摘要
Objective:To construct a double-closed-loop management model for medical equipment and explore its application value in hemodialysis machine maintenance and fault management.Methods:Based on the closed-loop management of clinical operation of medical equipment and the closed-loop management of technical support,a dual closed-loop management model of equipment was constructed.65 hemodialysis machines in clinical use in Huashan Hospital Fudan University from January 2021 to January 2023 were selected and divided into a conventional mode and double-closed-loop mode according to different management modes.The conventional mode adopted conventional equipment management methods,and the double-closed-loop mode adopted a double-closed-loop management model.The cost-effectiveness,social benefit,failure occurrence,effective management quality matters,disinfection status,average patient waiting time and satisfaction were compared between the two groups.Results:The hemodialysis machine operating profit growth rate,diagnosis and treatment cost growth rate,service life index,scientific research service growth rate,diagnosis and treatment service growth rate,startup rate and operation rate of the double-closed-loop mode were(3.95±1.04)%,(3.80±0.58)%,(1.58±0.31)%,(4.30±0.95)%,(7.91±1.58)%,(96.58±2.76)%and(89.90±5.58)%,which were higher than those of the Conventional mode,the difference was statistically significant(t=5.418,10.070,7.490,17.570,11.820,8.849,6.840,P<0.05).The technical support expenses growth rate,bacterial colony count,bacterial endotoxin content and average patient waiting time of patients in the Double-closed-loop mode were(2.60±0.33)%,(0.370±0.008)cfu/ml,(0.0063±0.0011)EU/ml and(0.76±0.13)h,which were less than those of the conventional mode,the difference was statistically significant(t=23.040,82.985,14.482,19.530,P<0.05).The incidence rate of hemodialysis machine failure in the double-closed-loop mode was 9.23%(6/65),which was lower than that in the conventional mode,the difference was statistically significant(x2=6.392,P<0.05);among the 120 items of management data collected,quality control testing,maintenance and repair,clinical operation,information data,and scrap processing effectiveness rates were 95.83%(115/120),89.17%(107/120),96.67%(116/120),95.00%(114/120),and 97.50%(117/120),respectively,which were higher than those of the conventional mode,the difference was statistically significant(x2=15.238,16.596,9.808,15.585,16.119,P<0.05).Conclusion:The application of closed-loop management model to hemodialysis machine maintenance and fault management can effectively improve equipment cost-effectiveness,social benefits,management quality and patient satisfaction,and reduce the incidence of faults.
摘要
Objective:To establish a total normalized productive maintenance(TnPM)model for medical equipment,and to explore its application value in the management of multi-source treatment equipment.Methods:In accordance with the principles of self-management,economic efficiency and dynamic improvement,the TnPM management mode of the medical equipment lifecycle management system was developed.22 multi-source treatment equipment in clinical use in the of department of burn and plastic surgery of The Second Affiliated Hospital of Air Force Medical University were selected and divided into a control group(16 units)and an observation group(18 units,including 12 of control group and 6 newly added units)according to different management modes.The control group implemented the traditional management mode,and the observation group adopted TnPM management mode.The operation quality,comprehensive efficiency and team management capabilities of the two groups were compared.Results:The equipment failure rate of the observation group was(4.82±0.21)%,which was lower than that of traditional group,the self-repair rate,maintenance rate and operating standard rate were(91.63±3.59)%,(96.60±2.47)%and(97.31±1.54)%,respectively,which were higher than those of the control group,the difference was statistically significant(t=2.434,5.246,4.525,5.311,P<0.05).The equipment availability rate,performance index and quality index of the observation group were(90.82±2.78)%,(97.03±2.24)%and(97.85±1.26)%,respectively,which were higher than those of control group,the difference was statistically significant(t=6.231,4.671,5.997,P<0.05).The assessment scores of the personnel involved in the equipment on job responsibilities,basic equipment theory,usage assurance level and management performance of observation group were(93.95±2.81)points,(91.45±2.47)points,(90.75±2.54)points and(93.08±3.34)%,respectively,which higher than those of the control group,the difference was statistically significant(t=2.831,3.979,6.472,4.001,P<0.05).Conclusion:The TnPM management mode can improve the operation quality of equipment in the treatment of clinical patients,reduce the incidence of failure,enhance the comprehensive efficiency of equipment and clinical service level,and promote the construction of a management team.
