Application of Specialized Group Management in the Quality Control of Perioperative Nursing

Objective:To explore the role of specialized group management in the quality control of perioperative nursing.Methods:45 surgical nurses from our hospital were selected as the research subjects.Traditional operating room management was adopted from July 2019 to June 2020,and specialized group management was adopted from July 2020 to June 2021.The surgeon’s satisfaction,surgical nurses’core professional competence,and surgical patients’satisfaction were obtained through surveys and the results were analyzed.Results:Surgeon satisfaction before the implementation of specialized group management was significantly lower than after its implementation(P<0.05).Besides,surgical nurses’core professional competency scores before the implementation of specialized group management were significantly lower than after its implementation(P<0.05).Lastly,surgical patients’satisfaction before the implementation of specialized group management was significantly lower than after its implementation(P<0.05).Conclusion:Specialized group management helps to improve the quality of perioperative care and should be applied in clinical practice.

Correlation of Hamstring Tendon Size in Pre-Operative MRI Measurement with Intra-Operative Graft Size in Primary Anterior Cruciate Ligament (ACL) Reconstruction

Background: The size of Hamstring autograft of less than 8.0 mm in ACL re-construction is one of the key factors that may contribute to the failure of the graft. In this study, we are going to assess the correlation of pre-operative MRI measurement of Hamstring tendons with the intra-operative ACL graft. Thus, it may help surgeons to anticipate the needs for graft augmentation should the final graft size be smaller than expected. Methods: We retrospectively re-viewed 41 cases of ACL reconstructions in which MRI were done pre-operatively, in Hospital Pakar Sultanah Fatimah (HPSF), Muar between January 2019 until December 2022. MRI measurements of Hamstring tendon (semitendinosus: ST, and gracilis) were done by a radiologist, and the in-tra-operative notes were reviewed for the final graft size. Pearson’s correlation coefficients were calculated to determine the relationship between graft size and tendon cross-sectional area. The intraclass correlation (ICC) by using two-way mixed model with type consistency, the reliability based on average measure was 0.41 (95% CI: ?0.10, 0.69). A p-value < 0.05 was considered sig-nificant. Results: Of 105 patients with primary ACL reconstruction done be-tween January 2019 to December 2022, only 41 patients were included in this study. There was fair correlation (p = 0.048) between pre-operative MRI measurement and the graft diameter intra-operatively. The mean of 17.0 mm of combined diameter of ST and gracilis tendon in MRI may results in graft diameter of 8.3 mm. There was also positive correlation between patients’ height and the intra-operative graft size. Conclusion: These results showed good correlation between pre-operative MRI measurement of Hamstring ten-don size with the intra-operative graft size, hence it is a reliable tool to predict the Hamstring autograft size in ACL reconstruction.

Associate factors for endoscopic submucosal dissection operation time and postoperative delayed hemorrhage of early gastric cancer

BACKGROUND Endoscopic submucosal dissection(ESD)is a treatment for early gastric cancer with the advantages of small invasion,fewer complications,and a low local recurrence rate.However,there is a high risk of complications such as bleeding and perforation,and the operation time is also longer.ESD operation time is closely related to bleeding and perforation.AIM To investigate the influencing factors associated with ESD operation time and postoperative delayed hemorrhage to provide a reference for early planning,early identification,and prevention of complications.METHODS We conducted a retrospective study based on the clinical data of 520 patients with early gastric cancer in the Second Affiliated Hospital of Hainan Medical University from January 2019 to December 2021.The baseline data,clinical features,and endoscopic and pathological characteristics of patients were collected.The multivariate linear regression model was used to investigate the influencing factors of ESD operation time.Logistic regression analysis was carried out to evaluate the influencing factors of postoperative delayed hemorrhage.RESULTS The multivariate analysis of ESD operation time showed that the maximum lesion diameter could affect 8.815%of ESD operation time when other influencing factors remained unchanged.The operation time increased by 3.766%or 10.247%if the lesion was mixed or concave.The operation time increased by 4.417%if combined with an ulcer or scar.The operation time increased by 3.692%if combined with perforation.If infiltrated into the submucosa,it increased by 2.536%.Multivariate analysis of delayed hemorrhage after ESD showed that the maximum diameter of the lesion,lesion morphology,and ESD operation time were independent influencing factors for delayed hemorrhage after ESD.Patients with lesion≥3.0 cm(OR=3.785,95%CI:1.165-4.277),lesion morphology-concave(OR=10.985,95%CI:2.133-35.381),and ESD operation time≥60 min(OR=2.958,95%CI:1.117-3.526)were prone to delayed hemorrhage after ESD.CONCLUSION If the maximum diameter of the lesion in patients with early gastric cancer is≥3.0 cm,and the shape of the lesion is concave,or accompanied by an ulcer or scar,combined with perforation,and infiltrates into the submucosa,the ESD operation will take a longer time.When the maximum diameter of the lesion is≥3.0 cm,the shape of the lesion is concave in patients and the operation time of ESD takes longer time,the risk of delayed hemorrhage after ESD is higher.

