O2 Uptake in hyperthyroidism during constant work rate and incremental exercise

Summary To investigate the effect of hyperthyroidism on the pattern and time course of O₂ uptake ( O₂) following the transition from rest to exercise, six patients and six healthy subjects performed cycle exercise at an average work rate (WR) of 18 and 20 W respectively. Cardiorespiratory variables were measured breath-by-breath. The patients also performed a progressively increasing WR test (1-min increments) to the limit of tolerance. Two patients repeated the studies when euthyroid. Resting and exercise steady-state (SS) O₂ (ml·kg^–1·min^–1) were higher in the patients than control (5.8, SD 0.9 vs 4.0, SD 0.3 and 12.1, SD 1.5 vs 10.2, SD 1.0 respectively). The increase in O₂ during the first 20 s exercise (phase I) was lower in the patients (mean 89 ml·min^–, SD 30) compared to the control (265 ml·min^–1, SD 90), while the difference in half time of the subsequent (phase 11) increase to the SS O₂ (patient 26 s, SD 8; controls 17 s, SD 8) were not significant (P = 0.06). The OZ cost per WR increment ( O₂/WR) in ml·min^–1·^–1, measured during the incremental period (mean 10.9; range 8.3–12.2), was always within two standard deviations of the normal value (10.3, SD 1). In the two patients who repeated the tests, both the increment of O₂ from rest to SS during constant WR exercise and the O₂/WRs during the progressive exercise were higher in the hyperthyroid state than during the euthyroid state. While both resting and exercise O₂ are increased in the hyperthyroid patients, the O₂ cost of a given increment of WR is within the normal range. However, a small reduction in the O₂ requirement to perform exercise following treatment of the hyperthyroid state suggests a subtle change O₂ cost of muscle work in this disease.     

Energy cost and mechanical efficiency of riding a four-wheeled, human-powered, recumbent vehicle

Oxygen consumption at steady state (V˙O ₂, l · min⁻¹) and mechanical power (W˙, W) were measured in five subjects riding a human-powered vehicle (HPV, the Karbyk, a four-wheeled recumbent cycle) on a flat concrete road at constant sub-maximal speeds. The external mechanical work spent per unit of distance (W, J · m⁻¹), as calculated from the ratio of W˙ to the speed (v, m · s⁻¹), was found to increase with the square of v: W˙=8.12+(0.262 ·v ²) (r=0.986, n=31), where the first term represents the mechanical energy wasted, over a unit of distance, against frictional forces (rolling resistance, R_r), and the second term (k · v ²) is the work performed, per unit distance, to overcome the air drag. The rolling coefficient (C_r, obtained dividing R_r by m · g, where m is the overall mass and g is the acceleration of gravity) amounted to [mean (SD)] 0.0084 (0.0008), that is about 60% higher than that of a racing bicycle. The drag coefficient was calculated from the measured values of k, air density (ρ) and frontal area (A) [C_x=k · (0.5 · A · ρ)⁻¹], and amounted to 1.067 (0.029), that is about 20% higher than that of a racing bicycle. The energy cost of riding the HPV (C_k, J · m⁻¹) was measured from the ratio of metabolic power above rest (net V˙O ₂, expressed in J · s⁻¹) to the speed (v, m · s⁻¹); the value of this parameter increased with the square of v, as described by: C_k=61.45 + (0.675 · v ²) (r=0.711, n=23). The net mechanical efficiency (η) was calculated from the ratio of W to C_k: over the investigated speed range this turned out to be 0.22 (0.021). Best performance times (BPTs) of a “typical”élite athlete riding the Karbyk were calculated over the distances of 1, 5 and 10 km: these were about 8% longer than the BPTs calculated, on the same subjects, when riding a conventional racing bicycle. Accepted: 7 August 2000     

评“McCall观察方法”——对一种色谱系统分配效果观察方法的商榷

本文通过理论分析和文献数据的分析,对McCall提出的色谱系统分配效果的观察方法提出了不同的看法,认为McCall方法中的所谓logK并不是常数。McCall的方法无论在理论上和实践上都是不妥的。     

江苏省护理院卫生资源配置现状和效率研究

目的:分析江苏省护理院卫生资源配置现状与效率,并提出完善对策。方法:应用描述性统计方法分析2013~2019年护理院卫生资源配置和利用情况,采用数据包络分析法评价卫生资源投入产出效率,采取TOPSIS法综合评估床位利用效率。结果:2019年江苏省护理院为246家,其中71.95%集中在城市地区;2019年护理院床位数为38274张,床位医生比和床位护士比分别为1:0.06和1:0.18,床位使用率为72.32%,平均住院天数比2013年缩短20.5天。数据包络分析结果显示,2016~2018年综合技术效率值均为1.0,2019年为0.990。TOPSIS法评估结果显示,2013~2017年床位利用效率逐年上升,2018和2019年有所下降。结论:护理院城乡分布不均衡,人员配置不足,近年来投入产出效率为相对有效或弱有效,但床位总体利用率偏低。今后合理规划设置护理机构,增加人力资源配置,提升护理院服务质量,最大限度发挥护理院卫生资源的作用。     