摘要
Based on the analysis of the network layout and functional structure of the central monitoring system,the daily maintenance strategy and common fault maintenance methods were discussed.In terms of function structure,the central monitoring system of inpatient ward was divided into four modules:network architecture,monitoring terminal,central monitoring and data management,which realized the functions of monitoring patients'vital signs,data transmission display,analysis and alarm.In the event of failure of equipment,the source of structural components was analyzed based on the fault phenomenon,and the failure handling was carried out by one by one.In the process of dealing with network faults,the signals before and after the switch were detected and analyzed according to the fault scope.When abnormal results of physiological parameters were found,the factors such as human operation,patient cooperation,and equipment hardware and software failures were considered at the same time.The cause of the failure was eliminated according to the results of the observation and test;the equipment returned to normal service after the failure.Medical personnel and equipment engineers should be familiar with the network layout of the central monitoring system,carry out routine maintenance,carefully make troubleshoot faults in maintenance and standardize operation and constantly improve the operation quality of the central monitoring system.
摘要
The structure and working principle of the multi-leaf collimator(MLC)optical system of Elekta linear accelerator were introduced.The causes for the faults of the MLC optical system were analyzed,and the fault repair and maintenance of the MLC optical system were summarized.References were provided for medical engineers to repair and maintain the MLC optical system.[Chinese Medical Equipment Journal,2024,45(1):76-83]
摘要
The structural composition and working principle of Senographe DS Digital Mammography System were introduced.The causes and elimination of 2 cases of faults of the system in exposure and artifact were proposed.References were provided for treating similar faults.[Chinese Medical Equipment Journal,2024,45(1):118-120]
摘要
Objective:To design and construct a remote fault detection method for CT scanning equipment based on two-dimensional search model and ZigBee network to improve the accuracy of fault detection.Methods:ZigBee network technology was used to collect the operating status data of CT scanning equipment from three aspects:environmental factors,electrical factors and gas circuit factors.The time and frequency domain signals were extracted from the monitoring data,and the extracted fault signal feature parameters were fused.The fault data were transformed into stationary time series by inverse binary transformation to restrain the fluctuation of the data.The dependence degree of fault data was calculated by establishing corresponding two-dimensional search model and matching function.Based on this,Bayesian evaluation function was introduced to realize the remote detection of equipment fault.A large-scale clinical CT scanner in clinical use in the hospital was selected as the experimental prototype,and at the same time,550 real fault data generated from the 80 CT scanning scanners with the same model and configuration as the experimental prototype were randomly selected as training samples.The accuracy of CT scanning equipment faults remote detection method with that of the long short-term memory network(referred to as method 1)and deep belief network(referred to as method 2)were compared.Results:The designed remote fault detection method of CT scanning equipment only had detection error on status label 5,but the judgment error was in the controllable range.In the five fault detection experiments,the detection accuracy of the remote fault detection method of CT scanning equipment was more than 80%,which was much higher than that of method 1 and method 2.Conclusion:The fault detection method of CT scanning equipment has a high detection accuracy and can realize the practical requirement of remote detection of CT scanning equipment.
摘要
Strengthening the supervision of medical insurance funds is an important measure to promote the healthy and sustainable development of the medical security system. In January 2022, a tertiary general hospital in Beijing carried out risk identification and prevention and control practices for the use of medical insurance funds. By using such methods as fault tree analysis and risk matrix, the probability and impact of events were quantitatively evaluated, high-risk events during the use of medical insurance funds were identified, and corresponding risk prevention and control measures were developed, relying on intelligent regulatory systems. From January to November 2022, the hospital outpatient medical insurance refusal amount(20 080 yuan) caused by such high-risk events as exceeding drug instructions, exceeding medical insurance indications, and exceeding age limits decreased by 42.30% compared to the same period in 2021(11 585 yuan). The discharge and settlement time of medical insurance patients decreased from 3 working days to 1 working day. This practice had effectively improved the quality and efficiency of hospital medical insurance fund supervision, improved patients′ medical experience, and provided reference for strengthening the safe and standardized use of medical insurance funds by medical institutions.