Experts consensus on the procedure of dental operative microscope in endodontics and operative dentistry

The dental operative microscope has been widely employed in the field of dentistry,particularly in endodontics and operative dentistry,resulting in significant advancements in the effectiveness of root canal therapy,endodontic surgery,and dental restoration.However,the improper use of this microscope continues to be common in clinical settings,primarily due to operators’insufficient understanding and proficiency in both the features and established operating procedures of this equipment.In October 2019,Professor Jingping Liang,Vice Chairman of the Society of Cariology and Endodontology,Chinese Stomatological Association,organized a consensus meeting with Chinese experts in endodontics and operative dentistry.The objective of this meeting was to establish a standard operation procedure for the dental operative microscope.Subsequently,a consensus was reached and officially issued.Over the span of about four years,the content of this consensus has been further developed and improved through practical experience.

Exploring ideal operative time for best outcomes in gastric cancer surgery:A multi-institutional study based on KLASS-07 database

Objective:While a rushed operation can omit essential procedures,prolonged operative time results in higher morbidity.Nevertheless,the optimal operative time range remains uncertain.This study aimed to estimate the ideal operative time range and evaluate its applicability in laparoscopic cancer surgery.Methods:A prospectively collected multicenter database of 397 patients who underwent laparoscopic distal gastrectomy were retrospectively reviewed.The ideal operative time range was statistically calculated by separately analyzing the operative time of uneventful surgeries.Finally,intraoperative and postoperative outcomes were compared among the shorter,ideal,and longer operative time groups.Results:The statistically calculated ideal operative time was 135.4-165.4 min.The longer operative time(LOT)group had a lower rate of uneventful,perfect surgery than the ideal or shorter operative time(IOT/SOT)group(2.8%vs.8.8%and 2.2%vs.13.4%,all P<0.05).Longer operative time increased bleeding,postoperative morbidities,and delayed diet and discharge(all P<0.05).Particularly,an uneventful,perfect surgery could not be achieved when the operative time exceeded 240 min.Regardless of ideal time range,SOT group achieved the highest percentage of uneventful surgery(13.4%),which was possible by surgeon's ability to retrieve a higher number of lymph nodes and perform≥150 gastrectomies annually.Conclusions:Operative time longer than the ideal time range(especially≥240 min)should be avoided.If the essential operative procedure were faithfully conducted without compromising oncological safety,an operative time shorter than the ideal range leaded to a better prognosis.Efforts to minimize operative time should be attempted with sufficient surgical experience.

Radiation therapy prior to a pancreaticoduodenectomy for adenocarcinoma is associated with longer operative times and higher blood loss

