Mini-CEX联合DOPS评价体系在牙体牙髓病学临床教学中的应用研究

目的:研究联合应用迷你临床演练评估(mini-clinical evaluation exercise,Mini-CEX)与诊疗技能直接观察法(direct observation of procedural skills,DOPS)评估量表在口腔医学专业本科生牙体牙髓病学临床实习教学中的应用效果。方法:对60名在牙体牙髓科实习的口腔医学专业本科生分别在实习开始(0个月)、实习中期(1个月)和实习结束(3个月)时采用Mini-CEX评测量表评测综合病例诊治能力,DOPS量表测评窝洞制备、橡皮障隔离、开髓术等基本临床技能操作并行统计学分析。结果:共完成Mini-CEX量表评测180次,DOPS量表评测540次。随着实习阶段的进展,两种量表的得分均逐步提高,差异有统计学意义(P<0.05)。结论:联合应用Mini-CEX与DOPS评估方法能够有效促进实习医师临床实践能力的培养,值得在牙体牙髓病学的本科临床实习教学中推广。

内科专业住院医师规范化培训指导医师线上DOPS培训的效果研究

目的探讨线上工作坊模式对内科专业住院医师规范化培训(简称住培)指导医师临床操作技能直接观察评估(direct observation of procedural skills,DOPS)师资培训的应用效果。方法选取2022年11月参加广东省内科专业住培普通师资培训班的45名指导医师为研究对象,采用线上分组讨论与教学视频评价反馈相结合的线上工作坊模式进行DOPS师资培训,采用问卷自评的方式评价指导医师对DOPS的掌握程度,并通过问卷调查了解培训前后指导医师对线上DOPS的培训需求与满意度。结果培训前仅17.8%的指导医师使用过DOPS量表;指导医师在培训后对DOPS的掌握程度明显高于培训前[(3.71±0.69)分比(2.29±0.87)分,P<0.01];且95.6%及以上的指导医师表示能够理解“DOPS评分项目的均质化制定方法”和“形成性反馈技巧”;100.0%的指导医师表示在今后住培教学中愿意尝试使用DOPS。课程的整体满意度评分为(8.40±1.70)分。结论线上工作坊模式对内科专业住培指导医师DOPS师资培训的短期效果满意,可进一步在住培形成性评价师资培训中推广应用。

Mini-CEX结合DOPS教学在产科护理教学中的应用

目的探讨对于产科护理实习生的教学工作,采用迷你临床演练评估(mini-clinical exercise evaluation,Mini-CEX)、操作技能直接观察评估(direct observation of procedural skills,DOPS)教学的应用效果。方法选择2022年2—12月接收的112名产科护理实习生,按随机数字表法分为研究组和对照组,每组56名。对照组采取常规护理教学方式,研究组采取Mini-CEX结合DOPS教学,经过2个月实习,对2组实习生进行Mini-CEX考核和DOPS考核,并且应用自制的满意度问卷来调查实习生的意见,评价教学满意度情况。结果研究组的产科护理实习生Mini-CEX考核的各项分值高于对照组,差异有统计学意义(P<0.001);研究组产科护理实习生的DOPS考核总分[(90.12±3.26)分]高于对照组DOPS考核总分[(81.15±3.12)分],差异有统计学意义(P<0.001);研究组的产科实习生满意度(94.64%)高于对照组满意度(78.57%),差异有统计学意义(P<0.05)。结论产科护理教学中应用Mini-CEX结合DOPS教学的效果满意,可提高实习生的满意度。

以DOPS为工具的形成性评价在免疫检验实习带教中的效果

目的探讨以操作技能直接观察评估(DOPS)为工具的形成性评价在免疫检验实习带教中的效果。方法选取2022年度和2023年度在浙江大学医学院附属第一医院免疫检验科实习的同学,2022年度的45名实习同学为对照组,2023年度的34名实习同学为实验组,对照组的同学在实习过程中使用传统教学终结性评价方法,实验组同学实习中使用以DOPS量表为工具的形成性评价方法。分析比较两组实习同学的出科考核成绩、教学的效果、实习收获调查、满意度调查。结果实验组的理论成绩和操作考核成绩明显高于对照组,差异均有统计学意义(t分别=-3.26、-4.31,P均<0.05);实验组的教学效果明显优于对照组,差异均有统计学意义(t分别=-6.31、-13.03、-12.01、-7.82、-10.22、-11.11,P均<0.05);实验组的实习收获评分高于对照组,差异均有统计学意义(t分别=-9.31、-8.33、-9.21、-7.76、-5.93,P均<0.05);实验组的满意度高于对照组。结论应用DOPS作为形成性评价工具能够帮助学生更好地掌握技能,带教老师也可以从中获得教学过程中的持续反馈,从而进一步提升免疫检验实习带教的效果和质量。