摘要
Objective To propose a neural network-based ventilator fault prediction method with a self-developed underlying data preprocessing method for ventilator IoT data.Methods Firstly the ventilator IoT data were sorted,categorized and cleaned.Secondly nondimensionalization and encoding of all the data were implemented via feature engineering methods based on data distribution.Thirdly data dimensionality reduction was carried out with a self-encoder.Finally,an artificial neural network was used for training with the abnormal data as the training label and predicting the abnormal data faults as the training objective,and the prediction performance of the neural network model was evaluated by calculating the accuracy,precision,recall rate,negative prediction value and specificity.Results The neural network model behaved well in learning with the accuracy being 99.68％,the precision being 99.66％,the recall rate being 99.99％,the negative prediction value being 99.95％and the specificity being 96.52％.Conclusion The proposed ventilator fault prediction model based on underlying data preprocessing and neural network can be used for the prediction of specific faults,and references are provided for IoT data-based medical equipment operation and maintenance management.[Chinese Medical Equipment Journal,2023,44(9):8-13]
摘要
The advantages of Canon Aquilion One CT scanner over the traditional CT machines were summarized.Three cases of scanning table faults of Canon Aquilion One CT scanner were introduced in terms of cause and specific troubleshooting method.References were provided for medical engineers to treat similar faults.[Chinese Medical Equipment Journal,2023,44(9):114-116]
摘要
Four kinds of common faults of the ventilator were introduced in terms of shutdown,airway,sensor and parameter determination.The thinking and solutions for eliminating the faults were put forward based on examples of ventilator maintenance.The method for emergency ventilator maintenance was proposed,and references were provided for enhancing the timeliness and accuracy of ventilator maintenance.[Chinese Medical Equipment Journal,2023,44(10):118-120]
摘要
Objective:To explore the effect of scenario simulation combined with "finding fault" teaching method on prevention and control of nosocomial infection training in standardized residency training of cardiovascular surgery.Methods:A total of 31 residents trained in the Department of Cardiovascular Surgery, The First Affiliated Hospital of Naval Medical University from April 2018 to March 2019 were selected as the control group, and another 31 residents trained from April 2019 to March 2020 were selected as the study group. All subjects were required to receive nosocomial infection prevention and control training. The control group was given conventional teaching method, while the study group was given scenario simulation combined with "finding fault" teaching method, all of which were taught for 1 month. The theoretical and operational assessment results of nosocomial infection prevention and control after teaching, the clinical core competence related to nosocomial infection prevention and control after teaching, and the recognition rate of teaching mode were compared between the two groups. SPSS 25.0 was used for t test and chi-square test. Results:The scores of theoretical assessment [(91.29±6.64) vs. (86.73±6.02)] and operational assessment [(90.32±6.80) vs. (83.51±7.43)] of nosocomial infection prevention and control after teaching in the study group were higher than those in the control group, with statistical differences ( P<0.05). The scores of clinical core competence in learning initiative, doctor-patient communication, problem thinking and problem solving of nosocomial infection prevention and control knowledge after teaching in the study group were higher than those in the control group, with statistical differences ( P<0.05). The recognition rates of innovation, interest, effectiveness and practicability of the teaching mode in the study group were 83.87%, 96.77%, 90.32% and 93.55% respectively, while those in the control group were 61.29%, 58.06%, 67.74% and 74.19% respectively, which were higher in the study group than in the control group, with statistically significant differences ( P<0.05). Conclusion:In the training of prevention and control of nosocomial infection for standardized residency training in the department of cardiovascular surgery, scenario simulation combined with "fault finding" teaching method can improve the theoretical and practical examination results of the residents, enhance their clinical core competence related to nosocomial infection prevention and control, and reach a higher recognition rate of the teaching mode.
