Is current training in basic and advanced cardiac life support(BLS & ACLS) effective? A study of BLS & ACLS knowledge amongst healthcare professionals of North-Kerala

BACKGROUND:Healthcare professionals are expected to have knowledge of current basic and advanced cardiac life support(BLS/ACLS) guidelines to revive unresponsive patients.METHODS:Across-sectional study was conducted to evaluate the current practices and knowledge of BLS/ACLS principles among healthcare professionals of North-Kerala using pretested self-administered structured questionnaire.Answers were validated in accordance with American Heart Association's BLS/ACLS teaching manual and the results were analysed.RESULTS:Among 461 healthcare professionals,141(30.6%) were practicing physicians,268(58.1%) were nurses and 52(11.3%) supporting staff.The maximum achievable score was 20(BLS15/ACLS 5).The mean score amongst all healthcare professionals was 8.9±4.7.The mean score among physicians,nurses and support staff were 8.6±3.4,9±3.6 and 9±3.3 respectively.The majority of healthcare professionals scored <50%(237,51.4%);204(44.3%) scored 51%-80%and 20(4.34%)scored >80%.Mean scores decreased with age,male sex and across occupation.Nurses who underwent BLS/ACLS training previously had significantly higher mean scores(10.2±3.4) than untrained(8.2±3.6,P=0.001).Physicians with <5 years experience(P=0.002) and nurses in the private sector(P=0.003)had significantly higher scores.One hundred and sixty three(35.3%) healthcare professionals knew the correct airway opening manoeuvres like head tilt,chin lift and jaw thrust.Only 54(11.7%) respondents were aware that atropine is not used in ACLS for cardiac arrest resuscitation and 79(17.1%) correctly opted ventricular fibrillation and pulseless ventricular tachycardia as shockable rhythms.The majority of healthcare professionals(356,77.2%) suggested that BLS/ACLS be included in academic curriculum.CONCLUSION:Inadequate knowledge of BLS/ACLS principles amongst healthcare professionals,especially physicians,illuminate lacunae in existing training systems and merit urgent redressal.

Advanced trauma life support training: How useful it is?

We have tried in a recently published systematic review(World J of Surg 2014; 38: 322-329) to study the educational value of advanced trauma life support(ATLS) courses and whether they improve survival of multiple trauma patients. This Frontier article summarizes whatwe have learned and reflects on future perspectives in this important area. Our recently published systematic review has shown that ATLS training is very useful from an educational point view. It significantly increased knowledge, and improved practical skills and the critical decision making process in managing multiple trauma patients. These positive changes were evident in a wide range of learners including undergraduate medical students and postgraduate residents from different subspecialties. In contrast, clear evidence that ATLS training reduces trauma death is lacking. It is obvious that it is almost impossible to perform randomized controlled trials to study the effect of ATLS courses on trauma mortality. Studying factors predicting trauma mortality is a very complex issue. Accordingly, trauma mortality does not depend solely on ATLS training but on other important factors, like presence of well-developed trauma systems including advanced pre-hospital care. We think that the way to answer whether ATLS training improves survival is to perform large prospective cohort studies of high quality data and use advanced statistical modelling.

Quality of Chest Compressions Differs over Time between Advanced and Basic Life Support

Purpose: According to guideline recommendations, chest compressions (CC) during cardiopulmonary resuscitation (CPR) should be performed at a rate of 100 - 120 per minute, with a CC fraction (CCF) of ≥80%. The aim of this work is to explore whether CC quality differs between advanced life support (ALS) and basic life support (BLS) performed by two rescuers. Method: Cardiopulmonary resuscitation was performed by two ambulance personnel in ten ALS and ten BLS manikin scenarios. Data from these scenarios were then compared with data on ten ALS cases from the clinical setting, all with non-shockable rhythms. Data from the first two 5-minute periods of CC were evaluated from impedance data (LIFEPAK 12 defibrillator monitors) using a modified Laerdal Skillmaster manikin. Quality parameters compared were: number of CC pauses (CCPs), total time of CC (%), number of CC given and CC rate/min. Results: During the first 5 minutes, the BLS manikin scenarios had the highest number of CCPs, 15 (14 - 16), compared with the ALS manikin scenario, 14 (13 - 15), and the clinical ALS cases, 12 (10 - 15). The BLS scenario also had the highest CCFs, 81% (77% - 85%), and number of CC, 450 (435 - 495), compared with the ALS manikin scenario, 75% (64% - 81%) and 400 (365 - 444) respectively, and the clinical ALS cases, 63% (50% - 74%) and 408 (306 - 489). The median rate of CC/min in the BLS scenario was 115 (110 - 120) compared with the ALS manikin scenario, 110 (106 - 115), and the clinical ALS cases, 130 (118 - 146). During the second 5-minute period, the BLS scenario had the highest number of CCPs, 16 (15 - 17), compared with 15 (14 - 16) for the ALS manikin scenario and 11 (11 - 12) for the clinical ALS cases. The CCF in the BLS setting was 79% (75% - 83%), and the number of CC 455 (430 - 480), compared with the ALS manikin scenario, 79% (74% - 84%) and 435 (395 - 480) respectively, and the clinical ALS cases, 71% (57% - 77%) and 388 (321 - 469) respectively. The median CC rate was 118 (113 - 124) for BLS, 111 (105 - 120) for ALS manikins and 123 (103 - 128) CC/min for clinical ALS cases. Conclusion: None of the groups being studied could deliver CC at a rate of 100 - 120 CC/min or a CCF of ≥80% over the whole 10-minute period in any of the resuscitation scenarios analyzed. However, BLS had the best compliance with CC quality recommendations according to the 2010 guidelines.

