基于Milestones系统的糖尿病联络护士培训体系构建与应用

目的 构建基于Milestones系统的糖尿病联络护士培训体系,并评价实施效果。方法 于2021年7~12月采用德尔菲法构建基于Milestones系统的糖尿病联络护士培训体系;2022年1~3月采用构建的培训体系对蚌埠医学院第一附属医院76名糖尿病联络护士进行培训。比较培训体系实施后和前期常规方法培训后糖尿病联络护士岗位胜任力各维度得分、糖尿病患者对有关糖尿病健康教育内容知晓度及对联络护士的满意度。结果 基于Milestones系统的培训体系实施后,糖尿病联络护士岗位胜任力各维度得分,包括理论、技能(胰岛素笔注射、指尖血糖检测、胰岛素泵植入与维护、健康教育)、态度(自评、护士长评价),患者对健康教育内容知晓得分和对联络护士满意度均高于常规培训,差异有统计学意义(P<0.001)。结论 构建并实施基于Milestones系统的培训体系,可提高糖尿病联络护士的岗位胜任力,为全院糖尿病患者提供专业同质化的护理;能提升患者对健康教育内容的知晓度,进而提高自我管理能力,改善患者就医感受。

运用Milestones评价体系评估肾内科住院医师为主的临床小讲课的分层效果分析

目的运用Milestones评价体系探讨住院医师为主的临床小讲课在肾内科住院医师规范化培训(以下简称住陪)中的分层应用效果。方法选择2020年9月~2021年8月在肾内科进行为期2个月住陪轮转的住院医师45人作为对照组,采用传统临床小讲课模式;选择2021年9月~2022年8月在肾内科进行为期2个月住陪轮转的住院医师36人作为研究组,采用住院医师为主的临床小讲课模式。对第1~3年住院医师(resident one-three,R1~3)轮转前后Milestones评价体系得分进行住院医师自评与主治医师评分,比较两组R1~3轮转前后Milestones得分变化,另外采用理论考核、实践技能考核及对住培满意度问卷调查评价两组R1~3的教学效果。结果轮转前两组Milestones评分比较,差异无统计学意义(P>0.05),两组主治医师评分均低于住院医师自评(P<0.05);研究组R1~3轮转后Milestones评分均高于轮转前(P<0.05),对照组R1~3轮转前后Milestones评分比较,差异无统计学意义(P>0.05);研究组R1~3理论考核成绩高于对照组,差异有统计学意义(P<0.05),研究组与对照组R1~3之间实践技能考核成绩比较,差异无统计学意义(P>0.05),研究组对住培满意度得分高于对照组(P<0.05)。结论住院医师为主的临床小讲课可以提高住院医师的患者照护能力、理论知识水平及从工作中学习与进步的能力,能改善住院医师住陪满意度。

建立临床胜任力评估委员会对麻醉科住院医师Milestone评估客观性的影响

目的 分析临床胜任力评估委员会(简称评估委员会)能否改善住院医师里程碑(Milestone)评估的客观性。方法 采取单中心横断面研究,选取2021年—2022年在北京协和医院麻醉科轮转的住院医师66名。应用自制麻醉科专业核心胜任力Milestone评估系统(简称评估系统),请导师和该院评估委员会进行评分,分析评分与客观考核成绩之间的相关性。结果 在评估系统的23个子项目中,导师与评估委员会给予评分的Kendall相关系数最低为0.60,最高为0.79;配对t检验提示两者存在显著差异。Pearson相关分析提示评估委员会给予的Milestone评分与客观考核成绩均呈显著相关性。与导师评分相比,评估委员会评分与客观成绩的差异更小。结论 评估委员会的建立有利于提高住院医师Milestone评估的客观性。

Simulation-based assessment for the emergency medicine milestones: a national survey of simulation experts and program directors

The focus of outcome-based education has shifted from the process of training to the end“product”of education.This has necessitated a reframing of the teaching,learning,and assessment.Therefore,in 2013,the Accreditation Council for Graduate Medical Education(ACGME)implemented the educational milestones for all accredited residencies and fellowship programs.[1]The milestones have been described as“developmentally based,specialty-specific achievements that residents are expected to demonstrate at established intervals as they progress through training.”[1]Milestones are based on the six core competencies established by the ACGME and American Board of Medical Specialties(ABMS),which consist of medical knowledge(MK),patient care(PC),interpersonal and communication skills(ICS),practice-based learning and improvement(PBLI),professionalism(PROF),and systems-based practice(SBP).[2,3]ACGME,in conjunction with the American Board of Emergency Medicine(ABEM),drafted 23 detailed subcompetencies relevant to emergency medicine(EM).[4]