摘要
Aiming at the dilemma of expensive and difficult maintenance, lack of technical data and insufficient maintenance force for modern medical equipment, an intelligent fault diagnosis expert system of multi-parameter monitor based on fault tree was proposed in this study. Firstly, the fault tree of multi-parameter monitor was established and analyzed qualitatively and quantitatively, then based on the analysis results of fault tree, the expert system knowledge base and inference engine were constructed and the overall framework of the system was determined, finally the intelligent fault diagnosis expert system for multi-parameter monitor was developed by using the page hypertext preprocessor (PHP) language, with an accuracy rate of 80% in fault diagnosis. The results showed that technology fusion on the basis of fault tree and expert system can effectively realize intelligent fault diagnosis of multi-parameter monitors and provide troubleshooting suggestions, which can not only provide experience accumulation for fault diagnosis of multi-parameter monitors, but also provide a new idea and technical support for fault diagnosis of medical equipment.
Subject(s)
Expert Systems , Monitoring, Physiologic摘要
Debate da resistência em psicanálise, decorrente da formação de defesas psíquicas durante o desenvolvimento psicossexual, as quais têm como finalidade a recuperação do objeto perdido quando do evento traumático, evento esse que constitui um marco para a proposta do conceito de falta básica, feita por Balint. O interesse pelo tema surge ao verificar-se crescente demanda de análise de pacientes com profunda angústia relativa ao desamparo e importantes conflitos familiares, descrença na instituição trabalho e em alcançar vida conjugal satisfatória. Trabalhamos na perspectiva de formular hipóteses, sustentadas em experiência clínica e campo teórico da psicanálise stricto sensu e psicanálise dos vínculos, que poderiam contribuir para a clínica de revisão dos vínculos. A análise envolve o Sujeito e os objetos primários bem como seus substitutos embora somente o Sujeito esteja em psicanálise.
Debate in psychoanalysis of resistance resulting from the formation of psychic defenses during psychosexual development. These defenses have as their purpose the recovery of the object that where lost during the traumatic event which is a milestone for the proposal of the concept of basic fault by Balint. Our interest in the subject arises because we observe at present increasingly demand for analysis of patients with deep anguish related to helplessness and important family conflicts, disbelief in the work institution and in achieving satisfactory marital life. We work from the perspective of formulating hypotheses, based on clinicai experience and theoretical field of psychoanalysis stricto sensu and psychoanalysis of bonds, that could contribute to the clinical review of the bonds. The analysis involves the Subject and the primary objects as well as their substitutes although only the Subject is in psychoanalysis.
Debate respeto a la resistencia en el psicoanálisis, que es resultante de la formación de defensas psíquicas durante el desarrollo psicosexual, cuyo objetivo es recuperar el objeto perdido durante el evento traumático, trauma ese que constituye un hito para la propuesta del concepto de "falta básica" de Balint. El interés en el tema surge por la constatación de que existe creciente demanda de análisis de pacientes con profunda angustia relacionada con el desamparo e importantes conflictos familiares, la perdida de la confianza en la institución laboral y bien en la esperanza de lograr una vida matrimonial satisfactoria. Trabajamos desde la perspectiva de formular hipótesis basadas en la experiencia clínica y en los campos teóricos del psicoanálisis stricto sensu y del psicoanálisis de los vínculos, que podrían contribuir a la revisión clínica de los enlaces. El análisis involucra al Sujeto y los objetos primarios, así como a sus sustitutos, aunque solo el sujeto esté en psicoanálisis.
Subject(s)
Psychoanalysis , Psychosexual Development , Family , Family Conflict , Object Attachment摘要
Objective:To analyze the application effect of day checklist model combined with fault finding and error correction method in the teaching of new nurses in neurology department.Methods:A total of 42 new neurology nurses accepted in the department of neurology from January 2019 to June 2020 were selected in the study and they were divided into control group and study group. The conventional group was given the conventional teaching method, while the study group was given the day checklist model combined with fault finding and error correction method, both of which were taught for 3 months. Assessment performance of theoretical knowledge and operational skills before and after teaching, critical thinking ability before and after teaching and satisfaction with the teaching after teaching in neurology nursing were compared between the two groups. SPSS 25.0 was used for t test and rank sum test. Results:After teaching, assessment performance of theoretical knowledge and operational skills, the 7 dimensions of critical thinking ability scores and the total scores were higher than those before teaching, and the study group did better than the control group ( P < 0.05). There were significant differences between the 2 groups of new nurses in the distribution of satisfaction with teaching ( P < 0.05), and the total satisfaction rate of the study group (100.00%) was higher than that of the control group (80.96%) ( P < 0.05). Conclusion:Using the method of day checklist model combined with fault finding and error correction method in the teaching of new nurses in the neurology department can improve their assessment results, enhance their critical thinking ability and improve the teaching satisfaction.
