目的构建科学、实用的出血中心护士核心素养培训体系,为出血中心护士的培养和课程设置提供参考。方法检索PubMed、Web of Science、中国生物医学文献服务系统(CBM)、中国知网(CNKI)、万方等数据库中的文献,并结合患者、家属及医护人员...目的构建科学、实用的出血中心护士核心素养培训体系,为出血中心护士的培养和课程设置提供参考。方法检索PubMed、Web of Science、中国生物医学文献服务系统(CBM)、中国知网(CNKI)、万方等数据库中的文献,并结合患者、家属及医护人员访谈结果,小组讨论后初步拟定出血中心护士培训体系,最后应用德尔菲法对12个省21名专家进行2轮函询,确定了三级指标体系。结果第1轮函询问问卷有效回收21/21份,第2轮专家函询问卷有效回收19/21份。出血中心护士核心素养培训体系专家咨询判断系数0.99,权威系数0.89,Miller金字塔理论专家咨询判断系数0.72,权威系数0.85,熟悉程度0.80。最终确立出血中心护士培训体系涵盖理论、应用、技能及实际表现能力4个层面,培训内容、培训管理及考核评价等3个部分。其中,培训内容一级指标22个、二级指标96个、三级指标78个;培训管理一级指标4个,二级指标8个,三级指标12个;考核评价一级指标5个,二级指标16个。结论基于Miller金字塔理论构建的出血中心护士核心素养培训体系专家意见集中,可信度高,能为出血中心护士开展培训提供参考。展开更多
目的探讨情景模拟训练结合Miller金字塔教学法在儿童重症监护病房(PediatricInten-sive Care Unit,PICU)住院医师规范化培训(以下简称住培)教学中的应用。方法将2023年1月~2024年1月至泰州市人民医院PICU进行规范化培训的规培生40人作...目的探讨情景模拟训练结合Miller金字塔教学法在儿童重症监护病房(PediatricInten-sive Care Unit,PICU)住院医师规范化培训(以下简称住培)教学中的应用。方法将2023年1月~2024年1月至泰州市人民医院PICU进行规范化培训的规培生40人作为研究对象,用信封法将其随机分为对照组(20人)和实验组(20人)。对照组采用常规教学方法。实验组采用情景模拟训练结合Miller金字塔联合教学方法。PICU的培训结束后,由指定带教老师对两组学生进行教学效果的考核评价,并进行满意度调查。结果理论知识考核成绩对照组82.40±1.35分,实验组91.45±0.60分,两组对比P<0.0001。操作技能考核成绩对照组80.05±0.97分,实验组90.10±0.46分,两组对比P<0.0001。满意度对照组86.25±0.83分,实验组91.80±0.97分,两组对比P<0.0001。结论情景模拟训练结合Miller金字塔教学法在PICU住培教学中应用效果佳,可推广应用。展开更多
The Miller cycle is a program that effectively reduces NOx emissions from marine diesel engines by lowering the maximum combustion temperature in the cylinder,thereby reducing NOx emissions.To effectively investigate ...The Miller cycle is a program that effectively reduces NOx emissions from marine diesel engines by lowering the maximum combustion temperature in the cylinder,thereby reducing NOx emissions.To effectively investigate the impact of Miller cycle optimum combustion performance and emission capability under high load conditions,this study will perform a one-dimensional simulation of the performance of a marine diesel engine,as well as a threedimensional simulation of the combustion in the cylinder.A 6-cylinder four-stroke single-stage supercharged diesel engine is taken as the research object.The chassis dynamometer and other related equipment are used to build the test system,carry out the diesel engine bench test,and collect experimental data.The simulation results are compared with the test results,and the error is less than 5%.In this study,the authors will use simulation software to simulate several Miller cycle scenarios designed for early inlet valve closure and analyze the impact of the Miller cycle on combustion and emissions at 100%load conditions.By comparing the flow field distribution of the engine at 1500 r/min condition,it was found that proper EIVC can prolong the ignition latency period and homogeneous fuel-air mixture combustion acceleration,but it can reduce pressure and temperature within the piston chamber and NOx emission.However,the Miller cycle reduces end-of-compression temperatures,which increases combustion duration and exhaust temperatures,making it difficult to improve fuel economy at the optimum fuel consumption point,and closing the intake valves prematurely leads to excessive fuel expenditure.Furthermore,temperature and heat release rate within the piston chamber,NOx,and SOOT generation were significantly enhanced.展开更多
BACKGROUND Miller fisher syndrome(MFS)is a variant of Guillain-Barrésyndrome,an acute immune-mediated peripheral neuropathy that is often secondary to viral infections.Anti-ganglioside antibodies play crucial rol...BACKGROUND Miller fisher syndrome(MFS)is a variant of Guillain-Barrésyndrome,an acute immune-mediated peripheral neuropathy that is often secondary to viral infections.Anti-ganglioside antibodies play crucial roles in the development of MFS.The positive rate of ganglioside antibodies is exceptionally high in MFS patients,particularly for anti-GQ1b antibodies.However,the presence of other ganglioside antibodies does not exclude MFS.CASE SUMMARY We present a 56-year-old female patient who suddenly developed right blepharoptosis and progressively worsening vision in both eyes.There were flu symptoms prior to onset,and a coronavirus disease 2019 test was positive.On physical examination,the patient exhibited bilateral extraocular muscle paralysis,weakened reflexes in both limbs,and impaired coordination.The cerebrospinal fluid examination results showed no obvious abnormalities.Bilateral peroneal nerve F-waves were not extracted.Serum anti-GD1b IgG and anti-GT1a IgG antibodies were positive.The patient received intravenous methylprednisolone(1000 mg/day),with the dosage gradually decreased.Additionally,intravenous high-dose immunoglobulin treatment was administered for 5 days(0.4 g/kg/day)from day 2 to day 6 of hospitalization.The patient’s symptoms improved after treatment with immunoglobulins and hormones.CONCLUSION Positive ganglioside antibodies may be used as supporting evidence for the diagnosis;however,the diagnosis of MFS is more reliant on clinical symptoms.展开更多