A Multi-Stage Differential-Multifactorial Evolutionary Algorithm for Ingredient Optimization in the Copper Industry

Ingredient optimization plays a pivotal role in the copper industry,for which it is closely related to the concentrate utilization rate,stability of furnace conditions,and the quality of copper production.To acquire a practical ingredient plan,which should exhibit long duration time with sufficient utilization and feeding stability for real applications,an ingredient plan optimization model is proposed in this study to effectively guarantee continuous production and stable furnace conditions.To address the complex challenges posed by this integer programming model,including multiple coupling feeding stages,intricate constraints,and significant non-linearity,a multi-stage differential-multifactorial evolution algorithm is developed.In the proposed algorithm,the differential evolutionary(DE)algorithm is improved in three aspects to efficiently tackle challenges when optimizing the proposed model.First,unlike traditional time-consuming serial approaches,the multifactorial evolutionary algorithm is utilized to optimize multiple complex models contained in the population of evolutionary algorithm caused by the feeding stability in a parallel manner.Second,a repair algorithm is employed to adjust infeasible ingredient lists in a timely manner.In addition,a local search strategy taking feedback from the current optima and considering the different positions of global optimum is developed to avoiding premature convergence of the differential evolutionary algorithm.Finally,the simulation experiments considering different planning horizons using real data from the copper industry in China are conducted,which demonstrates the superiority of the proposed method on feeding duration and stability compared with other commonly deployed approaches.It is practically helpful for reducing material cost as well as increasing production profit for the copper industry.

Multi-Stage Multidisciplinary Design Optimization Method for Enhancing Complete Artillery Internal Ballistic Firing Performance

To enhance the comprehensive performance of artillery internal ballistics—encompassing power,accuracy,and service life—this study proposed a multi-stage multidisciplinary design optimization(MS-MDO)method.First,the comprehensive artillery internal ballistic dynamics(AIBD)model,based on propellant combustion,rotation band engraving,projectile axial motion,and rifling wear models,was established and validated.This model was systematically decomposed into subsystems from a system engineering perspective.The study then detailed the MS-MDO methodology,which included Stage I(MDO stage)employing an improved collaborative optimization method for consistent design variables,and Stage II(Performance Optimization)focusing on the independent optimization of local design variables and performance metrics.The methodology was applied to the AIBD problem.Results demonstrated that the MS-MDO method in Stage I effectively reduced iteration and evaluation counts,thereby accelerating system-level convergence.Meanwhile,Stage II optimization markedly enhanced overall performance.These comprehensive evaluation results affirmed the effectiveness of the MS-MDO method.

Research on Regulation Method of Energy Storage System Based on Multi-Stage Robust Optimization

To address the scheduling problem involving energy storage systems and uncertain energy,we propose a method based on multi-stage robust optimization.This approach aims to regulate the energy storage system by using a multi-stage robust optimal control method,which helps overcome the limitations of traditional methods in terms of time scale.The goal is to effectively utilize the energy storage power station system to address issues caused by unpredictable variations in environmental energy and fluctuating load throughout the day.To achieve this,a mathematical model is constructed to represent uncertain energy sources such as photovoltaic and wind power.The generalized Benders Decomposition method is then employed to solve the multi-stage objective optimization problem.By decomposing the problem into a series of sub-objectives,the system scale is effectively reduced,and the algorithm’s convergence ability is improved.Compared with other algorithms,the multi-stage robust optimization model has better economy and convergence ability and can be used to guide the power dispatching of uncertain energy and energy storage systems.

Scheduling Model and Algorithm of Construction Equipment under Milestone Constraint

The scheduling of construction equipment is a means to realize network planning.With the large-scale and low-cost requirements of engineering construction,the cooperation among members of the engineering supply chain has become very important,and effective coordination of project plans at all levels to optimize the resource management and scheduling of a project is helpful to reduce project duration and cost.In this paper,under the milestone constraint conditions,the scheduling problems of multiple construction devices in the same sequence of operation were described and hypothesized mathematically,and the scheduling models of multiple equipment were established.The Palmer algorithm,CDS algorithm and Gupta algorithm were respectively used to solve the optimal scheduling of construction equipment to achieve the optimization of the construction period.The optimization scheduling of a single construction device and multiple construction devices was solved by using sequencing theory under milestone constraint,and these methods can obtain reasonable results,which has important guiding significance for the scheduling of construction equipment.