摘要
In order to solve the current problems in medical equipment maintenance, this study proposed an intelligent fault diagnosis method for medical equipment based on long short term memory network(LSTM). Firstly, in the case of no circuit drawings and unknown circuit board signal direction, the symptom phenomenon and port electrical signal of 7 different fault categories were collected, and the feature coding, normalization, fusion and screening were preprocessed. Then, the intelligent fault diagnosis model was built based on LSTM, and the fused and screened multi-modal features were used to carry out the fault diagnosis classification and identification experiment. The results were compared with those using port electrical signal, symptom phenomenon and the fusion of the two types. In addition, the fault diagnosis algorithm was compared with BP neural network (BPNN), recurrent neural network (RNN) and convolution neural network (CNN). The results show that based on the fused and screened multi-modal features, the average classification accuracy of LSTM algorithm model reaches 0.970 9, which is higher than that of using port electrical signal alone, symptom phenomenon alone or the fusion of the two types. It also has higher accuracy than BPNN, RNN and CNN, which provides a relatively feasible new idea for intelligent fault diagnosis of similar equipment.
Subject(s)
Algorithms , Electricity , Memory, Short-Term , Neural Networks, Computer摘要
Resumen 11. Freud no criticó los fundamentos de la ética ni prescribió deberes, prohibiciones, aspiraciones o respuestas alternativas a problemas tradicionales, sino entregó una nueva manera de formular problemas morales. Existen tres áreas en que Freud insinuó una ética que sostiene una dirección diferente a la actual bioética.1. El carácter no ético del psicoanálisis no está incluido entre las técnicas de dominación o adoctrinamiento sino en las de veracidad, en lo que importa es el auto-reconocimiento, la mala comprensión es la ruta necesaria para la comprensión. 2. La postura final de Freud mismo hacia su propia muerte se puede llamar apropiación de su finitud, cuando él asumió su ser-referido-a-la-muerte, no como estar-en-su-final, indicando con ello que comprendió que el final siempre penetró en su vida. 3. En la auténtica comprensión de sí mismo, Freud entendió que la última potencialidad de su existencia fue abandonarse a sí, reveló su potencialidad para su no-potencialidad, haciéndose libre para su propio fin, aceptó su existencia en su finitud.
Abstract 15. Freud did not make a critique of foundations of ethics nor prescribed duties, prohibitions, aspirations or alternative answers to unchanged questions, but he gave a new manner of asking moral questions. There are three areas in which Freud implied an ethic that maintains a different direction from current bioethics.1. The fundamentally nonethical character of Freud´s psychoanalysis is not included in the techniques of domination or indoctrination but of veracity, what is at stake is selfrecognition, misunderstanding is the necessary path to understanding. 2. The final position of Freud himself to his own death can be called appropriation of his finitude, when he assumed his being-unto-death, not as a being-at-his-end, indicating thereby that he understood that the end always penetrated his whole existence. 3. In the authentic comprehension of his self, Freud understood that the ultimate potentiality of his existence was to relinquish his self, he revealed to his self his potentiality for non-potentiality, becoming free for his own end, he accepted his existence in its finitude.
Resumo 19. Freud não criticou os fundamentos da ética nem prescreveu deveres, proibições, aspirações ou respostas alternativas a problemas tradicionais, e sim apresentou uma nova maneira de formular problemas morais. Existem três áreas nas quais Freud insinuou uma ética que indica uma direção diferente da atual bioética. 1. O caráter não ético da psicanálise não está incluído entre as técnicas de dominação ou doutrinamento e sim nas de veracidade, onde o que importa é o auto-reconhecimento, a má compreensão é o caminho necessário para a compreensão. 2. A postura final de Freud, mesmo até sua morte, pode se chamar de "apropriação de sua finitude", quando ele assumiu seu ser-referido-à- morte, não como estar-em-seu-final, indicando com isto que compreendeu que o final sempre infiltrou sua vida. 3. Na autêntica compreensão de si mesmo, Freud entendeu que a última potencialidade de sua existência foi abandonar-se a si, revelou sua potencialidade para sua não-potencialidade, libertando-se para seu próprio fim, aceitou sua existência em sua finitude.
