics in FAIR Data Point installation, and FAIR data in the management of healthcare and semantic data. Each week, participants are required to devote 7–8 hours of self-study to the modules, based on the resources provided. Once they have satisfied all requirements, students are certified as FAIR data scientists and qualified to serve as both FAIR data stewards and analysts. It is expected that in-depth and focused curricula development with diverse participants will build a core of FAIR data scientists for Data Competence Centres and encourage the rapid adoption of the FAIR Guidelines for research and development.

环保管家服务推动工业园区绿色发展价值的探讨

自“环保管家”概念提出以来,一种新的第三方服务也应运而生。工业园区环境管理水平受到各种因素的制约,管理水平有待提升。面对新的挑战,全国各地政府大力推行该项业务。本文结合环保管家的概念、政策以及自身参与的环保管家项目,通过实际案例对目前环保管家服务的问题进行探讨,明确环保管家在推动工业园区绿色发展过程中起到的重要推动作用。

工业园区环保管家服务新发展模式分析

当前,环保管家服务已经成为环保服务行业发展的必然趋势,经济绿色发展也成为当今时代经济发展的主题,但是我国制造工业发展迅猛,环境保护问题依旧突出。因此,国家对工业园区的环保管理工作也提出了更高的标准和更高的要求,引入更加高效化、精细化和专业化的全链式环保管家服务,也必将成为未来推动企业绿色发展不可缺少的新生力量,从而为优化工业园区环保管家服务提供依据。

“效期管家”小程序在提高病区抢救车管理质量中的应用

目的 探讨“效期管家”小程序在我院病区抢救车管理中的应用效果。方法 将抢救车内药品耗材的效期信息录入微信“效期管家”小程序,并设置到期提醒功能,同时在医院信息系统(Hospital Information System, HIS)系统里增加药品效期和一次性耗材效期的清单显示功能,比较使用前后6个月的效果。结果 建立“效期管家”小程序报警系统,可提升抢救车的管理质量、缩短清点时间,提高护士的满意度,与实施前比较差异均有统计学意义(均P<0.05)。结论 抢救车运用“效期管家”小程序管理,可提高抢救车管理工作的质量和效率,优化护士工作流程,保证患者的诊疗安全,提高医院管理水平。

Research on Steward Dynamic Platform Simulation Numerical Algorithm

In order to achieve attitude control of the six degrees of freedom steward dynamic platform, as well as the real time simulation cockpit attitude, Washout Filtering method was adopted in this paper as the simulation algorithm to derive Washout Fiher high-pass, low-pass filter transfer functions into a differential equation algorithm and longitudinal acceleration tilt strategy, pitching strategies etc. Experimental examples are used to verify correctness of the algorithm.

“医管家”一站式预住院准备中心构建与优化

目的:设置胸外科门诊“医管家”一站式预住院准备中心,为优化服务流程、提升运营效益提供经验。方法:2021年10月至2022年4月在武汉某三甲综合医院胸外科门诊成立“医管家”预住院准备中心,通过优化环境布局、制定流程指引、启动院内跨科借床、高级实践护士跟医查房、科内床位共享,开展门诊便民业务等全流程精细化管理,实现住院预约、精准分级收治、完善院前检查、入院宣教及随访延续护理等措施,以缓解病房床位紧张、均衡各医疗组有限资源,保障医疗安全,改善患者就医体验。结果:与2020年同期对比,平均住院日、术前平均住院日、病床周转次数、住院费用、第三方患者满意度等指标均有所改善。结论:“医管家”一站式预住院准备中心在进一步优化预住院全流程精细化管理中,增加了床位资源的使用率、减少了平均住院日、有效提升了医保精准支付与患者就医体验,有利于医院公益性进一步凸显。