美国放射科住院医师胜任力评价系统解读与思考(四):腹部放射学Milestone

腹部放射学分阶段目标胜任力评价系统(The Abdominal Radiology Milestone Project),是由美国毕业后医学教育认证委员会(The Accreditation Council for Graduate Medical Education,ACGME)与美国放射学会(The American Board of Radiology,ABR)联合倡议发起的用于评价放射学专科医师培训考核系统的一部分,该考核评价体系考核并记录腹部放射学专科医师在培训过程中所须具备六项胜任力,包括病患关切(Patient Care,PC),医学知识(Medical Knowledge,MK),基于系统的实践(Systems-based Practice,SBP),基于实践的学习(Practice-based Learning,PBL)、职业素养(Professionalism,PROF),人际关系和沟通技巧(Interpersonal and Communication Skills,ICS)。另外,评价系统指出了多种放射亚专业评估工具,对于完善国内培训机构考核方式与内容,有着积极的指导价值。

基于Multi-Stage DEA模型的中国细羊毛生产技术效率实证分析

以内蒙古等4省区为例，采用基于规模报酬可变假设的产出主导型Muhi-StageDEA模型，对2001～2010年中国细羊毛生产技术效率进行了测算和分析。研究结果表明，中国细羊毛生产技术效率不高，存在显著的技术效率损失；细羊毛生产在总体上出现了纯技术效率下降和规模效率提高并存的现象，2008年以来纯技术效率提高对细羊毛生产技术效率改善的促进作用逐渐增强，而细羊毛生产规模效率则呈现出了一定的下降趋势；各省区细羊毛生产技术效率存在较大差异，细羊毛生产的规模效率均要高于纯技术效率，规模效率仍是影响各省区细羊毛生产技术效率改善和提高的主要因素。最后提出改善和提高中国细羊毛生产技术效率的政策建议。

Triangular Au-Ag framework nanostructures prepared by multi-stage replacement and their spectral properties

Triangular Au-Ag framework nanostructures （TFN） were synthesized via a multi-step galvanic replacement reaction （MGRR） of single-crystalline triangular silver nanoplates in a chlorauric acid （HAuCl4） solution at room temperature. The morphological, compositional, and crystal structural changes involved with reaction steps were analyzed by using transmission electron microscopy（TEM）, energy-dispersive X-ray spectrometry （EDX）, and X-ray diffraction. TEM combined with EDX and selected area electron diffraction confirmed the replacement of Ag with Au. The in-plane dipolar surface plasmon resonance （SPR） absorption band of the Ag nanoplates locating initially at around 700 nm gradually redshifted to 1 100 nm via a multi-stage replacement manner after 7 stages. The adding amount of HAuCl4 per stage influenced the average redshift value per stage, thus enabled a fine tuning of the in-plane dipolar band. A proposed formation mechanism of the original Ag nanoplates developing pores while growing Au nanoparticles covering this underlying structure at more reaction steps was confirmed by exploiting surface-enhanced Raman scattering （SERS）.

美国放射科住院医师岗位胜任力评价系统:介入放射学Milestones 2.0解读与启示

美国放射科介入放射学新版住院医师胜任力评价系统Milestones 2.0发布于2019年12月,相对于第一版,新版以更广的考核视角,评估与记录放射介入方向住院医师的成长,其六大岗位胜任力包括医患照护、医学知识、基于医疗体系的实践、基于医疗实践的学习与提升、职业素养、人际沟通能力。介入放射学Milestones 2.0分为两个评价系统:融合版与独立版,分别对应放射学分支专业与放射学亚专业,分别涵盖31项、24项胜任力细则。其考核细则中的不少内容在国内放射科住培考核中尚未涉及,对于未来我国进一步完善放射科住院医师规范化培训(简称住培)内容,有重要的启示与指引作用。

美国骨科住院医师胜任力评价系统Milestones2.0的解读与思考

评估骨科住院医师核心胜任力对促进骨科住院医师规范化培训至关重要。骨科住院医师胜任力评价系统Milestones2.0是由美国毕业后医学教育认证委员会发布,针对骨科住院医师胜任力进行评价的系统,该系统的核心目的是评估参加ACGME培训项目骨科医师的核心胜任力。本文谨以该系统为例,围绕ACGME提出的六项胜任力,即患者照护、医学知识、基于系统的实践、基于实践的学习、职业素养和人际沟通技巧,介绍分阶段目标胜任力评价系统的主要内容、评价表主要结构及使用方法,以期为借鉴骨科住院医师核心胜任力的评估手段,起到促进作用。