基于ESMDO的级联双模型永磁同步电机鲁棒控制

考虑永磁同步电机调速控制系统中传统电流环数学模型的耦合非线性,结合无模型控制的优势,提出了一种基于扩展滑模观测器(extended sliding mode disturbance observer,ESMDO)的级联双模型永磁同步电机鲁棒控制方法,有效解决了传统PI控制器的鲁棒性差、动态响应慢的问题。首先,在转速环利用传统永磁同步电机数学模型设计了引入自校正开关增益的离散滑模转速控制器,通过离散的ESMDO观测综合扰动项并进行补偿。然后,在考虑电机参数的不确定性和外部扰动的情况下,建立了电流环超局部模型,设计了基于离散的ESMDO的无模型无差拍电流预测控制器。最后,以PI控制为对比方法进行仿真分析,仿真结果表明了所提方法的可行性与有效性。

Trajectory tracking guidance of interceptor via prescribed performance integral sliding mode with neural network disturbance observer

This paper investigates interception missiles’trajectory tracking guidance problem under wind field and external disturbances in the boost phase.Indeed,the velocity control in such trajectory tracking guidance systems of missiles is challenging.As our contribution,the velocity control channel is designed to deal with the intractable velocity problem and improve tracking accuracy.The global prescribed performance function,which guarantees the tracking error within the set range and the global convergence of the tracking guidance system,is first proposed based on the traditional PPF.Then,a tracking guidance strategy is derived using the integral sliding mode control techniques to make the sliding manifold and tracking errors converge to zero and avoid singularities.Meanwhile,an improved switching control law is introduced into the designed tracking guidance algorithm to deal with the chattering problem.A back propagation neural network(BPNN)extended state observer(BPNNESO)is employed in the inner loop to identify disturbances.The obtained results indicate that the proposed tracking guidance approach achieves the trajectory tracking guidance objective without and with disturbances and outperforms the existing tracking guidance schemes with the lowest tracking errors,convergence times,and overshoots.

改良Peyton四步教学法联合DOPS在西藏临床技能培训中的应用

目的探讨基于改良Peyton四步教学法的模拟教学联合操作技能直接观察(direct observation of procedural skills,DOPS)评估方法在西藏临床技能培训中的应用效果。方法选取西藏边坝县人民医院2021年5月—2022年5月参加临床技能培训的51名医护人员为研究对象,随机分为试验组与对照组。试验组采用结合改良Peyton四步教学法进行成人男性导尿术教学,并在培训开始前、培训中期及培训结束后,由带教教师采用DOPS评估方法对学员进行测评。对照组采用传统临床技能培训方法进行教学。在培训结束后发放满意度调查问卷,以了解学员对该教学模式的满意度。结果试验组技能考核平均成绩(90.12±5.50)分,对照组技能考核平均成绩(79.36±6.95)分,两组间成绩比较,其差异具有统计学意义(P<0.001);DOPS评估量表显示,试验组学员在培训结束后临床操作各项能力均较前有显著提高,其差异均具有统计学意义(P<0.05);课后满意度调查结果显示,在赞同“增强相关基础知识”等6个方面,试验组与对照组比较,其差异均具有统计学意义(P<0.001)。结论基于改良Peyton四步教学法的模拟教学联合DOPS评估方法的教学模式可提高西藏藏区医护人员的临床技能操作水平,适合在藏区医护人员临床技能培训中推广。

Mini-CEX联合DOPS在疼痛科住院医师规范化培训中的应用

目的:探讨迷你临床演练评估体系(Mini-CEX)和操作技能直接观察评估体系(DOPS)在疼痛科住院医师规范化培训中的应用效果。方法:将32名住院医师随机分为试验组和对照组,分别采用Mini-CEX联合DOPS教学法和传统教学法进行带教,比较两组住院医师的出科考试成绩。结果:试验组Mini-CEX和DOPS成绩较入科时均显著提升,出科考试成绩明显高于对照组(P<0.05)。结论:在疼痛科住院医师规范化培训中应用Mini-CEX联合DOPS可以显著提高带教效果。