BACKGROUND Pancreatic adenocarcinoma is currently the fourth leading cause of cancer-related deaths in the United States.In patients with“borderline resectable”disease,current National Comprehensive Cancer Center guidelines recommend the use of neoadjuvant chemoradiation prior to a pancreaticoduodenectomy.Although neoadjuvant radiotherapy may improve negative margin resection rate,it is theorized that its administration increases operative times and complexity.AIM To investigate the association between neoadjuvant radiotherapy and 30-d morbidity and mortality outcomes among patients receiving a pancreaticoduodenectomy for pancreatic adenocarcinoma.METHODS Patients listed in the 2015-2019 National Surgery Quality Improvement Program data set,who received a pancreaticoduodenectomy for pancreatic adenocarcinoma,were divided into two groups based off neoadjuvant radiotherapy status.Multivariable regression was used to determine if there is a significant correlation between neoadjuvant radiotherapy,perioperative blood transfusion status,total operative time,and other perioperative outcomes.RESULTS Of the 11458 patients included in the study,1470(12.8%)underwent neoadjuvant radiotherapy.Patients who received neoadjuvant radiotherapy were significantly more likely to require a perioperative blood transfusion[adjusted odds ratio(aOR)=1.58,95%confidence interval(CI):1.37-1.82;P<0.001]and have longer surgeries(insulin receptor-related receptor=1.14,95%CI:1.11-1.16;P<0.001),while simultaneously having lower rates of organ space infections(aOR=0.80,95%CI:0.66-0.97;P=0.02)and pancreatic fistula formation(aOR=0.50,95%CI:0.40-0.63;P<0.001)compared to those who underwent surgery alone.CONCLUSION Neoadjuvant radiotherapy,while not associated with increased mortality,will impact the complexity of surgical resection in patients with pancreatic adenocarcinoma.

Preliminary security investigation and short-time follow-up of intraoperative intraperitoneal chemotherapy with lobaplatin for advanced colorectal cancer

Objective The aim of this study was to conduct a security assessment of intraoperative intraperitoneal chemotherapy using lobaplatin for advanced colorectal cancer.Methods From February 2015 to February 2016,143 patients with colorectal cancer who underwent surgery in our department were selected prospectively.All patients were randomly screened and enrolled into the intraperitoneal chemotherapy(IPC)(74 cases)and control(69 cases)groups,depending on the distribution of cases in the random table.In the trial group,patients were administered 40 mg lobaplatin by intraperitoneal implantation intraoperatively,together with intravenous chemotherapy post-operatively using a typical FOLFOX strategy with oxaliplatin,fluorouracil,and leucovorin.In the control group,only FOLFOX was administered.Bowel function recovery time,adverse reactions and complications,and preand post-chemotherapy laboratory examinations were compared.In addition,a 5-year-long follow-up was performed.Results Recovery times of bowel function were 73.5±9.7 h and 74.8±10.3 h respectively,and the difference was not significant(P>0.05).Wound fat liquefaction was observed in five cases in both groups(6.8%vs.7.2%,P>0.05).The outcomes of nausea and vomiting(57 cases,77.0%vs.50 cases,72.5%),constipation(43 cases,58.1%vs.36 cases,52.2%),and diarrhea(5 cases,6.8%vs.5 cases,7.2%)were not statistically significant(all P>0.05).Indices of white blood cell count,blood platelet count,and hepatorenal function were not significantly different(all P>0.05)neither post-operatively nor post-chemotherapy.The 5-year survival rate was not significantly different between the groups(58.1%vs.56.5%,P>0.05).Conclusion Intraoperative chemotherapy with lobaplatin for advanced colorectal cancer is safe and tolerable.

Post-Operative Mortality Analysis in the Urology Department of Conakry University Hospital

Introduction: Death is a major accident which constitutes an element whose evaluation and analysis are necessary in a surgical service. Such a study is especially important in our country where the health structure operates with limited resources and more than half of the population lives below the poverty line. The objective of this study was to determine the frequency of post-operative mortality, to describe the main comorbidity factors responsible for this mortality and to identify the main cause of post-operative death in the urology department of the Ignace Deen National Hospital Material and Method: This was a retrospective descriptive study lasting 5 years from January 1, 2015 to December 31, 2019. It had focussed on all the files of patients operated on at the Urology Department of the Ignace Deen National Hospital, either in an emergency or planned and who died in per or post-operative immediately or 30 days later. Results: We recorded 63 cases of post-operative death, or a frequency of 1.84%. The average age was 61.92 ± 16.91 with the extremes of 12 and 91 years. Bladder (20.63%) and prostate tumours (60.3%) were the main admission diagnoses. High blood pressure was the main comorbidity factor found with 38.09% of cases followed by diabetes with 12.69%. Transurethral resection of the prostate, transurethral resection of the bladder and prostate adenocomectomy were the most performed surgical procedure with respective proportion of 19.04%, 20.63% and 38.09%. Probable cause of death were anemia in 25 cases (39.68%), septic in 20 cases (31.75%), heart failure in 6 cases (9.52%), pulmonary embolism in 5 cases (7.94%), obstructive renal failure 4 cases (6.35%) and stroke in 3 cases (4.76%). Conclusion: The majority of deaths occurred in patients over the age of fifty. Anaemia was the main cause of deaths. Difficulties in procuring blood products as well as the lack of modern therapeutic means are factors that make it difficult for patients to adequately manage.