基于数据包络分析的重庆市卫生资源配置效率研究

目的 分析2015—2020年重庆市各区县卫生资源配置效率,为重庆市提升资源配置效率提供参考。方法 采用数据包络分析的BCC模型和Malmquist指数对2015—2020年重庆市各区县卫生资源配置效率进行分析。结果 在2020年,重庆市卫生资源配置的综合效率不高,38个区县中有7个区县处于DEA有效状态,8个区县处于DEA弱有效状态;2015—2020年,重庆市全要素生产率指数均值为0.945,3个区县的全要素生产率指数大于1。结论 重庆市各区县卫生资源配置效率有待提高,重点在于提升技术进步水平;重庆市四大区域内部和四大区域之间卫生资源配置效率差异较大,需整合医疗卫生资源,重视医学科技创新和成果转化,达到提升卫生资源配置效率的目标。     

工作量为基础的手术室护士绩效方案及应用效果分析

目的探讨以工作量为基础计算手术室护士绩效的方法及效果。方法通过医院信息管理系统提取量化数据,根据"以资源为基础的相对价值比率评估系统(RBRVS)"计算手术护士工作量并转换为绩效分值。结果方案实施后整体工作时间内直接护理时间明显提升,达到总工作时间的73.22%,首台手术准时率从50.97%提高到75.11%(p<0.05),接台手术间隔时长从平均0.62小时降至0.33小时。结论建立以工作量为基础多维度评价手术护士绩效方案体现专科护士的工作特点与劳动价值,充分调动手术护士的工作积极性,有利于手术室运行效率和护士工作效率的提高。     

模拟复用的医用外科口罩清洗和消毒后主要性能指标变化

目的 医用外科口罩模拟复用清洗和消毒后主要性能指标变化。方法 以颗粒过滤效率（PFE）、细菌过滤效率（BFE）作为医用外科口罩的关键性能指标,对不同佩戴时间、不同干燥方式、不同洗消方式等试验条件进行验证。结果 试验后的医用外科口罩关键性能指标能够符合标准要求。结论 医用外科口罩采用清水洗涤、56℃热水浸泡和100℃沸水浸泡处理后主要性能指标未见明显下降。     

目标管理在医疗设备维修管理中的应用与效果分析

分析目标管理在医疗设备维修管理中的应用效果,选取2019年1月至2020年12月医疗设备维修数据,对比分析实施目标管理前后的设备整体平均维修时长、维修关单良好率、基础性设备(病床、监护仪及泵类)平均维修时长和工程师维修关单良好率,为医院维修管理精细化实践提供参考。     

正交试验法筛选口服阿苯达唑毫微球制备工艺

目的为提高阿苯达唑生物利用度,采用α-氰基丙烯酸正丁酯为聚合材料,乳化聚合法制备口服阿苯达唑毫微球,并优化处方工艺.方法紫外分光光度法测定阿苯达唑含量,以包封率为主要指标,乳化聚合二步法制备阿苯达唑毫微球,L9(34)正交试验设计处方工艺.结果首先制备pH为5.0的聚氰基丙烯酸正丁酯空白毫微球,再以0.5 ml/min速率缓慢将空白毫微球注入同体积的阿苯达唑醋酸溶液中,充分搅拌16 h.结论经过优化筛选的组方工艺制备的阿苯达唑毫微球包封率为(61.01士4.06)%,载药量为(48.00士5.20)%.     

不停跳冠状动脉旁路移植术中应用MostCare/PRAM监测系统进行血流动力学监测的临床研究

目的探究Most Care/PRAM系统监测下不停跳冠状动脉旁路移植术(OPCABG)患者术中血流动力学变化情况和预后分析。方法纳入2016年10月至2017年1月安贞医院89例OPCABG患者,其中男53例、女36例,年龄(60.50±8.40)岁。记录术中血流动力学变化情况。按是否发生心肌梗死、低心排血量等严重循环不良事件,分为平稳组和严重循环不良事件组,进行相关分析。结果手术全程监测完整血流动力学数据患者65例,开胸前和关胸后被动抬高试验的每搏量(SV)升高均值分别为23.00%±3.20%和29.40%±3.70%。麻醉、开胸、应用肝素时、搭桥中、应用鱼精蛋白时、关胸和术毕7个时间段,SV明显下降,外周血管阻力指数(SVRI)持续显著增加,最大压力梯度(d P/d T)和心脏循环效率(CCE)在麻醉后明显下降,搭桥时下降到最低,其后逐渐升高;每搏量变异率(SVV)和脉压变异率(PPV)在麻醉后下降,开胸后一直升高。89例患者发生严重循环不良事件共9例,其中4例死亡。严重循环不良事件组术中基础SVRI、SVV和PPV均显著高于平稳组(P<0.05),CCE、d P/d T和SV差异无统计学意义(P>0.05)。术中基础SVRI、CCE、d P/d T、SVV、PPV和SV均值与预后指标均无明显相关性。结论OPCABG术中易出现血流动力学的改变,因此,OPCABG术中宜应用Most Care/PRAM仪进行血流动力学监测,并及时纠正血流动力学异常。