LTE-Advanced网络Uu接口用户行为分析系统的研究与实现

大数据时代,面对海量且复杂的结构化、半结构化和非结构化数据,传统的信令监测分析系统无法快速准确地分类、处理以及存储海量数据中包含的信息。针对这些问题,提出了一种基于Hadoop系统技术平台和支持向量机(Support Vector Machine,SVM)分类算法的LTE-Advanced网络Uu接口用户行为分析系统。对用户行为分析系统的系统架构、在Hadoop平台下数据挖掘分类算法SVM的实现进行了详细阐述,并通过Uu接口进行了现网测试,测试结果表明,提出的用户行为分析系统达到了预期的效果,对用户偏好分析以及精准营销具有推广意义。

“To measure is to know”: how advances in image analysis are supporting neural repair strategies

Neuronal regeneration in the peripheral nervous system arises via a synergistic interplay of neurotrophic factors,integrins,cytoskeletal proteins,mechanical cues,cytokines,stem cells,glial cells and astrocytes.

Analyze the rules of Chinese herbal of Professor Xiong Lu in treating metaphase and advanced lung cancer by data mining

Objective： To analyze the experience of chief physician Xiong Lu in treating metaphase and advanced lung cancer through using TCM inheritance support system （V2.5）. Methods： Collecting the prescriptions used for metaphase and advanced lung cancer from November 1, 2014 to February 1, 2015, then the data were entered into the TCM inheritance support system. Based on principle analysis, revised mutual information, complex system entropy cluster and unsupervised hierarchical clustering composing principles were analyzed. Results： Based on the analysis of 228 cases of prescriptions, the frequency of each Chinese medicinal herb and association rules among herbs included in the database were computed. 15 core combinations and 2 new prescriptions were explored from the database. Conclusion： In treating metaphase and advanced lung cancer, chief physician Xiong Lu pay attention to Fuzheng Peiben （Therapy for support Zheng-qi to propup root）, according to the different situation cooperate with Tong Luo （dredging collaterals）, San Jie （Dissipating a mass）, Huo Xue （Activating blood）, Gong Du （Counteracting toxic substance） and so on. Xiong Lu is also good at using toxic drugs and incompatible medicaments.

Research on Robotized Advance Support and Supporting Time for Deep Fully Mechanized Excavation Roadway

To keep coal workers away from the hazardous area with frequent accidents such as the roof fall and rib spalling in an underground coalmine,we put forward the solution with robotized self-moving anchor-supporting unit.The existing research shows that the surrounding rock of the roadway has self-stability,and the early or late support is not conducive to the safe and reliable support of the roadway,so there is a problem of support opportunity.In order to study the supporting effect and the optimal supporting time of the above solution,we established the mechanical coupling model of surrounding rock and advance support,and investigated the surrounding rock deformation and advance support pressure distribution under different reserved roof subsidence by using the numerical simulation software FLAC3D.The results show that the deformation of surrounding rock increases and finally tends to a stable level with the increase of pre settlement of roadway roof,and when the pre settlement of roof is between 8-15 mm,the vertical pressure of the top beam of advance support reaches the minimum value,about 0.58 MPa.Based on the above research,we put forward the optimum supporting time in roadway excavation,and summarized the evaluation method based on the mechanical coupling model of surrounding rock-advance support.

