ABSTRACT
BACKGROUND: To explore the feasibility and effectiveness of multifaceted quality improvement intervention based on the clinical decision support system (CDSS) in VTE prophylaxis in hospitalized patients. METHODS: A randomized, department-based clinical trial was conducted in the department of respiratory and critical care medicine, orthopedic, and general surgery wards. Patients aged ≥18 years, without VTE in admission, were allocated to the intervention group and received regular care combined with multifaceted quality improvement intervention based on CDSS during hospitalization. VTE prophylaxis rate and the occurrence of hospital-associated VTE events were analyzed as primary and secondary outcomes. RESULTS: A total of 3644 eligible residents were enrolled in this trial. With the implementation of the multifaceted quality improvement intervention based on the CDSS, the VTE prophylaxis rate of the intervention group increased from 22.93% to 34.56% (p < 0.001), and the incidence of HA-VTE events increased from 0.49% to 1.00% (p = 0.366). In the nonintervention group, the VTE prophylaxis rate increased from 24.49% to 27.90% (p = 0.091), and the incidence of HA-VTE events increased from 0.47% to 2.02% (p = 0.001). CONCLUSIONS: Multifaceted quality improvement intervention based on the CDSS strategy is feasible and expected to facilitate implementation of the recommended VTE prophylaxis strategies and reduce the incidence of HA-VTE in hospital. However, it is necessary to conduct more multicenter clinical trials in the future to provide more reliable real-world evidence.
ABSTRACT
OBJECTIVE: To explore the scientific value of the three-level pre-viewing triage management practice by using "Alipay" health code and self-developed electronic version of screening table QR code to assist COVID-19 screening in a general hospital. METHODS: During Beijing Xinfadi wholesale market COVID-19 epidemic, the definition of epidemiological history and clinical symptom case of pre-viewing and triage were determined by referring to the COVID-19 Diagnosis and Treatment Protocol(Trial Seventh Edition). Through strengthening hospital import and export management, setting up the pre-viewing triage points scientifically, improving the three-level pre-viewing triage process by using information technology to improve efficiency, the three-level pre-viewing triage system was strictly implement. Data included information released by the country and the region, daily reports on the workload of the hospital. RESULTS: During the epidemic period in Beijing(June 11-July 5), the number of online appointments and the number of general outpatient clinics showed a downward trend compared with before and after period, and the difference was significant(P<0.05). The number of fever outpatient during the epidemic period in Xinfadi wholesale market accounted for 2.1%(6 647/322 041) of the total number of visits during the epidemic period, which was positively correlated with the number of confirmed cases in Xinfadi wholesale market(r_s=0.755). During the same period, the hospital confirmed 2 cases of coronal virus disease and 3 cases of asymptomatic infection;25 cases with positive epidemiological history and 920 cases with fever were detected, and all of them were guided to the fever clinic in an orderly manner. All medical staff and patients had zero infection. CONCLUSION: The three-level pre-viewing triage system is conductive to reduce the risk of nosocomial infection. The application of "QR code" is of great significance to improve the efficiency of pre-viewing triage and to achieve precise prevention and control of epidemics.
ABSTRACT
Developing small-scale soft continuum robots with large-angle steering capacity and high-precision manipulation offers broad opportunities in various biomedical settings. However, existing continuum robots reach the bottleneck in actuation on account of the contradiction among small size, compliance actuation, large tender range, high precision, and small dynamic error. Herein, a 3D-printed millimeter-scale soft continuum robot with an ultrathin hollow skeleton wall (300 µm) and a large inner-to-outer ratio (0.8) is reported. After coating a thin ferromagnetic elastomer layer (≈100-150 µm), the proposed soft continuum robot equipped with hybrid actuation (tendon- and magnetic-driven mode) achieves large-angle (up to 100°) steering and high-precision (low to 2 µm for static positioning) micromanipulation simultaneously. Specifically, the robot implements an ultralow dynamic tracking error of ≈10 µm, which is ≈30-fold improved than the state of art. Combined with a microneedle/knife or nasopharyngeal swab, the robot reveals the potential for versatile biomedical applications, such as drug injection on the target tissue, diseased tissue ablation, and COVID-19 nasopharyngeal sampling. The proposed millimeter-scale soft continuum robot presents remarkable advances in large-range and high-precise actuation, which provides a new method for miniature continuum robot design and finds broad applications in biomedical engineering.