文摘目的构建科学、实用的出血中心护士核心素养培训体系,为出血中心护士的培养和课程设置提供参考。方法检索PubMed、Web of Science、中国生物医学文献服务系统(CBM)、中国知网(CNKI)、万方等数据库中的文献,并结合患者、家属及医护人员访谈结果,小组讨论后初步拟定出血中心护士培训体系,最后应用德尔菲法对12个省21名专家进行2轮函询,确定了三级指标体系。结果第1轮函询问问卷有效回收21/21份,第2轮专家函询问卷有效回收19/21份。出血中心护士核心素养培训体系专家咨询判断系数0.99,权威系数0.89,Miller金字塔理论专家咨询判断系数0.72,权威系数0.85,熟悉程度0.80。最终确立出血中心护士培训体系涵盖理论、应用、技能及实际表现能力4个层面,培训内容、培训管理及考核评价等3个部分。其中,培训内容一级指标22个、二级指标96个、三级指标78个;培训管理一级指标4个,二级指标8个,三级指标12个;考核评价一级指标5个,二级指标16个。结论基于Miller金字塔理论构建的出血中心护士核心素养培训体系专家意见集中,可信度高,能为出血中心护士开展培训提供参考。
文摘目的探讨情景模拟训练结合Miller金字塔教学法在儿童重症监护病房(PediatricInten-sive Care Unit,PICU)住院医师规范化培训(以下简称住培)教学中的应用。方法将2023年1月~2024年1月至泰州市人民医院PICU进行规范化培训的规培生40人作为研究对象,用信封法将其随机分为对照组(20人)和实验组(20人)。对照组采用常规教学方法。实验组采用情景模拟训练结合Miller金字塔联合教学方法。PICU的培训结束后,由指定带教老师对两组学生进行教学效果的考核评价,并进行满意度调查。结果理论知识考核成绩对照组82.40±1.35分,实验组91.45±0.60分,两组对比P<0.0001。操作技能考核成绩对照组80.05±0.97分,实验组90.10±0.46分,两组对比P<0.0001。满意度对照组86.25±0.83分,实验组91.80±0.97分,两组对比P<0.0001。结论情景模拟训练结合Miller金字塔教学法在PICU住培教学中应用效果佳,可推广应用。
基金funded by the National Natural Science Foundation of China under Grant No.51505275.
文摘The Miller cycle is a program that effectively reduces NOx emissions from marine diesel engines by lowering the maximum combustion temperature in the cylinder,thereby reducing NOx emissions.To effectively investigate the impact of Miller cycle optimum combustion performance and emission capability under high load conditions,this study will perform a one-dimensional simulation of the performance of a marine diesel engine,as well as a threedimensional simulation of the combustion in the cylinder.A 6-cylinder four-stroke single-stage supercharged diesel engine is taken as the research object.The chassis dynamometer and other related equipment are used to build the test system,carry out the diesel engine bench test,and collect experimental data.The simulation results are compared with the test results,and the error is less than 5%.In this study,the authors will use simulation software to simulate several Miller cycle scenarios designed for early inlet valve closure and analyze the impact of the Miller cycle on combustion and emissions at 100%load conditions.By comparing the flow field distribution of the engine at 1500 r/min condition,it was found that proper EIVC can prolong the ignition latency period and homogeneous fuel-air mixture combustion acceleration,but it can reduce pressure and temperature within the piston chamber and NOx emission.However,the Miller cycle reduces end-of-compression temperatures,which increases combustion duration and exhaust temperatures,making it difficult to improve fuel economy at the optimum fuel consumption point,and closing the intake valves prematurely leads to excessive fuel expenditure.Furthermore,temperature and heat release rate within the piston chamber,NOx,and SOOT generation were significantly enhanced.
文摘BACKGROUND Miller fisher syndrome(MFS)is a variant of Guillain-Barrésyndrome,an acute immune-mediated peripheral neuropathy that is often secondary to viral infections.Anti-ganglioside antibodies play crucial roles in the development of MFS.The positive rate of ganglioside antibodies is exceptionally high in MFS patients,particularly for anti-GQ1b antibodies.However,the presence of other ganglioside antibodies does not exclude MFS.CASE SUMMARY We present a 56-year-old female patient who suddenly developed right blepharoptosis and progressively worsening vision in both eyes.There were flu symptoms prior to onset,and a coronavirus disease 2019 test was positive.On physical examination,the patient exhibited bilateral extraocular muscle paralysis,weakened reflexes in both limbs,and impaired coordination.The cerebrospinal fluid examination results showed no obvious abnormalities.Bilateral peroneal nerve F-waves were not extracted.Serum anti-GD1b IgG and anti-GT1a IgG antibodies were positive.The patient received intravenous methylprednisolone(1000 mg/day),with the dosage gradually decreased.Additionally,intravenous high-dose immunoglobulin treatment was administered for 5 days(0.4 g/kg/day)from day 2 to day 6 of hospitalization.The patient’s symptoms improved after treatment with immunoglobulins and hormones.CONCLUSION Positive ganglioside antibodies may be used as supporting evidence for the diagnosis;however,the diagnosis of MFS is more reliant on clinical symptoms.