决策支持框架理论干预在晚期癌症患者预立医疗照护计划中的应用

目的探讨决策支持框架理论干预在晚期癌症患者预立医疗照护计划中的应用效果。方法采用便利抽样法选取某肿瘤医院2023年3-6月收治的晚期癌症患者58例为对照组,2023年7-10月收治的同类患者58例为干预组。对照组采用常规护理方法,干预组在对照组基础上实施决策支持框架理论干预。比较两组患者预立医疗照护计划准备度与决策冲突得分情况。结果干预组患者预立医疗照护计划准备度总分及各维度得分均高于对照组,决策冲突总分及各维度得分均低于对照组,差异均有统计学意义(均P<0.05)。结论基于决策支持框架的预立医疗照护计划干预,能提高患者预立医疗照护计划准备度,降低决策冲突水平,对提高晚期癌症患者具有重要意义。

超前支护立柱动力稳定性与可靠性研究

针对超前支护立柱顶端受轴向载荷作用,建立立柱阶梯柱形结构的动力偏微分方程,经过转化为二阶常微分Mathieu型参数方程,利用Bolotin方法对其动力稳定性进行数值计算。建立立柱结构的安全余量方程,并成功求解动力不稳定区域边界。分别分析活柱与缸筒不同长度比、立柱不同弹性模量以及活柱与缸筒不同直径比等因素对立柱动力稳定性的影响。结果表明:随着活柱与缸筒长度比的增大,立柱稳定性降低;随着立柱弹性模量和活柱与缸筒直径比的增大,立柱稳定性提高。在此基础上,进行立柱结构的非概率可靠性分析,得到立柱结构的非概率可靠度,即立柱结构的非概率可靠度与活柱和缸筒长度比增减性相反,与立柱弹性模量、活柱与缸筒直径比增减性相同。

基于数字孪生和深度强化学习的矿井超前液压支架自适应抗冲支护方法

受深部开采冲击地压等地质灾害扰动的影响,存在矿井超前支护系统自感知能力差、智能抗冲自适应能力弱、缺乏决策控制能力等问题。针对上述问题,提出了一种基于数字孪生和深度强化学习的矿井超前液压支架自适应抗冲支护方法。通过多源传感器感知巷道环境和超前液压支架支护状态,在虚拟世界中创建物理实体的数字孪生模型,其中物理模型精确展现超前液压支架的结构特征和细节,控制模型实现超前液压支架的自适应控制,机理模型实现对超前液压支架自适应支护的逻辑描述和机理解释,数据模型存储超前液压支架实体运行数据和孪生数据,仿真模型完成超前液压支架立柱仿真以实现超前液压支架与数字孪生模型虚实交互。根据基于深度Q网络(DQN)的超前液压支架自适应抗冲决策算法,对仿真环境中巷道抗冲支护进行智能决策,并依据决策结果对物理实体和数字孪生模型下达调控指令,实现超前液压支架智能控制。实验结果表明:立柱位移与压力变化一致,说明超前液压支架立柱仿真模型设计合理,从而验证了数字孪生模型的准确性;基于DQN的矿井超前液压支架自适应抗冲决策算法可通过调节液压支架控制器PID参数,自适应调控立柱压力,提升巷道安全等级,实现超前液压支架自适应抗冲支护。

翻转课堂在心血管外科住院医师高级体外生命支持课程中的应用

目的探索翻转课堂在心血管外科住院医师高级体外生命支持课程中的应用效果。方法选取2019年1月至2022年6月在武汉大学人民医院心血管外科轮转的住院医师134名,其中71名纳入观察组,采取翻转课堂教学模式;63名纳入对照组,采用传统教学模式。教学前后进行理论考核和临床技能考核,采用调查问卷评价教学效果。结果(1)理论考核成绩:教学前观察组得分与对照组得分差异无统计学意义;教学后观察组(87.78±5.54)分高于对照组(83.46±5.57)分,差异有统计学意义(P<0.05);(2)临床技能考核:教学前观察组得分与对照组得分差异无统计学意义;教学后观察组(86.17±4.34)分高于对照组(82.73±4.11)分,差异有统计学意义(P<0.05)。观察组住院医师对提高主观能动性、增加操作机会和提高临床操作技能这3项指标的满意度高于对照组。结论应用翻转课堂教学可以提高住院医师在心血管外科高级体外生命支持课程理论和操作技能考核成绩,住院医师对于该种教学模式的满意度较高。