DOPS形成性评价在血管超声技能教学中的应用

目的:评估操作技能直接观察评估(direct observation of procedural skills,DOPS)在血管超声技能教学中的效果。方法:选取浙江大学医学院附属第一医院超声医学2019级-2021级住培医师40名为对象。结果:三年级DOPS试验组成绩高于三年级传统对照组(P=0.048),三年级传统对照组成绩与二年级DOPS试验组差异没有统计意义(P=0.512)。结论:应用DOPS可显著提升住培医师血管超声的技能操作能力和学习效率,值得进一步研究并在住院医师规范化培训中应用。

A Novel Disturbance Observer Based Fixed-Time Sliding Mode Control for Robotic Manipulators With Global Fast Convergence

This paper proposes a new global fixed-time sliding mode control strategy for the trajectory tracking control of uncertain robotic manipulators.First,a fixed-time disturbance observer(FTDO) is designed to deal with the adverse effects of model uncertainties and external disturbances in the manipulator systems.Then an adaptive scheme is used and the adaptive FTDO(AFTDO) is developed,so that the priori knowledge of the lumped disturbance is not required.Further,a new non-singular fast terminal sliding mode(NFTSM) surface is designed by using an arctan function,which helps to overcome the singularity problem and enhance the robustness of the system.Based on the estimation of the lumped disturbance by the AFTDO,a fixed-time non-singular fast terminal sliding mode controller(FTNFTSMC)is developed to guarantee the trajectory tracking errors converge to zero within a fixed time.The settling time is independent of the initial state of the system.In addition,the stability of the AFTDO and FTNFTSMC is strictly proved by using Lyapunov method.Finally,the fixed-time NFESM(FTNFTSM) algorithm is validated on a 2-link manipulator and comparisons with other existing sliding mode controllers(SMCs) are performed.The comparative results confirm that the FTNFTSMC has superior control performance.

Command filtered integrated estimation guidance and control for strapdown missiles with circular field of view

In this paper,an integrated estimation guidance and control(IEGC)system is designed based on the command filtered backstepping approach for circular field-of-view(FOV)strapdown missiles.The threedimensional integrated estimation guidance and control nonlinear model with limited actuator deflection angle is established considering the seeker's FOV constraint.The boundary time-varying integral barrier Lyapunov function(IBLF)is employed in backstepping design to constrain the body line-of-sight(BLOS)in IEGC system to fit a circular FOV.Then,the nonlinear adaptive controller is designed to estimate the changing aerodynamic parameters.The generalized extended state observer(GESO)is designed to estimate the acceleration of the maneuvering targets and the unmatched time-varying disturbances for improving tracking accuracy.Furthermore,the command filters are used to solve the"differential expansion"problem during the backstepping design.The Lyapunov theory is used to prove the stability of the overall closed-loop IEGC system.Finally,the simulation results validate the integrated system's effectiveness,achieving high accuracy strikes against maneuvering targets.

Design of integral sliding mode guidance law based on disturbance observer

With the increasing precision of guidance,the impact of autopilot dynamic characteristics and target maneuvering abilities on precision guidance is becoming more and more significant.In order to reduce or even eliminate the autopilot dynamic operation and the target maneuvering influence,this paper suggests a guidance system model involving a novel integral sliding mode guidance law(ISMGL).The method utilizes the dynamic characteristics and the impact angle,combined with a sliding mode surface scheme that includes the desired line-ofsight angle,line-of-sight angular rate,and second-order differential of the angular line-of-sight.At the same time,the evaluation scenario considere the target maneuvering in the system as the external disturbance,and the non-homogeneous disturbance observer estimate the target maneuvering as a compensation of the guidance command.The proposed system’s stability is proven based on the Lyapunov stability criterion.The simulations reveale that ISMGL effectively intercepted large maneuvering targets and present a smaller miss-distance compared with traditional linear sliding mode guidance laws and trajectory shaping guidance laws.Furthermore,ISMGL has a more accurate impact angle and fast convergence speed.