Subject(s)
Psychoanalysis/ethics , Bioethics , Attitude to Death , Guilt摘要
This paper aims to construct a Bayesian(BN) fault diagnosis model of traditional Chinese medicine dry granulation based on the failure model and effect analysis(FMEA), effectively control risk factors and ensure the quality of granules.Firstly, the risk ana-lysis of dry granulation process was carried out with FMEA, and the selected medium and high risk factors were taken as node variables to establish corresponding BN network with causality.According to the mathematical reasoning method of probability theory, the model was accurately inferred and verified by Netica, and the granule nonconformance was used as the evidence for reversed reasoning to determine the most likely cause of the failure that affected the granule quality.The BN fault diagnosis model of traditional Chinese medicine dry gra-nulation was established based on the medium and high risk factors of process, prescription and equipment screened out by FMEA, such as roller pressure, raw material viscosity, clearance between rollers in the paper.The fault diagnosis of traditional Chinese medicine dry granulation process was then carried out according to the model, and the posterior probability of each node under the premise of nonconforming granule quality was obtained.This method could provide strong support for operators to quickly eliminate faults and make decisions, so as to improve the efficiency and accuracy for fault diagnosis and prediction, with innovation in its application.
Subject(s)
Bayes Theorem , Medicine, Chinese Traditional , Probability摘要
INTRODUCTION@#Metro Manila is at risk from “the big one”, a magnitude 7.2 earthquake caused by the movement of the West Valley Fault, thus awareness and preparedness of the people are very important. The study compared the levels of earthquake awareness and preparedness of households in a high-risk area and a low risk area.@*METHODS@#This was a cross-sectional study among 376 households each from a high- and a low-risk barangay in Metro Manila using a self-administered household-based survey questionnaire consisting of questions on awareness and preparedness. The prevalence of households classified as aware and wellprepared was computed; the significance of differences between the high- and low risk barangays was determined through Fisher’s exact test. @*RESULTS@#There were fewer households classified as aware in the high-risk barangay compared with the low risk barangay, but the difference was not significant (PR = 0.98, 95% CI 0.84, 1.01, p = 0.078, Fisher’s exact test). Less than half of households were classified as well-prepared in both high- and low risk barangays (49.7 vs 46.5%) and the difference was not significant (PR = 1.07, 95% CI 0.92, 1.24, p = 0.422, Fisher’s exact test). Television was the most common source of information in both barangays. Households in the high-risk barangay were more likely to be well-prepared when a member was at least a high school graduate (PR = 2.54, 95% CI 1.24, 5.22, p = 0.001, Fisher’s exact test).@*CONCLUSION@#There was no difference in the levels of awareness and preparedness between high and low risk barangays. Television was the most common source of information in both high and low risk barangays. The presence of at least one high school graduate in the household from a high-risk barangay was associated with preparedness but not awareness.
Subject(s)
Environment , Earthquakes摘要
This paper is a summary of the three types of faults that have occurred in the recent years in the Carestream DR7500:hardware failure, software failure, and communication failure. The specific cases of three types of faults are introduced in a case-by-case basis.
Subject(s)
Equipment Failure , Maintenance , Radiographic Image Enhancement摘要
Assurance of the safety,reliability and effectiveness of in-use medical equipments is key to improving medical risk management and applied quality of medical equipments of a hospital.By means of regular field survey of in-use medical equipments of the hospital,the authors identified key risk exposures in the current equipment quality control system,and took targeted corrective measurements.Data of routine equipment maintenance and that of appraisal were compared and analyzed.Based on such,appraisal points are set dynamically,and a standardized and customized appraisal program is developed for the safety and quality evaluation of medical equipments,featuring comprehensive coverage and operability.Such efforts effectively supplement daily maintenance work and provide data basis for reliability and usability analysis of medical equipments.