Research on the cooperative train control method in the metro system for energy saving

Purpose–To address the problem that the current train operation mode that train selects one of several offline pre-generated control schemes before the departure and operates following the scheme after the departure,energy-saving performance of the whole metro system cannot be guaranteed.Design/methodology/approach–A cooperative train control framework is formulated to regulate a novel train operation mode.The classic train four-phase control strategy is improved for generating specific energy-efficient control schemes for each train.An improved brute force(BF)algorithm with a two-layer searching idea is designed to solve the optimisation model of energy-efficient train control schemes.Findings–Case studies on the actual metro line in Guangzhou,China verify the effectiveness of the proposed train control methods compared with four-phase control strategy under different kinds of train operation scenarios and calculation parameters.The verification on the computation efficiency as well as accuracy of the proposed algorithm indicates that it meets the requirement of online optimisation.Originality/value–Most existing studies optimised energy-efficient train timetable or train control strategies through an offline process,which has a defect in coping with the disturbance or delays effectively and promptly during real-time train operation.This paper studies an online optimisation of cooperative train control based on the rolling optimisation idea,where energy-efficient train operation can be realised once train running time is determined,thus mitigating the impact of unpredictable operation situations on the energy-saving performance of trains.

低温等离子治疗儿童鼻咽部第二鳃裂囊肿分析

目的探讨儿童鼻咽部第二鳃裂囊肿的临床特征和治疗方式,提高诊治能力。方法回顾性分析河北省儿童医院收治的4例儿童鼻咽部第二鳃裂囊肿的临床资料,包括年龄、性别、症状、影像学资料和治疗过程。总结分析病变部位特点,B超、CT或MRI特征,术后病理结果及治疗方式。结果4例鼻咽部第二鳃裂囊肿患儿均表现为鼻咽侧壁咽鼓管咽口与腭咽弓后上方连线上的囊性肿物,囊壁较厚,影像学检查结果均为囊性病变。4例患儿选择内镜下低温等离子病变切除术,其中2例为内侧囊壁大部分切除术,将囊腔充分敞开,2例为囊肿全部切除术。术后病理提示衬覆纤毛柱状上皮或复层上皮,周围淋巴组织增生。术后随访1.5~3年无复发。结论儿童鼻咽部第二鳃裂囊肿临床罕见,诊断主要依靠病变部位及术后病理结果,内镜下低温等离子切除病变组织是微创、安全、有效的治疗方式。

基于数字孪生的智能运维理论体系与实现方法

在建筑行业转型升级的背景下,针对大型建筑运维过程管理效率低、各类运维事件决策分析精度不足、智能化程度有待提高等问题,提出基于数字孪生的智能运维理论体系与实现方法。总结归纳大型建筑智能运维需要采集的信息,分析智能运维亟待解决的问题,融合智能感知与数字孪生技术,给出智能运维运行机理,建立针对大型建筑的智能运维架构体系与多维多尺度的孪生模型。研究建筑智能运维的实现方法,其中包含智能运维全要素信息的采集与传输、智能运维孪生体的构建与运行、智能运维孪生数据的管理机制及智能运维平台的架构。在智能运维理论体系和实现方法的指导下,搭建了智能运维平台,并应用于某大型建筑工程的运维管理。考虑运维管理过程中的虚实交互与时空演化,初步验证了数字孪生在提高运维管理智能化程度方面的有效性。