软弱土层的连拱隧道超前支护有限元分析及施工控制

以江苏某地铁站暗挖换乘通道下穿城市引桥工程为背景,研究连拱隧道穿越软弱土层超前支护施工控制问题,提出连拱隧道超前支护施工控制方法。采用MIDAS-GTS NX建立原始土层和全断面深孔注浆加固+超前小导管支护两种工况下连拱换乘通道的三维实体模型,分析通道开挖施工产生的地表沉降、拱顶沉降及对引桥的影响;根据有限元分析模型,确定连拱隧道超前支护注浆液的类型为AC液体、C液V(水玻璃)∶V(水)=0.6∶0.4,初始压力为0.30~0.75 MPa,终止压力为0.5~1.0 MPa,单位长度的注浆量为0.283 m^(3)。研究结果表明,注浆试验段开挖施工完成后,地表沉降最大值为5.57 mm,小于设计要求的沉降控制值10 mm,超前支护效果良好,能够有效提高连拱隧道加固效果。

晚期癌症患者预立医疗照护计划参与现状及影响因素研究

目的了解晚期癌症患者预立医疗照护计划参与现状,分析影响因素,为针对性干预提供参考。方法采用一般资料调查表、中文版预立医疗照护计划参与问卷、家庭支持量表、创伤后成长量表对349例晚期癌症患者进行调查与分析。结果患者中文版预立医疗照护计划参与总分为84.54±23.05;处于行为改变前意识阶段、思考阶段、准备阶段、行动阶段的患者比例依次为36.7%、37.2%、22.3%及3.7%。回归分析显示,文化程度、病程、替别人做过医疗决定、家庭支持、创伤后成长是患者预立医疗照护计划参与的主要影响因素(均P<0.05)。结论晚期癌症患者预立医疗照护计划参与水平处于中等偏下,仅少部分患者处于行为改变准备与行动阶段;应加强文化程度低、病程短、家庭支持及创伤后成长水平较低患者的干预与支持。

隧道斜向超前系统锚杆支护效果及承载规律

为研究渝昆高铁斜向超前系统锚杆支护体系的力学特性,在乐业隧道开展了斜向超前系统锚杆现场试验,结合有限差分数值模拟,基于支护应力场的概念,实现斜向超前系统锚杆有效支护范围的定量描述,采用多指标(隧道位移差、围岩塑性区、围岩最小主应力)对斜向超前系统锚杆的支护效果进行定量评价。通过分析锚杆轴力、钢拱架轴力的分布特征,确定斜向超前支护体系的承载规律,并与现场试验结果进行验证和对比分析。结果表明:1)隧道开挖后,锚杆支护会形成支护应力场,即在开挖面附近形成了最大主应力增大区,而最大主应力的增大提高了岩体抵抗变形的能力;2)随着掌子面空间效应的减弱,斜向锚杆需要承担的围岩荷载逐渐增大,其有效支护的范围也逐渐增大;3)在掌子面附近,斜向锚杆支护提高了围岩的自承载能力,降低了拱顶、拱肩和拱腰处钢拱架的轴力,改善了钢拱架的受力特征。

晚期癌症患者替代决策者安宁疗护问题提示列表的构建

目的构建安宁疗护问题提示列表,为晚期癌症患者替代决策者主动获取安宁疗护相关信息提供参考。方法2023年1-8月,在文献回顾和半结构式访谈基础上归纳整理晚期癌症患者替代决策者的信息需求主题及相应条目,通过专家函询和预调查优化问题提示列表内容。结果构建的晚期癌症患者替代决策者安宁疗护问题提示列表包括7个一级条目、44个二级条目,主题涵盖安宁疗护、治疗决策、症状管理、临终准备、决策辅助、心理及情感支持、社会支持7个方面。结论构建的安宁疗护问题提示列表内容全面、可靠,有助于替代决策者向医护人员获取关于安宁疗护和决策所需信息,减少其在安宁疗护决策过程中可能面临的决策冲突及延迟情况。

综采面沿空巷道超前动压区煤柱失稳效应与锚注加固技术

为探究综采面沿空巷道超前动压区煤柱对巷道围岩整体稳定的影响规律,综合采用数值模拟、工程应用等方法,建立沿空巷道超前巷道数值分析模型,研究综采面回采期间不同煤柱宽度下沿空巷道围岩力学和变形响应特征。研究结果表明:护巷煤柱宽度小于5 m时,工作面帮为采动应力主要承载结构,其内部应力及变形均大于煤柱帮,此时工作面帮应作为超前动压区重点加固对象,随着护巷煤柱宽度增加,煤柱承载应力逐渐增加、变形增大,护巷煤柱宽度增加至5 m以上时,煤柱承载应力显著增加,采动应力由沿空巷道两帮围岩共同承载,超前动压区应同时加强两帮支护,基于此开发超前动压区沿空巷道锚注加固技术,并进行工程应用。研究结果可为平顶山矿区类似条件沿空巷道超前控制提供一定参考。