Observer-based robust high-order fully actuated attitude autopilot design for spinning glide-guided projectiles

This paper investigates the design of an attitude autopilot for a dual-channel controlled spinning glideguided projectile(SGGP),addressing model uncertainties and external disturbances.Based on fixed-time stable theory,a disturbance observer with integral sliding mode and adaptive techniques is proposed to mitigate total disturbance effects,irrespective of initial conditions.By introducing an error integral signal,the dynamics of the SGGP are transformed into two separate second-order fully actuated systems.Subsequently,employing the high-order fully actuated approach and a parametric approach,the nonlinear dynamics of the SGGP are recast into a constant linear closed-loop system,ensuring that the projectile's attitude asymptotically tracks the given goal with the desired eigenstructure.Under the proposed composite control framework,the ultimately uniformly bounded stability of the closed-loop system is rigorously demonstrated via the Lyapunov method.Validation of the effectiveness of the proposed attitude autopilot design is provided through extensive numerical simulations.

An extended state observer with adjustable bandwidth for measurement noise

In this paper,a bandwidth-adjustable extended state observer(ABESO)is proposed for the systems with measurement noise.It is known that increasing the bandwidth of the observer improves the tracking speed but tolerates noise,which conflicts with observation accuracy.Therefore,we introduce a bandwidth scaling factor such that ABESO is formulated to a 2-degree-of-freedom system.The observer gain is determined and the bandwidth scaling factor adjusts the bandwidth according to the tracking error.When the tracking error decreases,the bandwidth decreases to suppress the noise,otherwise the bandwidth does not change.It is proven that the error dynamics are bounded and converge in finite time.The relationship between the upper bound of the estimation error and the scaling factor is given.When the scaling factor is less than 1,the ABESO has higher estimation accuracy than the linear extended state observer(LESO).Simulations of an uncertain nonlinear system with compound disturbances show that the proposed ABESO can successfully estimate the total disturbance in noisy environments.The mean error of total disturbance of ABESO is 15.28% lower than that of LESO.

Observer-Based Adaptive Robust Precision Motion Control of a Multi-Joint Hydraulic Manipulator

Hydraulic manipulators are usually applied in heavy-load and harsh operation tasks.However,when faced with a complex operation,the traditional proportional-integral-derivative(PID)control may not meet requirements for high control performance.Model-based full-state-feedback control is an effective alternative,but the states of a hydraulic manipulator are not always available and reliable in practical applications,particularly the joint angular velocity measurement.Considering that it is not suitable to obtain the velocity signal directly from differentiating of position measurement,the low-pass filtering is commonly used,but it will definitely restrict the closed-loop bandwidth of the whole system.To avoid this problem and realize better control performance,this paper proposes a novel observerbased adaptive robust controller(obARC)for a multi-joint hydraulic manipulator subjected to both parametric uncertainties and the lack of accurate velocity measurement.Specifically,a nonlinear adaptive observer is first designed to handle the lack of velocity measurement with the consideration of parametric uncertainties.Then,the adaptive robust control is developed to compensate for the dynamic uncertainties,and the close-loop system robust stability is theoretically proved under the observation and control errors.Finally,comparative experiments are carried out to show that the designed controller can achieve a performance improvement over the traditional methods,specifically yielding better control accuracy owing to the closed-loop bandwidth breakthrough,which is limited by low-pass filtering in fullstate-feedback control.

Disturbances rejection optimization based on improved two-degree-of-freedom LADRC for permanent magnet synchronous motor systems

Permanent magnet synchronous motor(PMSM)speed control systems with conventional linear active disturbance rejection control(CLADRC)strategy encounter issues regarding the coupling between dynamic response and disturbance suppression and have poor performance in suppressing complex nonlinear disturbances.In order to address these issues,this paper proposes an improved two-degree-of-freedom LADRC(TDOF-LADRC)strategy,which can enhance the disturbance rejection performance of the system while decoupling entirely the system's dynamic and anti-disturbance performance to boost the system robustness and simplify controller parameter tuning.PMSM models that consider total disturbances are developed to design the TDOF-LADRC speed controller accurately.Moreover,to evaluate the control performance of the TDOF-LADRC strategy,its stability is proven,and the influence of each controller parameter on the system control performance is analyzed.Based on it,a comparison is made between the disturbance observation ability and anti-disturbance performance of TDOF-LADRC and CLADRC to prove the superiority of TDOF-LADRC in rejecting disturbances.Finally,experiments are performed on a 750 W PMSM experimental platform,and the results demonstrate that the proposed TDOF-LADRC exhibits the properties of two degrees of freedom and improves the disturbance rejection performance of the PMSM system.

Disturbance Observer-Based Predictive Tracking Control of Uncertain HOFA Cyber-Physical Systems

Dear Editor,In this letter,an output tracking control problem of uncertain cyber-physical systems(CPSs)is considered in the perspective of high-order fully actuated(HOFA)system theory,where a lumped disturbance is used to denote the total uncertainties containing parameters perturbations and external disturbances.