基于“一中心四平台”的公立医院后勤运营管理实践研究

目的探讨基于“一中心四平台”的医院后勤运营管理模式成效。方法以医院智慧管理分级评估标准为依据,依托大数据、物联网、互联网+、人工智能等技术运用,打造后勤智慧运维管理中心以及设备管控信息化平台、安全防范信息化平台、能耗监测信息化平台、运营管理信息化平台的“一中心四平台”运营管理模式。结果经过样本医院的管理实践证明:基于“智慧联动”的设备故障处置能力得到显著提升,2022年故障报警次数同比2021年下降28.63%,其中高级、普通报警次数同比2021年分别下降69.53%、33.15%;基于“一站式”的后勤服务保障能力得到显著提升,2022年同比2021年维修次数下降2.92%,维修质量有所提高,反复维修频次降低;基于“数据挖掘”的能耗管控能力得到显著提升,2022年万元收入能耗支出同比2021年下降8.71%。结论“一中心四平台”可以显著提高后勤运维管理水平。

新型农业经营主体对劳动力流动的影响效应

新型农业经营主体是推进农业农村现代化和乡村振兴的有机载体,有效推动了农业规模化经营,有助于引导和促进劳动力流动,从而实现农村劳动力的优化配置。基于中国社会科学院农村发展研究所中国乡村振兴调查(CRRS)数据,选用Logit模型研究新型农业经营主体对劳动力流动的影响效应。研究表明:第一,新型农业经营主体会促进劳动力的回流,但对劳动力流出无显著影响;第二,有新型农业经营主体的村庄更容易吸引年龄较低和受教育程度较高的农村劳动力的回流;第三,在新型农业经营主体吸引劳动力回流的过程中,参与过非农职业技术培训的农村劳动力更容易回流。基于此,从管理与服务方式、培育方向、人才培养和体制机制四个角度提出了针对性的政策建议,为引导和优化农村劳动力的合理配置提供借鉴经验,对于当前农村经济社会可持续发展、推动建设农业强国具有重要的现实价值。

三级公立医院绩效考核背景下医院运营管理的研究

国家三级公立医院绩效考核开始于2019年,运营效率作为考核的一部分,相关的国家监测指标有9个,包含收支结构和费用控制。绩效考核是医改工作的有力抓手,也是加快现代医院管理制度建立的强劲推手。通过分析某三级甲等口腔专科医院在绩效考核背景下运营效率指标的得分情况,找出原因;并通过加强党建引领,做好医院运营管理体系架构顶层设计,加强医疗质量管理,落实医改相关政策,加强能耗管理,不断提高员工福利待遇,强化公立医院功能定位,提高医疗服务收入占比,绩效分配体现医务人员的劳动技术价值,提高运营管理能力,助推医院高质量发展。

耦合水文情势及鱼类繁殖的江垭水库生态调度需求研究

为了修复河流水文情势、维持河流生态系统健康,通过环境DNA采样、IHA水文指标变动分析和文献资料总结等方法,开展了江垭水库坝下水文情势及鱼类繁殖需求关系研究,提出了水库生态调度需求与建议。结果显示,2021年9月在溇水干支流综合调查获得鱼类55种,与20世纪90年代相比,流水性种类在干流江段显著减少了51.35%;按照生态调度优先等级评估原则,确定江垭水库生态调度的主要目标物种为产漂流性卵的银鲴(Xenocypris argentea)、银鮈(Squalidus argentatus)、贝氏䱗(Hemiculter bleekeri)和产粘沉性卵的鲤(Cyprinus carpio)、鲫(Carassius auratus);江垭建坝前后下游水文情势变化较大,发生高度改变且对鱼类洄游产卵及鱼卵发育有重要作用的水文指标包括年最大1日、3日平均流量指标、年出现高流量脉冲事件的次数和持续时间以及连续日流量上涨率。研究表明,以促进坝下不同产卵类型的鱼类繁殖为目标,生态调度需要一定的高流量脉冲次数和历时,还需要控制下游水位的日降幅,通过泄放合理的生态流量来维持下游鱼类的生物多样性。