新型便携式体外膜肺氧合动物实验在体安全性和有效性研究

目的本研究旨在验证一种自主研发的新型便携式体外膜肺氧合(ECMO)系统(西京高级生命支持系统JC-Ⅲ型)在大动物体内的安全性和有效性。方法共计10只健康小尾寒羊通过颈动脉-颈静脉插管方式进行静脉-动脉体外膜肺氧合(VA-ECMO)支持,以评价JC-Ⅲ型ECMO系统的性能。通过持续输注肝素实现全身抗凝,转机过程中每2 h记录1次活化凝血时间(ACT),维持ACT在200~250 s之间;离心泵转速设定在3000~3500 r/min。分别于ECMO启动前和启动后24 h监测血红蛋白、血细胞计数、凝血、肝肾功能、心肌损伤等指标变化情况,实验结束后解剖泵头和氧合器,探查血栓形成情况。结果VA-ECMO手术成功率为100%,ECMO转机24 h,流量波动于1.9~2.5 L/min,未发生溶血、泵头血栓、膜肺血栓。ECMO转机前后血红蛋白含量、白细胞计数、血小板计数、谷丙转氨酶、谷草转氨酶、尿素、肌酐、高敏肌钙蛋白I、N末端B型脑钠肽前体等指标差异均无统计学意义(均P>0.05)。结论本在体动物实验证实了西京高级生命支持系统JC-Ⅲ型的安全性和有效性。

隧道洞口浅埋偏压段超前支护方案数值模拟

由于山岭隧道洞口段多处于浅埋偏压地形,为保证施工进洞安全,常常需要采取超前支护以控制洞口段围岩变形,保证围岩稳定。以彝良隧道洞口段为工程背景,采用FLAC 3D有限差分软件,分别建立无超前支护、管棚超前支护、超前小导管超前支护和管棚+超前小导管联合超前支护方案进行比选分析。计算结果表明:超前支护可大幅度降低围岩竖向位移、水平位移、竖向应力以及抑制拱顶塑性区发育;从支护效果上看,管棚支护效果最佳,管棚+超前小导管联合支护次之,超前小导管最差;从管棚长度自身以及施工经济合理性考虑,在控制围岩变形效果相当的条件下,采用管棚+超前小导管联合支护较佳。研究可为类似浅埋偏压隧道洞口段超前支护方式的选择提供借鉴。

祁东煤矿厚硬顶板回采巷道锚杆(索)式主动超前支护技术及应用

针对我国当前被动式超前支护为主的超前支护形式难以匹配回采工作面自动化、少人化与智能化发展趋势这一问题,以8237工作面机巷为研究对象,提出了回采巷道主动式超前支护技术:在两巷超前区域采用主动式支护工艺,通过顶板损伤特征原位测试进行现场评估,采用FLAC^(3D)软件对比分析了无支护,无超前支护和主动式超前支护不同方案支护时的围岩应力演化与变形过程。矿压监测结果表明:巷道顶板最大下沉量32 mm,锚索受力最大变化量7 kN;主动式超前支护可显著提高围岩结构稳定性,确保工作面回采期间安全。

膨胀性软破岩层深竖井施工分级支护研究

境外某铜金矿千米深竖井在通过膨胀性软破岩层(泥灰岩)时,围岩遇水膨胀压力极大,先后出现两次井壁垮塌和开裂的情况,对施工进度及施工人员安全产生极大影响。为解决该问题,查找相关文献资料及国内外类似施工案例,对通过膨胀性软破岩层的井壁破裂机理进行分析,针对性地制定井壁破裂修复方案;在此基础上,进一步调查施工地点的工程地质和水文地质情况,通过分析与总结,提出深竖井不良岩层的施工及分级支护方案,对其所穿过的膨胀性软破岩层的围岩制定分级表,根据不同岩体等级分别提出相应的施工及具体支护方案。通过对两次破裂处井壁的修复,较长时间内未出现裂缝及漏水现象,修复效果良好,达到预期;此外,竖井井筒后续施工中在采用分级支护方案后,井筒顺利通过厚度超过500 m的不良岩层,且在工期、质量、安全三个方面都取得良好效果,保障该深竖井工程的施工质量与施工安全。该工程为膨胀性软破岩层中的深竖井掘进施工积累了宝贵经验,对类似工程具有一定的借鉴意义。