Reduced-Order Observer-Based LQR Controller Design for Rotary Inverted Pendulum

The Rotary Inverted Pendulum(RIP)is a widely used underactuated mechanical system in various applications such as bipedal robots and skyscraper stabilization where attitude control presents a significant challenge.Despite the implementation of various control strategies to maintain equilibrium,optimally tuning control gains to effectively mitigate uncertain nonlinearities in system dynamics remains elusive.Existing methods frequently rely on extensive experimental data or the designer’s expertise,presenting a notable drawback.This paper proposes a novel tracking control approach for RIP,utilizing a Linear Quadratic Regulator(LQR)in combination with a reduced-order observer.Initially,the RIP system is mathematically modeled using the Newton-Euler-Lagrange method.Subsequently,a composite controller is devised that integrates an LQR for generating nominal control signals and a reduced-order observer for reconstructing unmeasured states.This approach enhances the controller’s robustness by eliminating differential terms from the observer,thereby attenuating unknown disturbances.Thorough numerical simulations and experimental evaluations demonstrate the system’s capability to maintain balance below50Hz and achieve precise tracking below1.4 rad,validating the effectiveness of the proposed control scheme.

Interobserver and intraobserver reliability of skull base angles measured on magnetic resonance images

BACKGROUND Determination of platybasia and basilar kyphosis are significant parts of routine cranial magnetic resonance(MR)interpretations.These situations may explain a patient’s symptoms or may be associated with other anomalies.AIM To indicate the interobserver and intraobserver reliability of the skull base angles(SBA)(Koenigsberg standard)and modified SBA(mSBA)measurement techniques.METHODS In total,391 patients who had undergone cranial MR imaging were re-assessed regarding the SBA measurements.The SBA and mSBA techniques were used on MR images.Two reviewers independently measured the same angles twice within a 15-day interval,using different monitors.Intraclass correlation coefficient(ICC)was calculated to reveal the intraobserver and interobserver agreements.RESULTS There was an excellent agreement between reviewers regarding both angle measurements(ICC was 0.998 for SBA and mSBA).Excellent agreement levels were also observed for intraobserver measurements.ICC was 0.998 for SBA and 0.999 for mSBA for reviewer 1.ICC was 0.997 for SBA and 0.999 for mSBA according to the measurement results of reviewer 2.Higher SBA and mSBA values were observed for females compared to males.There was no correlation between SBA and age for SBA.However,a negative and low-level correlation was observed between mSBA values and age for both reviewers.CONCLUSION SBA and mSBA measurements indicated excellent agreement regarding interobserver and intraobserver differences.The study results showed that SBA angles were reliable measurement techniques to be used on MR images.

Clinical and demographic features of patients undergoing videocapsule endoscopy management:A descriptive study

BACKGROUND Video-capsule endoscopy(VCE)is an efficient tool that has proven to be highly useful in approaching several gastrointestinal diseases.VCE was implemented in Colombia in 2003,however current characterization of patients undergoing VCE in Colombia is limited,and mainly comes from two investigations conducted before the SARS-CoV-2 pandemic period.AIM To describe the characteristics of patients undergoing VCEs and establish the main indications,findings,technical limitations,and other outstanding features.METHODS A descriptive study was carried out using data from reports of VCE(PillCam SB3 system)use in a Gastroenterology Unit in Bogotá,Colombia between September 2019 and January 2023.Demographic and clinical variables such as indication for the VCE,gastric and small bowel transit times(GTT,SBTT),endoscopic preparation quality,and limitations were described[n(%),median(IQR)].RESULTS A total of 133 VCE reports were analyzed.Most were in men with a median age of 70 years.The majority had good preparation(96.2%),and there were technical limitations in 15.8%of cases.The main indications were unexplained anemia(91%)or occult bleeding(23.3%).The median GTT and SBTT were 14 and 30 minutes,respectively.The frequencies of bleeding stigma(3.79%)and active bleeding(9.09%)were low,and the most frequent abnormal findings were red spots(28.3%),erosions(17.6%),and vascular ectasias(12.5%).CONCLUSION VCE showed high-level safety.The main indication was unexplained anemia.Active bleeding was the most frequent finding.Combined with artificial intelligence,VCE can improve diagnostic precision and targeted therapeutic interventions.