公共数据授权运营数据要素流通监管的理念、模式与发展策略

[目的/意义]加强授权运营公共数据要素流通全生命周期的监管是其安全、高质量、平等和包容创新利用的重要保障。[方法/过程]文章采用了文献研究法和案例分析法,阐述了公共数据授权运营数据要素流通监管的含义、相关研究以及监管理念,重点构建和分析了其监管模式和发展策略。[结果/结论]提出公共数据授权运营需要建立全生命周期的数据质量管控机制,构建可用不可见与全程可追溯的科技监管模式,促进授权运营公共数据多元共享、严格规制算法垄断行为以及以监管沙盒优化与促进“包容审慎”监管模式的发展策略。

活性改性剂合成及其对环氧胶黏剂力学与界面粘接性能的影响

综合考虑环氧胶黏剂的施工性能、力学性能及与砂浆界面的粘接性能,利用三羟甲基丙烷三缩水甘油醚(TMPGE)与1,4-丁二醇(BDO),通过控制反应物物质的量比以及反应时间制备了四种低环氧值兼具高羟基含量的预聚体(PPM)。通过1H-NMR、盐酸-丙酮法及凝胶渗透色谱(GPC)对PPM进行了表征。进一步研究了PPM对改性环氧胶黏剂工作性能、固化力学性能、与水泥砂浆粘接强度以及表面性质的影响。结果显示:延长反应时间以及增加BDO用量使PPM的数均分子量更大、环氧值更低。四种PPM改性后,胶黏剂的放热峰值温度降低,可操作时间延长。同时,PPM使环氧固化物的延性显著增加。四种PPM改性后使环氧与水的接触角降低,固化物表面的极性组分升高。XPS分析表明,PPM使环氧固化物的羟基含量显著提高。最后,PPM使胶黏剂对湿砂浆基体的粘接强度提高了一倍以上。

虚拟现实场景下的精准化采摘机器人作业研究

利用虚拟现实场景仿真技术,对葡萄采摘机器人的精准作业控制过程进行分析,通过构建虚拟现实环境下葡萄采摘机器人作业场景模型,以机器人采摘运动柔顺、无碰撞和不损伤采摘对象为目标,对采摘作业过程的夹紧、托举以及剪切动作进行虚拟仿真。虚拟现实场景下20次采摘动作仿真结果中,有3次采摘发生碰撞、17次采摘成功。这表明,在设计阶段利用虚拟现实场景进行精准化作业仿真和控制算法测试,能够有效缩短采摘机器人研制过程中的调试和优化时间。

智慧供热系统数据运行核查方法研究

高质量数据是智慧供热系统数据分析的前提和分析结论可靠性的保障,计量器具的良好工作状态是获得高质量数据的基础。本文讨论了计量器具的检定、校准及运行核查的区别,研究了智慧供热系统计量器具在线运行核查方法。研究表明:流量计根据其实际安装工作条件,采用安装条件修正系数可解决直管段长度不够带来的测量误差问题;采用基准表法对使用的流量计进行技术性能核查,可正确判别单台流量计的工作状态;示踪法是解决大口径贸易结算表数据质量问题的有效方法。本研究可为及时发现工作异常的计量器具、确保测量数据的准确性及可靠性提供理论指导及技术支撑。

手术联合光动力治疗头部脓肿性穿掘性毛囊周围炎的临床疗效观察

目的:观察手术联合光动力治疗头部脓肿性穿掘性毛囊周围炎的临床疗效。方法:回顾性分析2021年1月-2022年6月笔者医院给予手术联合光动力治疗的24例头部脓肿性穿掘性毛囊周围炎患者临床资料。观察所有患者的临床治疗效果、不良反应和复发情况。结果:纳入治疗的患者痊愈13例(54.17%),显效6例(25.00%),有效3例(12.50%),无效2例(8.33%),总有效率91.67%。伤口均甲级愈合,未出现术后感染、皮瓣坏死、溃疡等并发症。随访0.5~2年,复发4例,复发率16.67%。大部分患者术后瘢痕不明显,患者满意度高。结论:手术联合光动力治疗头部脓肿性穿掘性毛囊周围炎疗效良好,可提高患者生活质量,且安全性好,复发率低。