基于Milestones的不同阶段医学人才岗位胜任力培养目标探讨

根据医学教育培养和医学人才成长规律的渐进性和连续性特征,以及我国《本科医学教育标准-临床医学专业(试行)》《住院医师规范化培训内容与标准(试行)》《关于印发临床医学、口腔医学和中医硕士专业学位研究生指导性培养方案的通知》等医学人才培养标准和目标,结合中国医师岗位胜任力8大核心要素,梳理并合理界定医学院校教育、毕业后医学教育和继续医学教育等不同培养阶段医学人才岗位胜任力培养内容和目标,以利于培养机构科学地制订、设计和实施不同培养阶段医学人才岗位胜任力培养方案,并通过基于Milestones(里程碑)评估系统的评价和促进作用确保和提高医学人才岗位胜任力培养质量。

适用于客户机/服务器系统的MILESTONE开发方法

传统的软件开发生存周期把软件开发过程划分成４个主要阶段．这种方法特别适合于单一的独立系统，但不适合客户机／服务器系统的开发．客户机／服务器系统由许多软部件组成，而且集成多个部门自己开发的软件，这些软部件特别适合采用并行且交互的实现方法．根据客户机／服务器系统开发的特点，文中介绍了一种基于ＭＩＬＥＳＴＯＮＥ的过程开发模型．

美国眼科学住院医师Milestones评价系统解读与思考

美国眼科学住院医师Milestones评价系统是由美国毕业后教育认证委员会(the accreditation council for graduate medical education,ACGME)和美国眼科委员会(the American board of ophthalmology,ABO)根据毕业后医生的核心能力评价教育质量所提出用于眼科学住院医师评价的评价系统,考核的六大核心竞争力包括患者照护、医学知识、职业素养、人际沟通、基于系统的实践和基于实践的学习,最终形成“以胜任力为基础的医学教育”。如何能够将基于培养临床胜任力的培训模式合理运用于我国眼科住院医师规范化培训体系中,并建立对眼科住院医师临床胜任力的评价与考核体系,需要进一步思考和实践。

美国传染病专科住院医师Milestones评价系统介绍与思考

20世纪90年代,我国就开始了住院医师规范化培训制度的探索,2014年原国家卫生与计划生育委员会发布的《住院医师规范化培训管理办法(试行)》正式全面启动实施,2015年底再次发布了《关于建立专科医师规范化培训制度试点的指导意见》,从制度上规范并完善了我国医学毕业后继续教育体系。传染病学专科医师培训是对参加内科住院医师规范化培训的医师或传染病学专业的临床型研究生开展传染病学专科阶段的培养,使其成长为能够独立、规范地从事传染性疾病专科诊疗工作的临床医师,以满足人民群众对高质量医疗卫生服务的需求。我国住院医师规范化培训制度尚在发展完善阶段,全程跟踪监管的科学的医师培养评价与反馈体系亟待完善。

美国放射科住院医师胜任力评价系统:肌骨放射学milestone解读与思考

美国毕业后医学教育认证委员会(ACGME)联合美国放射学会(ABR)倡议发布了针对放射科住院医师或专科医师的milestone胜任力评价系统,其主要目的是评估参加ACGME认可的放射科医师培训项目,为放射科住院医师或某个亚专业的专科医师核心胜任力的发展提供了一个评估框架。在此仅以肌骨放射学milestone为例,围绕ACGME提出的六项胜任力,即患者照护、医学知识、基于系统的实践、基于实践的学习、职业素养和人际沟通技巧,介绍分阶段目标胜任力评价系统的主要内容、评价表主要结构及使用方法。

Study on the hot deformation behavior of Al-Zn-Mg-Cu-Cr aluminum alloy during multi-stage hot compression

The mechanical behavior and microstructures of an Al-Zn-Mg-Cu-Cr aluminum alloy during multi-stage hot deformation were investigated by thermal stimulation test, optical microscopy, and transmission electron microscopy. The true stress vs true strain curves and the microstructure evolution of two hot deformation procedures were gained. The flow stress of the alloy studied decreases with increasing the deforming passes and declining the temperature, and the larger the temperature decline between adjacent stages, the larger the peak stress fall is. The stress-strain behavior mainly result from the dynamic recovery during deformation, the static recovery and recrystallization in the delay time, and the second phases precipitated from the matrix at high temperature.

Springback analysis and strategy for multi-stage thin-walled parts with complex geometries

Springback of a SUS321 complex geometry part formed by the multi-stage rigid-flexible compound process was studied through numerical simulations and laboratory experiments in this work.The sensitivity analysis was provided to have an insight in the effect of the evaluated process parameters.Furthermore,in order to minimize the springback problem,an accurate springback simulation model of the part was established and validated.The effects of the element size and timesteps on springback model were further investigated.Results indicate that the custom mesh size is beneficial for the springback simulation,and the four timesteps are found suited for the springback analysis for the complex geometry part.Finally,a strategy for reducing the springback by changing the geometry of the blank is proposed.The optimal blank geometry is obtained and used for manufacturing the part.